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Rampton Hospital, Nottinghamshire Healthcare NHS Trust, Retford DN22 0PD (tel: 01777 248321; fax: 01777 247737; e-mail: irene.cormac{at}nottshc.nhs.uk)
Rampton Hospital
Derby City General Hospital
Section of Mental Health, University of Sheffield
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Abstract |
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To evaluate the physical health and health risk factors in long-stay psychiatric patients in a high secure psychiatric hospital. A cross-sectional survey of consenting patients was undertaken using a semi-structured questionnaire, a brief physical examination and review of patient case notes. A comparison was made with data collected on admission and held on the Special Hospitals’ Case Register.
RESULTS
Main findings were: a mean increase in weight since admission, in men of 10.62 kg and in women of 12.74 kg; high rates of smoking, obesity and large waist size; 54% of patients had one or more health problems.
CLINICAL IMPLICATIONS
The study’s profile of the physical health of psychiatric in-patients indicates the need for health promotion initiatives in such hospitals and the need for primary care services.
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Introduction |
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TopAbstractIntroductionMethodResultsDiscussionReferences |
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Our study was designed to evaluate the physical health of the patient population and health risk factors in long-stay psychiatric patients in a high secure hospital.
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Method |
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Two researchers (I.C. and R.B.) invited patients to take part in the study. Patients were not approached if their mental state was too disturbed or if they were deemed incapable of giving informed consent. After obtaining written consent, the researchers conducted a semi-structured interview and examined the case notes, collecting information on smoking habits, past history of physical illness, current health problems and current psychotropic and non-psychotropic medication. The Maudsley criteria (Taylor et al, 2001) were used to determine whether the patient’s psychotropic medication carried a risk of weight gain. We noted the psychiatric diagnoses according to ICD-10 criteria (World Health Organization, 1992).
Central deposition of adipose tissue increases health risk, and waist size is positively correlated with abdominal fat content. Health risks in men are increased if waist size exceeds 94 cm, and an intervention is needed if waist size exceeds 102 cm. For women, waist sizes greater than 80 cm increase health risk and sizes greater than 88 cm require intervention (Lean et al, 1995).
Measurements were taken of height, weight, waist circumference and blood pressure using standard equipment, and body mass index (BMI) was calculated.
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Results |
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The age of interviewed patients ranged from 20.3 years to 80.7 years (mean 39.0 years, s.d.=10.75).The length of stay of the patients ranged from 0.02 years to 46.20 years (mean 8.93 years, s.d.=7.98). The Mental Health Act 1983 classifications of the sample were: 121 (49%) mental illness, 66 (27%) psychopathic disorder, 25 (10%) mental impairment or severe mental impairment; 36 (14%) had dual classifications.
The majority of the interviewed patients (131/248) had schizophrenia and 119 had disorders of adult personality and behaviour. There were 59 patients with mental retardation (learning disabilities), which may be associated with increased vulnerability to physical illness and communication difficulties and thus compromise access to physical healthcare. More than one form of mental disorder was present in 115 patients.
Comparison of interviewed and non-interviewed patients
There was no significant difference between the interviewed and
non-interviewed patients in terms of age, gender, ethnicity, Mental Health Act
1983 classification or on data collected on admission on smoking habits,
alcohol problems and BMI. Non-interviewed patients had a significantly greater
mean length of stay than the interviewed patients: 10.14 years (s.d.=9.04)
compared with 7.90 years (s.d.=6.80); t=12.97, P=0.003, 95%
CI –3.73 to –0.76. This finding was not significant when patients
on trial leave were eliminated from the analysis.
Smoking
Seventy-one per cent of both male patients (152/214) and female patients
(24/34) reported smoking tobacco, compared with 28% of the combined male and
female general population; 63% smoked loose tobacco (155/248). The average
daily consumption of cigarettes or cigarette equivalents was 15.6. At this
rate of tobacco consumption, an individual is 13 times more likely to die
prematurely than a non-smoker (Action on
Smoking and Health, 2002).
Obesity and body shape
The rate of obesity in the hospital sample was 36% in men and 75% in women.
This should be compared with rates of obesity in the UK population of 17% in
men and 22% in women (Peterson et
al, 2000). Just three patients (1.2%) were underweight.
Where data were available in the Special Hospitals’ Case Register, we compared weight on admission with current weight. This showed that 70 of 430 (16%) patients were admitted to Rampton Hospital with a BMI of 30 kg/m2 or over. There was a substantial increase in weight in most patients during their admission. In women the mean gain was 12.74 kg (s.d.=17.02) and in men it was 10.62 kg (s.d.=17.19).
