COVID-19
COVID-19
Supporting Patients
With

With
Serious Mental Illness

Examine the pathophysiology and comorbidities associated with bipolar disorder or schizophrenia

Not an actual patient.

View the presentation about the pathophysiology and comorbidities associated with bipolar disorder or schizophrenia

Displayed on a laptop computer screen, a split image with half of a human heart on the left side and half of a man's face on the right side

Learn more about the underlying pathophysiology of serious mental illness (SMI) and physical conditions that are commonly comorbid with bipolar disorder or schizophrenia. The presentation discusses how SMI can affect the whole patient, along with opportunities for improving whole-patient care of those living with SMI.

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SMI results in functional impairment

According to the National Institute of Mental Health (NIMH), SMI is a mental, behavioral, or emotional disorder resulting in serious functional impairment that substantially interferes with or limits one or more major life activities.1

But it is not just the psychiatric component of SMI that affects patients. A range of common physical comorbidities and higher mortality risk have been observed in patients with SMI.2

Patients with SMI may experience a range of common physical comorbidities

Studies have reported an increased prevalence of several physical comorbidities in patients with SMI, including bipolar disorder and schizophrenia. The following physical illnesses and disease categories were consistently reported to be more common compared with the general population2-6:

Infections

  • HIV
  • Hepatitis B/C

Cardiovascular

  • Hypertension
  • Stroke

COPD=chronic obstructive pulmonary disease.

Not an actual patient.

COPD=chronic obstructive pulmonary disease.

Not an actual patient.

A woman surrounded by small images of the heart, liver, lungs, and kidneys. Descriptions of the comorbidities associated with each organ are included: cardiovascular diseases (heart), infectious diseases (liver), respiratory diseases (lung), and metabolic diseases (kidneys).

Respiratory

  • COPD
  • Asthma

Metabolic

  • Diabetes
  • Obesity
  • Metabolic
    syndrome

Higher mortality risk has been observed in patients with serious mental illness

Higher mortality risk

In a 2017 observational study, patients diagnosed with bipolar disorder or schizophrenia had an increased risk of mortality compared to the general population (1.77 times greater for bipolar disorder and 2.08 times greater for schizophrenia).7†
 

1.77x
Risk for
bipolar disorder
2.08x
Risk for
schizophrenia

Reduced life expectancy

A 2014 fact sheet from the World Health Organization (WHO) suggested there is a 10-25 year life expectancy reduction in patients with severe mental disorders.8‡

10-25
Years

This study was a review of primary care electronic health records in patients in the United Kingdom.

Based on a 2014 WHO information sheet that refers to patients with psychosis, bipolar mood disorder, and moderate-to-severe depression.

Increased mortality has been observed in patients with bipolar disorder and schizophrenia

Bipolar disorder and schizophrenia mortality statistics have been compiled using an analysis of patients with bipolar disorder (n=15,386) and patients with schizophrenia (n=7,784) in Sweden. This analysis suggested respiratory diseases, accidents, suicide, and vascular diseases were among the most frequent causes of increased mortality compared with the general population from 1973–1995.9-11

Increased mortality in patients with bipolar disorder

Excess deaths
The X-axis of a bar graph that illustrates the increased mortality observed in a Swedish study due to respiratory and vascular disorders, and due to accidents and suicide, among patients with bipolar disorder as compared with the general population

Respiratory

Accidents

Suicide

Vascular

Increased mortality in patients with schizophrenia

Excess deaths
The X-axis of a bar graph that illustrates the increased mortality observed in a Swedish study due to respiratory and vascular disorders, and due to accidents and suicide, among patients with schizophrenia as compared with the general population

Respiratory

Accidents

Suicide

Vascular

These were the 4 largest determined causes out of 15 causes of increased mortality, calculated by subtracting the expected number of deaths from the observed number of deaths reported in the in-patient register and the national cause-of-death register in Sweden; the study was not powered for direct comparison among causes or between patient groups.

Mental health providers have opportunities to help manage the whole patient with SMI

There are opportunities that could help to improve whole-patient care through comprehensive management of comorbidities and behavioral risk factors that may be present in patients living with bipolar disorder or schizophrenia. These include the following strategies:

Icon consisting of a laptop computer

Sharing electronic health records between physical and mental health care systems, including reliable capture of diagnostics, laboratory values, demographics, and nonpharmacologic interventions12

Square icon of a lit cigarette emitting smoke

Enhancing tobacco smoking cessation efforts; eg, with behavioral interventions and pharmacologic smoking cessation options12

Icon consisting of 3 figures standing around a table

Promoting integration of care; eg, through co-location of primary care providers in community mental health clinics12

Icon consisting of electrocardiogram data superimposed on a heart located above the palm of a hand

Regular monitoring, including appropriate baseline screening and ongoing monitoring by clinicians and patients themselves13

Icon consisting of a computer monitor that displays a heart with superimposed electrocardiogram data

Referral to specialized services (healthcare professional or program with expertise), for patients who show worsening conditions from screening13

2020 APA Practice Guideline recommends ongoing monitoring of physical conditions

The 2020 American Psychiatric Association (APA) Practice Guideline for the Treatment of Patients with Schizophrenia suggests patients with SMI, and schizophrenia in particular, may more frequently experience a variety of health conditions. These include, but are not limited to, cancer, cardiovascular disease, obesity, metabolic syndrome, diabetes mellitus, hepatitis C and HIV infections, sleep apnea, and poor oral health.14

The guideline suggests physicians should discuss with their patients relevant physical and laboratory assessments that may be needed as part of initial evaluation and follow-up assessment.

