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The medical care of people with psychosis

Timothy J R Lambert
Med J Aust 2009; 190 (4): . || doi: 10.5694/j.1326-5377.2009.tb02339.x
Published online: 16 February 2009

Early detection and prevention applies to medical comorbidity as well as psychiatric symptoms

Having a psychotic illness has been and remains a barrier to all forms of effective medical care. All serious mental illness is associated with undue medical morbidity and mortality.1,2 Such morbidity stems from a complex web of interactions between the illness itself, various aspects of the patient’s environment, the nature of the antipsychotic medication and, most worryingly, barriers to the acceptance within the wider medical profession of adequate screening and treatment for comorbidity.3 As 70% of patients with persistent psychoses receive some or all of their treatment from non-psychiatric physicians,4 this is an important issue for the broader profession.


  • Concord Medical School, University of Sydney, Sydney, NSW.


Correspondence: tlambert@med.usyd.edu.au

Competing interests:

I have been a speaker/advisory board member for Hospira, one of the manufacturers of clozapine, in the past 2 years.

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  • 2. Lambert TJR, Velakoulis D, Pantelis C. Medical comorbidity in schizophrenia. Med J Aust 2003; 178 (9 Suppl): S67-S70. <MJA full text>
  • 3. Lambert TJR, Newcomer JW. Are the cardiometabolic complications of schizophrenia still neglected? Barriers to care. Med J Aust 2009; 190 (4 Suppl): S39-S42.
  • 4. Carr VJ, Lewin TJ, Barnard RE, et al. Attitudes and roles of general practitioners in the treatment of schizophrenia compared with community mental health staff and patients. Soc Psychiatry Psychiatr Epidemiol 2004; 39: 78-84.
  • 5. Lacro JP, Dunn LB, Dolder CR, et al. Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature. J Clin Psychiatry 2002; 63: 892-909.
  • 6. Fitzsimons J, Berk M, Lambert T, et al. A review of clozapine safety. Expert Opin Drug Saf 2005; 4: 731-744.
  • 7. Layland JJ, Liew D, Prior DL. Clozapine-induced cardiotoxicity: a clinical update. Med J Aust 2009; 190: 190-192.
  • 8. Borovik AM, Bosch MM, Watson SL. Ocular pigmentation associated with clozapine. Med J Aust 2009; 190: 210-211.
  • 9. John AP, Koloth R, Dragovic M, Lim SCB. Prevalence of metabolic syndrome among Australians with severe mental illness. Med J Aust 2009; 190: 176-179.
  • 10. Waterreus AJ, Laugharne JDE. Screening for the metabolic syndrome in patients receiving antipsychotic treatment: a proposed algorithm. Med J Aust 2009; 190: 185-189.
  • 11. Lambert TJR, Chapman LH; Consensus Working Group. Diabetes, psychotic disorders and antipsychotic therapy: a consensus statement. Med J Aust 2004; 181: 544-548. <MJA full text>
  • 12. Castle D, Lambert T, Melbourne S, et al. A clinical monitoring system for clozapine. Australas Psychiatry 2006; 14: 156-168.
  • 13. Brunzell JD, Davidson M, Furberg CD, et al. Lipoprotein management in patients with cardiometabolic risk: consensus statement from the American Diabetes Association and the American College of Cardiology Foundation. Diabetes Care 2008; 31: 811-822.
  • 14. Lambert T, Chen R, Snars J. The ccCHIP metabolic database. http://www.addat.com/page9/page9.html (accessed Jan 2009).
  • 15. Bellivier F. Schizophrenia, antipsychotics and diabetes: genetic aspects. Eur Psychiatry 2005; 20 Suppl 4: S335-S339.
  • 16. Holt RI, Peveler RC. Association between antipsychotic drugs and diabetes. Diabetes Obes Metab 2006; 8: 125-135.
  • 17. Maudsley H. The pathology of mind: a study of its distempers, deformities and disorders. London: Macmillan and Co, 1895.

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