Physical illness and schizophrenia : a review of the evidence

225 Pages·2007·3.48 MB·English

by  Stefan Leucht

Physical Illness and Schizophrenia
AReviewoftheEvidence
Thisbookprovidesthefirstcomprehensiveandsystematicreviewofcurrent
researchevidenceontheprevalenceofphysicaldiseasesinpeoplewith
schizophrenia,adisorderafflictingapproximately1%oftheglobalpopulation,
andagroupwithmortalityratestwiceashighasthegeneralpopulation.The
evidencepresentedwillsupportprogrammesaimingtoincreaseawarenessof
theseproblemsandimprovetreatment.Thisisthefirstinaseriesofbooks
addressinganissueemergingasapriorityinthementalhealthfield:thetimely
andproperrecognitionofphysicalhealthproblemsinpeoplewithmental
disorders.Itshouldbereadbypolicymakers,servicemanagers,mentalhealth
professionalsandgeneralpractitioners.
StefanLeuchtisAssistantProfessor,DepartmentofPsychiatryand
PsychotherapyintheTechnicalUniversity,Munich,Germany.
TonjaBurkardhasrecentlygraduatedinMedicinefromtheTechnicalUniversity,
Munich,Germany.
JohnHendersonisaretiredConsultantPsychiatrist.
MarioMajisProfessorofPsychiatryandChairman,DepartmentofPsychiatry,
UniversityofNaples,Italy.HeisPresident-ElectoftheWorldPsychiatric
Association.
NormanSartoriusisPresidentoftheInternationalAssociationforthe
ImprovementofMentalHealthProgrammesandAdjunctProfessorof
PsychiatryatWashingtonUniversity,StLouis,USA.Inaddition,heispart-time
ProfessorofPsychiatryattheUniversityofZagrebandVisitingProfessorof
PsychiatryattheUniversitiesofBeijing,LondonandPrague.

