Public health

Opportunities to screen and intervene in mental health

A little more effort is required to look for and manage respiratory conditions in people with severe mental illness such as schizophrenia and bipolar disorder.

A pilot study of 82 patients admitted to a mental health unit found high rates of symptoms such as a productive cough (37%), wheeze (38%) and dyspnea (44%).

Smoking rates were high with more than half smoking tobacco (52%) and 14% using cannabis. Smoking was also strongly associated with cough.

Dr Andrew Burke, a thoracic and infectious diseases physician at Brisbane’s Prince Charles Hospital, told the limbic there were opportunities to screen and intervene when patients were admitted for inpatient care.

“They all get a review within 24 hours but I would be surprised if it included detailed assessment. It’s more likely fairly tailored to the admission or previous diagnoses,” he said.

Dr Burke said higher rates of cardiac and metabolic diseases were well recognised in people with mental illness, and contributed to their shorter life expectancy.

However there was an evidence gap regarding the impact of mental illness on respiratory disease despite known higher smoking rates.

“Quite a number of patients had what we perceive to be undiagnosed COPD suggesting there is a lack of diagnosis of airways disease, COPD and asthma, in people with mental illness,” Dr Burke said.

He said patients were likely ‘falling between the cracks’ in terms of the non-psychiatric aspects of their care.

“About 20% of patients don’t have a regular GP and another 30% don’t see the same GP each visit so they may not necessarily have a very stable therapeutic relationship with one person who gets to know them over the years and knows the variations in their symptoms.”

He said different models of care such as GPs or chronic disease nurse practitioners attached to mental health units should be explored given patients were in hospital for an average of nine days.

“We need to explore whether there is an opportunity to screen or intervene early in these people who are going to be at high risk for the course of their life.”

As an example, admission to smoke free health facilities may be an opportunity to help people quit.

“Although we are scared of suicide, nicotine dependency is a far greater likely contributor to death for our mental health patients.”

He added that patients with mental illness were just as likely to want to quit but they found it harder and required more support.

“Manifestations of lung disease may be occurring earlier in people with mental illness due to smoking rates and diagnosing them may be a bit more difficult and require different resources. And so we need to try a bit harder.”

He said low vaccination rates for flu (14%) and pneumococcal disease (4%) should be easily addressed.

The Prince Charles Hospital was also investigating whether it was possible to diagnose sleep apnoea during a mental health unit admission given the high prevalence of symptoms.

Most patients (75%) reported feeling tired during the day, 25% were loud snorers and 13% reported witnessed apnoeic events.

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