The World Health Organization (WHO) has issued guidelines on the management of physical health conditions among adults with severe mental disorders.

Background Information:

Severe Mental Disorders (SMD) are defined as a group of conditions that include

• moderate to severe depression,
• bipolar disorder, and
• schizophrenia and other psychotic disorders.

People with SMD have a two to three times higher average mortality compared to the general population, which translates to a 10-20 year reduction in life expectancy.

While people with SMD do have higher rates of death due to unnatural causes (accidents, homicide, or suicide) than the general population, the majority of deaths amongst people with SMD are attributable to physical health conditions, both non-communicable and communicable. Furthermore, people with SMD are more likely to engage in lifestyle behaviours that constitute risk factors for non-communicable diseases (NCDs) such as tobacco consumption, physical inactivity and consuming unhealthy diets.

The objective of these guidelines is:

To improve the management of physical health conditions in adults with SMD and support the reduction of individual health behaviours constituting risk factors for these illnesses, with the aim of decreasing morbidity and premature mortality amongst people with SMD.

Key Messages:

Summary of Recommendations (Rather than reproduce all recommendations, I present only the best practice statements, since they best convey the messages):

Tobacco cessation:

Prescribers should take into account potential interactions between buproprion and varenicline with psychotropic medications as well as possible contra-indications.

Weight management:

For people with severe mental disorders who are overweight or obese or at risk of becoming overweight or obese, initiating a psychotropic medication with lower propensity for weight gain should be considered, taking into account clinical benefits and potential adverse effects.

For people with severe mental disorders who are overweight or obese, switching to a
psychotropic medication with a lower propensity for weight gain may be considered, taking into account clinical benefits and potential adverse effects.

Substance Use Disorders:

Prescribers should take into account the potential for drug-drug interactions between
medicines used for treatment of substance use disorders and severe mental disorders.

Cardiovascular Disease and Cardiovascular Risk:

For people with severe mental disorders and pre-existing cardiovascular disease:

• Initiating a psychotropic medication with lower propensity for cardiovascular risk is a strategy that should be considered, taking into account clinical benefits and potential adverse effects.
• Switching to a psychotropic medication with lower propensity for cardiovascular risk may be considered, taking into account clinical benefits and potential adverse effects.

For people with severe mental disorders and pre-existing cardiovascular disease or cardiovascular risk factors:

• Prescribers should be aware of potential interactions between prescribed medicines for
  cardiovascular disease and prescribed psychotropic medications, which may affect cardiovascular risk. Cardiovascular outcomes and risk factors should be monitored and dose adjustment of cardiovascular medicines may be required.

Diabetes mellitus:

For people with severe mental disorders and diabetes mellitus:

• Initiating an anti-psychotic medication with lower propensity for producing hyperglycaemia should be considered, taking into account clinical benefits and potential adverse effects.
• Switching to an anti-psychotic medication with lower propensity for producing hyperglycaemia is a strategy that may be considered, taking into account clinical benefits and potential adverse effects.
• Prescribers should be aware of potential interactions between prescribed medicines for diabetes mellitus and prescribed psychotropic medicines, which may affect glycaemic control. Glycaemic control should be monitored and dose adjustment of medicines may be required.

HIV/AIDS:

For people with severe mental disorders and HIV/ AIDS, prescribers should take into account the potential for drug-drug interactions between antiretroviral drugs and psychotropic medicines.

Other Infectious Diseases (Tuberculosis, Hepatitis B/ C):

For people with severe mental disorders and TB and/or Hepatitis B/C, prescribers should take into account the potential for drug-drug interactions between TB medicines, medicines for hepatitis B and C with psychotropic medicines.

Useful Links:

Link to the WHO news release:

http://www.who.int/mental_health/evidence/guidelines_physical_health_and_severe_mental_disorders/en/

Link to WHO Report ‘Excess mortality in persons with severe mental disorders’ (English)[PDF] (2016):

http://www.who.int/mental_health/evidence/excess_mortality_report/en/