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Researchers explore the role of psychiatrists in patients’ physical health

In a recent CME article in Psychiatric Annals, Geetha Reddy, MD, MPH, and Jeffrey T. Rado, MD, MPH, FAPA, of Northwestern University, discussed the role of the psychiatrist in management of patients’ physical health.

“Patients with chronic mental illness experience disproportionate rates of obesity, metabolic syndrome, diabetes and hypertension, leading to higher mortality and worse health outcomes compared to the general population. Causes include factors related to disease, patients and health care providers,” Reddy and Rado wrote.

Until recently, psychiatrists and mental health professionals have had a limited role in the physical health of patients, according to the researchers.

In 2015, the Association of Medicine and Psychiatry (AMP) and the APA approved a joint position statement that supported the psychiatrist’s role in decreasing physical health disparities among individuals with mental illness.

The statement suggests screening for common medical conditions and counseling on risk factor reduction.

“Psychiatrists should identify patients who may be receiving suboptimal primary care and intervene as necessary, based on available local resources, patient preference and their own competencies,” Reddy and Rado wrote.

The statement called for increased primary care training and practice guidelines for managing medical problems for psychiatrists.

Training opportunities could occur in residency, fellowship and throughout physician continuing medical education, according to researchers.

There are some barriers to integrating physical health into the role of the psychiatrist.

According to Reddy and Rado, there has been a lack of consensus in the field about when it is clinically appropriate to treat medical illness.

Further, some psychiatrists expressed concerns about the effect managing medical conditions in practice settings may have on the therapeutic relationship, as it is a departure from the traditional frame of treatment.

Other challenges include medical knowledge, medico-legal liability and time constraints.

“More research and real-world experience is needed to understand the perspectives of psychiatrists and their patients,” the researchers wrote. “With the push for increased involvement of psychiatrists in medical care, there lies hope of bridging the mortality gap in those with chronic mental illness.” – by Amanda Oldt

Disclosure: Rado reports receiving grant/research support from Otsuka Pharmaceutical, consultant affiliation with Clintara, and speaker’s bureau work with Alkermes. Reddy reports no relevant financial disclosures.