Physical health in schizophrenia and related disorders

People with schizophrenia and related disorders have higher rates of long-term medical conditions, such as obesity, cardiovascular disease, and diabetes mellitus, and these are likely to be mediated by unhealthier lifestyles, such as smoking, decreased physical activity, and poor nutrition which leads to weight gain and other negative health outcomes. Life expectancy is reduced by almost 20 years compared with that of the general population. Antipsychotics, especially certain atypical antipsychotics such as clozapine and olanzapine, have also been implicated in weight gain, but the strength of this association is still uncertain as studies have not consistently taken account of all the other reasons why people with schizophrenia might gain weight. It is also important to consider the psychological and social context of physical morbidity in this vulnerable patient group, such as self-esteem and poverty respectively. The emphasis on managing physical health in this group is primarily prevention, with close monitoring of weight and other components of the metabolic syndrome, and improving access to generic health services. Although there have been only a few intervention studies, commonsense approaches to health promotion, such as adapting exercise programmes and dietary education, are usually readily available within local resources.