Images of the heart, the liver, the lungs, the kidneys, the teeth, and the immune system.

Supporting patients with SMI during the COVID-19 pandemic

There is an opportunity for mental health providers to educate patients about basic strategies to recognize symptoms of COVID-19 and explain public health recommendations in ways that are comprehensible and actionable.15

During the COVID-19 pandemic, community mental health providers are often the primary point of contact with the healthcare system for their patients with SMI. Mental health providers have an opportunity to educate their patients on COVID-19 guidelines, including washing hands, wearing masks, and social distancing.15 Providers can help patients understand what to do if they believe they may be infected with COVID-19, including advocating for testing as indicated.15,16

An image showing a COVID-19 representation with a patient wearing a face mask and the help options available

Evidence suggests that the use of telepsychiatry (via telephone and videoconferencing) is both feasible and acceptable for individuals with SMI. Connecting with patients via phone, email, or videoconferencing can help extend and enhance mental health services. Even text message communications, where permitted by a healthcare practice's policies, can allow mental health providers to check in on patients more frequently and encourage management of their illnesses. Healthcare providers can also continue efforts to promote smoking cessation through various digital tools such as apps and websites.15

BIPOLAR DISORDER BIPOLAR DISORDER
Comorbidities and
Pathophysiology

Not an actual patient.

SCHIZOPHRENIA
Comorbidities and
Pathophysiology

Not an actual patient.

Resources

Support organizations and advocacy groups for patients with bipolar disorder or schizophrenia

Support and information are available from many organizations and advocacy groups for bipolar disorder and schizophrenia. Below is a partial list of organizations that provide information and support for healthcare professionals, caregivers, and patients with SMI.

Information about COVID-19

These links are provided for informational purposes only; they do not constitute an endorsement by Alkermes, Inc. Alkermes, Inc. is not responsible for the content of these third-party sites.

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References: 1. Mental illness. National Institute of Mental Health Web site. https://www.nimh.nih.gov/health/statistics/mental-illness.shtml#part_154788. Accessed February 3, 2021. 2. Bahorik AL, Satre DD, Kline-Simon AH, Weisner CM, Campbell CI. Serious mental illness and medical comorbidities: Findings from an integrated health care system. J Psychosom Res. 2017;100:35-45. 3. De Hert M, Correll CU, Bobes J, et al. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry. 2011;10(1):52-77. 4. Carney CP, Jones L, Woolson RF. Medical comorbidity in women and men with schizophrenia: a population-based controlled study. J Gen Intern Med. 2006;21(11):1133-1137. 5. Beyer J, Kuchibhatla M, Gersing K, Krishnan KR. Medical comorbidity in a bipolar outpatient clinical population. Neuropsychopharmacology. 2005;30(2):401-404. 6. Carney CP, Jones LE. Medical comorbidity in women and men with bipolar disorders: a population-based controlled study. Psychosom Med. 2006;68(5):684-691. 7. Hayes JF, Marston L, Walters K, King MB, Osborn DPJ. Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000-2014. Br J Psychiatry. 2017;211(3):175-181. 8. Mental disorders information sheet. World Health Organization. https://www.who.int/mental_health/management/info_sheet.pdf. Accessed February 3, 2021. 9. Osby U, Brandt L, Correia N, Ekbom A, Sparen P. Excess mortality in bipolar and unipolar disorder in Sweden. Arch Gen Psychiatry. 2001;58(9):844-850. 10. Weiner M, Warren L, Fiedorowicz JG. Cardiovascular morbidity and mortality in bipolar disorder. Ann Clin Psychiatry. 2011;23(1):40-47. 11. Osby U, Correia N, Brandt L, Ekbom A, Sparen P. Mortality and causes of death in schizophrenia in Stockholm county, Sweden. Schizophr Res. 2000;45(1-2):21-28. 12. Mangurian C, Newcomer JW, Modlin C, Schillinger D. Diabetes and cardiovascular care among people with severe mental illness: a literature review. J Gen Intern Med. 2016;31(9):1083-1091. 13. American Diabetes Association. Consensus development conference on antipsychotic drugs and obesity and diabetes. Diabetes Care. 2004;(2)27:596-601. 14. The American Psychiatric Association (APA). Practice Guideline for the Treatment of Patients with Schizophrenia. 3rd ed. American Psychiatric Association; 2020. 15. Kopelovich S, Monroe-DeVita M, Buck B, et al. Community mental health care delivery during the COVID-19 pandemic: practical strategies for improving care for people with serious mental illness. Community Ment Health J. 2021;57(3):405-415. doi:10.1007/s10597-020-00662-z 16. Kahl K, Correll C. Management of patients with severe mental illness during the coronavirus disease 2019 pandemic. JAMA Psychiatry. 2020;77(9):977-978.