Physico-physical comorbidity, poor health behaviour and health promotion in South Verona patients with functional psychoses

Background/Objectives: Epidemiological studies investigating the mortality and physical health of mental patients have provided evidence of an excess mortality and of a substantially higher prevalence of physical co-morbidity as compared to the general population. These findings have been explained with a multi-causal model including a higher prevalence of risk factors like high blood pressure, high plasma cholesterol and obesity, tendency to self neglect, unhealthy lifestyles, and medication side-effects. In addition, the mentally ill share the problems of disadvantaged people at large, especially of people with low income, and tend to have poorer lifestyles in general. This project are addresses physical co-morbidity, health status and lifestyles of mental patients. These topics that are less covered in the international literature in comparison to mortality, and minimally studied in the Italian literature. Aims of the study are: (a) To examine the prevalence of physical co-morbidity in mental patients with an ICD-10 diagnosis of affective and non-affective functional psychotic disorder in contact with the South-Verona Community Mental Health Service (CMHS) (Phase 1); (b) Then implementing health promotion strategies related to dietary habits and physical exercise, and studying their efficacy with a randomised controlled study (Phase 2). Methods: Subjects with an ICD-10 diagnosis of affective and non-affective functional psychotic disorder in contact with the South-Verona CMHS are recruited in Phase 1 via a cross-sectional design. The assessment procedure consists of a physical health examination, laboratory tests and an interview on socio-demographic data, physical health status, risk factors, lifestyles and quality of life. The following Phase 2 is a randomised controlled trial of a health promotion intervention programme (experimental group) and treatment as usual (control group). The PHYSICO intervention program builds upon the experience previously acquired in an exploratory project on health education for diet followed by practical demonstrations and exercise and coupled with a group-walking program performed in the South-Verona CMHS in 2006, with the participation of both mental health workers and patients, designed and implemented in collaboration with the Department of Prevention of the local health authority (LSS 20 Verona). Results: This presentation will illustrate and discuss the Phase 1 results. Results show that the diseases of the circulatory system, including hypertension and coronary heart disease take the lions’ share. Nervous systems disease including severe diseases like stroke or Alzheimer and less severe ailments like migraine follow. Metabolic diseases, including diabetes and thyroid dysfunctions, come as third, together with diseases of the musculoskeletal system/connective tissue. The comparison with the data of the Veneto population show that the patients in the PHYSICO sample present a higher percentage of overweight/obesity and of smoking habits and a lower percentage of adherence to WHO recommendations for diet and physical activity. Discussion/Conclusions: The PHYSICO study has successfully completed Phase 1 thus confirming the feasibility of this type of research. Phase 1 has already shown that it is possible to improve collaboration and has collected good quality data on health parameters and health-related lifestyles. The project has also witnessed an excellent cooperation of both the personnel and the patients of the South-Verona CMHS.