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Stark EL, Miller ES. Diabesity and Perinatal Mental Health: Evidence-based Recommendations for Screening and Intervention. Clin Obstet Gynecol 2020; 64:204-213. [PMID: 33284142 DOI: 10.1097/grf.0000000000000586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Perinatal mental illness, obesity, and diabetes mellitus are common complications of the perinatal period that are becoming ever more prevalent and frequently co-occur. This review seeks to examine the prevalence of comorbid obesity/diabetes (termed "diabesity") and mental illness in the perinatal period and current understandings of the psychosocial and pathophysiological relationships between these diseases. We will present current guidelines for screening and make recommendations for adaptations of mental health treatment in patients with this comorbidity. Finally, we present future directions for research and clinical intervention.
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Affiliation(s)
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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52
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McGinty EE, Daumit GL. Integrating Mental Health and Addiction Treatment Into General Medical Care: The Role of Policy. Psychiatr Serv 2020; 71:1163-1169. [PMID: 32487007 PMCID: PMC7606646 DOI: 10.1176/appi.ps.202000183] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Interventions that integrate care for mental illness or substance use disorders into general medical care settings have been shown to improve patient outcomes in clinical trials, but efficacious models are complex and difficult to scale up in real-world practice settings. Existing payment policies have proven inadequate to facilitate adoption of effective integrated care models. This article provides an overview of evidence-based models of integrated care, discusses the key elements of such models, considers how existing policies have fallen short, and outlines future policy strategies. Priorities include payment policies that adequately support structural elements of integrated care and incentivize multidisciplinary team formation and accountability for patient outcomes, as well as policies to expand the specialty mental health and addiction treatment workforce and address the social determinants of health that disproportionately influence health and well-being among people with mental illness or substance use disorders.
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Affiliation(s)
- Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health (McGinty), and Division of General Internal Medicine, Johns Hopkins School of Medicine (Daumit), Baltimore
| | - Gail L Daumit
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health (McGinty), and Division of General Internal Medicine, Johns Hopkins School of Medicine (Daumit), Baltimore
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Bartels SJ, Baggett TP, Freudenreich O, Bird BL. COVID-19 Emergency Reforms in Massachusetts to Support Behavioral Health Care and Reduce Mortality of People With Serious Mental Illness. Psychiatr Serv 2020; 71:1078-1081. [PMID: 32487009 DOI: 10.1176/appi.ps.202000244] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
People with serious mental illness are at disproportionate risk of COVID-19 morbidity and mortality because of high rates of risk factors that directly parallel those related to poor coronavirus outcomes, including smoking, chronic obstructive pulmonary disease, cardiovascular disease, and diabetes, along with housing instability, homelessness, food insecurity, and poverty. Community-based behavioral health organizations are also at risk of adverse outcomes because of dramatic declines in revenues and a diminished workforce. The State of Massachusetts has responded to this crisis by rapidly implementing a variety of policy, regulatory, and payment reforms. This column describes some of these reforms, which are designed to enhance remote telehealth delivery of care, ensure access to needed medications and residential care staff, and support the financial livelihood of community-based behavioral health services.
