NICE Guidance Physical Health [63]

Your physical health

Many people with schizophrenia are at risk of developing significant physical health problems (for example, heart disease from smoking, or increased weight and diabetes from some medicines), so it is very important that your physical health is checked regularly. These physical health checks should pay particular attention to things such as weight gain, blood pressure and heart problems, blood sugar and the side effects of your medicines. As well as closely monitoring these types of physical signs, good advice on reduction of smoking, taking appropriate physical exercise and having a healthy diet are important aspects of physical health care in schizophrenia.

How your GP can help (primary care)

Your GP (rather than your psychiatrist) will usually look after your physical health. He or she should talk to you about your physical health, and the risks of illness. The GP should make an agreement with you to do physical health assessments at regular intervals agreed jointly between you and him/her. This might be as often as once a year if your GP thinks you are at risk of becoming physically ill. Whatever you decide, how often you have physical health checks should be written into your GP’s notes and your psychiatrist will be told. To help your GP keep an eye on your physical and mental health, he or she should put your name on a register (this is just for the GP to keep a record of how and when he or she should be helping you).

Your GP or practice nurse should also help to look after your mental health. The GP may prescribe your medicines and ask about your mental health and progress. However, there may be times when your GP will want you to go back to your psychiatrist for assessment if you aren’t already seeing him or her. The main reasons for your GP to refer you to the mental health team are if:

• you are not taking your medicine properly
• the treatment isn’t working very well
• you are developing a problem with alcohol or drugs (some people with schizophrenia take drugs or drink too much because they feel anxious or depressed, but the drink and drugs usually make things worse)
• the GP thinks that you are becoming a danger to yourself or others (and this includes neglecting yourself)
• you have just changed GPs (tell your new GP that you have had a breakdown and he or she will offer to organise a referral for assessment).

If your GP refers you, you can expect to see the mental health team quickly.