May 11, 2010
Lloyd I. Sederer, MD
Deadly Consequences: Why We Need to Integrate Health and Mental HealthDr. Sederer talks about how people with severe mental illnesses die an average of 25 years younger than the general population--
He talks about lifestyles, the lack of a medical home, the contribution of medications to chronic illnesses, nicotine, and the role of prevention and early diagnosis.
Alarming evidence has emerged in recent years, from studies of people treated in the public mental health care system, that adults with serious mental illness die on average 25 years earlier than the general population. For a decade or two before their demise they suffer from early onset diabetes, high blood pressure, heart and lung disease and cancer. Why? Their habits place them at great risk for these conditions. They eat poorly, are sedentary and don't have a primary care doctor -- or if they do they don't go and get preventive and ongoing physical healthcare. They smoke heavily, with more than three out of four being nicotine dependent (see my previous blog on this issue here).
The psychiatric medications many receive for their mental illnesses increase the likelihood of weight gain, diabetes and cardiovascular disease. Mental health professionals have discovered what the Craig family painfully learned: physical disability and early death add to the burden of mental illness for those affected and their families. The burden does not stop there since our health care system, already groaning from the weight of the consequences of American habit disorders, shoulders the extraordinary health costs of this high need population.
What can be done? A lot.Click here to read the whole article. Well worth reading.
Maybe a cigar(ette) is more than just a cigar(ette) when you suffer from a chronic mental illness. I wonder if it's finally OK for a psychoanalyst to encourage a patient to give up smoking, or drinking, for that matter. It certainly wasn't PC when I did my residency ~1980.
As a patient, I been on psych meds that have made me jittery and restless or depressed, and I've lost weight merely from the drugs and eating less. I've also been on a mood stabilizer that caused a 30-lb weight gain in under 2 years. And then there's the secret of Topamax and its ability to reduce BMI (which worked for me until it caused troublesome signs of depression). So, I don't think I should be the one who gets blamed for being unhealthy, yet when I go to the PCP, comments like, "Wow. What's with the weight?" get thrown at me and all my medical problems are subsequently attributed to garden-variety obesity. And the author wonders why folks with serious mental illness aren't good healthcare consumers taking good care of themselves.
Meds don't always work, no matter how many you try...therapy works, when you find the right therapist...the you have to face the world again...damn.
And then, there's always the high risk of suicide that accompainies serious mental illness.
I'm really, really, really tired of fighting with mental health docs to get them to see past my mental illness.
The docs who treat my diabetes, sleep apnea and high blood pressure are emphatically telling me "do NOT gain any more weight." Then I go to my psych doc and she wants to put me on meds with known weight gain side effects. And then the argument starts. Its not that I dont want to be fat - its that I would like to live longer than another 10 years.
At 31 I'm too young to be this sick with these problems. It pisses me off that they exist in part from the psych meds liberally prescribed in past 15 yrs. I'm even more angry and mistrustful that I shouldnt have to fight so hard with my care providers to try and get well.
I never had health problems either until I went on meds. Now I have extremely high lipids (a cholesterol over 300) and I have to severely restrict my eating to maintain a healthy weight. I used to exercise daily and now I'm too tired and fatigued to exercise. I can barely get out of bed in the mornings and pre-meds I used to get up at 6am and head out for a run every day. Even when I'm not depressed I no longer have any motivation to do much of anything. Untreated mental illness isn't a good thing, but the meds have really trashed my health. I've tried different meds, and just end up with different health issues. It's always something - lipids, tanking sodium levels, trashed thyroid, elevated blood sugar, elevated liver enzymes... I hate what meds have done to my body. I've always had a mental illness, but I never had so many physical problems until I went on meds. Makes me wonder if it's even worth it.
Anon: Your docs should be talking to each other about how your meds might impact your physical health so you don't feel stuck in the middle. If they won't, see if you can find docs who will.
Let me get this straight... you object to the notion that psychiatrists shouldn’t be MDs, but you think physical health is someone else’s problem to look after? You don’t even have your basic scale and sphygmomanometer in your office?
What do you need that MD for if you aren’t going to do weight counselling or keep an eye on the blood lipids of the patients on meds that cause weight gain? Do you wait for the physical care doctors to notice and follow up on TD from Haldol, too?
For most people, the doctor they see most is who they consider their primary care doctor. Deal with it.
Thanks Moviedoc. I actually did a fruit basket turnover with docs over the last few years (really looked like I was doctor shopping then) and this group seem the best I can manage. They do coordinate better than any others. The conflict is a matter of who thinks their stuff is more important.
I will say whenever I read about a team centered approach I get jealous. It would be nice to viewed as a whole and not a collection of body parts.
When I used eating banana splits, sometimes several a day, as a coping mechanism when I felt suicidal, to keep from feeling suicidal and to feel as though I had something to live for (the banana splits) my therapist and I talked about how it was a temporary measure and farther on in therapy we'd work on my eating habits. But that for now, that was what I was "needing" to stay "sane", or to stay "here"; to keep from wanting to die.
Of course, at my weight, one might say he was being irresponsible, but it's a question of the lesser of two evils, and the more imminent threat at the time would have been the suicidal ideation, not death from weight-related issues.
That's no longer a coping mechanism I use, and, in fact, I've lost a great deal of weight since last December - last weigh-in had me at 240, though I suspect I'm closer to 230 by now.
I was 299, my heighest weight ever, last Dec. 2.
Something about the surgeries causes a weight loss each time, as well as a loss of appetite some weeks into to the recovery (pain pills, combined with pain, maybe?).
I try to eat enough, though.
Anyway, I was not offended at all by the comments my therapist had made at the time about my eating banana splits as a coping mechanism. He had a bit more to say than I mention here, but I was fine with all of it. The behavior continued for some time, in "jags", whenever.
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