Integrating general health care in private community psychiatry practice

Persons with serious mental illness represent a special at-risk population, with elevated medical comorbidity and mortality rates, mainly due to cardiovascular disease. For this reason, the treatment plan for patients with mental illness must include the assessment of medical risk factors, beginning at the time of the initial psychiatric evaluation. Follow-up assessments should proceed as recommended by the Expert Consensus Development Panel convened by the American Diabetes Association, the American Psychiatric Association, and other relevant specialty organizations. Because the various second-generation antipsychotics (SGAs) have unique side effect profiles with respect to cardiometabolic risk factors, such as weight gain and dyslipidemia, the selection of an SGA always should weigh efficacy versus potential risks. Prior to initiating antipsychotic therapy, the psychiatrist should not only explain to the patient the risks of the medication and alternative treatments, but also address preventive strategies and the importance of monitoring. To help evaluate the patient's response and manage SGA-related adverse effects, the psychiatrist should spend considerable time in contact with the patient, the patient's family and/or caregivers (as appropriate), and the patient's primary care physician. To enhance overall patient care, the psychiatrist in private practice should implement procedures to ensure adequate patient education and address overall health monitoring. Furthermore, the psychiatrist must serve as a patient advocate, actively working to foster communication with medical colleagues, especially primary care practitioners, and identify resources in the community that facilitate preventive health care.