Skip to main content Accessibility help
×
Home
Hostname: page-component-cf9d5c678-9z9qw Total loading time: 0.348 Render date: 2021-08-01T21:46:35.426Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Improving life expectancy in people with serious mental illness: Should we place more emphasis on primary prevention?

Published online by Cambridge University Press:  02 January 2018

Athif Ilyas
Affiliation:
Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
Edward Chesney
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
Rashmi Patel
Affiliation:
Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
Corresponding
E-mail address:
Rights & Permissions[Opens in a new window]

Summary

People with serious mental illness have a reduced life expectancy that is partly attributable to increased cardiovascular disease. One approach to address this is regular physical health monitoring. However, physical health monitoring is poorly implemented in everyday clinical practice and there is little evidence to suggest that it improves physical health. We argue that greater emphasis should be placed on primary prevention strategies such as assertive smoking cessation, dietary and exercise interventions and more judicious psychotropic prescribing.

Type
Analysis
Copyright
Copyright © The Royal College of Psychiatrists 2017

People with serious mental illnesses such as schizophrenia or bipolar disorder have a substantially reduced life expectancy compared with the general population. Reference Chesney, Goodwin and Fazel1 Much of this reduction is attributable to a 2–3 times greater risk of cardiovascular morbidity and mortality, with the prevalence of cardiovascular disease up to 3.6 times greater in people with serious mental illness. Reference Brown, Kim, Mitchell and Inskip2Reference Crump, Winkleby, Sundquist and Sundquist4 Recent meta-analyses suggest around one in three people with serious mental illness has metabolic syndrome and one in ten has type 2 diabetes. Reference Vancampfort, Stubbs, Mitchell, De Hert, Wampers and Ward5,Reference Vancampfort, Correll, Galling, Probst, De Hert and Ward6 Both meta-analyses demonstrated wide variation in prevalence depending on geographical distribution, diagnosis, treatment length and psychotropic prescribing. Baseline data from a large randomised controlled trial evaluating interventions to improve physical health outcomes has shown that cardiovascular risk factors are much more prevalent in people with serious mental illness compared with those without. Reference Gardner-Sood, Lally, Smith, Atakan, Ismail and Greenwood7 The vast majority of participants in the trial were above the threshold for central obesity, and half the sample had a body mass index (BMI) ⩾ 30 kg/m2. Over half (57%) were diagnosed with metabolic syndrome, and one in five met the criteria for type 2 diabetes. There is also evidence to suggest that second-generation antipsychotic treatment is associated with a higher risk of cardiovascular disease, due to increased weight gain, dyslipidaemia and impaired glucose regulation. Reference Mitchell, Vancampfort, Sweers, van Winkel, Yu and De Hert8 Furthermore, people with serious mental illness have a much higher prevalence of smoking compared with the general population. Reference Cook, Wayne, Kafali, Liu, Shu and Flores9 Although smoking prevalence in the general population has reduced over the past few decades, smoking prevalence among people with serious mental illness has remained largely unchanged Reference Szatkowski and McNeill10 with over 60% of people with schizophrenia reporting current cigarette use. Reference Dickerson, Stallings, Origoni, Vaughan, Khushalani and Schroeder11

There has been a recent drive by the UK Department of Health and the National Institute for Health and Care Excellence (NICE) to implement regular physical health monitoring in people with serious mental illness in an attempt to improve their physical health. 12 Within the published guidance, there has been a great deal of attention paid to monitoring of cardiovascular risk factors. We consider the evidence behind physical health monitoring, whether it is effective in reducing cardiovascular disease, and whether placing greater emphasis on strategies for primary prevention would be more effective in reducing premature mortality in people with serious mental illness.

