Influence of physical health comorbidity and disparities on life expectancy in patients with schizophrenia

People with schizophrenia experience a substantial reduction in life expectancy, driven predominantly by cardiometabolic disease. In this presentation, Dr Pillinger will describe a translational research programme examining the mechanisms, clinical consequences, and prevention of this mortality gap. The talk will begin by outlining evidence that schizophrenia is associated with multi-system physiological dysfunction from illness onset, including metabolic and inflammatory abnormalities. Building on this, Dr Pillinger will present work investigating cardiac dysfunction in psychosis, including MRI evidence of myocardial inflammation and altered cardiac structure that may not be fully explained by lifestyle or treatment factors, supporting a role for intrinsic disease mechanisms alongside antipsychotic-related effects. The relative cardiometabolic risk of different psychotropic agents will also be considered. He will then examine how these mechanisms translate into real-world multi-morbidity and excess mortality, with a particular focus on disparities in access to cardiometabolic prevention and treatment. Drawing on recent epidemiological and health systems research, the presentation will highlight inequities in the delivery of care, including access to effective weight management and pharmacological interventions. Finally, the focus will shift to solutions. This will include the TUNE-UP programme, a novel co-produced specialist weight management service for people with psychosis designed to address barriers to engagement and reduce inequities in care. Emerging strategies for the prevention of antipsychotic-induced weight gain will also be discussed, including early pharmacological intervention and the role of GLP-1 receptor agonists. Overall, the session will integrate mechanistic, clinical, and implementation research to outline a pathway towards reducing excess mortality in schizophrenia.