Mental Illness Can Raise Physical Health Risks; Psychiatrists Urge Integrated Care

Hyderabad:People living with severe mental illnesses such as schizophrenia and bipolar disorder face higher burden diabetes making regular physical-health monitoring an important part of psychiatric care, psychiatrists said. Individuals with other mental health illnesses were facing the physical health problems of obesity, hypertension and cardiovascular disease.

Dr Raju Boosa, assistant professor of psychiatry and child and adult psychiatrist at the Institute of Mental Health, Erragadda, said people with severe mental illnesses could have a 10–20-year shorter life expectancy than the general population. Their risk of cardiovascular morbidity was about 1.5 times higher, and cardiovascular mortality about 1.8 times higher.

The increased physical-health burden was linked to several factors, including the underlying illness, genetic and biological factors, smoking and substance use, disturbed sleep, reduced physical activity and, in some patients, the metabolic effects of psychiatric medication.

Dr Boosa said patients with severe mental illness may not always recognise their physical symptoms or seek medical attention. Lack of insight into the psychiatric illness itself can also affect their ability to recognise other health problems and adhere to treatment.

Patients with schizophrenia, for instance, may have higher rates of obesity and smoking, while unhealthy sleep patterns, reduced physical activity, alcohol and substance use can further increase their risk of metabolic and cardiovascular conditions. Some infectious diseases, including tuberculosis, are also reported more frequently in vulnerable groups.

Psychiatrists cautioned against attributing diabetes, obesity or other metabolic conditions solely to antipsychotic medication.

Dr Sai Krishna Tikka, associate professor of psychiatry at AIIMS Bibinagar, said severe mental illnesses themselves were associated with metabolic conditions such as diabetes and hypertension. Schizophrenia and bipolar disorder could share biological and inflammatory pathways with metabolic disorders, while genetic predisposition can also contribute.

At the same time, some antipsychotic medicines can cause weight gain and metabolic changes in susceptible patients. The increased risk therefore cannot automatically be attributed to medication alone, he said.

Patients should not stop or reduce psychiatric medication on their own, Dr Tikka said, as interruption of effective treatment can result in relapse. Any change in medication should be made in consultation with the treating psychiatrist and other doctors.

When a patient with schizophrenia develops diabetes, both conditions need to be treated together rather than stopping psychiatric treatment in an attempt to control diabetes, he said.

Dr Divya Nellur senior consultant psychiatrist, said bipolar disorder was also associated with a higher burden of obesity, metabolic syndrome, diabetes, hypertension and abnormal cholesterol levels. Changes in sleep, appetite, physical activity and lifestyle during different phases of the illness can further affect physical health.

Psychiatrists said regular monitoring of weight, blood pressure, blood sugar and cholesterol, along with attention to smoking, alcohol, substance use, sleep, diet and physical activity, should form part of long-term care. Families and caregivers can also help patients attend medical appointments and recognise physical symptoms, particularly when severe psychiatric symptoms affect their ability to care for themselves.

Early psychiatric treatment and regular follow-up can help patients better recognise and address physical health problems, but protecting their overall health requires psychiatric and medical care to continue together.