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Affiliation(s)
- Stephen J Bartels
- Department of Medicine (Bartels) and Department of Psychiatry (Freudenreich), Harvard Medical School, Boston; Mongan Institute (Bartels), Boston Health Care for the Homeless Program, Institute for Research, Quality, and Policy in Homeless Health Care (Baggett), and Department of Medicine (Bartels) and Department of Psychiatry (Freudenreich), Massachusetts General Hospital, Boston; Vinfen, Cambridge, Massachusetts (Bird). Marvin S. Swartz, M.D., is editor of this column
| | - Travis P Baggett
- Department of Medicine (Bartels) and Department of Psychiatry (Freudenreich), Harvard Medical School, Boston; Mongan Institute (Bartels), Boston Health Care for the Homeless Program, Institute for Research, Quality, and Policy in Homeless Health Care (Baggett), and Department of Medicine (Bartels) and Department of Psychiatry (Freudenreich), Massachusetts General Hospital, Boston; Vinfen, Cambridge, Massachusetts (Bird). Marvin S. Swartz, M.D., is editor of this column
| | - Oliver Freudenreich
- Department of Medicine (Bartels) and Department of Psychiatry (Freudenreich), Harvard Medical School, Boston; Mongan Institute (Bartels), Boston Health Care for the Homeless Program, Institute for Research, Quality, and Policy in Homeless Health Care (Baggett), and Department of Medicine (Bartels) and Department of Psychiatry (Freudenreich), Massachusetts General Hospital, Boston; Vinfen, Cambridge, Massachusetts (Bird). Marvin S. Swartz, M.D., is editor of this column
| | - Bruce L Bird
- Department of Medicine (Bartels) and Department of Psychiatry (Freudenreich), Harvard Medical School, Boston; Mongan Institute (Bartels), Boston Health Care for the Homeless Program, Institute for Research, Quality, and Policy in Homeless Health Care (Baggett), and Department of Medicine (Bartels) and Department of Psychiatry (Freudenreich), Massachusetts General Hospital, Boston; Vinfen, Cambridge, Massachusetts (Bird). Marvin S. Swartz, M.D., is editor of this column
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Fochtmann LJ, Medicus J, Hong SH. Performance in Practice: Practice Assessment Tool for the Care of Patients With Schizophrenia. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:402-423. [PMID: 33343252 PMCID: PMC7725154 DOI: 10.1176/appi.focus.20200034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Schizophrenia is associated with significant health, social, occupational, and economic burdens, including increased mortality. Despite extensive and robust research on the treatment of individuals with schizophrenia, many individuals with the illness do not currently receive evidence-based pharmacological and nonpharmacological treatments. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia, Third Edition, aims to enhance knowledge and increase the appropriate use of interventions for schizophrenia, thereby improving the quality of care and treatment outcomes. To this end, this evidence-based Performance in Practice tool can facilitate the implementation of a systematic approach to practice improvement for the care of individuals with schizophrenia. This practice assessment activity can also be used in partial fulfillment of Continuing Medical Education and Maintenance of Certification, part IV, requirements, which can also satisfy requirements for the Centers for Medicare & Medicaid Services Merit-based Incentive Payment System program.
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Affiliation(s)
- Laura J Fochtmann
- Department of Psychiatry, Stony Brook University, Stony Brook, New York (Fochtmann); Division of Policy, Programs, and Partnerships, Department of Practice Management and Delivery Systems Policy, American Psychiatric Association, Washington, D.C. (Medicus, Hong)
| | - Jennifer Medicus
- Department of Psychiatry, Stony Brook University, Stony Brook, New York (Fochtmann); Division of Policy, Programs, and Partnerships, Department of Practice Management and Delivery Systems Policy, American Psychiatric Association, Washington, D.C. (Medicus, Hong)
| | - Seung-Hee Hong
- Department of Psychiatry, Stony Brook University, Stony Brook, New York (Fochtmann); Division of Policy, Programs, and Partnerships, Department of Practice Management and Delivery Systems Policy, American Psychiatric Association, Washington, D.C. (Medicus, Hong)
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Keepers GA, Fochtmann LJ, Anzia JM, Benjamin S, Lyness JM, Mojtabai R, Servis M, Walaszek A, Buckley P, Lenzenweger MF, Young AS, Degenhardt A, Hong SH. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:493-497. [PMID: 33343262 DOI: 10.1176/appi.focus.18402] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
(Reprinted with permission from The American Journal of Psychiatry 2020; 177:868-872).
