What is a medical complication of psychiatric conditions or their treatment?

From the Guidelines

Medical complications of psychiatric conditions or their treatment are numerous, but one notable example is the increased risk of premature mortality and cancer death associated with depression in patients with cancer.

Key Complications

• Depression is associated with a heightened risk for premature mortality (relative risk 1.22-1.39) and cancer death (relative risk 1.18) 1
• Anxiety is also associated with increased adverse effects and symptoms, and poorer physical functioning 1
• Psychiatric disorders, such as schizophrenia, are associated with increased morbidity and mortality related to physical health, including obesity, diabetes, and hyperlipidemia 1
• Delirium, a medical emergency, can be precipitated by underlying medical conditions, intoxication, or withdrawal, and is associated with high mortality if left undiagnosed 1

Treatment Considerations

• Treatment of psychiatric conditions, such as depression and anxiety, can reduce the risk of premature mortality and cancer death 1
• Antipsychotic medications, such as clozapine, can be effective in treating schizophrenia, but require careful monitoring and management strategies for anticipated side effects 1
• A "start low, go slow" approach to medication dosing may be beneficial in patients with 22q11.2 deletion syndrome 1

Important Considerations

• Early detection, diagnosis, and prompt institution of treatment are crucial for effective management of psychiatric conditions 1
• Collateral information and obtaining an appreciation of the environment and its challenges are valuable in diagnosing and managing psychiatric disorders in patients with intellectual disabilities 1

From the Research

Medical Complications of Psychiatric Conditions or Their Treatment

• Medical complications can arise from psychiatric treatment due to direct toxicity from psychotropic medications, drug-drug interactions, or intoxication or withdrawal states 2
• These complications can range from minor issues such as dry mouth and nausea to serious and life-threatening conditions like neuroleptic malignant syndrome and cardiac arrhythmias 2
• Psychiatric medications can affect essentially all organ systems, and their use in hospitalized patients requires close monitoring for adverse reactions and medical complications 3
• Undiagnosed physical illnesses are common in psychiatric patients, highlighting the need for comprehensive medical examinations as part of standard psychiatric evaluations 4

Comorbidities and Undertreatment

• Severe mental disorders often co-occur with chronic medical illnesses like cardiovascular disease and diabetes, leading to a more severe course of mental illness and reduced quality of life 5
• Medical conditions in patients with severe mental disorders are often undertreated, resulting in premature mortality and a life expectancy approximately 30% shorter than that of the general population 5
• Factors such as cognitive impairment, reduced ability to function, and lack of communication skills can make accessing general health care difficult for patients with severe mental disorders 5

Psychiatric Complications in Cancer Patients

• Psychiatric disorders like depression, anxiety, and delirium occur in a significant percentage of cancer patients, particularly as disease advances and cancer treatments become more aggressive 6
• Identifying patients at risk for psychiatric complications is crucial, and factors such as advanced disease, certain cancer treatments, uncontrolled physical symptoms, and past history of psychiatric disorder can be used to predict risk 6