General MedicineTier 2Disease (DEADMAN)

Psychiatry - medical complications relating to mental health

Description

Severe mental illness carries meaningfully elevated risk of medical complications - both direct physiological consequences (e.g. metabolic syndrome from antipsychotic medication, cardiovascular disease from combined illness and treatment factors) and indirect consequences (reduced engagement with preventive healthcare, higher rates of modifiable risk factors like smoking) - contributing to a well-documented mortality gap between people with severe mental illness and the general population

A significant, under-addressed cause of premature mortality in people with severe mental illness, with life expectancy gaps of years observed in several large studies comparing this population against the general population

Multiple compounding factors explain the elevated medical complication burden - psychotropic medication metabolic adverse effects, reduced health-seeking behaviour and preventive care engagement (partly reflecting illness-related factors and partly reflecting healthcare system barriers/stigma affecting access), higher rates of modifiable risk factors (smoking, sedentary lifestyle), and sometimes diagnostic overshadowing (physical symptoms attributed to the mental illness rather than investigated as a potential separate physical condition)

Structured cardiometabolic screening (weight, waist circumference, blood pressure, lipids, glucose/HbA1c) at baseline and regular intervals for anyone on second-generation antipsychotic therapy, mirroring the monitoring approach described in
A full physical assessment should accompany any new symptom presentation in a patient with severe mental illness, rather than defaulting to a psychiatric explanation without adequate physical work-up

Structured physical health monitoring (metabolic parameters, cardiovascular risk factors) should be routine and proactive in people with severe mental illness on psychotropic medication, not reserved for symptomatic presentation
Diagnostic overshadowing should be actively guarded against - new physical symptoms in a patient with severe mental illness warrant the same thorough physical assessment as in any other patient, not automatic attribution to the mental illness

Integrated physical and mental healthcare models, proactive cardiometabolic screening for patients on psychotropic medication, addressing modifiable risk factors (smoking cessation support particularly relevant given high prevalence in this population), diagnostic overshadowing avoidance

Diagnostic overshadowing - attributing new physical symptoms in a patient with severe mental illness to their psychiatric condition without adequate physical investigation - is a recognised, harmful pattern contributing to delayed diagnosis and the broader mortality gap in this population; new physical symptoms deserve the same thorough work-up regardless of a patient's psychiatric history

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