Clinical guidelines for physical health monitoring

Since 2002, the Department of Health and NICE have provided an increasing amount of guidance on monitoring the physical health of people with serious mental illness (Appendix). Although guidelines were initially vague and called for annual or ‘regular’ monitoring, they have since become more explicit, with the most recent guidelines calling for much more frequent physical health monitoring: as often as weekly for weight monitoring during the first 6 weeks of starting an antipsychotic. In England, financial incentives are offered to mental healthcare providers who effectively deliver physical health monitoring as part of the commissioning for quality and innovation (CQUIN) scheme. 13

Despite clear guidelines, the uptake of physical health monitoring in people with serious mental illness has been variable. A systematic review of studies investigating physical health monitoring for people prescribed antipsychotics found that the rates of screening varied from 25 to 70% but that rates improved after the implementation of guidelines for physical health monitoring. Reference Mitchell, Delaffon, Vancampfort, Correll and De Hert19 A study investigating rates of cardiovascular risk screening in UK general practices found that people with serious mental illness over the age of 60 were less likely to receive screening compared with people without serious mental illness. Reference Osborn, Baio, Walters, Petersen, Limburg and Raine20

In 2014, NHS England, NHS Improving Quality, Public Health England and the National Audit of Schizophrenia Team coproduced the Lester UK Adaptation of the Positive Cardio-metabolic Health Resource. Reference Shiers, Rafi, Cooper and Holt21 The resource supports NICE guidelines on physical health monitoring in people with serious mental illness in an attempt to improve monitoring and also to encourage intervention in patients with abnormal physical health parameters. However, the degree to which detection of abnormal results leads to an intervention in those who undergo physical health monitoring remains uncertain.

Evidence for physical health monitoring

A greater understanding of the risk factors associated with cardiovascular disease has led to the development of clinical prediction rules such as the Framingham Score Reference D'Agostino, Vasan, Pencina, Wolf, Cobain and Massaro22 and QRISK Reference Hippisley-Cox, Coupland, Vinogradova, Robson, May and Brindle23,Reference Hippisley-Cox, Coupland, Vinogradova, Robson, Minhas and Sheikh24 to identify people at greater risk in the general population. More recently, a cardiovascular risk prediction tool for people with serious mental illness has been developed (PRIMROSE) Reference Osborn, Hardoon, Omar, Holt, King and Larsen25 and the QRISK tool has been updated to include severe mental illness and atypical antipsychotic medication as predictors of cardiovascular disease. Reference Hippisley-Cox, Coupland and Brindle26 Clinical prediction rules are used in physical health monitoring programmes to identify individuals at high risk who may benefit from interventions such as smoking cessation, antihypertensives and lipid-lowering therapies with the aim of reducing future cardiovascular morbidity and mortality. The National Health Service (NHS) health check programme is an example of a general population screening programme that offers physical health checks for adults aged between 40 and 74 in the UK at an annual cost of £165 million. Reference Robson, Dostal, Sheikh, Eldridge, Madurasinghe and Griffiths27 A recent observational study evaluating the programme found that those who attended were more likely to be diagnosed with diabetes, hypertension and chronic kidney disease, and were more likely to be prescribed a statin than those who did not attend. Reference Robson, Dostal, Madurasinghe, Sheikh, Hull and Boomla28

However, several studies have indicated that physical health monitoring programmes have limited benefits in terms of reducing morbidity and mortality. Reference G⊘tzsche, J⊘rgensen and Krogsb⊘ll29 A systematic review of 16 randomised trials investigating clinical outcomes of physical health monitoring found that although screening programmes resulted in an increase in the diagnosis of hypertension and hypercholesterolaemia, they had no significant impact on cardiovascular morbidity or mortality. Reference Krogsb⊘ll, J⊘rgensen, Larsen and G⊘tzsche30 Furthermore, a systematic review investigating the use of clinical prediction rules to screen for cardiovascular disease suggests that although cardiovascular disease risk assessment (and offering interventions to those considered to be at high risk) may result in reductions in blood pressure, cholesterol and smoking, there is no evidence that this strategy is associated with significant reductions in cardiovascular morbidity and mortality. Reference Collins, Tompson, Onakpoya, Roberts, Ward and Heneghan31

Although the implementation of physical health screening programmes in the general population has been widely studied, a recent systematic review revealed there are no randomised clinical trials or economic evaluations investigating the effectiveness of physical health monitoring in people with serious mental illness. Reference Tosh, Clifton, Xia and White32 Therefore as of yet, there is no evidence to support the current NICE guidelines for physical health monitoring in people with serious mental illness.

