Citrome Leslie, Yeomans David
New York University School of Medicine, Department of Psychiatry, and Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA.
J Psychopharmacol. 2005 Nov;19(6 Suppl):102-9. doi: 10.1177/0269881105059505.
The effective management of individuals with severe mental illnesses (SMIs) requires an holistic approach that offers reliable symptom control, but also addresses other clinical, emotional and social needs. The physical health of individuals with an SMI is often poor, with many being overweight or obese, having hypertension, diabetes or dyslipidaemia, and at significant risk of developing cardiovascular disease or other comorbidities. We have recently reviewed current UK and US guidelines for the management of individuals with schizophrenia and bipolar disorder, and found very different approaches to the holistic care of people with SMIs, especially in relation to the management of physical health and cardiovascular risk. UK guidelines acknowledge the high risk of physical morbidity and mortality in individuals with an SMI, but fail to address in detail the specifics of physical health monitoring and lifestyle management. US guidelines are more descriptive in terms of the type and extent of monitoring recommended, but there are inconsistencies between the guidelines produced by different organizations, and studies in the field suggest that none of them is being adequately implemented. Clear and consistent recommendations on how and when to monitor weight, cardiovascular function, and metabolic parameters and, importantly, what to do with the results, would support clinicians wishing to integrate physical and mental healthcare. Publication of specific recommendations on evidence-based physical health interventions that can work for people with SMIs would also help primary care and mental health services improve general well-being in their patients with severe mental illnesses.
对重症精神疾病（SMI）患者进行有效管理需要采取整体方法，这种方法不仅要提供可靠的症状控制，还要满足其他临床、情感和社会需求。SMI患者的身体健康状况往往较差，许多人超重或肥胖，患有高血压、糖尿病或血脂异常，并且有患心血管疾病或其他合并症的重大风险。我们最近回顾了英国和美国目前关于精神分裂症和双相情感障碍患者管理的指南，发现对于SMI患者的整体护理存在非常不同的方法，特别是在身体健康管理和心血管风险方面。英国指南承认SMI患者存在较高的身体发病和死亡风险，但未详细阐述身体健康监测和生活方式管理的具体细节。美国指南在推荐的监测类型和范围方面描述得更为详细，但不同组织制定的指南之间存在不一致之处，该领域的研究表明这些指南均未得到充分实施。关于如何以及何时监测体重、心血管功能和代谢参数，以及重要的是如何处理监测结果的明确且一致的建议，将有助于希望整合身心医疗保健的临床医生。发布关于对SMI患者有效的循证身体健康干预措施的具体建议，也将有助于初级保健和心理健康服务机构改善其重症精神疾病患者的总体健康状况。
