Are the cardiometabolic complications of schizophrenia still neglected? Barriers to care.

Patients with schizophrenia have a wide range of risk factors for cardiometabolic disease, at rates 1.5-5 times greater than the general population. Despite the provision of many sets of guidelines and protocols for screening and monitoring of cardiometabolic risks, morbidity and mortality rates for those with psychotic illnesses remain excessive and premature. Surveys of mental health practitioners reveal a clear acknowledgement of the importance of managing cardiometabolic risks and subsequent comorbidity. However, inadequate screening rates of patients with antipsychotic-treated mental illnesses suggest "knowing is not doing". Surmountable barriers (at service, patient and illness levels) to adequate integrated health care are not being adequately challenged for this population. Recommendations to improve the situation include service reorganisation, communication enhancement, improved training and education, better incentives, accreditation rigour, and government leadership.