Improving physical health through intervention

A number of strategies to improve physical health in people with serious mental illness have been investigated, including support for smoking cessation, dietary interventions, exercise interventions and avoiding prescription of antipsychotics associated with adverse metabolic outcomes. Reference Baxter, Harris, Khatib, Brugha, Bien and Bhui33 Such interventions are relevant to all patients with serious mental illness and not just those who are found to have abnormal results from physical health monitoring.

Pharmacological support for smoking cessation

Tobacco smoking rates in the UK general population have dropped considerably from 46% of adults in 1974 to 19% in 2016. 34 However, around 60–70% of those with schizophrenia are smokers, making them more than three times as likely to smoke compared with the general population. Reference Dickerson, Stallings, Origoni, Vaughan, Khushalani and Schroeder11 A network meta-analysis has demonstrated that pharmacological therapies such as nicotine replacement therapy (NRT), bupropion and varenicline are effective in supporting smoking cessation in the general population. Reference Cahill, Stevens, Perera and Lancaster35 Bupropion and varenicline have also been found to significantly increase the chances of smoking cessation in people with schizophrenia. Reference Tsoi, Porwal and Webster36 NRT and e-cigarettes could also help to support smoking cessation in people with mental disorders. Reference O'Brien, Knight-West, Walker, Parag and Bullen37 However, prescribing data from UK general practices suggests that despite providing financial incentives to healthcare providers, there has been little change in the rates of prescribing pharmacological interventions to reduce smoking and prescription rates are likely to be lower in those with serious mental illness. Reference Szatkowski and Aveyard38 A much more assertive strategy to promote smoking cessation using pharmacological interventions could lead to an enormous improvement in the physical health of people with serious mental illness. Reference Gaballa, Drowos and Hennekens39

Dietary and exercise interventions

People with serious mental illness have a poorer diet than the general population. This may contribute towards obesity, dyslipidaemia and impaired glucose regulation, which can increase the risk of cardiovascular disease. Reference Dipasquale, Pariante, Dazzan, Aguglia, McGuire and Mondelli40 A meta-analysis of randomised trials investigating dietary interventions in people with serious mental illness showed that dietary interventions result in a significant reduction in weight (−2.7 kg), BMI (−0.87kg/m2), waist circumference (−2.3 cm) and blood glucose levels (−0.47mmol/L), particularly if interventions are led by dieticians. Reference Teasdale, Warad, Rosenbaum, Samaras and Stubbs41

A review of randomised trials investigating exercise interventions in people with schizophrenia found no significant change in BMI but that exercise interventions may improve physical fitness and are associated with a reduction in psychiatric symptoms. Reference Firth, Cotter, Elliott, French and Yung42 However, reduced motivation can make it difficult to sustain adequate participation in exercise interventions. Reference Buhagiar, Parsonage and Osborn43 Exercise interventions that incorporate education and coaching sessions may help to improve uptake in people with serious mental illness who may otherwise have low levels of physical activity. Reference Williams, Stubbs, Gaughran and Craig44 In contrast, a systematic review investigating the effect of general physical health advice in people with serious mental illness found limited evidence for an improvement in outcomes. Reference Tosh, Clifton, Xia and White45 This suggests that improving diet and exercise in people with serious mental illness requires a more assertive approach than simply providing general health advice. However, there are relatively few studies investigating the cost-effectiveness of dietary and exercise interventions in people with serious mental illness and further evaluation is required to determine which interventions could be feasibly implemented in clinical practice. Reference Park, McDaid, Weiser, Von Gottberg, Becker and Kilian46

