The Sane Guide to Living with Mental Illness: Medications

I was watching cigarette advertising from the 1950s onwards on Youtube today. It’s all very aspirational, grand cars billowing Camels smoke from the driver’s window, doctor extolling the virtues of Chesterfields and such like. So I made my own non-aspirational cigarette advert.

Anyway…

Here is another one of my more sensible guides to mental illness, this time, medication, from someone who’s been on most of them and suddenly packed in nearly all of them. (Although I am on 50mg Lamictal with Seroquel now to see if it dents my mixed episode). I guess a lot of you who are already on medications won’t find this helpful, but some other people might.

So!

The Psychiatrist has decided that you’re mental. Well done! By now you’ve probably been told what flavour of mental you have. The flavour favoured by most is bipolar disorder but you may have been told you have schizophrenia, depression, anxiety, a personality disorder, obsessive compulsive disorder or an eating disorder. Or even more than one of those things! That’s good, it means you’re extra special.

What will happen now is that they’ll hold a little conference behind your back to determine whether you’re going to be prescribed medication, going to be referred for therapy or whether you’re going to be kicked out of their office.

Chances are, you’ll be prescribed medication. It’s likely that they’ll be an antidepressant, antipsychotic, anti anxiety drug or mood stabiliser. Or pick and mix from all of the above.

So, here is the guide to medication.

1. You’re taking them because…?

Psychiatrists sometimes have a habit of thinking that their patients won’t understand clinical terms like “psychosis” or, “you’re flipping the fuck out”. So they might use helpful little phrases to explain to you why you’re being prescribed a certain medication, and they try to avoid frightening you by implying that your behaviour is a little…let’s say, off?

“This will calm you down”- “You are vibrating like a badly drawn cartoon”.

“This will help….even you out”- “You have burst into tears six times and then burst out laughing another ten for the thirty minutes you’ve been said here”.

“These should help lift your mood”- “You tried to kill yourself with my stapler”.

“These will help alleviate your compulsive behaviour”- “I’ve noticed that you’ve been counting the vowels I use in my sentences” (That was twenty three).

“These will help with your strange beliefs”- “You’ve referred to yourself as The Queen for the duration of this discussion”.

2. Know your enemy

Occasionally, a doctor will withhold a diagnosis from you or whoever bought you to the psychiatrist in the first place. Generally, you can guess what’s up with you via your medication. Antipsychotics, like Risperidone, Quetiapine, Amisulpride, Haloperidol and Olanzapine are generally used for psychotic disorders like schizophrenia, schizoaffective disorder, delusional disorder, manic depression, some types of personality disorders, some sleep, anxiety and compulsive disorders and occasionally, depression. Antidepressants like Prozac, Citalopram and Effexor are used for depression, some personality disorders, panic and anxiety. Anti anxiety drugs (the ones that are benzos, not antidepressants like Paxil) like Valium are for anxiety and panic and mood stabilisers, usually anticonvulsants, like Lithium (which is an antimanic), Depakote, Carbamazepine and Lamictal are used for some types of depression, personality disorders and manic depression.

If you have the interweb, and you do, since you’re reading this, research your medication. But be prepared to find out some things you didn’t want to know about…

3. Side Effects

Psychiatric medications are notoriously awful to take for some people and chances are you’ll have side effects. In short:

Get used to drooling. Antipsychotics and anti anxiety drugs can be really sedating and make your body go a little bit floppy, though it probably feels as though your limbs are made of lead. They can also cause you to slur your words, so, a little bit of spit might make a dash for freedom.

You will feel weird for a few weeks. Lots of medications take a while to work on the illness they’ve been prescribed for. In the wilderness of waiting, you might feel weird. You might feel blunted, spaced out, anxious, irritable or you might be having some odd thoughts. Tell your doctor.

You will sleep forever. If you’re taking antipsychotics, anyway.

Avoid the scales. It’s a shitter but psychiatric medication can make you gain weight. Antipsychotics are worst, anticonvulsants like Lithium and Depakote are pretty much wank too, antidepressants can be tricky and anti anxiety drugs, well, the benzo type, aren’t meant to be used for more than a week or two, so you shouldn’t gain weight from them.