Physical Illness and
Schizophrenia
A Review of the Evidence
Stefan Leucht
AssistantProfessor
DepartmentofPsychiatryandPsychotherapy,TechnischeUniversita¨tMu¨nchen,Germany
Tonja Burkard
MedicalDoctor
John H Henderson
RetiredConsultantPsychiatrist
Mario Maj
ProfessorofPsychiatryandChairmanoftheDepartmentofPsychiatry,Universityof
Naples,Italy
Norman Sartorius
President,InternationalAssociationfortheImprovementofMentalHealthProgrammes
AdjunctProfessorofPsychiatry,WashingtonUniversity,USA
ProfessorofPsychiatry,UniversityofZagreb
VisitingProfessorofPsychiatry,UniversitiesofBeijing,LondonandPrague
CAMBRIDGEUNIVERSITYPRESS
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© Cambridge University Press 2007
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without the written permission of Cambridge University Press.
First published in print format 2007
ISBN-13 978-0-511-37117-2 eBook (NetLibrary)
ISBN-10 0-511-37117-9 eBook (NetLibrary)
ISBN-13 978-0-521-88264-4 paperback
ISBN-10 0-521-88264-8 paperback
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Contents
Preface page ix
Acknowledgements xii
Listofabbreviations xiii
1 Introduction 1
2 Method 3
3 Results 7
3.1 Bacterialinfectionsandmycoses 7
3.1.1 Borreliaburgdorferi 7
3.1.2 Tuberculosis 7
3.2 Virusdiseases 9
3.2.1 Influenzavirus 9
3.2.2 Herpessimplextype1and2,rubellavirus,measles
virus,cytomegalovirus,Epstein–Barrvirus 10
3.2.3 HumanT-celllymphotropicvirustype1 10
3.2.4 Bornadiseasevirus 11
3.2.5 Humanimmunodeficiencyvirus 11
3.2.6 HepatitisBandCviruses 14
3.2.7 HepatitisGB-C/HGandTTviruses 15
3.3 Parasiticdiseases 15
3.3.1 Toxoplasmagondii 15
3.3.2 Chlamydialinfections 16
3.3.3 Intestinalparasiticinfections 16
3.4 Neoplasms 17
3.5 Musculoskeletaldiseases 27
3.5.1 Osteoporosis 28
3.6 Digestivesystemdiseases 32
3.6.1 Coeliacdisease 32
v
vi Contents
3.6.2 Acuteappendicitis 33
3.6.3 Gastriculcer 35
3.6.4 Acuteintermittentporphyria 36
3.6.5 Irritablebowelsyndrome 37
3.6.6 Cancersofthedigestivesystem 39
3.6.7 Miscellaneous 40
3.7 Stomatognathicdiseases 40
3.7.1 Oraldyskinesia 40
3.7.2 Dentaldisease 41
3.7.3 Temporomandibulardisorders 42
3.8 Respiratorytractdiseases 42
3.8.1 Respiratoryhealth:asthma,bronchitis,upper
respiratorytractinfections,emphysema,
pneumonia,chronicobstructivepulmonary
disease 42
3.8.2 Cancersoftherespiratorytract 43
3.9 Otorhinolaryngologicdiseases 43
3.9.1 Middleeardisease 43
3.9.2 Vestibularresponseabnormalities 44
3.9.3 Deafness 44
3.10 Diseasesofthenervoussystem 47
3.10.1 Folatestatus 47
3.10.2 Autoimmunediseasesofthenervoussystem 47
3.10.3 Autonomicnervoussystemdiseases 48
3.10.4 Centralnervoussystemdiseases 48
3.10.5 Chronobiologydisorders 50
3.10.6 Cranialnervediseases 50
3.10.7 Demyelinatingdiseases 50
3.10.8 Nervoussystemmalformations 51
3.10.9 Nervoussystemneoplasms 51
3.10.10 Neurocutaneoussyndrome 51
3.10.11 Neurodegenerativediseases 51
3.10.12 Neurologicalmanifestations 53
3.10.13 Neuromusculardiseases 54
3.10.14 Neurotoxicitysyndromes 55
3.10.15 Sleepdisorders 55
3.10.16 Trauma,nervoussystem 56
3.11 Eyediseases 56
Contents vii
3.11.1 Cataractsandhyperpigmentationsofthelens
andcornea 56
3.11.2 Albinism 56
3.11.3 Blindness 56
3.12 Urologicalandmalegenitaldiseases 57
3.12.1 Urinaryincontinence 57
3.12.2 Sexualdysfunction 57
3.12.3 Cancersoftheurinarysystem 59
3.12.4 Prostatecancer 60
3.12.5 Cancerofthetestis 62
3.13 Femalegenitaldiseasesandpregnancycomplications 62
3.13.1 Obstetricandneonatalcomplications 62
3.13.2 Galactorrhoea 84
3.13.3 Amenorrhoea 86
3.13.4 Breastcancer 86
3.13.5 Cancerofthecervixuteri 87
3.13.6 Cancerofthecorpusuteri 87
3.13.7 Canceroftheovary 87
3.14 Cardiovasculardiseases 87
3.15 Haemicandlymphaticdiseases 111
3.15.1 Laboratoryabnormalities 111
3.15.2 Cancerofthelymphaticandhaemapoietic
system 111
3.16 Congenital,hereditaryandneonataldiseasesand
abnormalities 114
3.16.1 Klinefelter’ssyndrome 115
3.16.2 Neurologicalabnormalities 115
3.17 Skinandconnectivetissuediseases 115
3.17.1 Allergicskinreactions 115
3.17.2 Hyperpigmentationoftheskin 115
3.17.3 Lupuserythematodes 116
3.17.4 Tuberoussclerosis 116
3.17.5 Pellagra 116
3.17.6 Skincancerandmalignantmelanoma 117
3.17.7 Rheumatoidarthritis 117
3.18 Nutritionalandmetabolicdiseases 129
3.18.1 Overweight,obesity,diabetesmellitusand
metabolicsyndrome 129
3.18.2 Polydipsia 151
viii Contents
3.18.3 Idiopathicunconjugatedhyperbilirubinaemia
(Gilbert’ssyndrome) 156
3.18.4 Homocystinuria 156
3.19 Endocrinediseases 157
3.19.1 Thyroidfunctionabnormalities 157
3.19.2 Thyroidcancer 165
3.20 Immunesystemdiseases 165
3.20.1 Autoimmunediseases 165
3.20.2 Allergies 166
3.21 Disordersofenvironmentalorigin 166
3.22 Animaldiseases 166
3.23 Pathologicalconditions,signsandsymptoms 166
4 Discussion 167
Mostimportantfindingsofthereview 167
Limitationsofthereview 169
Causesfortheincreasedphysicalcomorbidityinpatients
withschizophrenia 171
Disease-relatedfactors 171
Factorsrelatedtodrugtreatment 172
System-relatedfactorsandstigmasonmentalillness 172
Psychiatrist-relatedfactors 173
Whatcouldbedonetochangethisunsatisfactory
situation? 173
5 Summary 175
References 177
Index 202
Preface
Thisisthefirstofaseriesofvolumesaddressinganissuewhichisemergingasa
priorityinthementalhealthfield:thetimelyandproperrecognitionofphysical
healthproblemsinpeoplewithseverementaldisorders.
Itisnowwelldocumentedbyresearchthatpeoplewithseverementaldisor-
dershaveahigherprevalenceofseveralphysicaldiseasesandahighermortality
fromnaturalcausesthanthegeneralpopulation.Theyseemnottohaveben-
efited from the recent favourable trends concerning mortality due to some
physical diseases, in particular cardiovascular illness. Their access to physical
healthcareisreducedandthequalityofthephysicalcaretheyreceiveisworse
ascomparedwiththegeneralpopulation.Ifwearereallyconcernedaboutthe
quality of life of people with mental disorders and wish to protect their civil
rights,wecannotignorethefactthatphysicalhealthisacrucialdimensionof
theirqualityoflife,andthataccesstoaphysicalhealthcareofthesamequalityas
thatavailabletotherestofthepopulationisoneoftheirbasicrightsashuman
beingsandascitizens.
Theinitialtriggerforthepreparationofthisseriesofbookshasbeenapersonal
communicationtooneofusfromaphysicianworkingwiththeMe´decinssans
Frontie`resinaCentralAsianrepublic.Hefeltdesperatebecausehewasunable
togetsufficientresourcestodealwiththeveryhighmortalityofpeoplewith
schizophreniaadmittedtothecentralmentalhospitalinthecountry:according
tohisaccount,onepersonoutoftwoadmittedforschizophreniawaslikelyto
bedeadattheendoftheyearinwhichhe/shewasadmittedfortreatment.Some
of the excess mortality would be due, like in other countries, to suicide, but
alargeproportionofthosewhowoulddiewouldhaveaphysicaldisease(e.g.
tuberculosis)asthemaincauseofdeath.
Indeed,mentalhospitalsinmanycountriesareoftenlackingequipmentthat
could help in making the diagnosis of physical illness as well as medications
andothermaterialthatwouldmakeitpossibletorecognizeandtreatphysical
illness.Psychiatristsarereluctanttotreatphysicalillness,perhapsasfrequently
asdoctorsinothermedicalspecialtiesfailtorecognizethattheirpatientsalso
sufferfromamentaldisorderorrefusetoprovidetreatmentforit.
Whypeoplewithmentalillnessaremorelikelytohaveaphysicalillnessthan
the rest of the population is only partially known. Part of the answer to this
ix