Of all the mental disorders, schizophrenia may be the cruelest. Not only do patients suffer the terrible symptoms of their illness, they also are likely to die earlier than the general population. A new study finds the elevated risks of heart disease and metabolic syndrome in schizophrenics are due to the combination of the mental illness itself, unhealthy lifestyle behaviors, and the antipsychotic drugs patients take to control their symptoms.

“Our results strongly suggest that clinicians need to pay much more attention to promoting physical health in people with severe mental illness,” said lead author Dr. Christoph Correll of Albert Einstein College of Medicine. By following his suggestions, overall health care expenses might be reduced in the process.

A 'Spectrum' Disorder

Like autism, schizophrenia is described as a “spectrum disorder,” spanning a range of linked conditions that either have a similar appearance or are thought to be caused by the same underlying condition. First episode schizophrenia spectrum disorders are characterized by abnormalities in one or more of these five areas: delusions, hallucinations, disorganized thinking, abnormal motor behavior (including catatonia), and negative symptoms (including diminished emotional expression and a lack of drive). The schizophrenia spectrum disorders, then, represent a range of symptom severity, with some patients exhibiting just one mild sign of the disease while other patients demonstrate all of the symptoms.

For the current study, referred to as RAISE (Recovery After an Initial Schizophrenia Episode), Correll and a team of researchers examined nearly 400 individuals treated at 34 clinics across 21 states between 2010 and 2012. The patients ranged in age from 15 to 40, and all had confirmed diagnoses of first episode psychosis (FES), with less than six months of lifetime antipsychotic treatment. The researchers tracked various measures of health in these patients, while accounting for sex, race/ethnicity, illness duration, and antipsychotic treatment type and duration.

What did they discover after closely observing this group of patients? Overall, the frequency of obesity in these patients was on par with those of the same age in the general population. However, smoking and metabolic syndrome — a major risk factor for cardiovascular illness — were much more common. While none of these patients had been taking medication for very long, their antipsychotic drugs seemed to be linked to their increased risk of metabolic syndrome. Worse, rates of pre-hypertension and dyslipidemia in these patients ran as high as the rates found in people 15 to 20 years older.

Considering these results, the researchers concluded these FES patients require combined psychiatric and general medical care to address their needs. Psychiatric intervention, lower-risk antipsychotic medications, routine monitoring, and smoking cessation programs would improve their health while simultaneously reducing overall expenditures.

“We need to routinely educate patients about healthy lifestyle behaviors, monitor physical health, choose lower risk treatments whenever possible, and manage issues as they arise,” Correll said. “Without a combined physical and mental health care approach, we miss major opportunities to improve psychiatric as well as medical health in patients with schizophrenia and other severe conditions.”

Source: Correll CU, Robinson DG, Schooler NR, et al. Cardiometabolic Risk in First Episode Schizophrenia-Spectrum Disorder Patients: Baseline Results from the RAISE-ETP Study, JAMA Psychiatry. 2014.