Choice and duration of antipsychotic prescribing

Some antipsychotics (particularly clozapine, olanzapine and risperidone) may contribute towards increased cardiovascular risk in people with serious mental illness because of increased weight gain, dyslipidaemia and impaired glucose regulation. Reference Mitchell, Vancampfort, Sweers, van Winkel, Yu and De Hert8 There is growing debate about whether long-term treatment with antipsychotics is beneficial for all patients with schizophrenia, not only because of their adverse metabolic effects but also their long-term effects on brain structure and dopamine receptor function. Reference Moncrieff47 This raises the question of whether psychiatrists should be more cautious about avoiding long-term prescription of antipsychotics associated with adverse metabolic effects in people with serious mental illness and to consider reducing or stopping these in patients at greater risk of cardiovascular disease. Reference Murray, Quattrone, Natesan, van Os, Nordentoft and Howes48

Conclusions

People with serious mental illness die up to 20 years younger because of preventable physical disorders. Reference Chesney, Goodwin and Fazel1 In England, the NHS has attempted to address this issue by incentivising physical health monitoring programmes to reduce risk factors in those who are deemed to be at high risk of future cardiovascular events. 13 However, there is no evidence that physical health monitoring in itself is effective in reducing cardiovascular risk in people with serious mental illness.

Healthcare services should consider a shift away from physical health monitoring strategies and instead focus their resources on primary prevention strategies that are provided to all people with serious mental illness from the moment they first present to mental healthcare services. These include assertive smoking cessation (with pharmacological support), diet and exercise interventions and where possible, to avoid long-term prescription of antipsychotics associated with adverse metabolic outcomes. This approach could help to substantially improve the long-term health and life expectancy of people with serious mental illness.

Funding

R.P. has received support from a UK Medical Research Council (MRC) Clinical Research Training Fellowship () and a Starter Grant for Clinical Lecturers () supported by the Academy of Medical Sciences, The Wellcome Trust, MRC, British Heart Foundation, Arthritis Research UK, the Royal College of Physicians and Diabetes UK.

Appendix National Institute for Health and Care Excellence (NICE)/Department of Health guidelines on physical health monitoring in people with serious mental illness

Year Description of guidelines
2002 NICE guidelines on schizophrenia are released (CG1) that state that clinicians should ‘regularly monitor the physical health’ of patients,
stating that ‘particular attention should be paid to the risk of metabolic and cardiovascular disease’. 14
2006 The Department of Health release best practice guidance for supporting the physical health needs of people with severe mental illness. 15
The guidance states that patients should receive annual physical health check reviews, including blood tests and urinalysis, basic health
checks (including blood pressure, pulse and body mass index), and lifestyle review (including diet, physical activity and smoking).
2009 NICE guidelines on schizophrenia are updated (CG82) to recommend that patients should receive annual physical health check reviews,
with a ‘focus on cardiovascular disease risk assessment’. 16
2014 Current NICE guidelines on psychosis and schizophrenia in adults (CG178) recommend more frequent regular physical health monitoring
for patients receiving antipsychotic medication. The guidelines state the following physical health markers should be measured: 12
  1. (a) weight: baseline, then weekly for the first 6 weeks, at 12 weeks, at 1 year and then annually;

  2. (b) waist circumference: baseline, and then annually;

  3. (c) pulse and blood pressure: baseline, then at 12 weeks, at 1 year and then annually;

  4. (d) fasting blood glucose, HbA1c and blood lipid levels: baseline, then at 12 weeks, at 1 year and then annually;

  5. (e) overall physical health (nutritional status/diet/physical activity): baseline and at regular intervals.


There are similar NICE guidelines that recommend regular physical health monitoring for young people which psychosis and schizophrenia
(CG155), 17 and for patients with bipolar disorder (CG185). 18

Footnotes

Declaration of interest

None.

