Irish Journal of Medical Science (1971 -)

, Volume 184, Issue 1, pp 107–112 | Cite as

A double-edged sword: review of the interplay between physical health and mental health

  • C. Behan
  • R. Doyle
  • S. Masterson
  • D. Shiers
  • M. Clarke
Review Article


It is widely acknowledged that there is interplay between physical and mental health, with causality in both directions. A common theme across countries is the uncertainty surrounding who should act as gatekeeper for physical health matters in psychiatry. Much of the metabolic monitoring is carried out by psychiatrists who often feel ill equipped to treat medical problems such as abnormal cholesterol or disturbances of glucose metabolism. However many patients do not attend primary care on a regular basis and may not be likely to follow through on referral to primary care. This review aims to examine the interplay between co-morbid physical and mental health conditions, identify the physical health conditions particularly associated with severe affective and psychotic illness and briefly discuss interventions and recommendations in this area. As people with severe mental illness die 10–20 years younger than their peers, with much of this premature mortality due to cardiovascular disease, this topic is emerging as one of great importance amongst clinicians and policymakers internationally.


Physical health Mental health Morbidity Mortality Education Review 


  1. 1.
    Langan J, Mercer SW, Smith DJ (2013) Multimorbidity and mental health: can psychiatry rise to the challenge? Br J Psychiatry 202:391–393CrossRefPubMedGoogle Scholar
  2. 2.
    Barnett K, Mercer SW, Norbury M et al (2012) Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. The Lancet 380(9836):37–43CrossRefGoogle Scholar
  3. 3.
    Emanuel EJ (2012) Where are the health care cost savings? JAMA 307(1):39–40CrossRefPubMedGoogle Scholar
  4. 4.
    Naylor C, Parsonage M, McDaid D et al. (2012) Long-term conditions and mental health: The cost of co-morbidities. The King’s FundGoogle Scholar
  5. 5.
    Williams S, Dale J (2006) The effectiveness of treatment for depression/depressive symptoms in adults with cancer: a systematic review. Br J Cancer 94(3):372–390CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Chapman DP, Perry GS, Strine TW (2005) The vital link between chronic disease and depressive disorders. Prev Chronic Dis. 2(1):A14PubMedCentralPubMedGoogle Scholar
  7. 7.
    McNamee L, Mead G, MacGillivray S et al (2013) Schizophrenia, poor physical health and physical activity: evidence-based interventions are required to reduce major health inequalities. Br J Psychiatry 203:239–241CrossRefPubMedGoogle Scholar
  8. 8.
    A vision for change (2006) Report of the expert group on mental health policy. Dublin Accessed 21 Feb 2013
  9. 9.
    Schizophrenia: Core interventions in the treatment and management of adults with schizophrenia in primary and secondary care. NICE Clinical Guideline 178 (2014) London: NICE Accessed 21 Feb 2013
  10. 10.
    De Hert M, Cohen D, Bobes J et al (2011) Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry 10(2):138–151PubMedGoogle Scholar
  11. 11.
    Cradock-O’Leary J, Young AS, Yano EM et al (2002) Use of general medical services by VA patients with psychiatric disorders. Psychiatr Serv 53(7):874–878CrossRefPubMedGoogle Scholar
  12. 12.
    Lawrence D, Kisely S (2010) Inequalities in healthcare provision for people with severe mental illness. J Psychopharmacol 24(4 Suppl):61–68CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Royal College of Psychiatrists (2012) Report of the national audit of schizophrenia (NAS) 2012. Healthcare Quality Improvement Partnership, LondonGoogle Scholar
