SCHIZOPHRENIA AND PHYSICAL COMORBIDITY

Schizophrenia is a severe psychiatric disorder increasingly recognized as a systemic disorder. In addition to the burden and suffering caused by the mental illness itself, individuals with schizophrenia have a high risk for physical illnesses. The life expectancy gap remains 13 to 30 years wider in people with schizophrenia compared to the general population. This premature mortality is caused largely by deaths due to cardiovascular disease, cancer, diabetes mellitus, and other natural causes, poor diagnosis and treatment, and insufficient prevention of modifiable risk factors. Although the links between schizophrenia and physical illnesses are well established, in clinical practice, physical illnesses in patients with schizophrenia are often overlooked, and the mortality gap between general population and people with schizophrenia continues to widen. The physical health of people with schizophrenia is commonly self-neglected but also ignored by people around them and by health systems, resulting in significant physical health disparities and limited access to health services. The root of the problem of insufficient healthcare appear to lie in interrelated contributory factors from illness, patients, and medical and mental healthcare system. Furthermore, a growing body of literature has been indicating the effect of the chronic physical illness on the treatment outcome of psychosis. Premature mortality and disability could be reduced if there was a greater focus on the implementation of strategies that effectively prevent modifiable risk factors from the first psychotic episode and enhance early recognition of physical illnesses, reduce the burden of physical comorbidity and lead to improved health outcomes. Ultimately, to improve treatment outcome and to reduce the suffering of people with schizophrenia, it is crucial to treat physical comorbidity promptly and assertively from the appearance of the first symptoms of the psychotic disorder. The integrative approach and collaborative care within all levels of healthcare providers should be the imperative in clinical practice

SCHIZOPHRENIA AND PHYSICAL COMORBIDITY

Schizophrenia is a severe psychiatric disorder increasingly recognized as a systemic disorder. In addition to the burden and suffering caused by the mental illness itself, individuals with schizophrenia have a high risk for physical illnesses. The life expectancy gap remains 13 to 30 years wider in people with schizophrenia compared to the general population. This premature mortality is caused largely by deaths due to cardiovascular disease, cancer, diabetes mellitus, and other natural causes, poor diagnosis and treatment, and insufficient prevention of modifiable risk factors. Although the links between schizophrenia and physical illnesses are well established, in clinical practice, physical illnesses in patients with schizophrenia are often overlooked, and the mortality gap between general population and people with schizophrenia continues to widen. The physical health of people with schizophrenia is commonly self-neglected but also ignored by people around them and by health systems, resulting in significant physical health disparities and limited access to health services. The root of the problem of insufficient healthcare appear to lie in interrelated contributory factors from illness, patients, and medical and mental healthcare system. Furthermore, a growing body of literature has been indicating the effect of the chronic physical illness on the treatment outcome of psychosis. Premature mortality and disability could be reduced if there was a greater focus on the implementation of strategies that effectively prevent modifiable risk factors from the first psychotic episode and enhance early recognition of physical illnesses, reduce the burden of physical comorbidity and lead to improved health outcomes. Ultimately, to improve treatment outcome and to reduce the suffering of people with schizophrenia, it is crucial to treat physical comorbidity promptly and assertively from the appearance of the first symptoms of the psychotic disorder. The integrative approach and collaborative care within all levels of healthcare providers should be the imperative in clinical practice