Regarding waist size, 112 of 214 (53%) of male patients and 26 of 34 (76%) female patients in the sample had a waist size that required an intervention to reduce health risk. The mean waist size in male patients was 103.1cm (s.d.=14.4, range 68.5-156) and in female patients it was 110.0 cm (s.d.=18.8, range 77.0-143.0). Both of these means fall in the category of risk for which an intervention is recommended.
Body mass index and psychotropic medication
Table 1 shows the
relationship between current medication and age, gender, ethnicity, length of
stay, Mental Health Act 1983 classification, current BMI and weight change
since admission. Those taking medication associated with side-effects of
weight gain were significantly more likely to be female, non-White, to have a
shorter length of stay, a classification of mental illness and a higher mean
BMI. There was no significant relationship with BMI increase since
admission.
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There was no statistical difference between the mean waist size for women taking medication with a risk of weight gain and women not taking medication or taking medication with no risk of weight gain. Male patients taking medication with a risk of weight gain had a statistically significant greater mean waist size (t=72.874, P=0.004) than male patients on no medication or taking medication with no risk of weight gain.
Hypertension
We found that 103 (48%) of the 214 interviewed male patients and 3 (9%) of
the 34 interviewed female patients might be at risk due to hypertension. In
comparison, the levels of hypertension in the British population are 41% of
men and 33% of women (Britton &
McPherson, 2002).
General patient morbidity
We found that 90 (36%) of our sample reported being breathless after
climbing one flight of stairs; 134 (54%) had one or more diagnosed significant
health problems. Table 2 shows
the number and percentage of patients with health problems in the ten most
frequently reported medical categories.
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Discussion |
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TopAbstractIntroductionMethodResultsDiscussionReferences |
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The study findings have raised serious concerns about avoidable health risks in a population of long-stay psychiatric patients. These risks include high rates of smoking, obesity, central weight distribution and excessive weight gain. The results of this study should be seen in the context of increased health risks, morbidity and mortality in psychiatric populations elsewhere and in the general population.
There are well-developed and proven strategies for decreasing health risk factors that could be implemented in long-stay psychiatric facilities (Cormac et al, 2004). Since the completion of this study, Rampton Hospital has developed interventions for health promotion for long-stay psychiatric patients. Further research is needed in this important area of patient care.
Psychiatric hospitals have a responsibility for the physical health of their patients. Hospitals should promote healthy living and provide the same standard of healthcare that is available to the general population. This paper shows the need for the provision of primary care services and health promotion for psychiatric patients with mental disorders.
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References |
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TopAbstractIntroductionMethodResultsDiscussionReferences |
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BRITTON, A. & McPHERSON, K. (2002) Coronary Heart Disease: Estimating the Impact of Changes in Risk Factors. London: National Heart Forum.
BROWN, S., INSKIP, H. & BARRACLOUGH, B. (2000)
Causes of the excess mortality of schizophrenia. British Journal of
Psychiatry, 177, 212
-217.
CORMAC, I., FERRITER, M. & MARTIN, D. (2004)
Improving the physical health of long-stay psychiatric in-patients.
Advances in Psychiatric Treatment,
10, 107
-115.
HARRIS, E. C. & BARRACLOUGH, B. (1998) Excess mortality of mental disorder. British Journal of Psychiatry, 137, 11 -53.
LEAN, M. E. J., HAN, T. S. & MORRISON, C. E.
(1995) Waist circumference as a measure for indicating need for
weight measurement. BMJ,
311, 158
-161.
PETERSON, S., RAYNOR, M. & PRESS, V. (2000) Coronary Heart Disease Statistics. London: British Heart Foundation.
TAYLOR, D., McCONNELL, H., McCONNELL, D., et al (2001) Prescribing Guidelines (6th edn), p. 105. London: Martin Dunitz.
WORLD HEALTH ORGANIZATION (1992) The ICD-Classification of Mental and Behavioural Disorders. Clinical Descriptions and Diagnostic Guidelines. Geneva:WHO.
This article has been cited by other articles:
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  I. Cormac, S. Hallford, L. Hart, S. Creasey, and M. Ferriter Evaluation of an integrated weight management and fitness programme in a high-security psychiatric setting Psychiatr. Bull., March 1, 2008; 32(3): 95 - 98. [Abstract] [Full Text] [PDF]
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 R. Kiani and M. Abbas Smoking in a long-stay psychiatric rehabilitation centre Advan. Psychiatr. Treat., November 1, 2005; 11(6): 457 - 458. [Full Text] [PDF]
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H. Pannu Are psychiatrists real doctors? Psychiatr. Bull., November 1, 2005; 29(11): 436 - 436. [Full Text] [PDF]
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