How much do you know about the physical health needs of people with mental health problems?

This brief exercise should take about 10 minutes.  It is aimed primarily at mental health professionals, but may be of interest to others.   Your answers will not be scored, so feel free to guess!

1.	Before we begin, which of these roles, if any, describe you?
	Non-mental health professional in a general hospital
	Primary care professional
	Mental health professional
	Social services professional
	Voluntary sector professional
	Patient, carer or member of the public
	Other (please state below)

Thanks! Click 'Next' to begin...

2.	On average, people with mental illness die five to ten years younger than the general population.
	True
	False

Answer - this is true.  People with mental health problems are more likely to die younger than the general population.   This is due a range of factors.  The good news is that there are ways of preventing many of these factors, such as: - The better diagnosis and treatment of physical and mental health problems   - Individuals making lifestyle changes around things like smoking, drinking, diet and exercise - Closer monitoring of the side effects of medication Other important factors include genetics and social circumstances (such as poverty and poor housing).

3.	People with both mental and physical illness tend to die younger than others because of unnatural deaths like suicide and accidents
	True
	False

Answer - false.   Even after accounting for deaths such as suicide, people with mental and physical health problems are still more likely to die younger than people without mental health problems.

4.	If a person has depression, they are:
	Less likely than a non-depressed person to develop type 2 diabetes
	More likely than a non-depressed person to develop type 2 diabetes
	Neither more or less likely than anyone else to develop type 2 diabetes

Answer - more likely.  Major depression doubles one's lifetime risk of developing type 2 diabetes and several studies have found cases of depression predating the onset of type 2 diabetes by many years.  Depression and depressive symptoms in diabetes are associated with poorer glycaemic control, diabetes complications and increased risk of death.

5.	People who have schizophrenia are more likely than other citizens to develop: (select as many as apply)
	Diabetes
	High blood pressure
	Heart disease
	Breast cancer
	Stroke
	Bowel cancer

Research suggests that people with schizophrenia face a higher risk of all these physical conditions.  It is therefore essential that healthcare professionals from both physical and mental health specialites are aware of this and monitor their patient's wellbeing. Multi-disciplinary working also needs to be improved so that a person's psychological and physical symptoms are considered and tackled together.                       It is recommended that all patients with mental illness recieve annual health checks (usually from primary care) and further physical treatment where needed.

6.	According to NICE*, which of the following tests and examinations should be performed on someone when they are first diagnosed with bipolar disorder? Select as many as appropriate. *The National Institute of Health and Clinical Excellence
	Thyroid test
	Liver test
	Renal function test
	Blood pressure
	Full blood count
	Blood glucose levels
	Lipid profile
	Weight and height measurement
	Electroencephalography (EEG)
	Computed tomography (CT) scan
	Magnetic Resonance Imaging (MRI) scan
	Drug screening
	Chest X-ray
	Electrocardiography (ECG)

Standard tests Thyroid, liver and renal function tests should be performed as well as blood pressure monitoring, a full blood count, and tests of blood glucose and lipids.                                             Additional tests EEGs, CT scans or MRI scans should be considered if an organic aetiology or a relevant comorbidity is suspected.  Drug screening, chest X-ray and ECGs might be useful if the clinical history suggests so.

7.	Joe has a mental health problem and has recently been diagnosed with coronoary heart disease (CHD).   Generally speaking, is he more or less likely than another person with CHD (who does not have a mental health problem) to:
		More likely	Less likely
	Seek medical help
	Have a lower pain threshold
	Adhere to treatment and health monitoring
	Be diagnosed at an older age
	Be alive 5 years after his diagnosis

This will of course vary from person to person, but statistically speaking, Joe is: Less likely to seek medical help. He might feel that his physical symptoms will not be taken seriously because of his mental health 'history'. If Joe has low self-esteem, he may (rightly or wrongly) believe that his lifestyle has contributed to the illness.  He might even feel unworthy of medical help.   Joe is less likely to be diagnosed at an older age  - for example, 31% of people with schizophrenia and CHD are diagnosed under the age of 55, compared with 18% of others with CHD.  Once diagnosed, Joe is less likely to adhere to treatment; he might struggle to keep appointments or follow a treatment plan.

Joe is more likely to have a lower pain threshold and experience worse physical symptoms than other patients.   Sadly, Joe is less likely to be alive 5 years after his diagnosis compared with other CHD patients, although this will depend on various factors, including his medication and lifestyle.

8.	The long term use of antipsychotic drugs increases the risk of developing metabolic syndrome which is characterised by:  (select as many as apply)
	Weight gain
	High blood lipid levels
	High blood pressure
	Glucose intolerance

Answer - all of the above.   Furthermore, the risk of sudden death in schizophrenia increases incrementally with each additional psychotropic medication taken.

9.	This is the end of the quiz  - did you find it informative?
	Yes thanks
	No, not really

	Any other comments, or ideas for future quizzes?

Thanks very much -please now click submit.