References

1 Chesney, E, Goodwin, GM, Fazel, S. Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry 2014; 13: 153–60.CrossRefGoogle ScholarPubMed
2 Brown, S, Kim, M, Mitchell, C, Inskip, H. Twenty-five year mortality of a community cohort with schizophrenia. Br J Psychiatry 2010; 196: 116–21.CrossRefGoogle ScholarPubMed
3 Osborn, DP, Levy, G, Nazareth, I, Petersen, I, Islam, A, King, MB. Relative risk of cardiovascular and cancer mortality in people with severe mental illness from the United Kingdom's General Practice Rsearch Database. Arch Gen Psychiatry 2007; 64: 242–9.CrossRefGoogle ScholarPubMed
4 Crump, C, Winkleby, MA, Sundquist, K, Sundquist, J. Comorbidities and mortality in persons with schizophrenia: a Swedish national cohort study. Am J Psychiatry 2013; 170: 324–33.CrossRefGoogle ScholarPubMed
5 Vancampfort, D, Stubbs, B, Mitchell, AJ, De Hert, M, Wampers, M, Ward, PB, et al. Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: a systematic review and meta-analysis. World Psychiatry 2015; 14: 339–47.CrossRefGoogle ScholarPubMed
6 Vancampfort, D, Correll, CU, Galling, B, Probst, M, De Hert, M, Ward, PB, et al. Diabetes mellitus in people with schizophrenia, bipolar disorder and major depressive disorder: a systematic review and large scale meta-analysis. World Psychiatry 2016; 15: 166–74.CrossRefGoogle ScholarPubMed
7 Gardner-Sood, P, Lally, J, Smith, S, Atakan, Z, Ismail, K, Greenwood, KE, et al. Cardiovascular risk factors and metabolic syndrome in people with established psychotic illnesses: baseline data from the IMPaCT randomized controlled trial. Psychol Med 2015; 45: 2619–29.Google ScholarPubMed
8 Mitchell, AJ, Vancampfort, D, Sweers, K, van Winkel, R, Yu, W, De Hert, M. Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders—a systematic review and meta-analysis. Schizophr Bull 2013; 39: 306–18.Google ScholarPubMed
9 Cook, B, Wayne, G, Kafali, E, Liu, Z, Shu, C, Flores, M. Trends in smoking among adults with mental illness and association between mental health treatment and smoking cessation. JAMA 2014; 311: 172–82.CrossRefGoogle ScholarPubMed
10 Szatkowski, L, McNeill, A. Diverging trends in smoking behaviors according to mental health status. Nicotine Too Res 2015; 17: 356–60.Google ScholarPubMed
11 Dickerson, F, Stallings, CR, Origoni, AE, Vaughan, C, Khushalani, S, Schroeder, J, et al. Cigarette smoking among persons with schizophrenia or bipolar disorder in routine clinical settings, 1999–2011. Psychiatr Serv 2013; 64: 4450.CrossRefGoogle ScholarPubMed
12 National Institute for Health and Care Excellence. Psychosis and Schizophrenia in Adults: Prevention and Management. NICE Clinical Guideline 178. NICE, 2014.Google Scholar
13 NHS England. Commissioning for Quality and Innovation (CQUIN). NHS England, 2016 (https://www.england.nhs.uk/wp-content/uploads/2016/03/cquin-guidance-16-17-v3.pdf).Google Scholar
14 National Institute for Health and Care Excellence. schizophrenia. NICE Clinical Guideline 1. NICE, 2002.Google Scholar
15 Department of Health. Choosing Health: Supporting the Physical Needs of People with severe Mental Illness. Department of Health, 2006.Google Scholar
16 National Institute for Health and Care Excellence. Psychosis and Schizophrenia: Management. NICE Clinical Guideline 82. NICE, 2009.Google Scholar
17 National Institute for Health and Care Excellence. Psychosis and Schizophrenia in Children and Young People: Recognition and Management. NICE Clinical Guideline 155. NICE, 2013.Google Scholar
18 National Institute for Health and Care Excellence. Bipolar Disorder: Assessment and Management. NICE Clinical Guideline 185. NICE, 2014.Google Scholar
