Physical and Metabolic Consequences of Severe Mental Illness (SMI)

Established: April 2005. First meeting October 4th 2005. Second: March 14th 2006.

Convenor (Chair): Dr David Osborn. Senior Lecturer in Psychiatry, Department of Mental Health Sciences, University College London

Members:
Prof. Thomas Barnes. Professor of Psychiatry, Imperial College London; Adele Greaves. Senior Research and Policy Officer Rethink; Mike Nash, Nursing, Middlesex University
Dr Joy Hinson. Reader in Molecular & Cellular Endocrinology, Barts and the London, Queen Mary School of Medicine and Dentistry; Dr Richard IG Holt. Senior Lecturer in Endocrinology & Metabolism. University of Southampton.; Prof. Michael King. Professor of Primary Care Psychiatry, UCL; Prof. Irwin Nazareth. Professor of Primary Care, Scientific Director of MRC General Practice Research Framework, UCL; Prof. Robert Peveler, Professor of Liaison Psychiatry, University of Southampton; Dr Michael Phelan, Honorary Senior Lecturer in Psychiatry, Imperial College London, Royal College of Psychiatrists Physical Health Group; Dr Peter Raven, Senior Lecturer in Psychiatry, Director of Metabolic and Clinical Trials Unit, UCL; Prof. Tom Craig. Early Onset Psychosis Services, IOP; Dr Craig Ritchie, Old age psychiatry and clinical trials, UCL; Dr Shubulade M Smith, Clinical Senior Lecturer and Honorary Consultant Psychiatrist; Prof. Scott Weich, Professor of Psychiatry, Warwick University; Dr Oliver Howes, Institute of Psychiatry; Mike Holland, IOP Rehabilitation Psychiatry; Dr Martin Gulliford; Public Health Sciences, Kings College London. Nutrition and diabetes; Dr Joe Reilly, Psychiatry, Durham University;  Dr David Yeomans, Consultant Psychiatrist, Leeds; Dr Paul Machin, Psychiatry University of Newcastle-upon-Tyne; Dr Aroon Hingorani, Cardiovascular Pharmacologist, UCL; Karen Thwaite, forensic nursing; 

Devolved Nation Members:                                                                                  Professor Robin McCreadie. Dumfries;Professor Gavin P Reynolds, Psychiatry and pharmacogenetics. Belfast; Dr Jogin Thakore, Psychiatry, Dublin

Remit and Aims:
To produce wide-ranging large scale research addressing the physical and metabolic health of people with SMI, including in particular schizophrenia and bipolar affective disorder.

Poor physical health, not suicide, is the main cause of premature death in people with SMI. This problem is finally attracting international recognition academically and clinically. People with SMI have an excess of CHD risk factors, including smoking, dyslipidaemia, weight gain, impaired glucose tolerance and other features of the metabolic syndrome. The causes are multi-factorial including addictions, the effects of psychotropic medications (particularly atypical agents), symptoms and direct consequences of the illnesses such as negative symptoms and neurocognitive deficits, lifestyle issues, social adversity and psychosocial stressors.

National access to physical health services and specialist clinics by people with SMI remains unquantified. Interventions will be evaluated in terms of effectiveness and cost effectiveness in setting including inpatient wards, secure/forensic settings, home treatment/crisis teams, general practice and community teams.

Current Status & Future Plans:
The group formed 3 focused writing groups:
i) Service delivery in physical health care for people with SMI ; ii) cohort study writing group; iii) Intervention studies. These writing groups have submitted the following grant applications for major national studies for which they are awaiting funding decisions:

1) Project submitted to SDO call Pha-202: "Delivering effective physical health care to people with Severe Mental Illnesses". (submitted to the SDO 21st November 2006).
The application included new collaborators from the NHS and service user and carers were represented by RETHINK. The Sainsbury Centre for Mental Health were also involved.

2) Project submitted to MRC: "Cardiovascular Outcomes in Mental health.  Physical Assessment and Screening Study" (submitted 31/1/2007; Lead Applicant: David Osborn, UCL). This represents a national 2 year cohort study of physical and metabolic risk factors in people with first onset psychosis, in collaboration with the established PsyGrid study.We are currently in negotiation with MRC on possible future funding.

3) We formed a smoking and psychosis writing group and led a bid to the HTA for an RCT of specialist smoking cessations for people with severe mental illness, as compared to standard smoking services.  This included collaborators from the MHRN research group on 'Psychosis and co-morbid substance misuse'. The bid was submitted in August 2007 and we will hear whether we have been shortlisted in November.