Sartorius N. Physical illness and schizophrenia: a review of the literature.Objective: The lifespan of people with schizophrenia is shortened compared to the general population. We reviewed the literature on comorbid physical diseases in schizophrenia to provide a basis for initiatives to fight this unacceptable situation. Method: We searched MEDLINE (1966( -May 2006 combining the MeSH term of schizophrenia with the 23 MeSH terms of general physical disease categories to identify relevant epidemiological studies. Results: A total of 44 202 abstracts were screened. People with schizophrenia have higher prevalences of HIV infection and hepatitis, osteoporosis, altered pain sensitivity, sexual dysfunction, obstetric complications, cardiovascular diseases, overweight, diabetes, dental problems, and polydipsia than the general population. Rheumatoid arthritis and cancer may occur less frequently than in the general population. Eighty-six per cent of the studies came from industrialized countries limiting the generalizability of the findings. Conclusion: The increased frequency of physical diseases in schizophrenia might be on account of factors related to schizophrenia and its treatment, but undoubtedly also results from the unsatisfactory organization of health services, from the attitudes of medical doctors, and the social stigma ascribed to the schizophrenic patients. Summations• According to this review it has been known for decades that incidences physical diseases are frequent in schizophrenia. Nevertheless, some areas such as infectious diseases have not been sufficiently studied.• Psychiatrists are often not trained well enough in the detection and treatment of physical diseases.They must be aware of the frequent medical comorbidities and should play a more active role in their diagnosis, prevention, and treatment.• Other necessary strategies include the education of patients, general practitioners and of doctors working in other medical specialities. The access to medical care of the mentally ill also needs to be improved, among others, by reducing the stigma associated with mental disorders. Considerations• The review covered a broad area of research accordingly, focusing attention to details has not been possible.• Despite the broad search strategy, studies not covered by MEDLINE or not indexed by the MeSH term of schizophrenia could have been missed. • Due to considerable differences in the design and quality of the studies in assorted and diverse areas, quantitative approaches using meta-analysis were not possible, but should be the target of future reviews focusing.

It is well established that people suffering from schizophrenia have a higher prevalence of serious physical illness and a higher mortality than the general population. This book provides the first comprehensive and systematic review of current research evidence on the prevalence of physical diseases in people with schizophrenia, a disorder afflicting approximately 1% of the global population, and a group with mortality rates twice as high as the general population. The epidemiological data described in this book will provide the basis for improved awareness of these problems and better treatment for patients. This is the first in a series of books addressing an issue emerging as a priority in the mental health field: the timely and proper recognition of physical health problems in people with mental disorders. They should be read by policy makers, service managers, mental health professionals and general practitioners.

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