Shake, shake, shake. The anticonvulsants will give you the shakes, listed on the PI sheet as “tremors”. It can be a bit embarrassing as people might assume, like they did me, that you’re an alcoholic. Try not to take sugar in your tea as it just causes confetti.

You might not think as clearly as you used to. Most drugs affect how your mind works. Even caffeine does, so psychiatric medications will. Well, they’re designed to. For the first while taking them, your head might be a bit foggy and…

I had a point here, but I don’t remember what it was… because I’m taking antipsychotics.

4. Don’t expect miracles.

Some drugs work on some aspects of illness very quickly. Antipsychotics are good for getting people out of psychotic and manic episodes pretty fast. Antidepressants can lift your mood within a fortnight.

You have to take drugs in order for them to work. If you’re not taking the medication as prescribed, the medication isn’t “not working”. You’re just not taking them.

There is more to mental illness than direct symptoms and medication isn’t a cure for them. The chances of you being suddenly completely better are slim, and because of this, medications will be changed, doses will be adjusted and other treatments will be drafted in alongside them.

You don’t actually have to take medication if you don’t want to. There will be times when you will have to- i.e if you’re under section, but aside from that, you can choose. Of course, if you’re under the care of a psychiatrist or mental health team, you will be strongly advised to take what they’ve prescribed you.

But, you can weigh up the pros and cons of medications. If the side effects are too much, say so, because another medication can be tried. If you hate the way they make you feel, say so, same applies. The decision is ultimately yours, though.

In reality, it’s best if the decision is ultimately yours and someone elses’ because getting ill again- relapsing into mania or psychosis, for example- means that you won’t be in the place to decide if you should be taking them because you might feel that nothing is wrong. It’s always good to have someone else tell you that you’re mental when you don’t believe it yourself.

5. The medication Hissy Fit.

Yeah, chances are you hate your medication, even if it is helping. You’ll want to flush them down the toilet, chuck them into the Thames, strap them to a rocket, etc etc etc. Have your hissy publically with the doctor before you decide to do the above, as they will be only too happy to tell you what a pain in the arse you were when you weren’t taking medication.

6. If you’re going to continue medication, DON’T:

Drink. Alcohol and psychiatric medications are a ridiculous mix. They make you a lightweight and you’ll be drunk a lot quicker, but be less inhibited so you’ll drink more. That way lies making a total dick of yourself in front of your friends, passing out in the street and pissing yourself or ending up in hospital.

It can be dangerous to drink alcohol while on certain medications like Lithium and Depakote.

And alcohol is a CNS depressant and it will generally make any mood unstable. There’s no point in taking an antidepressant to make you feel better, only to get wasted and feel like shit.

Take drugs. Because you’re already pumping powerful chemicals into your body and you don’t need more.

Drive. Don’t even attempt to drive if you’ve just taken an antipsychotic as it will result in a DUI and probably the end of your car. Don’t cycle either, because, like me, you might find that you’ve forgotten how to steer and career into the pavement of the Seven Sisters Road.

and DO:

Get a pill organiser. One of those cheap plasticky things you can get from chemists for the princely sum of £4.99. They sort your pills out by day so you can’t forget or take too many.

Keep tabs on them. By recording how you feel every day. Or ask someone else to do it for you if you don’t trust your own insight.

Drink lots of water. Because they can piss about in your blood stream, liver and kidneys.

7. And if you’re not going to continue taking medication:

Do it slowly. Don’t come off medications suddenly. They are drugs, and like any drug, they might have withdrawal. Do it slowly.

Look into other treatments. Like therapy, for example. For some people therapy works as well as or better than medication.

Tell someone. If you’re in the right frame of mind to. Quitting medication can cause a relapse that you might not notice but other people will. Subtle things, like stripping to your knickers and running into traffic.

Anyway, that’s my Sane Guide to Medication. Anything you want to add?

Labels and language

Bipolar disorder is “just a label”.

Not to me.

