Do you think that the psychiatrist has a role in ensuring that patients who are being treated for schizophrenia or with antipsychotic drugs also receive preventive treatments to protect their cardiovascular health?

I think psychiatrists should play a role in this issue. Many patients suffering from schizophrenia don’t have very good access to health care for a variety of reasons. But psychiatrists should encourage them to try and get appropriate medical care whenever possible. The psychiatrist may be more or less able to do this based on practice setting and the patient’s economic and insurance situation.

At the very least, psychiatrists can identify potential health risks and educate the patient about them. For example, you can tell a patient that this medication may increase heart risks and inform the patient of any laboratory results that show that a problem may be brewing. Also consider referring patients to available community health services.

Some mental health centers encourage physical activity by taking patients bowling or offering walking clubs, or providing smoking cessation services. Some have case managers that can help patients by pairing them with a primary care physician and linking them with resources. It’s a tough battle to get patients with schizophrenia to make lifestyle changes due to the nature of the disease. These individuals often don’t have the motivation to make the necessary changes, which are difficult even for individuals not struggling with mental illness.

While psychiatrists should educate and refer patients for services I don’t advocate psychiatrists treating patients for non-psychiatric conditions. This isn’t the best option for the patient and could expose the psychiatrist to legal risks.

Are there any other patient management strategies that should be adhered to in these cases?

It’s important to note that anti-psychotic medications are also commonly and effectively used in patients who are suffering from conditions other than schizophrenia. These drugs are prescribed for both adults and children suffering from ADHD, oppositional defiant disorder and major depression. It’s important to recognize that the risk-to-benefit profile may be different for these individuals.We need to be particularly careful about prescribing these medications for children.

REFERENCES

1. National Institute of Mental Health. Mental Health Medications. Available at: http://www.nimh.nih.gov/health/publications/mental-health-medications/complete-index.shtml. Accessed on June 7, 2012.

2. Lieberman JA, Stroup TS, McEvoy JP, Swartz MS, Rosenheck RA, Perkins DO, Keefe RS, Davis SM, Davis CE, Lebowitz BD, Severe J, Hsiao JK; Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE). Effectiveness of antipsychotic drugs in patients with chronic schizophrenia. New England Journal of Medicine. 2005 Sep 22;353(12):1209-1223.