Psychiatric populations show high rates of significant medical disease – about 50% of in-patients in most studies, and tend to receive poorer treatment for physical disease than the rest of the population. There is ongoing discussion about how best to co-ordinate effective treatment of physical disease in people with severe mental illness but there is no doubt that psychiatrists must be competent in the recognition and management of  physical diseases especially those which are particularly common in the population which they treat.

In this module we look at the prevalence and aetiology of physical morbidity among the psychiatric population, notably in those with severe mental illness. We outline some of the factors affecting the treatment of disease within this population.

In particular, we address the increased prevalence of the following health problems as well as some of their related pathologies, and provide clear guidance on how to monitor for some of these conditions:

• weight gain and obesity
  
  
• diabetes
  
  
• the metabolic syndrome
  
  
• sexual dysfunction
  
  
• EPSEs
  
  
• cardiovascular risk
  
  
• cigarette smoking
  
  
• drug and substance misuse.
  
  

Importantly, we also address the inter-relationship between certain psychotropic drugs and these conditions.

The module concludes with a section on medication and prescribing advice for psychiatrists having to make difficult decisions on choice of drug for patients with severe mental illness, following principles of safe prescribing and being aware of any contra-indications and specific drug-related syndromes.

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