Mental Disorders and Physical Diseases

Pravodobno prepoznavanje i kvalitetno liječenje komorbiditetnih tjelesnih bolesti u psihijatrijskih bolesnika izazov su i cilj modernog i uspješnog liječenja te donose poboljšanje kvalitete života bolesnika i ukupnu uštedu zdravstvenom sustavu i društvu. Životni vijek psihijatrijskih bolesnika u odnosu prema općoj populaciji je 13 − 30 godina kraći. Razlog tomu jest velik broj prekasno prepoznatih i loše liječenih tjelesnih bolesti od kojih dominiraju metaboličke i kardiovaskularne koje uzrokuju loše životne navike (prehrana, pušenje, manjak kretanja i vježba) te same psihijatrijske bolesti. Posljedice za bolesnike sa psihijatrijskim i tjelesnim komorbiditetom mnogobrojne su te vode pogoršanju prognoze i ishoda liječenja obaju poremećaja. Neprepoznate ili prekasno dijagnosticirane tjelesne bolesti razlog su i do 60% preranih ili iznenadnih smrti, a multimorbiditeti su povezani s težom kliničkom slikom, većom učestalošću pogoršanja bolesti i terapijskom rezistencijom. Bolesnici koji boluju od shizofrenije ili velikoga depresivnog poremećaja imaju znatno povišen rizik od razvoja kardiovaskularne bolesti, metaboličkog sindroma, dijabetesa, bolesti dišnog sustava, raka i ostalih kroničnih tjelesnih bolesti. Visoki morbiditet, invaliditet, mortalitet te posljedično i visoki troškovi liječenja oboljelih od kroničnih psihičkih bolesti u komorbiditetu s tjelesnim bolestima razlog su pokretanja jedinstvenog programa CIP-a (Centra za integrativnu psihijatriju) u Psihijatrijskoj bolnici „Sveti Ivan“ i Republici Hrvatskoj s glavnim ciljem smanjenja smrtnosti i poboljšanja kvalitete života psihijatrijskih bolesnika.Timely recognition and treatment of underlying physical conditions in psychiatric patients presents a challenge and is the goal of modern and successful treatment. It results in quality of life improvement of the individual patients and overall savings for the health care system and society. The life expectancy of psychiatric patients is reduced by 13 to 30 years compared to general population. This excess mortality is mainly due to late-diagnosed and poorly treated physical illness such as metabolic and cardiovascular disease (consequence of bad living habits; nutrition, smoking and lack of physical activity and exercise) as well as mental disorder. The consequences for patients with mental and somatic comorbidities are numerous and lead to worsening of prognosis and outcome of treatment. Unrecognized or late-diagnosis of underlying physical illness is the cause of up to 60% of premature or sudden deaths. Multimorbidities are associated with a more severe clinical picture, more frequent disease deterioration, as well as therapeutic resistance. Patients suffering from schizophrenia or major depressive disorder have a significantly higher risk of cardiovascular disease, metabolic syndrome, diabetes, respiratory disease, cancer and other chronic diseases. High morbidity, disability, mortality rates and consequently high costs of treatment of chronic mental disorders with underlying physical illness are the reasons for launching a unique CIP program (Integrative Psychiatric Centre) at the Psychiatric Hospital “Sveti Ivan” as well as accross Republic of Croatia with the main aim of reducing mortality and improving the quality of life of psychiatric patients

PERSONAL SPACE OF WAR VETERANS WITH PTSD – SOME CHARACTERISTICS AND COMPARISON WITH HEALTHY INDIVIDUALS

Background: The aim of this study was to determine the size of personal space among war veterans with PTSD, compared to healthy individuals, and to examine its associations with some sociodemographic and clinical characteristics. Subjects and Methods: Participants were 83 male war veterans with chronic PTSD and 85 healthy male employees of the medical institutions. Preferred interpersonal distances were assessed by using a stop-distance technique, where male and female research assistants approached the participants from four directions (front, behind, left, right). The patients filled out The Mississippi Scale for Combat-Related Posttraumatic Stress Disorder (M-PTSD). Results: War veterans with PTSD preferred significantly larger interpersonal distances compared to healthy participants. Larger personal space size was preferred by those who had children, and the largest preferred distances were observed for the approaches from behind. Both samples preferred larger distances when approached by a male person. Conclusion: The findings of this study contribute to increased understanding of the personal space in patients with PTSD, and may be implemented into prevention of aggressive behavior during psychiatric treatment, and into development of more effective therapeutic strategies

Connection Between Psychological and Somatic Symptoms in Schizophrenia – Early Intervention