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Affiliation(s)
- George A Keepers
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Laura J Fochtmann
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Joan M Anzia
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Sheldon Benjamin
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Jeffrey M Lyness
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Ramin Mojtabai
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Mark Servis
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Art Walaszek
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Peter Buckley
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | | | - Alexander S Young
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Amanda Degenhardt
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Seung-Hee Hong
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
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Grassi L, Riba M. Cancer and severe mental illness:
Bi‐directional
problems and potential solutions. Psychooncology 2020; 29:1445-1451. [DOI: 10.1002/pon.5534] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/03/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences University of Ferrara Ferrara Italy
| | - Michelle Riba
- Department of Psychiatry University of Michigan Ann Arbor Michigan USA
- University of Michigan Depression Center Ann Arbor Michigan USA
- Psycho‐oncology Program University of Michigan Rogel Cancer Center Ann Arbor Michigan USA
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McClellan C, Maclean JC, Saloner B, McGinty EE, Pesko M. Integrated care models and behavioral health care utilization: Quasi-experimental evidence from Medicaid health homes. HEALTH ECONOMICS 2020; 29:1086-1097. [PMID: 32323396 PMCID: PMC7863583 DOI: 10.1002/hec.4027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 02/18/2020] [Accepted: 04/07/2020] [Indexed: 05/06/2023]
Abstract
Integration of behavioral and general medical care can improve outcomes for individuals with behavioral health conditions-serious mental illness (SMI) and substance use disorder (SUD). However, behavioral health care has historically been segregated from general medical care in many countries. We provide the first population-level evidence on the effects of Medicaid health homes (HH) on behavioral health care service use. Medicaid, a public insurance program in the United States, HHs were created under the 2010 Affordable Care Act to coordinate behavioral and general medical care for enrollees with behavioral health conditions. As of 2016, 16 states had adopted an HH for enrollees with SMI and/or SUD. We use data from the National Survey on Drug Use and Health over the period 2010 to 2016 coupled with a two-way fixed-effects model to estimate HH effects on behavioral health care utilization. We find that HH adoption increases service use among enrollees, although mental health care treatment findings are sensitive to specification. Further, enrollee self-reported health improves post-HH.
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Affiliation(s)
- Chandler McClellan
- Agency for Healthcare Research and Quality, Center for Financing, Access, and Trends, Rockville, MD, USA
- Corresponding author. . Phone: 301-427-1646
| | - Johanna Catherine Maclean
- Department of Economics, Temple University, Research Associate, National Bureau of Economic Research, Research Affiliate, Institute of Labor Economics, Philadelphia, PA, USA
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emma E. McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael Pesko
- Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta GA, USA
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58
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Shukla AP, Mandel LS, Tchang BG, Litman E, Cadwell J, Kumar RB, Waitman J, Igel LI, Christos P, Aronne LJ. Medical Weight-Loss Outcomes in Patients Receiving Concomitant Psychotropic Medication: A Retrospective Cohort Study. Obesity (Silver Spring) 2020; 28:1671-1677. [PMID: 32776501 DOI: 10.1002/oby.22903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE This study aimed to elucidate medical weight-loss outcomes in patients unexposed or exposed to psychotropic medication(s). METHODS This retrospective cohort study evaluated weight-loss outcomes of completers treated at an academic weight-management center between April 1, 2014, and April 1, 2016. Patients were classified as either unexposed (not prescribed psychotropic medication) or exposed (prescribed psychotropic medication) based on use of antidepressants, mood stabilizers, or antipsychotics during the study. RESULTS Of 1,932 patients seen during the study period, 885 were eligible for inclusion, of whom 619 (70.0%) were unexposed and 266 (30.0%) were exposed to psychotropic medications. In the unexposed and exposed groups, the mean age, sex distribution, proportion with type 2 diabetes, initial BMI, and number of weight-loss medications prescribed were similar. At 12 months, the unexposed group lost 1.6% more weight on average than the exposed group (9.1% [SD 7.6%] vs. 7.5% [SD 8.1%], respectively; P = 0.02); 71.0% and 41.2% of the unexposed group achieved ≥ 5% and ≥ 10% weight loss at 12 months, respectively, compared with 63.1% and 31.8% in the exposed group at 12 months (P = 0.04 at 5%; P = 0.02 at 10%). CONCLUSIONS Exposure to psychotropic medications was associated with diminished weight loss in patients with medically managed overweight and obesity.
