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'
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
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
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
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
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>.▪