Medical comorbidities in patients with serious mental illness: a retrospective study of mental health patients attending an outpatient clinic in Qatar

Abstract

BackgroundThe life span of individuals with serious mental illness (SMI) is shorter compared to the general population. This excess mortality is mainly due to physical illness. The aim of the study was to investigate the prevalence rates of different physical illnesses in individuals with SMI and to examine how these are being managed.MethodsThe study was a cross-sectional retrospective chart review of a cohort of patients with SMI. A comprehensive electronic data extraction tool using SurveyMonkey® was used to collect patient demographics, psychiatric and medical comorbidities, medications and all relevant physical assessments. Data were then first extrapolated into an Excel® spreadsheet and later to SPSS® for data analysis. A descriptive statistical approach was used to analyze the demographic and clinical data. Chi-square test for categorical variables and t-test for continuous variables were used to compare the demographic and clinical characteristics of the cohort.ResultsA total of 336 patients with SMI were included for the retrospective chart review. The majority of these patients had a diagnosis of depression (50.3%), followed by schizophrenia (33.0%) and bipolar disorder (19.6%). Diabetes was the most frequent medical comorbidity, diagnosed in 16.1% of SMI patients, followed by hypertension (9.2%) and dyslipidemia (9.8%). Monitoring of comorbidity-associated risk factors and other relevant physical assessment parameters (such as blood pressure, weight, hemoglobin A1c [HbA1c], blood glucose and lipids) were documented in less than 50% of patients, and some parameters, such as smoking status, were not documented at all.ConclusionBoth, the literature and our cohort provide evidence that individuals with SMI are less likely to receive standard levels of care for their medical comorbidities.

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“…This finding is consistent with findings from similar studies which highlight that people with SMI are less likely to receive preventive services such as immunizations, cancer screening, and smoking cessation counseling than the general population [18][19][20]. Local research from an assessment of the medical charts of outpatients attending follow up appointments at a psychiatric hospital in Qatar found that monitoring of comorbidity-associated risk factors and other relevant physical assessment parameters (such as blood pressure, weight, hemoglobin A1c [HbA1c], blood glucose and lipids) were documented in less than 50% of patients [10].…”

“…In addition to this morbidity and morbidity gap, there is also evidence of disparities in the provision of medical care to people with mental illness: they are less likely to have regular physical or diagnostic examinations, and to receive evidence-based medications for chronic medical conditions than people without mental illness [1,[4][5][6][7][8][9]. In a recently published study in Qatar, which consisted on a retrospective chart review of patients attending a psychiatric outpatient clinic, it was reported that almost 30% of patients with serious mental illness (SMI) had at least one medical comorbidity for which inadequate medical care was being provided [10]. Reasons for the gap in medical care to people with mental illness have been highlighted in several studies, including: fragmentation of care, limited access and time pressure in general practice, staff attitudes regarding what falls within their clinical role, communication difficulties between services, lack of training, inadequate access or compliance with clinical guidelines in the part of healthcare practitioners (HCPs) to support people with psychiatric comorbidity [5,[11][12][13][14][15].…”

COVID-19 Vaccination: crucial roles and opportunities for the mental health professionals

“…In addition, medical comorbidities are common in persons with mental illness (PMI), making them more susceptible to infection. In severe mental illnesses (SMI) such as schizophrenia, depression, bipolar disorder, medical illnesses, including diabetes mellitus, cardiovascular disorders, respiratory tract infections, neurocognitive disorders, obesity and smoking, are found to be higher than in general population, even after controlling for the contribution of psychotropic medications (Miller et al, 2006;DE Hert et al, 2011;Sadock et al, 2017;Zolezzi et al, 2017). Further risk factors mediating the link between psychiatric illnesses may be socioenvironmental factors like homelessness, reduced access to healthcare, lack of information, high-risk living conditions, etc.…”

Prevalence and correlates of diagnosed and undiagnosed epilepsy and migraine headache among people with severe psychiatric disorders in Ethiopia

“…Research evidence shows that a considerable percentage of people with SPD have comorbid medical conditions including neurologic disorders such as epilepsy and migraine headaches [6][7][8][9]. For example, a recent meta-analysis that assessed the prevalence of migraine headaches among patients with bipolar disorder involving seven studies on the subject found that roughly one-third of patients with bipolar disorder had comorbid migraine headaches (30.36%) [8].…”