Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level

Physical disorders are, compared to the general population, more prevalent in people with severe mental illness (SMI). Although this excess morbidity and mortality is largely due to modifiable lifestyle risk factors, the screening and assessment of physical health aspects remains poor, even in developed countries. Moreover, specific patient, provider, treatment and system factors act as barriers to the recognition and to the management of physical diseases in people with SMI. Psychiatrists can play a pivotal role in the improvement of the physical health of these patients by expanding their task from clinical psychiatric care to the monitoring and treatment of crucial physical parameters. At a system level, actions are not easy to realize, especially for developing countries. However, at an individual level, even simple and very basic monitoring and treatment actions, undertaken by the treating clinician, can already improve the problem of suboptimal medical care in this population. Adhering to monitoring and treatment guidelines will result in a substantial enhancement of physical health outcomes. Furthermore, psychiatrists can help educate and motivate people with SMI to address their suboptimal lifestyle, including smoking, unhealthy diet and lack of exercise. The adoption of the recommendations presented in this paper across health care systems throughout the world will contribute to a significant improvement in the medical and related psychiatric health outcomes of patients with SMI.     

Phylogeography of two parthenogenetic sawfly species (Hymenoptera: Tenthredinidae): relationship of population genetic differentiation to host plant distribution

This study compares the population genetic structure of two obligate parthenogenetic sawfly species, Aneugmenus padi (L.) Zhelochovtsev and Eurhadinoceraea ventralis (Panzer) Enslin (Hymenoptera: Tenthredinidae). Allozymes were used to detect genetic differences in larvae collected at different sites in six European countries. For A. padi , scoring six polymorphic enzymes revealed the existence of five dominant, widely distributed clones and several more with only very few individuals occurring locally. The clonal diversity and identity differed across collection sites, with up to at maximum eight clones coexisting at a single locality. In contrast, in E. ventralis , individuals from different localities were all monomorphic for at least six different enzymes and are therefore assumed to belong to the same clone. Differences in population genetic structure of these sawfly species can be related to the differing distributions of their host plants: the fern, Pteridium aquilinum , the host of A. padi , has been an invasive species for more than two hundred years. Spread of clones of A. padi is likely to have closely followed the complex invasive pattern of spread of the plant. Larvae of E. ventralis were collected from local, horticultural plantings of Clematis spp. of recent origin probably with gardeners having traded plants infested with the sawfly.  © 2004 The Linnean Society of London, Biological Journal of the Linnean Society , 2004, 83 , 219–227.