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 prevalentin people with severe mental illness (SMI). Although this excess morbidityand mortality is largely due to modifiable lifestyle risk factors, the screeningand assessment of physical health aspects remains poor, even in developedcountries. Moreover, specific patient, provider, treatment and system factorsact as barriers to the recognition and to the management of physical diseasesin people with SMI. Psychiatrists can play a pivotal role in the improvementof the physical health of these patients by expanding their task from clinicalpsychiatric care to the monitoring and treatment of crucial physical parameters.At a system level, actions are not easy to realize, especially for developingcountries. However, at an individual level, even simple and very basic monitoringand treatment actions, undertaken by the treating clinician, can already improvethe problem of suboptimal medical care in this population. Adhering to monitoringand treatment guidelines will result in a substantial enhancement of physicalhealth outcomes. Furthermore, psychiatrists can help educate and motivatepeople with SMI to address their suboptimal lifestyle, including smoking,unhealthy diet and lack of exercise. The adoption of the recommendations presentedin this paper across health care systems throughout the world will contributeto a significant improvement in the medical and related psychiatric healthoutcomes of patients with SMI.     

Modifications to the photosynthetic apparatus of higher plants in response to changes in the light environment

A brief review of the photosynthetic apparatus of higher plants is given, followed by a consideration of the modifications induced in this apparatus by changes in light intensity and light quality. Possible strategies by which plants may optimize photosynthetic activity by both long- and short-term modifications of their photosynthetic apparatus in response to changing light regimes are discussed.