WHO has released evidence-based guidelines for managing physical health conditions in adults with severe mental disorders, according to a press release.
The guidelines include recommendations on healthy lifestyle behaviors (eg, healthier diet, more physical activity and tobacco cessation), psychosocial support and considering possible interactions between different medications prescribed for mental and physical health conditions.
“The majority of deaths amongst people with [severe mental disorders] are attributable to physical health conditions, both non-communicable and communicable,” Graham Thornicroft, PhD,FRCPsych, chair of the guideline developmental group and Professor of Community Psychiatry at King’s College London, and colleagues wrote in the WHO executive summary.
“Equitable access to comprehensive health services remains out of reach for the majority of people with [severe mental disorders],” they continued. “Unfortunately, people with [severe mental disorders] often lack access to health services or receive poor quality care, including promotion and prevention, screening and treatment. It is crucial to address the disparities in health care access and provision for people with [severe mental disorders].”
The guidelines feature recommendations for treating people with mental illnesses who have cardiovascular disease, diabetes, HIV/AIDS, tuberculosis, hepatitis B and C, tobacco dependence, substance use dependence and/or overweight/obesity. WHO offered these guidelines to improve the management of physical health conditions in adults with severe mental disorders, help reduce potentially risky lifestyle behaviors for these illnesses and decrease morbidity and premature mortality among those with severe mental illness.
Taking into consideration the potential for interactions between psychotopic or antipsychotic medications and medications for other conditions is a significant feature of the guidelines.
For patients at risk of becoming overweight or obese, WHO recommends initiating a psychotropic medication with lower propensity for weight gain after considering clinical benefits/possible adverse effects. For people with severe mental disorders and pre-existing cardiovascular disease or cardiovascular risk factors, WHO advises initiating a psychotropic medication with lower proclivity for cardiovascular risk.
For those with severe mental disorders and diabetes, clinicians should consider initiating an antipsychotic medication with lower propensity for producing hyperglycemia and be aware of the potential interactions. WHO also advises monitoring glycemic control and adjusting dose as needed.
For infectious diseases, clinicians should consider the potential for drug-drug interactions between psychotropic medicines and antiretroviral drugs, tuberculosis medicines and medicines for hepatitis B and C. For tobacco cessation programs, WHO recommends considering potential interactions between bupropion and varenicline with psychotropic medications.
“Following the principle of non-discrimination and universal health coverage as elaborated in target of the United Nations Sustainable Development Goals, people with [severe mental disorders] should be offered at least the same level of treatment for physical health conditions and their risk factors as the general population,” the WHO guideline developmental group wrote in the executive summary.
By Savannah Demko
WHO. Management of physical health conditions in adults with severe mental disorders. http://apps.who.int/iris/bitstream/handle/10665/275718/9789241550383-eng.pdf?ua=1. Accessed on Nov. 7, 2018.