  14. 14.
    Kessler RC, Berglund P, Demler O et al (2003) National comorbidity survey replication. The epidemiology of major depressive disorder: results from the national comorbidity survey replication (NCS-R). JAMA 289(23):3095–3105CrossRefPubMedGoogle Scholar
  15. 15.
    Musselman DL, Evans DL, Nemeroff CB (1998) The relationship of depression to cardiovascular disease: epidemiology, biology, and treatment. Arch Gen Psychiatry 55(7):580–592CrossRefPubMedGoogle Scholar
  16. 16.
    Benton T, Staab J, Evans DL (2007) Medical co-morbidity in depressive disorders. Ann Clin Psychiatry 19(4):289–303CrossRefPubMedGoogle Scholar
  17. 17.
    Pan A, Lucas M, Sun Q et al (2010) Bidirectional association between depression and type 2 diabetes mellitus in women. Arch Intern Med 170(21):1884–1891CrossRefPubMedCentralPubMedGoogle Scholar
  18. 18.
    Patten SB, Williams JV, Lavorato DH et al (2009) Major depression as a risk factor for high blood pressure: epidemiologic evidence from a national longitudinal study. Psychosom Med 71(3):273–279CrossRefPubMedGoogle Scholar
  19. 19.
    Sullivan MD, Katon WJ, Lovato LC et al (2013) Association of depression with accelerated cognitive decline among patients with type 2 diabetes in the ACCORD-MIND trial. JAMA Psychiatry 10:1041–1047CrossRefGoogle Scholar
  20. 20.
    MacHale S (2002) Managing depression in physical illness. Adv Psychiatr Treat 8(4):297–305CrossRefGoogle Scholar
  21. 21.
    Yusuf S, Hawken S, Ounpuu S et al (2004) Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 364(9438):937–952CrossRefPubMedGoogle Scholar
  22. 22.
    Healthy active lives (HeAL): keeping the body in mind in youth with psychosis (2013)
  23. 23.
    The Schizophrenia Commission (2012) The abandoned illness: a report from the Schizophrenia Commission. Rethink Mental Illness, LondonGoogle Scholar
  24. 24.
    Andreassen OA, Djurovic S, Thompson WK et al (2013) Improved detection of common variants associated with schizophrenia by leveraging pleiotropy with cardiovascular-disease risk factors. Am J Hum Genet 92(2):197–209CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    Lahti M, Tiihonen J, Wildgust H et al (2012) Cardiovascular morbidity, mortality and pharmacotherapy in patients with schizophrenia. Psychol Med 42:1–11CrossRefGoogle Scholar
  26. 26.
    Dee A, Perry IJ, Staines A et al (2012) Executive summary: the cost of overweight and obesity on the island of Ireland. Accessed 01/02/2013
  27. 27.
    Behan C, McGlade N, Haq F et al (2008) Physical health and attendance at primary care in people with schizophrenia. Ir J Psychol Med 25(2):57–60Google Scholar
  28. 28.
    de Vegt F, Dekker JM, Jager A et al (2001) Relation of impaired fasting and postload glucose with incident type 2 diabetes in a Dutch population: the Hoorn Study. JAMA 285(16):2109–2113CrossRefPubMedGoogle Scholar
  29. 29.
    Jagun O, Chan G, Tee WJ et al (2013) Guesstimating body mass index (BMI): how good are we really? Gut 62:A38. doi: 10.1136/gutjnl-2013-305143.91 CrossRefGoogle Scholar
  30. 30.
    Husin M, Kasim S, Tuthill A (2012) Accuracy of visual estimation in diagnosing obese individuals-a blinded study. Br J Med Pract 5(2)Google Scholar
  31. 31.
    Vancampfort D, Knapen J, De Hert M et al (2009) Cardiometabolic effects of physical activity interventions for people with schizophrenia. Physical Ther Rev 14(6):388–398CrossRefGoogle Scholar
  32. 32.
    McCreadie RG (2003) Diet, smoking and cardiovascular risk in people with schizophrenia: descriptive study. Br J Psychiatry 183:534–539CrossRefPubMedGoogle Scholar
  33. 33.
    Craft LL, Perna FM (2004) The benefits of exercise for the clinically depressed. Prim Care Companion J Clin Psychiatry 6(3):104–111CrossRefPubMedCentralPubMedGoogle Scholar