I know mental illness is culturally and personally complicated. A faction, a rather large vocal faction, don’t believe in the existence of mental illness. There’s another debate about this over at Mental Nurse. I stayed out of it.

It’s fair enough to hold your own opinion but to me, it’s insulting when people refer to bipolar disorder as a label. The same is true of schizophrenia, some people refer to it as a label, but, more often than not, there’s a little get out clause stating that “oh, but schizophrenia, that’s an illness” because it is more obviously destructive and indiscriminating than bipolar disorder. “Learned” types don’t make this distinction but the laymen do.

One of the problems is that bipolar disorder is seen as a middle-class illness. Its famous sufferers are by and large educated, artistic people. Schizophrenia, on the other hand, is an illness that is known for affecting people from working class backgrounds. Its very image is of the mad bag lady, or the unwashed black man gibbering on the bus. This is a stereotype, not from me but from society as a whole. Schizophrenia is the poor man’s disorder, and manic depression is the rich man’s disorder. Because manic depression tends to be publicised as an artistic disease, it’s easy to see it as a label that auguments this image, rather than an illness like schizophrenia.

I can see why some people prefer to see mental illness as a label.

Mental illness, particularly schizophrenia and personality disorders, come with stigma attached to it. The public’s perception of schizophrenia isn’t a sympathetic one. It’s wrongly associated with violence, and people fear those affected by schizophrenia.

Because of the stigma attached to mental illness, it’s better to see it as just a psychiatric label with no real meaning to the individual. Being “a schizophrenic” or being “a manic depressive” says something about you, something that might be seen as negative. Labels you can get rid of. Labels are interchangeable and unreal. The causes of mental illness are unknown, so maybe it isn’t worthy of being called illness at all, and sometimes diagnosis can vary from person to person. There’s no way of proving that somebody has a mental illness. A label that says, “Something is wrong with you” is insulting and unnecessary. Lots of people believe that psychiatric labels are just imposed on someone because society doesn’t know how to cope with them. In my own experiences, some people have considered me to be arrogant because I explained that I had manic depression. Implying that I have a real problem, and am not just a contrary, melodramatic woman.

I see this as real. As real as any other illness.

I think seeing mental illness as being as real as physical illnesses is the way forward in reducing stigma. A lot of people don’t agree with me, though. If mental illness is real, then your diagnosis does mean something. And you can be defined by it. And people are defined by mental illness, far moreso than they are by physical illnesses, because a mental illness lives in your control tower, pulling the switches that make you who you are. But if mental illness is real, then it’s not the fault of the person who has it. They didn’t do anything to make this happen to them.

But if people just dismiss mental illness as a label, it devalues those problems. It implies that any suffering the person is experiencing is not real. It’s all part of a disposable label. If someone kills themselves over a label, well, that’s just stupid. Mental illness can be treated. (Although the actual wanting to be treated for it is another problem altogether). And, although there’s no real scientific evidence of yet that shows that mental illness is hardwired into the brain, there are a lot of physical illness that cause symptoms of mental illness. Dementia, epilepsy, MS. So there is something in the mind that causes hallucinations and mania. People suffering from hallucinations that have been triggered by a physical cause aren’t fashioning coping methods, so why are people with mental illness supposedly doing just that?

I don’t think that I’d be “free” if I thought of manic depression as a label rather than an illness. I don’t think I’d be liberated from all that manic depression implies. This feels like an illness to me. It feels like an infection. It swept through my body eleven years ago, it weighed down my bones and dissolved its sickness through my body and mind. This feels absolutely physical to me. I don’t just become depressed sometimes and manic at others. It’s not an isolated syndrome. It affects everything and it is not a case of “letting it”, no more than a person with cancer can “let” their cancer destroy their body. My energy is affected by it. My perceptions and my abilities are affected by it. Days I can’t sleep, and days I can’t wake, and days I can barely walk more than a few yards, and days when my hands shake so badly that I can’t hold a cigarette, and ash is confetti. It isn’t “all in my head” because it’s not confined to my mind. It’s in my body, too.

