Metabolic disturbance and schizophrenia
Introduction In comparison to the general population, people with schizophrenia have poorer physical health and increased mortality. Their life expectancy is reduced by some 20%, and around 60% of the excess mortality is due to physical illness, primarily cardiovascular disease (Brown, Birtwistle, Roe, & Thompson, 1999; Newman & Bland, 1991). In fact, more premature deaths result from cardiovascular disease than suicide among patients with schizophrenia. The excess in early death is largely related to increased risk of metabolic disturbance including obesity, dyslipidaemia and diabetes. Lifestyle factors such as physical inactivity, unhealthy diets and high rates of smoking and alcohol use all contribute to the metabolic problems in this group. Iatrogenic factors are also pertinent. In particular, antipsychotic medications are known to cause metabolic disturbance and some of the atypical antipsychotics, now widely used in preference to typical agents, tend to have particularly problematic metabolic side effects. Patients with schizophrenia frequently take other medication including antidepressants and mood stabilizers, some of which are also associated with metabolic problems. Compounding this is the poor standard of medical care patients with schizophrenia receive due to barriers that include under utilization of medical services, therapeutic nihilism, and the separation of medical and mental-health care systems. This chapter reviews the metabolic problems associated with schizophrenia and provides an overview of a concerted service-based programme set up to tackle these problems.