Physical illness accumulates two to three times faster in psychosis and bipolar disorder — and earliest in the young

The edition in brief

A Queensland cohort of 30,189 people with schizophrenia-spectrum or bipolar disorder, matched with 148,476 hospital comparators, found physical disease across multiple body systems accumulated much faster: the hazard of three or more affected systems was 2.65 times higher, meaning about 19 extra people per 100 over 20 years. The gap was widest in the young — women under 25 had a ninefold hazard of five-system multimorbidity — so physical health monitoring should start at the first episode. The updated Cochrane review of zuclopenthixol acetate for acute behavioural disturbance (11 trials, 714 people) found no clear advantage over haloperidol-based regimens for tranquillisation, mental state or adverse effects, but more sedation at 24 and 48 hours; evidence is low quality. A meta-analysis of 16 trials found long-term psychodynamic psychotherapy reduced depressive symptoms modestly (SMD 0.34), with high-certainty evidence against all comparators. A Japanese trial of a self-guided interpersonal therapy app in pregnancy showed no effect during pregnancy but lower depression scores one month postpartum. FDA approved a supplement to a generic risperidone application; it is administrative and changes nothing for prescribers.