19 Mitchell, AJ, Delaffon, V, Vancampfort, D, Correll, CU, De Hert, M. Guideline concordant monitoring of metabolic risk in people treated with antipsychotic medication: systematic review and meta-analysis of screening practices. Psychol Med 2012; 42: 125–47.CrossRefGoogle ScholarPubMed
20 Osborn, DPJ, Baio, G, Walters, K, Petersen, I, Limburg, H, Raine, R, et al. Inequalities in the provision of cardiovascular screening to people with severe mental illnesses in primary care. Cohort study in the United Kingdom THIN Primary Care Database 2000–2007. Schizophr Res 2011; 129: 104–10.Google ScholarPubMed
21 Shiers, DE, Rafi, I, Cooper, SJ, Holt, RIG. 2014 update (with acknowledgement to the late Helen Lester for her contribution to the original 2012 version). Positive Cardiometabolic Health Resource: an intervention framework for patients with psychosis and schizophrenia. Royal College of Psychiatrists, 2014 (https://www.rcpsych.ac.uk/pdf/Lester%20update%20June%202014%20FINAL.pdf).Google Scholar
22 D'Agostino, RB, Vasan, RS, Pencina, MJ, Wolf, PA, Cobain, M, Massaro, JM, et al. General cardiovascular risk profile for use in primary care. Circulation 2008; 117: 743–53.CrossRefGoogle ScholarPubMed
23 Hippisley-Cox, J, Coupland, C, Vinogradova, Y, Robson, J, May, M, Brindle, P. Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study. BMJ 2007; 335: 136.CrossRefGoogle ScholarPubMed
24 Hippisley-Cox, J, Coupland, C, Vinogradova, Y, Robson, J, Minhas, R, Sheikh, A, et al. Predicting cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2. BMJ 2008; 336: 1475–82.CrossRefGoogle ScholarPubMed
25 Osborn, DPJ, Hardoon, S, Omar, RZ, Holt, RIG, King, M, Larsen, J, et al. Cardiovascular risk prediction models for people with severe mental illness: results from the prediction and management of cardiovascular risk in people with severe mental illnesses (PRIMROSE) research program. JAMA Psychiatry 2015; 72: 143–51.CrossRefGoogle ScholarPubMed
26 Hippisley-Cox, J, Coupland, C, Brindle, P. Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study. BMJ 2017; 357: 2099.CrossRefGoogle ScholarPubMed
27 Robson, J, Dostal, I, Sheikh, A, Eldridge, S, Madurasinghe, V, Griffiths, C, et al. The NHS Health Check in England: an evaluation of the first 4 years. BMJ Open 2016; 6: e008840.CrossRefGoogle ScholarPubMed
28 Robson, J, Dostal, I, Madurasinghe, V, Sheikh, A, Hull, S, Boomla, K, et al. NHS Health Check comorbidity and management: an observational matched study in primary care. Br J Gen Pr 2017; 67: e8693.CrossRefGoogle ScholarPubMed
29 G⊘tzsche, PC, J⊘rgensen, KJ, Krogsb⊘ll, LT. General health checks don't work. BMJ 2014; 348: g3680.CrossRefGoogle Scholar
30 Krogsb⊘ll, LT, J⊘rgensen, KJ, Larsen, CG, G⊘tzsche, PC. General health checks in adults for reducing morbidity and mortality from disease: Cochrane systematic review and meta-analysis. BMJ 2012; 345: e7191.CrossRefGoogle Scholar
31 Collins, DRJ, Tompson, AC, Onakpoya, IJ, Roberts, N, Ward, AM, Heneghan, CJ. Global cardiovascular risk assessment in the primary prevention of cardiovascular disease in adults: systematic review of systematic reviews. BMJ Open 2017; 7: e013650.CrossRefGoogle ScholarPubMed
32 Tosh, G, Clifton, AV, Xia, J, White, MM. Physical health care monitoring for people with serious mental illness. Cochrane Database Syst Rev 2014; 1: CD008298.Google Scholar
33 Baxter, AJ, Harris, MG, Khatib, Y, Brugha, TS, Bien, H, Bhui, K. Reducing excess mortality due to chronic disease in people with severe mental illness: meta-review of health interventions. Br J Psychiatry 2016; 208: 322–9.CrossRefGoogle ScholarPubMed
34 Health and Social Care Information Centre. Statistics on Smoking. HSCIC, 2016 (http://content.digital.nhs.uk/catalogue/PUB20781/stat-smok-eng-2016-rep.pdf).Google Scholar
