Medical Morbidity and Mortality

  • Oliver Freudenreich
Part of the Current Clinical Psychiatry book series (CCPSY)


Psychiatrists are instrumental in improving the medical care that patients with schizophrenia receive. Given the mortality gap between patients with schizophrenia and their peers, this is not an academic issue, and a medical prevention mind-set is needed. In this chapter, I review what psychiatrists can do to prevent medical diseases, particularly cardiovascular disease. Guideline-concordant metabolic monitoring is one specific task that falls onto our shoulders. Taking on a leadership role to reduce substandard care will require reverse care integration (bringing medical care to psychiatric patients) and novel models of care.


Medical morbidity and mortality Physical health monitoring Medical prevention Metabolic syndrome Screening Metformin Reverse care integration 


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Additional Resources

    Web Sites

    1. – The website for the SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) contains a lot of information and tools about integrated care. Spend some time to look around.


    1. Fitzgerald FT. The tyranny of health. N Engl J Med. 1994;331:196–8. – Mandatory reading so you do not become a health zealot.PubMedCrossRefGoogle Scholar
    2. Marder SR, Essock SM, Miller AL, Buchanan RW, Casey DE, Davis JM, et al. Physical health monitoring of patients with schizophrenia. Am J Psychiatry. 2004;161:1334–49. – Important consensus guidelines on health monitoring. While over a decade old, people still refer to them as the fundamental principles are as current as they were in 2004.PubMedCrossRefGoogle Scholar
    3. Irwin KE, Freudenreich O, Peppercorn J, Taghian AG, Freer PE, Gudewicz TM. Case records of the Massachusetts General Hospital. Case 30–2016. A 63-Year-old woman with bipolar disorder, cancer, and worsening depression. N Engl J Med. 2016;375:1270–81. – A case discussion that illustrate the complexity of providing optimal cancer care (breast cancer in this case) if there is poorly controlled psychiatric illness.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Oliver Freudenreich
    • 1
  1. 1.Department of PsychiatryMassachusetts General HospitalBostonUSA

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