Prevention in the severely mentally ill: Primary care quality and adverse events among persons with schizophrenia, and the benefit of physical activity on sleep in a community sample of persons with severe mental illness

The public health impact of schizophrenia extends beyond the psychiatric effects of the illness itself, to the associated adverse health risk profile, medical comorbidity, mortality, and the complexity of management of medical disease in this population. This dissertation traces the path of persons with schizophrenia through the healthcare system by examining the quality of primary care, evaluating the risk of adverse events during hospitalization, and examining the impact of exercise as a remedy for poor sleep quality, a common complaint of people with severe mental illness (SMI).;Paper 1 systematically reviews the evidence evaluating the quality of primary care for physical conditions among persons with schizophrenia. Only 17 studies with persons with either schizophrenia or a psychotic disorder were identified. Most studies indicated that the quality of care for persons with schizophrenia is both below clinical standards and reduced when compared to that given to the general population. Further research for the quality of primary care regarding other illnesses and settings is needed.;Paper 2 estimates the national cumulative incidence of adverse events in non-psychiatric hospitalizations for persons with schizophrenia compared with those for persons without schizophrenia and examines the relationship between adverse events and in-hospital death, length of stay, and total charges for persons with schizophrenia using the Nationwide Inpatient Sample. Hospitalizations for patients with schizophrenia had greater risk of the following adverse event compared with those for patients without schizophrenia: decubitus ulcer, postoperative respiratory failure, postoperative deep venous thrombosis, and postoperative sepsis and reduced risk for accidental puncture or laceration and failure to rescue. Adverse events were associated with greater risk of in-hospital death, longer length of stay, and greater total charges.;Paper 3 examines the potential of physical activity as a possible remedy for sleep problems frequently experienced by persons with SMI. We assessed self-reported sleepiness and sleep quality in a group of 24 overweight and obese participants with SMI before and after undergoing a 6-month physical activity and nutritional counseling program as part of the Trial of Achieving Healthy Lifestyles in Psych Rehabilitation Study. Significant pre- to post-treatment improvements were found for sleep quality and reductions in daytime sleepiness.;People with schizophrenia and other severe mental illnesses encounter the same physical health problems and have adverse risk profiles as people without mental illness. More effort should be made for detection, management, and prevention of medical comorbidity in patients with schizophrenia. In addition, care should be taken to prevent certain adverse events that tend to be elevated in persons with schizophrenia. Finally, further study of sleep quality following a 6-month exercise and nutritional guidance program in persons with SMI is warranted, with a control group, a larger number of participants, and objective measures of sleep in addition to self-report. The high levels of morbidity and mortality in this population warrant a comprehensive strategy for the understanding and prevention of medical comorbidity in persons with SMI.