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Affiliation(s)
- Alpana P Shukla
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Lindsay S Mandel
- Department of Medicine, Mount Sinai Beth Israel, New York, New York, USA
| | - Beverly G Tchang
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Ethan Litman
- Department of Obstetrics and Gynecology, The George Washington University, Washington, DC, USA
| | - Joshua Cadwell
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Rekha B Kumar
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Jonathan Waitman
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Leon I Igel
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Paul Christos
- Department of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, New York, USA
| | - Louis J Aronne
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Weill Cornell Medical College, New York, New York, USA
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Keepers GA, Fochtmann LJ, Anzia JM, Benjamin S, Lyness JM, Mojtabai R, Servis M, Walaszek A, Buckley P, Lenzenweger MF, Young AS, Degenhardt A, Hong SH. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia. Am J Psychiatry 2020; 177:868-872. [PMID: 32867516 DOI: 10.1176/appi.ajp.2020.177901] [Citation(s) in RCA: 308] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- George A Keepers
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Laura J Fochtmann
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Joan M Anzia
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Sheldon Benjamin
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Jeffrey M Lyness
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Ramin Mojtabai
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Mark Servis
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Art Walaszek
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Peter Buckley
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | | | - Alexander S Young
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Amanda Degenhardt
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | - Seung-Hee Hong
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
| | -
- APA Practice Guideline Writing Group (George A. Keepers, M.D., Chair)
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60
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Weinstein LC, Chilton M, Turchi R, Klassen AC, LaNoue M, Silvero A, Cabassa LJ. 'It's common sense that an individual must eat': Advocating for food justice with people with psychiatric disabilities through photovoice. Health Expect 2020; 24 Suppl 1:161-173. [PMID: 32671916 PMCID: PMC8137492 DOI: 10.1111/hex.13101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 03/25/2020] [Accepted: 06/24/2020] [Indexed: 01/02/2023] Open
Abstract
Background People with SMI have often been excluded in advocacy efforts focused on physical health, health care and health and social policy. Objective Following a Photovoice project focused on barriers to healthy eating and physical activity in urban neighbourhoods, participant‐researchers were invited to present their insights in community advocacy settings. The purpose of this study was to explore the feasibility and participant–researchers’ experience of these community advocacy activities. Design We held four focus groups with the eight participant‐researchers after each community advocacy activity to explore their experience with public speaking, presenting their experiences and advocating. Setting and Participants People with serious mental illness who were overweight/obese living in supportive housing. Analysis approach Qualitative analysis of the focus group transcripts, using a modified grounded theory approach followed by structured coding focused on empowerment, participation and non‐discrimination. Results Participant‐researchers gave three oral presentations of their photographs at a variety of community‐based programmes and settings and participated in a rally to advocate for SNAP benefits. Two themes emerged from analysis: (a) Empowerment (the level of choice, influence and control that users of mental health services can exercise over events in their lives) and (b) Barriers to Empowerment (obstacles to participation and well‐being). Conclusions This evaluation strengthens the evidence that it is feasible for participant‐researchers in Photovoice projects to engage in robust advocacy activities, such as presentations and discussions with local policymakers. During focus groups, participant‐researchers demonstrated realistic optimism towards their roles as change agents and influencers in spite of acknowledged systemic barriers.
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Affiliation(s)
- Lara Carson Weinstein
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Mariana Chilton
- Dornsife School of Public Health, Health Management and Policy, Drexel University, Philadelphia, PA, USA
| | - Renee Turchi
- Dornsife School of Public Health, Community Health and Prevention, Drexel University, Philadelphia, PA, USA
| | - Ann C Klassen
- Dornsife School of Public Health, Community Health and Prevention, Drexel University, Philadelphia, PA, USA
| | - Marianna LaNoue
- School of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexis Silvero
- Department of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Leopoldo J Cabassa
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MI, USA
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Weinstein L, LaNoue M, Hurley K, Payton C, Sifri R, Myers R. Feasibility Pilot Outcomes of a Mammography Decision Support and Navigation Intervention for Women With Serious Mental Illness Living in Supportive Housing Settings. J Prim Care Community Health 2020; 10:2150132719867587. [PMID: 31416398 PMCID: PMC6698985 DOI: 10.1177/2150132719867587] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: People with serious mental illness (SMI) experience
significant disparities in morbidity and mortality from preventable and
treatable medical conditions. Women with SMI have low mammography screening
rates. SMI, poverty, and poor access to care can have a significant effect on a
woman’s opportunity to learn about and discuss breast cancer screening with
health care providers. This study examines the feasibility pilot outcomes of
mammography decision support and patient navigation intervention (DSNI) for
women with SMI living in supportive housing settings. The primary research
question was: Does the DSNI increase knowledge, promote favorable attitudes, and
decrease decisional conflict relating to screening mammography?