There is a theory that people develop mental illness to cope with unbearable stresses in life. There is one illness in which I support this theory: Dissociative Identity Disorder, because, overwhelmingly in those who suffer from it, there has been a massively traumatic event that has happened to them, and I can see and understand why someone would want “alters” in order to escape, in order to cope.

I don’t believe that other mental illnesses are caused by stresses in life. Certainly worsened by them, as any human emotion is affected by the life around them. In my case, I’ve had those traumatic events. A lot of my life was a nightmare. But, in a way, I deal with that well, just like I’m good at dealing with emergencies, I get on with it, and I always have. Nothing “triggered” my first episode, the same way that nothing has triggered all my episodes since. And I did not just “become” manic depressive when I was twelve. I can see its roots stretched back as far as my childhood, which makes me believe even more so that this is just an illness that I was born with.

If mental illness is real, then the people who suffer from it are not just burdens on society who got there on their own volition by being fucked up and reckless. It just happened to them, like cancer happens to other people. Because a lot of people with mental illness drink and do drugs to cope with it, well, the image of mental illness is unfavourable because we’re all alcoholics and druggies, on the bottom rung of society. They didn’t do anything for this to happen to them. It’s not their fault.

If mental illness is real, it can be treated. Maybe one day cured. If I saw this as a label, a label that was destroying my life, not because I let it (believe me, I try, very hard, every single day, to not let it do anything), I’d have no hope. I probably wouldn’t have accepted the diagnosis in the first, probably wouldn’t be treated for it, probably wouldn’t have a CPN, probably would never have spoken to Rob about it, probably never would have started this blog, probably would have killed myself the second I left hospital.

I don’t believe in the “Big Pharma”. All huge businesses are corrupt, and a lot of people shouldn’t be on psychiatric medications. But some people should, and for some people, it does help. Of course, because it’s a label, psychosis, mania, depression, it’s all good, it’s all someone “experiencing” stuff. But those experiences can be so destructive. And sometimes, people need a drug to pull them out of the depths and heights of these experiences. It’s not coercion (although I do agree with detractors that in the past, “inconvenient” people were put into hospitals), there is a need for antipsychotics and hospitals to help stop someone ruining their lives, or taking their lives. Of course people should be allowed to, but it’s unlikely that once you help someone ease back into a more rational frame of mind that they’d want to.

Another thing is that being “ill” grants you a “victim” status that those who espouse the label theory don’t like. I’ve written before about the survivor/victim mentality so I’ll just let you read that instead.

And there is, of course, the language of mental illness. Words that you are not supposed to use, lest you be a “victim”:

• Mental illness, as opposed to mental disorder/mental distress/fantastic thing that makes me so unique
• “Suffering”. You’re not allowed to “suffer” from mental illness because if you do, you’re a victim
• “Medication can be helpful”, no, medication is EVIL.

I understand the reason people refer to mental illness as a label. But it is insulting to me. And it’s insulting to me when people comment here and tell me to take a bit more exercise and eat my greens and do a bit of yoga and I’ll be fine, as if I did this to myself by sitting around, did this to myself by not eating enough leafy vegetables. Over eleven years, I have done all the good stuff, done the exercise, got my vitamins, had a “positive attitude” and it didn’t help. I did not do this to myself. If I did this to myself, I would undo it to myself. Oh, yeah, and if you want to be in my bad books forever, do come here and tell me three things:

1) Pull yourself together, I did, it’s just a label, think positively, your diagnosis doesn’t mean anything, etc etc

2) DIET and EXERCISE? Oh, and YOGA and REIKI and other bollocks? It worked FOR ME. You don’t need ANY OTHER TREATMENT AT ALL. In fact if the above doesn’t work for you, YOU’RE WEAK, AND BEING CONTROLLED BY THE BIG PHARMA!

3) Your illness is an EXCUSE for you not to live a NORMAL LIFE because obviously due to your EXCUSE you must not ever tell anyone that you LOVE them or PLAY WITH YOUR KITTENS or ANYTHING since you spend ALL DAY just being MANIC DEPRESSIVE.

