Issues in physical health monitoring and management of patients with schizophrenia [Problematiche nel monitoraggio e nella gestione della salute fisica del paziente con schizofrenia]

bjective: The last few years have witnessed a growing interest of the scientific community towards physical health problems in individuals with mental disorders. To explore these issues, ABR Pharma, in cooperation with Bristol-Myers Squibb, has carried out - end of June through July 2006 - a postal survey of 43,215 psychiatrists in 11 European countries on their attitudes and beliefs towards physical health of their patients suffering from schizophrenia (PanEuropean Survey on Physical Health). The authors of the current manuscript, 3 psychiatrists and 3 endocrinologists, have been appointed as "experts" to comment the answers provided by the first 749 Italian psychiatrists who have completed the survey. Aim of this paper is to discuss the results of the survey and to provide information and practical management tools for physical health care of patients with schizophrenia. Methods: Survey questionnaires have been sent to 6,037 Italian psychiatrists, working in hospital practice, community mental health centres or private practice. Descriptive analysis has been carried out on preliminary data from the first 749 Italian respondents as of 17th January 2007 (redemption rate: 12%). The "experts" met on three different occasions in order to jointly evaluate and discuss, supported by evidence-based literature, the distribution of answers provided by Italian psychiatrists to every item of the survey questionnaire. Results: 749 psychiatrists (66% males and 34% females) completed the survey questionnaire. 62% of respondents worked in community mental health centres, 20% in hospital practice, 24% in private practice, and 24% provided 2 or 3 answers (Fig. 1). The answers outline a substantial interest and awareness regarding monitoring and management of physical health in schizophrenia patients. Main concerns include weight gain (72%), extrapyramidal symptoms (64%) and sexual dysfunctions (53%) (Fig. 3). Psychiatrists are mostly concerned with the impact of physical health problems on medication compliance, mortality risk, and relapselrehospitalisation. 94% of the respondents stated that in order to monitor physical health of their patients they carry-out physical examination and blood tests (Fig. 8). They also refer their patients not only to their general practitioner, but also to endocrinologists/diabetologists and general medicine physicians. Conclusions: Based on the results of this survey, Italian psychiatrists consider physical health issues in patients with schizophrenia to be of great importance. Psychiatrists may play a major role in the monitoring and management of physical health disorders; therefore, they should be further encouraged to detect such disturbances early, aiming, above all, to bridge the mortality gap between these patients and the general population, and to improve their quality of life.