Strategies to implement physical health monitoring in people affected by severe mental illness: a literature review and introduction to the Italian adaptation of the Positive Cardiometabolic Health Algorithm

Strategie per implementare il monitoraggio della salute fisica in soggetti affetti da disturbi psichiatrici gravi: revisione della letteratura e presentazione dell’adattamento italiano del Positive Cardiometabolic Health Algorithm

M. Ferrara (1), F. Mungai (1), M. Miselli (1), D. Shiers (2), J. Curtis (3 4), F. Starace (1)

1 Department of Mental Health and Substance Abuse, AUSL Modena, Modena, Italy; 2 Retired General Practictioner, Leek, North Staffordshire, UK; 3 School of Psychiatry, University of New South Wales, Sydney, Australia; 4 Early Psychosis Programme, The Bondi Centre, South Eastern Sydney Local Health District, Sydney, Australia.



To review the strategies implemented in clinical practice to increase monitoring and active interventions to reduce cardiovascular risk in individuals with severe mental illness and their possible implementation in first episode psychosis (FEP) care.


A PubMed literature search was performed using the following key words: “metabolic syndrome”, “antipsychotic”, “schizophrenia”, “psychosis”, “severe mental illness”, “intervention”, “obesity”, “weight”, “physical health” and a combination of all above. Additional papers were identified through references and based on expert consultation as necessary.


The review identified 14 studies in which a variety of different monitoring instruments were adopted in a range of clinical settings. Only three studies were carried out in subjects affected by FEP. The degree to which systematic monitoring was successfully utilised varied across studies and was mediated by a broad range of barriers. Nevertheless, some studies showed that the introduction of a systematic approach can improve the monitoring by up to 100%.


Despite heightened risk of developing cardiovascular and metabolic disorders, systematic monitoring of physical health is often suboptimal and haphazard. There is a paucity of specific protocols for people with FEP. Results seem more promising when the approach to physical health is multidisciplinary and integrated with primary care. In this regard, a computerized version of the Australian Positive Cardiometabolic Health Algorithm, along with a health check list completed by psychiatric nurses, seems to be the basis to improve monitoring and effective interventions aimed at preventing cardiovascular events in individuals suffering from FEP.

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