Psychiatrists, Patients Disagree About Extent of Communication

Psychiatrists and their patients with schizophrenia may not be communicating about overall health care to the extent that they should, according to the results of a new survey released by Mental Health America, but both express a desire to discuss issues such as smoking, obesity, diabetes, and metabolic syndrome—issues that are critical to patients' recovery.

According to a summary of the report's findings, “By promoting a holistic approach to health care, mental health consumers and their providers can minimize and prevent conditions that contribute to excess mortality and improve overall quality of life.”

The authors of the report noted that they surveyed schizophrenia patients and psychiatrists in response to a 2006 report about morbidity and mortality among people with serious mental illness showing that, on average, they die 25 years earlier than the rest of the population due to problems stemming from obesity, diabetes, insulin resistance, and metabolic syndrome due to side effects of antipsychotic medications.

In late 2007, MHA commissioned staff of International Communications Research (ICR) to undertake a survey via the Internet of 250 adults with schizophrenia about their overall health status, their perceptions of and relationship with their psychiatrist, and their attitudes toward their own health. They also interviewed a sample of 250 practicing psychiatrists who treat patients with schizophrenia.

The sample of patients and psychiatrists came from nationally representative online research panels maintained by ICR.

According to the results, approximately 70 percent of the respondents with schizophrenia said that at least at one point during their treatment, they had stopped taking an antipsychotic medication due to side effects.

Further analysis revealed that only a quarter of patient respondents were of normal weight, with the majority being classified as obese or overweight. Over a third of the respondents had been diagnosed with high cholesterol and hypertension.

About a quarter of respondents (27 percent) said that it is difficult for them to access medical care when they need it.

In terms of expectations, respondents with schizophrenia were about equally divided on whether they expected their psychiatrists to focus exclusively on mental health (48 percent) or mental and physical health (52 percent).

About 73 percent of psychiatrists surveyed responded that they are responsible for ensuring that their patients with schizophrenia receive comprehensive care for all health problems.

In addition, according to the patients, just 66 percent of psychiatrists asked them about issues pertaining to their weight, 49 percent asked them about their body weight, and less than half addressed issues related to blood pressure, blood sugar levels, or cholesterol levels.

About 62 percent of respondents with schizophrenia said that their psychiatrist provided them with tips on how to live a healthier life.

In contrast, psychiatrists' responses indicated that they discuss health issues more frequently than patient respondents reported.

For instance, at least 90 percent of the psychiatrists responded that they address health topics, including those related to medication side effects.

Eighty-two percent of psychiatrists, when asked to define their responsibility to patients, reported that they viewed themselves as being responsible for providing preventative care to their patients and screening for co-occurring conditions.

When asked about obstacles that prevent the psychiatrists from discussing all health problems with their patients with schizophrenia, 83 percent responded that, at least to some extent, one factor was lack of time during a typical office visit. In addition, 74 percent responded that to some extent, psychiatrists are not as well equipped as primary care physicians to deal with patients' overall health.

The vast majority of psychiatrists reported regularly screening their patients with schizophrenia for diabetes (94 percent) and hyperlipidemia (88 percent).

In a press release accompanying the report, MHA CEO and President David Shern, Ph.D., said, “We should all be alarmed and outraged that the lives of people with schizophrenia are being cut short by 25 years.” He also noted that there is a need for more communication among psychiatrists and their patients with serious mental illness.

Joseph Parks, M.D., president of the Medical Director's Council of the National Association of State Mental Health Program Directors, the organization that issued the initial report on the mortality of patients with schizophrenia, noted in the press release that “as psychiatrists, every one of us must redouble our efforts to protect the health and promote the well-being of our patients with schizophrenia.”

Still others see the findings as a sign that psychiatrists and their patients are on the same page in terms of what they believe is important to discuss.

John Davis, M.D., who has been treating patients with schizophrenia for 50 years, told Psychiatric News that he is “more impressed with the similarities than the differences” in the frequency with which consumers and psychiatrists discussed health topics during treatment and noted that it is important for psychiatrists to work in tandem with primary care physicians to reduce health problems related to medication side effects when possible.

Davis, a professor of psychiatry at the University of Illinois at Chicago, acknowledged that sometimes health issues may be too complex for psychiatrists to treat and that they should feel comfortable referring patients to a specialist for additional treatment. “I think it's important that physicians be aware of their limitations” in these cases, he said.

The survey was funded by an unrestricted grant from Solvay Pharmaceuticals and Wyeth Pharmaceuticals and by an anonymous donation.

The results of the survey “Communicating About Health: A Mental Health America Survey of People With Schizophrenia and Providers” are posted at<www.nmha.org/go/surveys>.▪