Disrupting the Adverse Interplay Between Psychiatric and Medical Illnesses

Psychiatric illnesses increase the morbidity and mortality of comorbid medical disease, and current research targets the identification of specific mechanisms that account for this association. Psychotic illness complicates the management of chronic diseases where self-care activities often play a major role, such as in the regulation of blood glucose levels in diabetes. In this issue, Wykes et al. describe an interactive relationship between cognitive functioning and negative symptoms, self-efficacy, and diabetic control in patients with psychotic illnesses and Type 1 diabetes. Although high self-efficacy was associated with better hemoglobin A1C levels in patients with mild negative symptoms and higher cognitive function, in patients with more severe negative symptoms and lower cognitive function, high-self-efficacy was linked to higher A1C levels. These findings point to the need for designing diabetes management plans based on careful assessments of specific psychiatric symptomatology in this population. Severe mental illness is also associated with poor general physical health and higher rates of somatic complaints. Madan and colleagues describe in this issue an integrated model of psychiatric and medical care that substantially reduced physical symptoms in patients with severe mental illness during an 8-week hospitalization, with striking improvements in those presenting with substance abuse and sleep disorders. If these findings are shown to persist after discharge, then accountable care organizations should be encouraged to incorporate this more aggressive approach to caring for this vulnerable population. Such targeted approaches are likely to result in decreased utilization of outpatient medical services and improved long-term outcomes.