CLINICAL HANDBOOK OF SCHIZOPHRENIA

41. Medical Comorbidity 427search studies to help address this fragmentation of services by bridging the gap betweenmental health and medical services. For example, a designated health care advocate whofacilitates personal empowerment and access to services may be helpful for persons withschizophrenia. Other possible approaches include adapting medical disease managementservices specifically for persons with serious mental illness or redesigning services to provideintegrated models of mental health care and medical care.Important factors in effective management of persons with schizophrenia and medicalconditions include mitigating barriers to optimal care, and increasing communicationand coordination between medical providers and mental health providers. Basic knowledgeabout the most common medical conditions better equips mental health providers inassisting persons with schizophrenia in optimal self-management and health promotionstrategies.COMMON MEDICAL CONDITIONSIN PERSONS WITH SCHIZOPHRENIAThe following sections describe several common medical conditions in persons withschizophrenia, including diabetes, hypertension, heart disease, COPD, hepatitis B and C,and HIV, along with areas of special consideration in the self-care of these specific conditionswhen supporting persons with schizophrenia. The section concludes with a discussionof the significance of smoking, as well as health monitoring in connection withantipsychotic use.Caring for Diabetes in Persons with SchizophreniaThere are two types of diabetes: type 1 diabetes and type 2 diabetes. Type 1 diabetes (previouslycalled juvenile diabetes), which generally begins in childhood or early adulthood,is caused by an early failure by the body to produce enough insulin. Insulin is a hormonethat converts sugar (glucose), starches, and other important foods into energy necessaryfor daily life. Type 1 diabetes is not caused by obesity or inactivity. In contrast, type 2 diabetesmore frequently begins later in life and commonly occurs in overweight individuals.Persons with schizophrenia may have either type 1 or type 2 diabetes, although type 2 diabetesis much more common.The hormone insulin helps the body metabolize sugar. With diabetes, the body frequentlydoes not have enough insulin and is therefore unable to reduce the blood sugarlevel adequately after a meal. Persons with type 2 diabetes may also develop a resistanceto insulin. As a result, their blood sugar (glucose) is consistently elevated and builds up inthe blood rather than going into cells. Over the long run, consistently elevated blood glucosecan seriously damage the eyes, kidneys, heart, and nerves of persons with diabetes.To maintain a normal blood sugar level, all persons with type 1 diabetes must take insulin.Persons with type 2 diabetes may be able to control their blood sugar with rigorousdietary changes and regular exercise. When diet and exercise do not adequately lowerblood sugar, persons with type 2 diabetes must take oral medications or insulin.Regardless of the type of diabetes, a person with diabetes has an increased risk forheart disease and stroke, as well as longer-term diabetic complications in other organ systems,including damage to the nerves that results in loss of sensation in the feet or hands,damage to the eyes that causes a progressive loss of vision, and damage to the kidney thatcan result in kidney failure. The risk for complications is reduced if normal or safe bloodsugar levels are continuously maintained and monitored.