4) How dare you use the words SUFFERING and MENTAL ILLNESS. It is “MENTAL DISTRESS” and saying that people SUFFER from it makes it sound BAD.

For those people, I can use other words, like “fuck” and “off”.

The only thing that my illness is an “excuse” for is for my slurring my words occasionally on medication. I’m not defined by my illness, even if I don’t consider it a label. It’s part of me. Part. It does hold the reigns on my life, but hey, whatcanyoudoaboutit. Not much more than I am doing, really. I think therapeutic exercises like yoga and whatsit are important as supplements to actual medical treatment (indeed, I am getting a prescription to exercise to help my energy), but not the be-all, end-all. I don’t like to be made to feel like a failure just because I’m in psychiatric treatment, and just because, so far, I’m not better yet.

It doesn’t mean that I define myself as “manic depressive”. I don’t. I think of myself as someone with manic depression.

I still don’t feel very well so that may account for the tone of this post, and the fact that it doesn’t make that much sense. Although at least I managed to get out of bed before 4pm today.

The Insane Guide to Living with Mental Illness: Depression

Contrary to part 1 of my “Sane Guide to Living With Mental Illness“, here is part 1 of my “Insane Guide to Living with Mental Illness: Depression”.

Introduction

So you’re mental! Congratulations! Your journey here may have taken you many years or you could simply have fallen off the doorstep of sanity one day and into the garden of madness. Either way, welcome!

Insanity isn’t an exclusive club; we welcome people of all ages, genders, shapes, races and cultural backgrounds.

Now, let’s get started. Being mad, you’ll want to know just how to wear your madness well, what the etiquette is in our club and how to make the most of your insanity. Each category will have five subcategories:

1. Eating and self-care

2. Social etiquette

3. Hobbies

4. Sleep

5. How to deal with those around you, who may not be so excited about your insanity as you are! Includes lovers, friends and the medical profession.

6. The future

So let’s get started with depression.

Depression

You’re depressed! Well done. It might have started one day: you were walking home from work and you felt the bottom of your world fall out. There was a hole in the earth that you could fall through, forever. And you did. I’ll keep this short; after all, you can’t waste valuable staring-at-the-ceiling time reading this. If you can read it at all. It’s difficult to concentrate when you’re depressed. Reading the back of the pill bottle can be a daunting task- those damn letters just won’t stay still! You might find that your vision is a bit blurry- don’t worry, this is caused by the constant trough of tears that have been welling up in your eyes.

Do you remember what you were like before you were depressed? You probably thought you were a pretty good person. Well, you’re not! Say that to yourself every day: “I am a bad and disgusting person”. All you’ve ever done is make mistakes in your life. There you go!

1. Eating and self-care

When you’re depressed, there’s a limited source of food available. After all, you won’t have the energy to cook something, and if you try, you’ll probably forget and burn it. So stick with these staples: cereal, chocolate, wilted old fruit. If you can get to the shops, that is. If not, just order takeout food. It’ll make you happy!

In fact, you may not be feeling hungry at all. This is normal. Don’t worry about eating. It’s too much of an effort anyway. You could drink tea to keep going or, even better, alcohol! Alcohol is well-known to make you feel better. If you feel depressed, hit the bottle and you’ll be right as rain in no time.

If you do feel hungry, overeat! Overeating makes you feel better. It means you won’t have to eat as much next time. This saves valuable energy. Try to get some fish oil in your diet (omega 3), it’s been clinically proven to be more effective at treating depression than anything else in the world!

You might get a lot fatter but that’s unimportant; no-one cares what you look like, anyway! There is no cure for ugliness! You’re fat and useless even if you’re 110lbs!

As for your appearance, you have two choices: either remove all mirrors from your room (who’d want to look at you anyway? ) or stand staring into one for hours on end measuring your every flaw, and let’s face it, you have many!
Since you won’t be leaving the house much, there’s no point in brushing your hair and teeth and absolutely no point in changing or washing your clothes. As you’re depressed, you’re not going anywhere so who cares what you look like! If anybody- lovers, friends, social workers- express concern, lie and say you changed your pants earlier! They’ll soon back off.