Methods: We developed the intervention with the community using
participatory methods. Women (n = 21) with SMI who had not undergone screening
mammography in the past year participated in an educational module and decision
counseling session and received patient navigation over a 6-month period. We
conducted surveys and interviews at baseline and follow-ups to assess
mammography decisional conflict. Results: Among study participants,
67% received a mammogram. The mammogram DSNI was feasible and acceptable to
women with SMI living in supportive housing settings. From baseline to 1-month
follow-up, decisional conflict decreased significantly (P =
.01). The patient navigation process resulted in 270 attempted contacts
(M = 12.86, SD = 10.61) by study staff (phone calls and
emails with patient and/or case manager) and 165 navigation conversations
(M = 7.86, SD = 4.84). A barrier to navigation was phone
communication, with in-person navigation being more successful. Participants
reported they found the intervention helpful and made suggestions for further
improvement. Conclusions: The process and outcomes evaluation
support the feasibility and acceptability of the mammography DSNI. This project
provides initial evidence that an intervention developed with participatory
methods can improve cancer screening outcomes in supportive housing programs for
people with SMI.
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Affiliation(s)
| | | | | | | | - Randa Sifri
- 2 Sidney Kimmel Medical College, Philadelphia, PA, USA
| | - Ronald Myers
- 1 Thomas Jefferson University, Philadelphia, PA, USA
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Gandré C, Coldefy M. Disparities in the Use of General Somatic Care among Individuals Treated for Severe Mental Disorders and the General Population in France. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103367. [PMID: 32408658 PMCID: PMC7277621 DOI: 10.3390/ijerph17103367] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/30/2020] [Accepted: 05/10/2020] [Indexed: 01/13/2023]
Abstract
Individuals with severe mental illnesses (SMI) face a striking excess and premature mortality which has been demonstrated in several national contexts. This phenomenon, which constitutes a red-flag indicator of public health inequities, can be hypothesized to result from healthcare access issues which have been insufficiently documented so far. In this context, our objective was to explore patterns of general somatic healthcare use of individuals treated for SMI in comparison to those of the general population in France using national health administrative data and a matched case-control study. Differences in the use of general and specific somatic preventive care services, primary care, routine specialized somatic care and admissions to non-psychiatric hospital departments for somatic causes were described between cases and controls after adjustment on differing clinical needs, socio-economic status, and living environment. Our results show a lower use of general preventive care services and of routine specialized somatic care in the SMI population, despite more frequent comorbidities, and a higher occurrence of avoidable hospitalizations, despite higher contacts with primary care physicians. These findings suggest that the health system fails to address the specific needs of this vulnerable population and support the development of measures aimed at reducing this gap.
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63
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Rozario SS, Gondwe T, Lu J. Gender differences in the association between mental health status, hypertension, and emergency department visits in the United States. J Health Psychol 2020; 26:2538-2551. [DOI: 10.1177/1359105320909873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hypertension has been found to be elevated in people with mental illness, and this comorbidity may lead to differential emergency department use by gender. Gender differences in this association were assessed using the 2016 Medical Expenditure Panel Survey ( n = 20,443). A combined effect variable for mental health and hypertension was created for stratified, multivariable logistic regression analysis. The likelihood of emergency department visits was higher for women compared to men in all categories of the combined effect variable. In particular, regardless of hypertension status, women with poor mental health had 35 percent and 39 percent increased likelihood of emergency department visits compared to men.
