CLINICAL HANDBOOK OF SCHIZOPHRENIA

432 VI. SPECIAL POPULATIONS AND PROBLEMSoverlapping chronic respiratory diseases, such as chronic bronchitis chronic obstructivebronchitis, and emphysema.COPD frequently is diagnosed late in the disease process. No cure exists, but effectivemanagement may help to prevent complications and improve quality of life. It is absolutelyessential to quit smoking. This may require referral to a specialized smoking cessationprogram for persons with serious mental illness. Regular flu and pneumoniaimmunizations help the person to avoid chest infections. Inhaled medications, such asbronchodilators and steroids, can help to control symptoms. In advanced stages of thedisease, long-term oxygen therapy and even surgery may become necessary. Individualizedrehabilitation programs can teach essential skills and provide education andpsychosocial support.It is important for persons with COPD to know about the factors that trigger episodesof acute exacerbations of the illness, including increased shortness of breath,wheezing, and coughing. Persons with advanced COPD must monitor their pulmonaryfunction with spirometry and carefully watch for worsening of symptoms. Managingsymptoms may include increasing or changing medications and knowing when acutemedical attention is required. Given the complex challenges associated with smoking cessationand self-management of COPD, persons with schizophrenia require extra supportand ongoing monitoring. Collaboration between primary care medical providers andmental health providers (including regular input from pulmonology specialists) is importantin identifying and individually tailoring these necessary supports and self-managementstrategies.Caring for HIV and Hepatitis in Persons with SchizophreniaIndividuals with serious mental illness are at increased risk for blood-borne infections dueto a variety of factors, including high rates of substance abuse, unsafe behaviors, and lackof knowledge about how these infections are transmitted. The prevalence of HBV infectionamong persons with serious mental illness is approximately five times higher thanthat in the general population, and the prevalence of HCV infection is more than 10times higher. Many people are infected with both HCV and HIV, which may worsen theprognosis for both conditions.Mental health and primary care providers should screen for risk behaviors. This maybe a sensitive issue, because some risk behaviors are illegal and most are socially stigmatized.It is important to be aware of the tendency to underreport. Table 41.4 provides examplesof risk behaviors. Inquiries about at-risk behaviors should occur in a supportive,nonjudgmental, and confidential manner. Of note, researchers have found that use ofcomputer-based health screening for risky behaviors sometimes overcome barriers to accuratereporting. All persons with schizophrenia and an identified risk factor should bequickly screened to ensure that appropriate treatment is started promptly and to preventfurther transmission. Vaccination against hepatitis A and B should also be provided. Novaccinations have yet been developed for HCV and HIV infection.TABLE 41.4. Risk Behaviors for HBV/HCV/HIVCurrent or past use of . . .• Intravenous drugs• Shared needles• Unprotected sex• Multiple or high-risk sexual partners• Sexual activity under the influence of drugs• Commercial sexual activity