2. Social Etiquette

Who needs friends? Not you! Let your friends know that you don’t need them by pulling the phone out of the wall or ignoring your mobile as it rings for the fifth time that day. Try not to panic if that tinny ringtone irritates you; everything is going to irritate you, or, you just might not care at all! It’s great to be free of these social conventions.

Your friends will stop ringing eventually. But if you want to make a half-hearted attempt at sociability, make sure you meet your friends in a pub. That way you can drink! It may be very difficult for you to go outside, after all, the world is a hideous place. Show your friends you care by crying on them, shouting at them or treating them to miserable, stony silence. It’s okay; they don’t really like you anyway.

3. Hobbies

Before you became depressed, there may have been things in your life that you enjoyed doing. You may find that now you have no absolutely no interest in these things; in fact, the thought of doing them fills you with dread or total indifference. This is normal. None of it matters. Nothing matters.

4. Sleep

Sleep is important so you should get as much of it as possible! It’s much better to sleep in the day time because that’s when all those boring things you don’t care about; your job, your family commitments, your friends; are at their most demanding.

Of course, feel free to sleep at night time, too. When you are awake, remember that nothing is as fulfilling as lying there looking at the ceiling- what a fun way to collect your thoughts!

You may be finding it difficult to sleep. Panic and anxiety could be tearing through you, making you feel as though your own skin is infected. You may feel like you’re dying. Never fear, abusing prescription medication (which can be obtained from the doctors, more in part 5) or alcohol can help.

5. How to deal with those around you, who may not be so excited about your insanity as you are! Includes lovers, friends and the medical profession!

So, you’re depressed! Those around you may not be so excited about this as you are. But who cares about them? They don’t care about you.

Your friends and family may plead with you to talk to them. Don’t! They are trying to bring you to their side. Who wants to be there? You’re certainly not good enough for that. They may say they love you and care for you; they don’t! Don’t succumb to guilt. It’s all a ruse!

They may convince you to go a doctor; resist this for as long as possible! Nothing’s wrong with you- you’re wasting their time! Being depressed is all your fault. There’s nothing they can do to help. It’s all up to you! You don’t have depression. You’re depressed. Big difference! Depression is serious. Do you really think you’re that important?

The doctor may prescribe antidepressants. He’s trying to control you! He wants you to be a happy pill popping patient! Can’t he understand that there’s nothing wrong with you? Being happy is overrated- you’ll never be happy again.

However, if you’re finding sleep difficult, just tell the doctor that you’re depressed due to lack of sleep. Bingo! Happy little sleeping pills for you so you can spend all day every day in bed! Score!

Your employers or tutors may be worried about you. You’ve missed a lot of school or work, haven’t you? Tell them that you’re fine. They’ll believe you! If you lose your job or school place because you don’t have the energy, all the better! It wouldn’t have done you any good anyway.

Your lover may lie next to you night after night wondering why you don’t want to touch them.  Or they may have stopped calling.  It doesn’t matter.   They don’t really care.

6. The future

Ha, this is a joke category. What future? You don’t have a future. I mean, look at you, you can barely get out of bed and cook yourself a meal. You spend your whole day abandoned to the horrible thoughts in your mind, you could be shot and you wouldn’t feel it. Everybody hates you and you’re a failure at everything you do. The world isn’t meant for people like you- you should just kill yourself. Why not kill yourself? Then you wouldn’t feel like this anymore. You will never feel like anything else ever again. It’s either death or this is the rest of your life. Can you imagine this being the rest of your life? Then kill yourself. No one will miss you. Nobody cares.

I hope you enjoyed part 1 of the Insane Guide to Mental Illness! Tomorrow: Mania- Nature’s way of telling you that you’re the best.

Mental Illness and Mortality

Last night when my brain was car-crashing, I was reading about 10 articles per five minutes. One them was this about serious mental illness and mortality.

That was the article that triggered my panic attack. Here’s another:

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Clinical & Research News

Death Data Have Researchers Searching for Answers Eve Bender

People with serious mental illness are dying at higher rates and at earlier ages than people in the general population who don’t have mental illness.