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Affiliation(s)
| | - Tamala Gondwe
- Virginia Commonwealth University School of Medicine, USA
| | - Juan Lu
- Virginia Commonwealth University School of Medicine, USA
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64
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Keers RN, Hann M, Alshehri GH, Bennett K, Miller J, Prescott L, Brown P, Ashcroft DM. Prevalence, nature and predictors of omitted medication doses in mental health hospitals: A multi-centre study. PLoS One 2020; 15:e0228868. [PMID: 32027720 PMCID: PMC7004323 DOI: 10.1371/journal.pone.0228868] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 01/24/2020] [Indexed: 12/02/2022] Open
Abstract
Objective Limited evidence concerning the burden and predictors of omitted medication doses within mental health hospitals could severely limit improvement efforts in this specialist setting. This study aimed to determine the prevalence, nature and predictors of omitted medication doses affecting hospital inpatients in two English National Health Service (NHS) mental health trusts. Methods Over 6 data collection days trained pharmacy teams screened inpatient prescription charts for scheduled and omitted medication doses within 27 adult and elderly wards across 9 psychiatric hospitals. Data were collected for inpatients admitted up to two weeks prior to each data collection day. Omitted doses were classified as ‘time critical’ and ‘preventable’ based on established criteria. Omitted dose frequencies were presented with 95% confidence intervals (CI). Multilevel logistic regression analyses determined the predictors of omitted dose occurrence, with omission risks presented as adjusted odds ratios (OR) with 95% CI. Results 18,664 scheduled medication doses were screened for 444 inpatients and 2,717 omissions were identified, resulting in a rate of 14.6% (95% CI 14.1–15.1). The rate of ‘time critical’ omitted doses was 19.3% (95% CI 16.3–22.6%). ‘Preventable’ omitted doses comprised one third of all omissions (34.5%, 930/2694). Logistic regression analysis revealed that medicines affecting the central nervous system were 55% less likely to be omitted compared to all other medication classes (9.9% vs. 18.8%, OR 0.45 (0.40–0.52)) and that scheduled doses administered using non-oral routes were more likely to be omitted compared the oral route (inhaled OR 3.47 (2.64–4.57), topical 2.71 (2.11–3.46), ‘other’ 2.15 (1.19–3.90)). ‘Preventable’ dose omissions were more than twice as likely to occur for ‘time critical’ medications than non-time critical medications (50.4% vs. 33.8%, OR 2.24 (1.22–4.11)). Conclusions Omitted medication doses occur commonly in mental health hospitals with ‘preventable’ omissions a key contributor to this burden. Important targets for remedial intervention have been identified.
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Affiliation(s)
- Richard N. Keers
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre (GM PSTRC), Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
- * E-mail:
| | - Mark Hann
- Primary Care Research Group, School of Community Based Medicine, The University of Manchester, Manchester, United Kingdom
| | - Ghadah H. Alshehri
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Karen Bennett
- School of Health and Human Sciences, The University of Bolton, Bolton, United Kingdom
| | - Joan Miller
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Lorraine Prescott
- North West Boroughs Health Care NHS Foundation Trust, Warrington, United Kingdom
| | - Petra Brown
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- Pennine Care NHS Foundation Trust, Aston-Under-Lyne, United Kingdom
| | - Darren M. Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre (GM PSTRC), Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, United Kingdom
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65
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Clarke A, Glick ID. The Crisis in Psychiatric Hospital Care: Changing the Model to Continuous, Integrative Behavioral Health Care. Psychiatr Serv 2020; 71:165-169. [PMID: 31690220 DOI: 10.1176/appi.ps.201900259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Inpatient psychiatric hospital services, as they currently exist, have little to no evidence base. Deficits in the current system represent a critical missed opportunity to improve the trajectory of patients' lives and long-term outcomes. The authors posit that a fresh approach to hospitalization is needed, one that incorporates distinct, measurable goals tied to a comprehensive, individualized treatment plan tailored to address a patient's lifetime course of illness. A structured approach can ultimately improve care quality and continuity by allowing for rigorous testing of each aspect of the assessment and care provision process, improving patient outcomes and care engagement while shortening average lengths of hospital stays, and accelerating the movement of care to cost-effective, need-specific settings. In an effort to move the field toward establishing a systematic, evidence-based protocol for hospital-based psychiatric care, the authors describe a new model, called the S.E.T.U.P. approach.
