24.02.2011 » A.S.I.C.S.

Een kort uittreksel uit het gezaghebbende medische tijdschrift ‘The Lancet’:

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The Lancet, Volume 377, Issue 9766, 19 February 2011-25 February 2011, Page 611

No mental health without physical health


Editorial

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However, for mental health professionals, the mainstay of treatment for psychotic illness is—as it has been for over half a century—antipsychotic medication. Data published in The Lancet in 2009 indicated that patients with schizophrenia on long-term antipsychotic treatment had lower all-cause mortality than their untreated counterparts. Nevertheless, there is a large health gap between patients with severe mental illness and the general population, and consistent evidence of increased cardiovascular mortality with antipsychotic treatment. The combination of antipsychotic side-effects with poor diet, physical inactivity, high rates of smoking, and other factors associated with psychotic illness, together with socioeconomic deprivation, has a devastating effect on cardiometabolic health. It is no surprise, therefore, that people with severe mental illness have lives 16–25 years shorter than does the general population, and that coronary heart disease, not suicide, is the major cause of death.
If existing antipsychotics are here to stay—at least for the foreseeable future—what can be done to ameliorate their effects and improve patients' cardiometabolic health?

In its current mental health strategy, the UK Government sets out the objective that “more people with mental health problems will have good physical health”. This approach is to be applauded. However, the details of its implementation are frustratingly vague.
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The first issue to address is who should take the lead in monitoring cardiometabolic health. This is generally acknowledged as the role of primary care; however, some patients might see the mental health team more frequently than any other health provider, and may prefer to be monitored by this service. Communication between health professionals is essential.
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Besides organisational changes, individual practitioners must take responsibility for their patients' physical health through appropriate prescribing and management. A lack of training in physical health issues is worrying in psychiatric doctors and nurses alike. In view of the wealth of evidence about the interconnections between mental health, physical health, and prescribed medication, postgraduate psychiatric training should prioritise up-to-date knowledge about evidence-based management of cardiometabolic disease.

Antipsychotic drugs are a clear risk to cardiometabolic health. This risk is, all too often, a necessary one. But the trade-off between mental and physical wellbeing is one that no patient should be forced to make. The mind–body dichotomy is both outdated and dangerous. The price of good mental health must not be a lifetime of physical illness.



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