Hello, and welcome to the third and final chapter of a three-part series for the Keep the Body in Mind initiative.
This non-CME program is sponsored by Alkermes, Incorporated. I’m Dr. Andrew J. Cutler, Chief Medical Officer at the Neuroscience Education Institute, and a Clinical Associate Professor of Psychiatry at SUNY Upstate Medical University. I’m also a paid consultant of Alkermes, Incorporated. In this chapter, I’ll be discussing opportunities to manage the whole patient.
The other two chapters in this series discussed a range of common physical comorbidities, including infectious, respiratory, cardiovascular and metabolic diseases, in patients with serious mental illness, or SMI, including bipolar disorder or schizophrenia.1-5
With this knowledge, what opportunities do we have as mental health providers that could help manage the whole patient?
One suggested strategy is sharing electronic health records between physical and mental health care systems.6
Reliable capture of diagnostic information, laboratory values, demographics, and nonpharmacologic interventions is often inconsistent across physical and mental health care system databases.6
Another strategy involves enhancing tobacco smoking cessation efforts, which may involve behavioral interventions such as motivational interviewing and cognitive behavioral therapy. These strategies have shown promise for smokers with SMI.6
Strategies for promoting the integration of care include co-location of primary care providers in community mental health clinics to serve patients who are too psychotic or disorganized to access care in traditional primary care clinics. Many primary care providers are unaware of monitoring recommendations, and education for primary care providers about monitoring guidelines is suggested by the literature.6
Finally, professional guidelines recommend that patients receive appropriate baseline screening and ongoing monitoring, and that clinicians also encourage patients to monitor themselves.7 For patients who show worsening from screening, referral to a health care professional or program with expertise may be appropriate.7
Finally, it is important to provide education for patients, family, and caregivers.7
The chosen strategy should be tailored to the individual patient.6
It may also be important to keep in mind that the 2020 American Psychiatric Association practice guideline for schizophrenia suggests patients with SMI, and schizophrenia in particular, may more frequently experience a variety of health conditions, including, but not limited to, cancer, cardiovascular disease, obesity, metabolic syndrome, diabetes, hepatitis C infection, HIV infection, sleep apnea, and poor oral health.8
The APA practice guideline for schizophrenia recommends that, as part of initial evaluation and follow- up assessment, physicians should discuss relevant physical and laboratory assessments that may be needed with their patients.8
The final version of these APA guidelines is expected to be released in summer 2020.
In summary, there’s an opportunity to improve whole patient care through comprehensive management of comorbidities and behavioral risk factors that may be present in patients living with bipolar disorder or schizophrenia.7,8
You can find additional information related to this topic at www dot keep the body in mind dot com or visit the Related section below to watch the other two videos in this three-part series about bipolar disorder and schizophrenia. Thank you for joining me!
1. De Hert M et al. World Psychiatry. 2011;10(1):52-77;
2. Bahorik AL et al. J Psychosom Res. 2017;100:35-45;
3. Carney CP et al. J Gen Intern Med. 2006;21(11):1133-1137;
4. Beyer J, et al. Neuropsychopharmacology. 2005;30(2):401-404;
5. Carney CP et al. Psychosom Med. 2006;68(5):684-691;
6. Mangurian C et al. J Gen Intern Med. 2016;31(9):1083-1091;
7. ADA, APA, American Association of Clinical Endocrinologists, North American Association for the Study of Obesity. Diabetes Care. 2004;27:596-601;
8. APA. Practice Guideline for the Treatment of Patients with Schizophrenia (Dec 2019). https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Clinical%20Practice%20Guidelines/APA-Draft-Schizophrenia-Treatment-Guideline-Dec2019.pdf. Accessed January 14, 2020.