Cardiovascular disease in patients with schizophrenia

I thank Kritharides and colleagues1 for their review Cardiovascular disease in patients with schizophrenia. I agree with them and support their work, which seeks to improve the physical health of patients living in the community with a chronic mental illness such as schizophrenia, through an innovative, coordinated and multidisciplinary model of care. Clozapine side effects, including risks of myocarditis and cardiomyopathy, hypercholesterolaemia and weight gain, reduce years of life and require medical attention.

But the management is not always straightforward. One challenge is patient compliance with often demanding allied health therapies. How do we keep our patients motivated to continue with prescribed regular exercise most days of the week? How do we encourage compliance with a weight-reducing, low salt, low glycaemic index diet?

Multidisciplinary primary care and specialist teams may consider a rehabilitation approach to complement the model of care. Two essential elements are goal setting and measurement of function.2

Some patients will be motivated by their personal goals (eg, getting back to weighing 80 kg or playing a game of table tennis) and other patients will appreciate their gain in terms of function (eg, walking up the stairs without a rest or shopping for groceries independently) more so than in terms of presented data (eg, cholesterol levels or absolute cardiovascular risk reduction). For motivating patients with schizophrenia and significant cardiovascular risk, a rehabilitation approach may be worth a try.