35 Cahill, K, Stevens, S, Perera, R, Lancaster, T. Pharmacological interventions for smoking cessation: an overview and network meta-analysis. Cochrane Database Syst Rev 2013; 5: CD009329.Google Scholar
36 Tsoi, DT, Porwal, M, Webster, AC. Interventions for smoking cessation and reduction in individuals with schizophrenia. Cochrane Database Syst Rev 2013; 2: CD007253.Google Scholar
37 O'Brien, B, Knight-West, O, Walker, N, Parag, V, Bullen, C. E-cigarettes versus NRT for smoking reduction or cessation in people with mental illness: secondary analysis of data from the ASCEND trial. Tob Indue Dis 2015; 13: 5.CrossRefGoogle ScholarPubMed
38 Szatkowski, L, Aveyard, P. Provision of smoking cessation support in UK primary care: impact of the 2012 QOF revision. Br J Gen Pract 2015; 66: e1015.CrossRefGoogle ScholarPubMed
39 Gaballa, D, Drowos, J, Hennekens, CH. Smoking cessation: the urgent need for increased utilization of varenicline. Am J Med 2017; 130: 389–91.CrossRefGoogle ScholarPubMed
40 Dipasquale, S, Pariante, CM, Dazzan, P, Aguglia, E, McGuire, P, Mondelli, V. The dietary pattern of patients with schizophrenia: a systematic review. J Psychiatr Res 2013; 47: 197207.CrossRefGoogle ScholarPubMed
41 Teasdale, SB, Warad, PB, Rosenbaum, S, Samaras, K, Stubbs, B. Solving a weighty problem: systematic review and meta-analysis of nutrition interventions in severe mental illness. Br J Psychiatry 2017; 210: 110–8.CrossRefGoogle ScholarPubMed
42 Firth, J, Cotter, J, Elliott, R, French, P, Yung, AR. A systematic review and meta-analysis of exercise interventions in schizophrenia patients. Psychol Med 2015; 45: 1343–61.CrossRefGoogle ScholarPubMed
43 Buhagiar, K, Parsonage, L, Osborn, DP. Physical health behaviours and health locus of control in people with schizophrenia-spectrum disorder and bipolar disorder: a cross-sectional comparative study with people with non-psychotic mental illness. BMC Psychiatry 2011; 11: 104.CrossRefGoogle ScholarPubMed
44 Williams, J, Stubbs, B, Gaughran, F, Craig, T. ‘Walk This Way’ – a pilot of a health coaching intervention to reduce sedentary behaviour and increase low intensity exercise in people with serious mental illness: study protocol for a randomised controlled trial. Trials 2016; 17: 594.CrossRefGoogle ScholarPubMed
45 Tosh, G, Clifton, AV, Xia, J, White, MM. General physical health advice for people with serious mental illness. Cochrane Database Syst Rev 2014; 3: CD008567.Google Scholar
46 Park, A-L, McDaid, D, Weiser, P, Von Gottberg, C, Becker, T, Kilian, R. Examining the cost effectiveness of interventions to promote the physical health of people with mental health problems: a systematic review. BMC Public Health 2013; 13: 787.CrossRefGoogle ScholarPubMed
47 Moncrieff, J. Antipsychotic maintenance treatment: time to rethink? PLoS Med 2015; 12: e1001861.CrossRefGoogle ScholarPubMed
48 Murray, RM, Quattrone, D, Natesan, S, van Os, J, Nordentoft, M, Howes, O, et al. Should psychiatrists be more cautious about the long-term prophylactic use of antipsychotics? Br J Psychiatry 2016; 209: 361–5.CrossRefGoogle ScholarPubMed
Submit a response

eLetters

No eLetters have been published for this article.
You have Access
Open access
23
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Improving life expectancy in people with serious mental illness: Should we place more emphasis on primary prevention?
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Improving life expectancy in people with serious mental illness: Should we place more emphasis on primary prevention?
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Improving life expectancy in people with serious mental illness: Should we place more emphasis on primary prevention?
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *