Psychiatry: core clinical skills
Physical health in mental illness
People with severe mental illness die on average much earlier than the general population, mostly from preventable physical illness. Psychiatrists must assess and protect their patients' physical health, including the effects of their medicines.
Depth by stage, Pre-U → Consultant (details)
What is it?
Psychiatrists remain medical doctors throughout their careers. People with schizophrenia, bipolar disorder and severe depression have much higher rates of diabetes, heart disease, smoking-related illness and infection, and are often diagnosed late.
Some causes are linked to the illness and lifestyle; others to treatment, for example weight gain and diabetes with certain antipsychotics. Psychiatrists are expected to monitor weight, blood pressure, glucose and lipids, check ECGs, and act on abnormal results or refer appropriately.
The subject also covers the reverse direction: physical illnesses and drugs that cause psychiatric symptoms, such as thyroid disease, infections, autoimmune encephalitis or steroids.
Why does a psychiatrist need it?
Closing the 'mortality gap' is a major goal in modern psychiatry. A psychiatrist who keeps general medical skills can catch diabetes, heart problems or neuroleptic malignant syndrome early, choose medicines with fewer metabolic effects, support smoking cessation and avoid missing a medical cause that looks psychiatric.
What level is expected at each stage?
Scale: 1. Aware → 2. Understands → 3. Applies → 4. Masters / Teaches. What the levels mean.
- Pre-UNot expected
- Pre-clinicalAwareLearns the physiology and pathology behind cardiovascular and metabolic disease.
- ClinicalUnderstandsPerforms physical examinations and recognises common medical conditions.
- HousemanshipAppliesManages medical problems day to day, which builds skills later used for psychiatric patients.
- Medical officerAppliesMonitors physical health of psychiatric inpatients and outpatients and manages common problems.
- Psych traineeAppliesApplies monitoring guidelines, manages psychotropic adverse effects and recognises medical mimics.
- Specialist / consultantMasters / TeachesLeads integrated physical–mental health care pathways and sets monitoring standards.
What are the key topics?
The mortality gap
- Reduced life expectancy in severe mental illness
- Main causes: cardiovascular disease, diabetes, respiratory disease, cancer
- Diagnostic overshadowing (physical complaints dismissed as psychiatric)
- Barriers to physical health care for psychiatric patients
Medication-related problems
- Metabolic syndrome: weight, glucose, lipids
- QTc prolongation and sudden cardiac death risk
- Clozapine-related myocarditis, constipation and neutropenia
- Lithium effects on kidneys, thyroid and parathyroid
- Hyperprolactinaemia and bone health
- Neuroleptic malignant syndrome and serotonin syndrome as medical emergencies
Monitoring and prevention
- Baseline and follow-up checks for antipsychotics and mood stabilisers
- Smoking cessation support
- Diet, physical activity and weight management
- Vaccination, dental and sexual health
- Screening for blood-borne viruses where relevant
Medical causes of psychiatric symptoms
- Endocrine: thyroid, adrenal, calcium disorders
- Neurological: epilepsy, tumours, stroke, multiple sclerosis
- Infections: HIV, syphilis, encephalitis
- Autoimmune encephalitis (e.g. anti-NMDA receptor)
- Drug-induced symptoms: steroids, interferon, substances
- Delirium as a medical emergency
How is it learned and assessed?
- General medicine teaching and postings in medical school and housemanship
- Physical health clinics and ward duties as MO and trainee
- Examined in MMed Psychiatry and MRCPsych (Paper B and CASC include physical health stations)
- Local audits of metabolic monitoring
Typical textbooks and resources
- The Maudsley Prescribing Guidelines in Psychiatry — physical monitoring sections
- Oxford Handbook of Psychiatry — physical health chapter
- MOH Malaysia Clinical Practice Guidelines (e.g. management of schizophrenia, diabetes)
- NICE guidance on psychosis and physical health monitoring
Titles are widely used examples; editions change. Use university libraries or legitimate purchases.
Common questions
Why does a psychiatrist check my weight and blood sugar?
Some psychiatric medicines can raise weight, blood sugar and cholesterol, and mental illness itself is linked with higher physical health risks. Regular checks let problems be caught early and treatment adjusted.
Can a physical illness look like a mental illness?
Yes. Thyroid disease, infections, brain conditions and some medicines can all cause depression, anxiety, confusion or psychosis. That is why psychiatrists examine patients and order tests, especially at the first presentation.