CLINICAL HANDBOOK OF SCHIZOPHRENIA

CHAPTER 41MEDICAL COMORBIDITYINGRID B. RYSTEDTSTEPHEN J. BARTELSSerious medical disorders are more common in persons with schizophrenia and are associatedwith increased disability, diminished quality of life, and early mortality. Thischapter offers an overview of common medical conditions in schizophrenia, along withimportant considerations for effective management.The chapter consists of two parts. The first section describes the problem (prevalenceand impact of medical conditions in schizophrenia and quality of medical care), as well aspotential barriers to effective medical care and health promotion. Drawing on this background,the second section of the chapter reviews in lay language four groups of medicalconditions from the perspective of persons with schizophrenia (diabetes, hypertension/heart disease, chronic obstructive pulmonary disease [COPD], and HIV/hepatitis B andC). Important self-management strategies are highlighted. Health monitoring related toantipsychotic medications is briefly reviewed.PrevalenceDESCRIPTION OF THE PROBLEMA variety of medical conditions are more common among persons with schizophreniathan in the general population, including diabetes, COPD, HIV/AIDS, and hepatitis Band C. Up to three-fourths of persons with schizophrenia have a co-occurring medicalcondition, and many of these individuals have more than one medical disorder. It is estimatedthat one in six persons with schizophrenia has diabetes, one in four has hypertension,and one in eight has other cardiovascular disease. Furthermore, almost one-fourthof persons with serious mental illness have COPD. Finally, infections with the hepatitis Bvirus (HBV), hepatitis C virus (HCV), and HIV are more common in persons with schizophreniathan in the general population. Approximately one in four persons with seriousmental illness has been infected with HBV, and one in five persons with HCV. Rates of infectionwith HIV vary, with higher estimates approaching one-fourth of persons withschizophrenia.424