Page 499 - Encyclopedia of Nursing Research

466 n SeRIOUS menTAl IllneSS

of the illness trajectory of patients with SmI. of a higher incidence of obesity, hyperlipid-
Relapse rates ranging from 40% to 80% in emia, and diabetes. patients receiving anti-
S the first year after discharge have been psychotic medications often suffer from
reported (Irmiter, mcCarthy, Barry, Soliman, significant abdominal weight gain, hyper-
& Blow, 2007; Stevens & Sin, 2005). The cost cholesterolemia and elevated blood pressure
of relapse in this population has been esti- (Usher, Foster, & park, 2006).
mated to be almost $2 billion annually in the evidence-based practice guidelines
United States (Weiden & Olfsson, 1995). In (Kreyenbuhl, Buchanan, Dickerson, &
a recent prospective study of 1,557 patients Dixon, 2010) include specific new recom-
with schizophrenia, 20% had relapsed in mendations that target weight gain, smok-
the 6 months before the study, their cost of ing cessation and substance abuse. Current
health care was almost three times as much research is beginning to target interventions
as those who had not relapsed (Ascher- to help patients manage these factors that
Svanum et al., 2010). are prevalent in this population an adversely
most SmIs are treated with medications. affect their physical health. physical health
newer “second-generation” antidepressants of patients with SmI has been a recent focus
and antipsychotic medications present more of research because persons with SmI have
treatment options with fewer disabling or a life span that is shortened by as much as
disturbing side effects. Second-generation 25 years compared with the general popula-
antipsychotic medications for schizophrenia, tion. premature death in this population is
for example, are more successful for some caused by common medical conditions such
patients in targeting the negative symptoms as untreated cardiovascular diseases noted
(e.g., amotivation, anhedonia) than earlier above, cancers undetected due to lack of
drugs. however, they have increased risk for screening, and medical conditions related to
metabolic syndrome, and weight gain is a risk-taking behaviors, such as hepatitis and
serious concern for patients. moreover, medi- hIV. As many as 50% of patients with SmI
cation adherence continues to be a significant have a co-occurring diagnosis of substance
problem for patients with SmIs, suggesting abuse. patients with SmI often have diffi-
that more research is needed to understand culty consistently accessing primary care
and address this important problem. providers who attend to preventive health
A contemporary concern for researchers care needs.
is the increased risk for cardiovascular dis- From the societal perspective, SmI
ease in patients with SmI. prevalence of car- remains poorly understood by the general
diovascular risk factors is greater in patients public. Stigmatizing attitudes toward per-
with SmI than in the general population (27% sons with mental illness persist, despite the
vs. 17%) and mortality risk from cardiovas- fact that most people acknowledge that the
cular disease is two to three times that of the illnesses are outside the patients’ control.
general population (Robson & gray, 2006). The economic costs associated with SmI
In a recent meta-analysis of risk factors for have been estimated to be in the billions
cardiovascular disease (Osborn et al., 2008), and include loss of earnings as well as the
diabetes was found to be the strongest car- direct costs associated with care (Insel, 2008).
diovascular risk factor and patients with a Almost a quarter of incarcerated persons have
diagnosis of schizophrenia are almost twice mental illnesses; it has been estimated that a
as likely to have diabetes. “metabolic syn- third of homeless persons have an SmI (Insel,
drome” is a cluster of medical conditions that 2008). Family members continue to take on a
have been identified in patients with schizo- caregiving role, with limited resources and
phrenia taking newer generation antipsy- accompanying caregiver stress and burden.
chotic medications. This syndrome consists Some interventions to reduce the burden