WHO guidelines address need for physical health management in severe mental illness

The guidelines include recommendations on healthy lifestyle behaviors (eg, healthier diet, more physical activity and tobacco cessation), psychosocial support and considering possible interactions between different medications prescribed for mental and physical health conditions.

“The majority of deaths amongst people with [severe mental disorders] are attributable to physical health conditions, both non-communicable and communicable,” Graham Thornicroft, PhD,FRCPsych, chair of the guideline developmental group and Professor of Community Psychiatry at King’s College London, and colleagues wrote in the WHO executive summary.

“Equitable access to comprehensive health services remains out of reach for the majority of people with [severe mental disorders],” they continued. “Unfortunately, people with [severe mental disorders] often lack access to health services or receive poor quality care, including promotion and prevention, screening and treatment. It is crucial to address the disparities in health care access and provision for people with [severe mental disorders].”

The guidelines feature recommendations for treating people with mental illnesses who have cardiovascular disease, diabetes, HIV/AIDS, tuberculosis, hepatitis B and C, tobacco dependence, substance use dependence and/or overweight/obesity. WHO offered these guidelines to improve the management of physical health conditions in adults with severe mental disorders, help reduce potentially risky lifestyle behaviors for these illnesses and decrease morbidity and premature mortality among those with severe mental illness.

Taking into consideration the potential for interactions between psychotopic or antipsychotic medications and medications for other conditions is a significant feature of the guidelines.

For patients at risk of becoming overweight or obese, WHO recommends initiating a psychotropic medication with lower propensity for weight gain after considering clinical benefits/possible adverse effects. For people with severe mental disorders and pre-existing cardiovascular disease or cardiovascular risk factors, WHO advises initiating a psychotropic medication with lower proclivity for cardiovascular risk.

For those with severe mental disorders and diabetes, clinicians should consider initiating an antipsychotic medication with lower propensity for producing hyperglycemia and be aware of the potential interactions. WHO also advises monitoring glycemic control and adjusting dose as needed.

For infectious diseases, clinicians should consider the potential for drug-drug interactions between psychotropic medicines and antiretroviral drugs, tuberculosis medicines and medicines for hepatitis B and C. For tobacco cessation programs, WHO recommends considering potential interactions between bupropion and varenicline with psychotropic medications.

“The main message for clinicians in WHO’s new guidelines on management of physical health conditions in adults with severe mental disorders is that it is important to pay as much attention to the physical health of people with severe mental disorders as to their mental health,” Neerja Chowdhary, MD, from the department of mental health and substance abuse at WHO, told Healio Psychiatry. “This means providing advice on leading a healthy lifestyle as well as detecting and treating physical health conditions. Encouraging regular check-ups is essential to ensure improved physical and mental health in the long-term.” – by Savannah Demko

References:

WHO. Management of physical health conditions in adults with severe mental disorders. http://apps.who.int/iris/bitstream/handle/10665/275718/9789241550383-eng.pdf?ua=1. Accessed on Nov. 7, 2018.

Source: Healio