Physical health of patients with schizophrenia : findings from a health examination study

Patients with schizophrenia have an increased risk of comorbid somatic diseases compared to the general population. Their life expectancy is reduced by ca. 15 years, mostly due to premature deaths from physical conditions. Regular evaluation of physical health is recommended in the schizophrenia treatment guidelines. However, the overall picture of somatic problems emerging in a comprehensive health examination is not clear. This study investigated the range of somatic health care needs among Finnish outpatients with schizophrenia. In the study, a GP performed a comprehensive health examination of 275 patients. The structured examination consisted of a review of medical records, visit to a nurse, basic laboratory tests and measurements, assessment of the medical history and physical examination. The mean age of the participants was 45 years. Of the participants, 45% reported distressing somatic symptoms interfering with daily life, 81% received lifestyle counselling and 88% were in need of somatic interventions (i.e. additional treatment, examinations, monitoring, prescriptions). Obesity and smoking were associated with increased need for any type of somatic intervention. Of the participants, 59% were diagnosed with metabolic syndrome. Clozapine use doubled the risk for metabolic syndrome whereas regular physical activity reduced the risk. One in three of the participants had constipation and one in four had dyspepsia. Clozapine use was associated with a fivefold risk of constipation. Also paracetamol use and living in sheltered housing increased the risk of constipation. The risk for dyspepsia was increased by use of non-steroidal anti-inflammatory drugs and antidiabetic medication. Cerumen impaction was common among the participants, and living in sheltered housing was associated with increased risk for it. Based on the findings of this study, health examinations for people with schizophrenia are necessary. In the health checks, it is essential to obtain information on the patient´s lifestyle and somatic medication use, medical history and to conduct a physical examination. In order to promote better physical health for individuals with schizophrenia, prevention and treatment of obesity and smoking are important priorities.