Metabolic dysfunction caused by some medications may play a role. People with serious mental illness in one sample of psychiatric inpatients had more than three times the rate of death of those in the general population without mental illness and died an average of 32 years earlier.

The leading causes of death among people in the sample, most of whom were diagnosed with a psychotic disorder, were heart disease, suicide, accidents, and cancer.

The findings call for increased screening and monitoring of patients with serious mental illness for medical comorbidities, according to the authors of the study, published in the October Psychiatric Services.

Researchers collected medical information on 20,018 patients hospitalized on at least one occasion at one of nine hospital sites associated with five behavioral health care organizations in Ohio’s public mental health system between 1998 and 2002.

They matched patients’ hospital records with death records from the Ohio Department of Health and identified 608 patients who died during the four-year period (hospital deaths were included in the sample).

The patients who died had been diagnosed with a number of mental disorders, including schizophrenia (134), schizoaffective disorder (128), alcohol abuse (101), bipolar disorder (87), alcohol dependence (85), major depressive disorder (80), cannibis abuse (59), other mixed or unspecified drug abuse (56), and cocaine abuse (35). The majority of patients in the sample died from heart disease (126), suicides (108), accidents (83), or cancer (44).

Researchers also measured years per life lost for those who died, which is a measure of premature death based on the current mean survival age for a cohort matched by age and gender in the general population. Patients with serious mental illness died an average of 32 years earlier than patients in the general population, according to the findings.

The average age of death for the people in the sample was 47.7 years. When researchers calculated the standard mortality ratio for patients in the sample who died, they found 3.2 times the rate of death as that of the general U.S. population.

The most prevalent comorbid medical conditions for patients in the sample who died included obesity (144), hypertension (136), diabetes (70), chronic obstructive pulmonary disease (62), and injuries (39). Among the 126 patients who died of heart disease, leading comorbidities included hypertension, obesity, diabetes, chronic obstructive pulmonary disease, and disorders of lipid metabolism.

Previous research has yielded similar results. For example, a report released by the federal Centers for Disease Control and Prevention in April said that patients with schizophrenia or bipolar disorder lose as much as 20 years off their average life expectancy compared withsimilar individuals in the general population without seriousmental illness and had elevated rates of heart disease (Psychiatric News, July 7).

At a 2004 meeting convened by the American Diabetes Association and attended by several APA members, the organization issued a consensus statement confirming the risk of metabolic changes associated with second-generation anti-psychotics and calling for careful monitoring of patients on these medications.

In the study of hospitalized patients with serious mental illness in Ohio, researchers could not draw conclusions about cause of death. They speculated, however, that underlying factors may have included medication-induced weight gain, poor personal hygiene, reduced physical activity, increased prevalence of smoking and substance use, and inadequate social support, according to C. Bayard Paschall III, Ph.D., chief of the Ohio Department of Mental Health’s Office of Performance Improvement.

“The question is how we tease some of these characteristics away” from others to be able to associate them with cause of death for patients with serious mental illness, Paschall told Psychiatric News.

Study findings indicate a need for closer collaboration between psychiatry and primary care, according to lead author Brian Miller, M.D., M.P.H., a PGY-2 psychiatry resident at the Medical College of Georgia. In ideal circumstances, patients with serious mental illness could walk from their psychiatrist’s office to an office across the hall to see a primary care physician “who might screen them for some of the comorbid medical conditions we observed in our study,” he said.

In addition, he suggested that psychiatrists and other physicians treating patients who take second-generation antipsychotics carefully monitor these patients for side effects associated with metabolic dysfunction and also write orders for tests of fasting blood glucose, lipid profiles, and liver and thyroid function. Miller and Paschall are conducting further research on some of the factors that may be contributing to excess death rates among people with serious mental illness.

 

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I’m not sure what to draw from that as they don’t mention if the alcohol/drug abuse is co-morbid with mental illnesses. Still, it is sobering and frightening. Especially given just how low on the agenda mental illness is in Britain.

My dad died right on the money- aged 47.11 years.