Shizofrenija je psihički poremećaj koji sve više shvaćamo kao sistemski poremećaj. Osobe oboljele od shizofrenije, osim niza psihičkih simptoma, suočavaju se s povećanim rizikom obolijevanja od kroničnih tjelesnih bolesti i multimorbiditeta. Očekivani životni vijek muškaraca oboljelih od shizofrenije kraći je i do 20 godina, a žena do 15 godina u odnosu na opću populaciju. Razlika u stopi smrtnosti između ovih dviju skupina nastavlja rasti. Neprihvatljivo visoka smrtnost oboljelih od shizofrenije ukazuje na diskriminaciju oboljelih, a 60 % smrti u oboljelih uzrokovano je upravo kroničnim tjelesnim bolestima i zaraznim bolestima od čega najveći udio otpada na kardiovaskularne bolesti i malignome povezane s pretilošću. Iako je povezanost između shizofrenije i tjelesnih bolesti prepoznata dulje od stoljeća, u praksi se često zanemaruje tjelesno zdravlje oboljelih. Da bi se smanjila stopa smrtnosti i invaliditeta, potrebno je više pažnje posvetiti prevenciji i ranoj dijagnostici tjelesnih bolesti kod osoba oboljelih od shizofrenije. Ključno je pružiti brzu i učinkovitu tjelesnu skrb od pojave prvih psihotičnih simptoma. Integrirani pristup i suradnja među svim pružateljima zdravstvenih usluga trebaju postati standard u kliničkoj praksi.Schizophrenia is a serious mental disorder that is increasingly understood as a systemic disorder. In addition to mental suffering, individuals with schizophrenia face an increased risk of chronic physical illnesses and multimorbidity. The expected lifespan of men with schizophrenia is shorter by up to 20 years, and for women by up to 15 years compared to the general population. The mortality rate difference between these two groups continues to grow. The unacceptably high mortality of those with schizophrenia points to discrimination against these individuals, while deaths in those affected are caused by chronic physical diseases and infectious diseases, with the largest proportion being due to cardiovascular diseases and obesity-related malignancies. Although the connection between schizophrenia and physical illnesses has been recognized for over a century, the physical health of these patients is often overlooked in practice. To reduce the mortality and disability rate, more attention needs to be given to the prevention and early diagnosis of physical diseases in individuals with schizophrenia. It is crucial to provide fast and effective physical care from the onset of the first psychotic symptoms. An integrated approach and collaboration among all healthcare providers should become the standard in clinical practice

COMPARISON OF THE SCHEIN AND OSDI QUESTIONNAIRE AS INDICATOR OF TEAR FILM STABILITY IN PATIENTS WITH SCHIZOPHRENIA

Background: The aim of this research was to determine which of two chosen questionnaires for subjective symptoms of dry eye (Ocular Surface Disease Index and Schein questionnaire) is more reliable in the assessment of dry eye in patients with schizophrenia. Subjects and methods: Our research included 80 patients (160 eyes) of both sexes with schizophrenia ranging between the age of 25 and 55 who have been taking one of three antipsychotic drugs namely clozapin, olanzapin, quetiapin for five or more years and were in a stable phase of the disease or remission. All participants were required to satisfy all included and excluded criteria. They all filled out the Schein and OSDI questionnaires for assessment of subjective symptoms. Tear break-up time test (TBUT) for objective evaluation of tear film stability was also performed. In order to determine the correlation between two subjective and objective tests we calculated Spearmans correlation coefficients. Results: Obtained results of the correlation between OSDI questionnaire and TBUT test for the right eye was r=-0.73; p<0.01 and for the left eye was r=-0.72; p<0.01. Results of the correlation between Schein questionnaire and TBUT test for the right eye was r=-0.62; p<0.01 and for the left eye was r=-0.60; p<0.01. A detailed analysis shows that there are no statistically significant differences between the correlations. Both subjective questionnaires are statistically significantly and negatively related to the TBUT test, showing that an increase in the results on the OSDI and Schein\u27s questionnaires led to the decreases in the results on the TBUT test. Conclusion: In patients with schizophrenia the OSDI and Schein questionnaires are equally reliable in the assessment of subjective symptoms of Dry eye disease. Considering that, OSDI is more common in clinical practice and includes questions regarding quality of life, it would have certain advantages and it is recommended for use in patients with schizophrenia