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Affiliation(s)
- Alex Clarke
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Ira D Glick
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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66
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Goldman ML, Mangurian C, Corbeil T, Wall MM, Tang F, Haselden M, Essock SM, Frimpong E, Mascayano F, Radigan M, Schneider M, Wang R, Dixon LB, Olfson M, Smith TE. Medical comorbid diagnoses among adult psychiatric inpatients. Gen Hosp Psychiatry 2020; 66:16-23. [PMID: 32593912 PMCID: PMC8684817 DOI: 10.1016/j.genhosppsych.2020.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 06/14/2020] [Accepted: 06/20/2020] [Indexed: 01/21/2023]
Abstract
OBJECTIVE Shortened life expectancy of people with mental disorders has been attributed to medical comorbidities, yet these conditions remain under-recognized and under-treated. This study characterizes the medical demands placed on inpatient psychiatric units to help guide medical assessment and management practices in these settings. METHODS Medicaid claims records and clinician data were linked with hospital and regional data for individuals with a principal diagnosis of any mental disorder admitted to psychiatric inpatient units in New York State from 2012 to 2013. A modified Elixhauser Comorbidity Index (ECI) score was calculated for each unique individual (n = 14,458). Adjusted odds ratios (AORs) of having a medical comorbidity were calculated using logistic regression analyses. RESULTS 74.9% of psychiatric inpatients had at least one medical comorbidity, including 57.5% of people ages 18-24. Higher rates of medical comorbidity were associated with older age, female gender, non-schizophrenia diagnoses, and engagement in care prior to hospitalization. Patients with medical comorbidities had lower odds (AOR 0.54; 99% CI 0.35-0.83) of being treated in hospitals with 100 or more total beds compared to smaller hospitals. CONCLUSIONS A high prevalence of common medical diagnoses among psychiatric inpatients underscores the importance of adequate detection and medical treatment of medical comorbidities in psychiatric inpatient settings.
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Affiliation(s)
| | - Christina Mangurian
- Department of Psychiatry, University of California, San Francisco,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital
| | | | - Melanie M. Wall
- New York State Psychiatric Institute,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Fei Tang
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | - Morgan Haselden
- New York State Psychiatric Institute,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Susan M. Essock
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Eric Frimpong
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | | | - Marleen Radigan
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | - Matthew Schneider
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Montefiore Medical Center
| | - Rui Wang
- Office of Performance Measurement and Evaluation, New York State Office of Mental Health
| | - Lisa B. Dixon
- New York State Psychiatric Institute,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Mark Olfson
- New York State Psychiatric Institute,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
| | - Thomas E. Smith
- New York State Psychiatric Institute,Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons
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67
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Anderson KN, Ailes EC, Lind JN, Broussard CS, Bitsko RH, Friedman JM, Bobo WV, Reefhuis J, Tinker SC. Atypical antipsychotic use during pregnancy and birth defect risk: National Birth Defects Prevention Study, 1997-2011. Schizophr Res 2020; 215:81-88. [PMID: 31761471 PMCID: PMC7036025 DOI: 10.1016/j.schres.2019.11.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/09/2019] [Accepted: 11/12/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE To examine the prevalence of, and factors associated with, atypical antipsychotic use among U.S. pregnant women, and potential associations between early pregnancy atypical antipsychotic use and risk for 14 birth defects. METHODS We analyzed data from the National Birth Defects Prevention Study (1997-2011), a U.S. population-based case-control study examining risk factors for major structural birth defects. RESULTS Atypical antipsychotic use during pregnancy was more common among women with pre-pregnancy obesity, and women who reported illicit drug use before and during pregnancy, smoking during pregnancy, alcohol use during pregnancy, or use of other psychiatric medications during pregnancy. We observed elevated associations (defined as a crude odds ratio [cOR] ≥2.0) between early pregnancy atypical antipsychotic use and conotruncal heart defects (6 exposed cases; cOR: 2.3, 95% confidence interval [CI]: 0.9-6.1), and more specifically Tetralogy of Fallot (3 exposed cases; cOR: 2.5, 95% CI: 0.7-8.8), cleft palate (4 exposed cases, cOR: 2.5, 95% CI: 0.8-7.6), anorectal atresia/stenosis (3 exposed cases, cOR: 2.8, 95% CI: 0.8-9.9), and gastroschisis (3 exposed cases, cOR: 2.1, 95% CI: 0.6-7.3). CONCLUSIONS Our findings support the close clinical monitoring of pregnant women using atypical antipsychotics. Women treated with atypical antipsychotics generally access healthcare services before pregnancy; efforts to reduce correlates of atypical antipsychotic use might improve maternal and infant health in this population.
