The diet of people with schizophrenia improved when they were given free fruit and vegetables but this was given free fruit and vegetables but this was not sustained after withdrawal of the intervention. A support programme added no benefit.
People with schizophrenia have a higher risk of medical illness than does the general population. They also have an increased (by two-to fourfold) relative risk of premature death, dying at least 10 years earlier than age-matched contemporaries (Brown, 1997;Joukamaa et al, 2001). Brown's study of mortality in schizophrenia found that 12% of reported deaths were by suicide, which accounted for 28% of the excess. A further two-thirds of this excess was attributed to 'natural causes' such as cardiovascular disease, respiratory disease and diabetes.Undoubtedly, much of the excess morbidity and mortality of schizophrenia is preventable through lifestyle modification and the recognition and treatment of common diseases. Although there is a clear evidence base acknowledging the poor physical health of people with mental illness, the potential for improving outcomes in this area has been largely neglected in both research and clinical practice.With changing clinical practice, outcome studies have tended to concentrate on psychiatric outcomes -symptomatology, service use, level of function and quality of life. The general lifestyle and physical health of patients with schizophrenia are relatively rarely studied.In this article, we bring together these areas of research and practice to inform the debate on how to improve the physical health of patients with schizophrenia and, ultimately, overall outcomes for the illness. Risk factorsMorbidity can be estimated individually using predictive risk factors and markers, some clearly modifiable and others not (Box 1). Modifiable risk factors are prevalent in people with schizophrenia. They are a consequence of the illness itself, and of associated behaviours, lifestyle and treatment. It is clearly important that services available to people with schizophrenia appreciate the inflated risk and how it contributes to morbidity and premature mortality in these individuals. LifestyleOur lifestyle choices are influenced by a variety of factors such as genes, environment and sociodemographic status. In schizophrenia, the illness itself also plays a part. A drift down the social scale associated with unemployment and poorer financial Lifestyle and physical health in schizophrenia Moira Connolly & Ciara KellyAbstract People with schizophrenia die prematurely. Their illness, its treatment and their lifestyle all contribute to the excess morbidity and mortality. Lifestyle 'choices' (e.g. poor diet, low rates of physical activity and increased likelihood to smoke cigarettes) predispose them to poor physical health and comorbid medical diseases. In addition, weight gain and obesity are a consequence of most antipsychotics, particularly the atypicals. Excessive body weight increases the risk of morbidity and mortality, and is the biggest risk factor for type II diabetes in schizophrenia. Much of the excess mortality of schizophrenia is preventable through lifestyle and risk factor modification and the treatment of common diseases, but the potential for improving outcomes in this area is only s...
BackgroundClozapine is widely prescribed and, although effective, can cause weight gain and dysglycemia. The dysmetabolic effects of clozapine are thought to be more prevalent in women with this gender on average attaining 17 % higher plasma clozapine concentrations than men.MethodsWe investigated the relationship between dose, body mass index (BMI), plasma glucose concentration, and plasma clozapine and N-desmethylclozapine (norclozapine) concentrations in 100 individuals with a severe enduring mental illness.ResultsMean (10th/90th percentile) plasma clozapine concentrations were higher for women [0.49 (0.27–0.79) mg/L] compared with men [0.44 (0.26–0.70) mg/L] (F = 2.2; p = 0.035). There was no significant gender difference in the prescribed clozapine dose. BMI was significantly higher in women [mean (95 % CI) = 34.5 (26.0–45.3)] for females compared with 32.5 (25.2–41.0) for males. Overall, BMI increased by 0.7 kg/m2 over a mean follow-up period of 210 days. A lower proportion, 41 % of women had a fasting blood glucose ≤6.0 mmol/L (<6.0 mmol/L is defined by the International Diabetes Federation as normal glucose handling), compared with 88 % of men (χ2 = 18.6, p < 0.0001).ConclusionsWe have shown that mean BMI and blood glucose concentrations are higher in women prescribed clozapine than in men. Women also tended to attain higher plasma clozapine concentrations than men. The higher BMI and blood glucose in women may relate to higher tissue exposure to clozapine, as a consequence of sex differences in drug metabolism.
BackgroundSocioeconomic status has important associations with disease-specific mortality in the general population. Although individuals with Severe Mental Illnesses (SMI) experience significant premature mortality, the relationship between socioeconomic status and mortality in this group remains under investigated. We aimed to assess the impact of socioeconomic status on rate and cause of death in individuals with SMI (schizophrenia and bipolar disorder) relative to the local (Glasgow) and wider (Scottish) populations.MethodsCause and age of death during 2006-2010 inclusive for individuals with schizophrenia or bipolar disorder registered on the Glasgow Psychosis Clinical Information System (PsyCIS) were obtained by linkage to the Scottish General Register Office (GRO). Rate and cause of death by socioeconomic status, measured by Scottish Index of Multiple Deprivation (SIMD), were compared to the Glasgow and Scottish populations.ResultsDeath rates were higher in people with SMI across all socioeconomic quintiles compared to the Glasgow and Scottish populations, and persisted when suicide was excluded. Differences were largest in the most deprived quintile (794.6 per 10,000 population vs. 274.7 and 252.4 for Glasgow and Scotland respectively). Cause of death varied by socioeconomic status. For those living in the most deprived quintile, higher drug-related deaths occurred in those with SMI compared to local Glasgow and wider Scottish population rates (12.3% vs. 5.9%, p = <0.001 and 5.1% p = 0.002 respectively). A lower proportion of deaths due to cancer in those with SMI living in the most deprived quintile were also observed, relative to the local Glasgow and wider Scottish populations (12.3% vs. 25.1% p = 0.013 and 26.3% p = <0.001). The proportion of suicides was significantly higher in those with SMI living in the more affluent quintiles relative to Glasgow and Scotland (54.6% vs. 5.8%, p = <0.001 and 5.5%, p = <0.001).ConclusionsExcess mortality in those with SMI occurred across all socioeconomic quintiles compared to the Glasgow and Scottish populations but was most marked in the most deprived quintiles when suicide was excluded as a cause of death. Further work assessing the impact of socioeconomic status on specific causes of premature mortality in SMI is needed.
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