CLINICAL HANDBOOK OF SCHIZOPHRENIA

41. Medical Comorbidity 429TABLE 41.2. Diabetes Follow-Up• Glycated hemoglobin (HbA1c)• Blood pressure• Dilated ophthalmic exam• Urine screen• Test of kidney function (blood draw)• Cardiovascular checkup• Influenza vaccine• Pneumonia vaccine• Lipid panel• Foot exam• Self-management education (diabetes educator)• Smoking cessation counseling referral, if a smoker• Exercise recommendation/facilitation• Weight loss recommendation, if obese• Nutritionist referral (or diet recommendations/facilitation)physical disabilities, or mortality. Consequently, persons with diabetes should be taughthow to examine their feet carefully for wounds or cuts on a daily basis.A person with schizophrenia and diabetes should be encouraged continually to adhereto his or her follow-up schedule and self-management regimens. If the person doesnot follow through with screening or blood draws, it is important to address potentialunderlying fears or misunderstandings. Follow-up is always a good strategy to ensurethat medical visits have occurred. It may also be helpful to accompany someone withschizophrenia to medical appointments.Very high and very low blood sugar levels are dangerous and potentially life threatening.Consequently, it is important to learn to recognize symptoms of low blood sugar(e.g., cold sweating, shaking, and concentration difficulties) and high blood sugar (e.g.,tiredness, increased thirst, hunger, and urination). If these conditions cannot be quicklyresolved, then immediate medical attention is urgently needed. The self-managementstrategies and the choice of medication optimally should limit the frequency of theseevents. The patient should be encouraged to discuss promptly any such event (even if resolvedwithout medical attention) with his or her medical provider.Caring for Hypertension and Heart Disease in Personswith SchizophreniaHypertension, or high blood pressure, is referred to as essential hypertension, orprimaryhypertension when no underlying cause for the high blood pressure is identified. When anunderlying condition is the cause, the hypertension is referred to as secondary hypertension.Most frequently, a person with high blood pressure does not experience any symptoms.Nevertheless, long-standing high blood pressure can cause damage to many organsand substantially increase the risk of heart attack and stroke. Given the lack of symptoms,it can be difficult to motivate people with hypertension to manage their silent illnesswith lifestyle changes and medication. This may be especially challenging for personswith schizophrenia, who have numerous challenges in managing serious psychiatricsymptoms and may not consider a “silent” medical disorder a priority. For this reason, itis important to provide ongoing education, reminders, and support in addressing the seriouslong-term risks of hypertension through appropriate preventive and treatment strategies.Lifestyle changes are important in hypertension, because many lifestyle-related factorsthemselves represent risk factors for heart disease, such as smoking and obesity. Fora summary of relevant lifestyle changes, see Table 41.3. Because hypertension increasesthe risk for heart disease, it is important to address all risk factors that are amenable tochange. For persons with family history of heart disease, it is particularly important to