Surprisingly, psychiatrists and psychiatric nurses “were just as likely” as their primary care counterparts to display negative biases toward individuals with schizophrenia seeking general medical care, according Dinesh Mittal, MD, staff psychiatrist with the Central Arkansas Veterans Healthcare System and Associate Professor in the Department of Psychiatry and Behavioral Sciences at the University of Arkansas.
In a press briefing at the recent American Psychiatric Association (APA) meeting in San Francisco, Mittal described a study in which he and his colleagues sought to determine whether mental health and primary care providers at Veterans Affairs facilities treat patients with and without schizophrenia any differently. The authors did so by analyzing the providers’ responses to clinical scenarios.
Although at high risk for chronic medical conditions, persons with serious and persistent mental disorders, such as schizophrenia, often receive poor care for their physical health problems, Mittal said.
In their research poster presented at the APA meeting, Mittal and colleagues cited the work of Kisely and associates,1 who found that the incidence of cancer was no higher in psychiatric patients than in the general population: however, psychiatric patients were more likely to have metastases at diagnosis and were less likely to receive specialized interventions, thereby possibly explaining their higher case fatality rate.
Also cited was a study by Druss and associates,2 which found that patients with any comorbid mental disorder were significantly less likely to undergo percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft (CABG) surgery after a myocardial infarction. After adjusting for demographic, clinical, hospital, and regional factors, Druss et al found that individuals with mental disorders were 41% (for schizophrenia) to 78% (for substance abuse/dependence) less likely to undergo cardiac catheterization as those without mental disorders.
To investigate possible bias among providers, Mittal and colleagues presented a hypothetical clinical vignette to 55 primary care physicians, 91 primary care nurses, 62 psychiatrists and 67 psychiatric nurses at 5 VA facilities.
The vignette described a 34-year-old man with hypertension, obesity, insomnia, and chronic back pain. The patient, currently being treated with naproxen, lisinopril, and fluoxetine, was returning for a follow-up and seeking stronger pain medications. He did not have any substance abuse. He was working in a cafeteria at a VA facility, and his job performance was above average. He attended church, enjoyed reading magazines, and occasionally went fishing.
Two versions of the vignette were created . . . one in which the patient had stable schizophrenia and was taking risperidone . . . and the other in which the patient did not have the disorder and did not take risperidone. The vignettes were distributed in 3 waves to the providers who completed their responses anonymously.
1. Kisely S, Crowe E, Lawrence D. Cancer-related mortality in people with mental illness. JAMA Psychiatry. 2013;70:209-217.
2. Druss BG, Bradford DW, Rosenheck RA, et al. Mental disorders and use of cardiovascular procedures after myocardial infarction. JAMA. 2000;283:506-511.
3. Daumit GL, Dickerson FB, Wang NY, et al. A behavioral weight-loss intervention in persons with serious mental illness. N Engl J Med. 2013;368:1594-1602.