Co-morbidity represents one of the greatest challenges for twenty-first-century medicine. A high prevalence of co-morbidity in the severely mentally ill (SMI) has been well established leading to a significant impact on quality of life, life expectancy and premature death by 15-20 years. The major recognised contributor to excess death is cardiovascular disease. Known risk factors include smoking, obesity, alcohol and drug misuse and diabetes. The field of knowledge of the linkage between common psychiatric disorders and cardiometabolic risk is growing with a focus on common pathophysiological and inflammatory processes in addition to the already well-recognised cluster of risk factors which have been described in the past as 'metabolic syndrome'. International/national guidelines and consensus statements provide the guidance and evidence to optimise screening for and management of risk factors with increasing emphasis on early intervention with lifestyle changes and treatment review. In this chapter, we have prepared a narrative review of the relevant literature complimented by the authors' experience of providing holistic care for the SMI. Also we refer to the evidence for shared pathophysiological mechanisms and cardiometabolic risk factors contributing to the high levels of co-morbidity in this population. Finally we make recommendations for screening and treatment outlining effective interventions to improve quality of life and life expectancy.
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