People with severe mental disorders (SMD) - i.e. schizophrenia and other psychotic disorders, bipolar disorder, and moderate‐to‐severe depression - have a 2-3 times higher average mortality rate compared to the general population, translating to a reduced life expectancy by 10 to 20 years. The majority of deaths amongst people with SMD are attributable to physical health conditions such as non-communicable diseases as well as infectious diseases. Risk factors for non-communicable diseases, such as sedentary behaviour and harmful use of alcohol, are also risk factors for SMD and strongly link the two. In clinical practice, however, such interactions and comorbidities are routinely overlooked.

WHO has initiated the process of development of recommendations on the management of physical health conditions in people with severe mental disorders. To this end, a Guideline Development Group (GDG) reviewed the GRADE evidence profiles for each outcome and each key question relevant to these guidelines and is formulating recommendations based on the evidence for the management of physical health conditions in people with severe mental disorders.

These new guidelines from WHO on management of physical health conditions in people with SMD will provide evidence-based, up-to-date recommendations to practitioners regarding how to appropriately clinically manage such co-morbid illness. These guidelines will facilitate the implementation of WHO’s Comprehensive Mental Health Action Plan(World Health Organization, 2013) and the Mental Health Gap Action Programme (mhGAP).

Contents

• Acknowledgements
• Acronyms & abbreviation
• Executive summary
  • Introduction
  • Guideline Development Methods
  • Summary of Recommendations
• 1. Introduction
  • 1.1. Background and Rationale
  • 1.2. Related WHO Guidelines and Tools
  • 1.3. Target Audience
  • 1.4. Goal and Objective
  • 1.5. Guiding Principles
• 2. Guideline development process
  • 2.1. Guideline Development Group
  • 2.2. Declarations of Interest and Management of Conflicts of Interest
  • 2.3. Collaboration with External Partners
  • 2.4. Identifying, Appraising and Synthesizing Available Evidence
  • 2.5. Decision-Making During the Guideline Development Group Meeting
  • 2.6. Document Preparation and Peer Review
• 3. Evidence and recommendations
  • 3.1. Tobacco Cessation
  • 3.2. Weight Management
  • 3.3. Substance Use Disorders
  • 3.4. Cardiovascular Disease and Cardiovascular Risk
  • 3.5. Diabetes Mellitus
  • 3.6. HIV/AIDS
  • 3.7. Other Infectious Diseases (Tuberculosis, Hepatitis B/C)
• 4. Implementation considerations
• 5. Publication, dissemination, and evaluation
  • 5.1. Publication and Dissemination
  • 5.2. Monitoring and Evaluation
  • 5.3. Implications for Further Research
  • 5.4. Future Review and Update
• References
• Annex 1. Guideline Development Group (GDG) members
• Annex 2. Assessment of conflict of interest
• Annex 3. Scoping questions
• Annex 4. Background question: Association of physical health conditions with severe mental disorders
• Annex 5. Evidence review methodology
• Annex 6. Drug – drug interactions
• Glossary

Suggested citation:

Guidelines for the management of physical health conditions in adults with severe mental disorders. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO.

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