Treat the head and the heart
Dr. Henry Nasrallah’s editorial on mortality in schizophrenia (“Dying too young: Cardiovascular neglect of the mentally ill”, Current Psychiatry, January 2007) to my knowledge could be the first article on the subject written by a psychiatrist. It is time that psychiatrists remember that the specialty is a branch of medicine and its practitioners are physicians.
Because of psychiatry’s unique understanding of the effects of the mind and emotions on the body—particularly on the heart—we have an opportunity to make a major contribution to medicine in terms of understanding and treating heart disease, the world’s leading cause of death.
I practiced family medicine for many years and later devoted my career to adult and child psychiatry. I employ an integrative approach to psychiatric illness because of my background in medicine and psychoanalysis. I focus on the physiology of mood and its link to the development of heart disease and diabetes.
Based on the literature, the causes of premature death in schizophrenia—such as heart disease and diabetes—result from disturbances in underlying physiology including activation of the hypothalamic-pituitary-adrenal axis and sympathetic adrenal-medullary system, autonomic dysfunction, low heart rate variability, and platelet activation. These are the same physiologic aberrations that increase the risk of depression in patients with heart disease.
R. Claire Friend, MD
Assistant clinical professor,
University of California, Los Angeles
Harbor General Hospital Medical Center