A23 23..23

Several papers in the BJPsych this month address issues arising from the overlap or comorbidity between mental and physical ill health. In a UK sample of individuals with affective disorders, Forty et al (pp. 465–472) found significantly increased rates of several medical illnesses among those with bipolar and unipolar disorder compared with controls. Among those with affective disorder, migraine headache, asthma, and cardiovascular risk factors such as hyperlipidaemia and hypertension, were particularly common, for example. The authors also found a link between the burden of medical illness and the severity of mental illness course among those with bipolar disorder. Among those with mental illness, not only is prevalence of physical ill health elevated but healthcare quality is often poorer. Crawford et al (pp. 473–477) examined the quality of physical healthcare offered to those with schizophrenia, utilising data from a UK cross-sectional survey, the National Audit of Schizophrenia, and a service user survey. The authors found that medical records for only one-fifth of patients with schizophrenia indicated that all of nine identified key health measures had been assessed, with only half having their body mass index recorded in the previous 12 months, for example. Levels of intervention for abnormal physical health results, including high blood sugar and dyslipidaemia, were also low but, despite this, most patients continued to report satisfaction with the physical healthcare they received. Considering the raised rates of cancer mortality among those with mental illness, Mitchell et al (pp. 428–435) conducted a systematic review and meta-analysis of breast cancer screening studies and found that overall rates of mammography are reduced among those with mental illness, particularly among women with severe mental illness. The authors conclude that such inequality of breast cancer screening could result in approximately 90 unnecessary extra deaths due to breast cancer each year in the UK. Symptoms of delirium among general hospital patients are common and prognostically important but little studied. Meagher et al (pp. 478–485) undertook a point prevalence study of full and subsyndromal delirium in one acute general hospital in Ireland and found that approximately one-fifth of patients had delirium. The authors also found that another substantial proportion of patients had subsyndromal delirium. They conclude that current conceptualisations of the syndrome and methods of definition lack precision; they describe a definition of subsyndromal delirium which they hope will facilitate more robust studies of the phenomenon.