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Affiliation(s)
- Kayla N Anderson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS S-106, Atlanta, GA 30341, USA.
| | - Elizabeth C Ailes
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS S-106, Atlanta, GA 30341, USA
| | - Jennifer N Lind
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS S-106, Atlanta, GA 30341, USA; United States Public Health Service, 4770 Buford Highway, MS S-106, Atlanta, GA 30341, USA
| | - Cheryl S Broussard
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS S-106, Atlanta, GA 30341, USA
| | - Rebecca H Bitsko
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS S-106, Atlanta, GA 30341, USA
| | - Jan M Friedman
- Department of Medical Genetics, University of British Columbia, 4500 Oak Street, Vancouver V6H 3N1, Canada
| | - William V Bobo
- Department of Psychiatry and Psychology, Mayo Clinic, 4500 San Pablo Road S #378, Jacksonville, FL 32224, USA
| | - Jennita Reefhuis
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS S-106, Atlanta, GA 30341, USA
| | - Sarah C Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway, MS S-106, Atlanta, GA 30341, USA
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68
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Stone EM, Daumit GL, Kennedy-Hendricks A, McGinty EE. The Policy Ecology of Behavioral Health Homes: Case Study of Maryland's Medicaid Health Home Program. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:60-72. [PMID: 31506860 PMCID: PMC7040852 DOI: 10.1007/s10488-019-00973-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Behavioral health homes, shown to improve receipt of evidence-based medical services among people with serious mental illness in randomized clinical trials, have had limited results in real-world settings; nonetheless, these programs are spreading rapidly. To date, no studies have considered what set of policies is needed to support effective implementation of these programs. As a first step toward identifying an optimal set of policies to support behavioral health home implementation, we use the policy ecology framework to map the policies surrounding Maryland's Medicaid behavioral health home program. Results suggest that existing policies fail to address important implementation barriers.
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Affiliation(s)
- Elizabeth M Stone
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Alene Kennedy-Hendricks
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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69
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Al-Mrayat YD, Okoli CTC, Studts CR, Rayens MK, Hahn EJ. The Psychometric Properties of the Minnesota Tobacco Withdrawal Scale Among Patients With Mental Illness. Biol Res Nurs 2019; 22:247-255. [PMID: 31854206 DOI: 10.1177/1099800419895573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Approximately 65% of psychiatric inpatients experience moderate-to-severe nicotine withdrawal (NW), a set of symptoms appearing within 24 hr after an abrupt cessation or reduction of use of tobacco-containing products in those using nicotine daily for at least a couple of weeks. The Minnesota Tobacco Withdrawal Scale (MTWS) is a widely used instrument for detecting NW. However, the psychometric properties of the MTWS have not previously been examined among patients with serious mental illness (SMI) undergoing tobacco-free hospitalization. The objective of this study was to examine the validity and reliability of the MTWS among patients with SMI during tobacco-free psychiatric hospitalization. METHODS Reliability was tested by examining Cronbach's α and item analysis. Validity was examined through hypothesis testing and exploratory factor analysis (N = 255). RESULTS The reliability analysis yielded a Cronbach's α coefficient of .763, an inter-item correlations coefficient of .393, and item-total correlations between .291 and .691. Hypothesis testing confirmed the construct validity of the MTWS, and an exploratory factor analysis yielded a unidimensional scale. CONCLUSION The MTWS demonstrated adequate reliable and valid psychometric properties for measuring NW among patients with SMI. Nurses and other health-care professionals may use this instrument in clinical practice to identify patients with SMI experiencing NW. The MTWS is psychometrically sound for capturing NW during tobacco-free psychiatric hospitalization. Future research should examine the efficacy of the MTWS in measuring NW in this population over an extended period of hospitalization.
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Affiliation(s)
| | | | | | - Mary K Rayens
- The University of Kentucky College of Nursing, Lexington, KY, USA
| | - Ellen J Hahn
- The University of Kentucky College of Nursing, Lexington, KY, USA
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70
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Breslau J, Pritam R, Guarasi D, Horvitz-Lennon M, Finnerty M, Yu H, Leckman-Westin E. