Chronic physical health conditions and mental illness

Depression is common in individuals with chronic physical health conditions and should be assessed and treated. People with serious mental illness including schizophrenia and bipolar disorder die 15–20 years earlier than the general population. Of these deaths 70% result from physical health conditions, particularly cardiovascular and respiratory disease. Multimorbidity is common and occurs earlier in this population. There are higher rates of obesity, diabetes and cardiovascular disease in patients with mental illness, which should be screened for and treated. Antipsychotic agents improve symptoms of psychotic illnesses and reduce all-cause mortality, but cause weight gain and hyperlipidaemia and predispose to diabetes, which should be monitored. Anorexia nervosa carries a high rate of premature mortality; medical emergencies such as hypoglycaemia and refeeding syndrome must also be recognized and treated. Clinicians should be aware of diagnostic overshadowing and system-level factors that contribute to the disparity in treatment of physical health complaints in those with mental illness.