  34. 34.
    Barry MM, van Lente E, Molcho M et al (2009) SLÁN 2007: Survey of lifestyle, attitudes and nutrition in Ireland: Mental health and social well-being report. Department of Health and Children. The Stationery Office, DublinGoogle Scholar
  35. 35.
    Myles N, Newall HD, Curtis J et al (2012) Tobacco use before, at, and after first-episode psychosis: a systematic meta-analysis. J Clin Psychiatry 73(4):468–475CrossRefPubMedGoogle Scholar
  36. 36.
    De Hert M, Dekker JM, Wood D et al (2009) Cardiovascular disease and diabetes in people with severe mental illness position statement from the European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC). Eur Psychiatry 24(6):412–424CrossRefPubMedGoogle Scholar
  37. 37.
    Zhang XY, Chen DC, Xiu MH et al (2012) Cigarette smoking, psychopathology and cognitive function in first-episode drug-naive patients with schizophrenia: a case-control study. Psychol Med 1–10Google Scholar
  38. 38.
    McNeill A (2001) Smoking and mental health: a review of the literature. In Symposium report: Smoking and mental health. Smoke-free LondonGoogle Scholar
  39. 39.
    Campion J, Checinski K, Nurse J (2008) Review of smoking cessation treatments for people with mental illness. Adv Psychiatr Treat 14(3):208–216CrossRefGoogle Scholar
  40. 40.
    Winterbourne S (2012) Preventing future physical morbidity and premature mortality in first-episode psychosis patients: an economic evaluation of smoking cessation interventions. Dissertation London School of Economics and Social PolicyGoogle Scholar
  41. 41.
    Holt RIG, Peveler RC (2010) Diabetes and cardiovascular risk in severe mental illness: a missed opportunity and challenge for the future. Pract Diabetes Internatl 27(2):79–84CrossRefGoogle Scholar
  42. 42.
    Ryan MC, Collins P, Thakore JH (2003) Impaired fasting glucose tolerance in first-episode, drug-naive patients with schizophrenia. Am J Psychiatry 160(2):284–289CrossRefPubMedGoogle Scholar
  43. 43.
    Fiedorowicz JG, Miller DD, Bishop JR et al (2012) Systematic review and meta-analysis of pharmacological interventions for weight gain from antipsychotics and mood stabilizers. Curr Psychiatry Rev 8(1):25–36CrossRefPubMedCentralPubMedGoogle Scholar
  44. 44.
    Gorczynski P, Faulkner G (2010) Exercise therapy for schizophrenia. Schizophr Bull 36(4):665–666CrossRefPubMedCentralPubMedGoogle Scholar
  45. 45.
    Smith SM, Soubhi H, Fortin M et al (2012) Managing patients with multimorbidity: systematic review of interventions in primary care and community settings. BMJ 345:e5205CrossRefPubMedCentralPubMedGoogle Scholar
  46. 46.
    Hasnain M, Fredrickson SK, Vieweg WVR et al (2010) Metabolic syndrome associated with schizophrenia and atypical antipsychotics. Curr Diab Rep 10(3):209–216CrossRefPubMedGoogle Scholar
  47. 47.
    Corrigan PW, Larson JE, Ruesch N (2009) Self-stigma and the “why try” effect: impact on life goals and evidence-based practices. World Psychiatry 8(2):75–81PubMedCentralPubMedGoogle Scholar
  48. 48.
    Thornicroft G (2011) Physical health disparities and mental illness: the scandal of premature mortality. Br J Psychiatry 199:441–442CrossRefPubMedGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2014

Authors and Affiliations

  • C. Behan
    • 1
  • R. Doyle
    • 1
  • S. Masterson
    • 1
  • D. Shiers
    • 2
  • M. Clarke
    • 1
    • 3
  1. 1.DETECT Early Intervention Service in PsychosisDublinIreland
  2. 2.General Practitioner & NICE Guidance Development Group (GDG)North StaffordshireUK
  3. 3.School of Medicine, University College DublinDublinIreland

Personalised recommendations