Severe mental illness (SMI) is associated with a 20-year reduction in life expectancy, predominantly through premature cardiac disease. Both depression and schizophrenia are associated with higher rates of diabetes. Treatment of SMI is associated with significant and rapid weight gain, even obesity, with insulin resistance, deteriorated cardiovascular risk factors and increased blood pressure. There is clear evidence linking these weight and metabolic factors to initiation of antipsychotic medication. People with SMI are less frequently treated for cardiometabolic risk factors and have poorer diabetes control. As such, they are amongst our most vulnerable patients to outcomes such as advanced diabetes complication. This can be attributed, at least in part, to well described disparities in access to treatment, but also to lower presentation rates and disparity in treatment despite presentation.
The prevalence of obesity, disturbances in glucose metabolism and metabolic syndrome in young people with psychosis will be discussed. Screening tools available for this clinical setting will be discussed, in addition to a local intervention program and its translation into the National Institute of Clinical Excellence (UK) guidelines.
The diabetes care and prevention paradigm dovetails well into the multidisciplinary team usually caring for youth with SMI. Diabetes care team skill sets in chronic disease management and lifestyle intervention lend themselves well to this clinical setting. Much can be gained by clinical collaboration and joint patient care between the multidisciplinary teams of diabetes and psychiatry for improved physical care.
Early intervention to prevent weight gain and its cardiometabolic sequelae may help prevent the double disability of physical illness and SMI. Early intervention to prevent obesity, diabetes and cardiovascular disease may also reduce the relentless and premature loss of physical health that has been, tragically, the natural physical history of people with SMI.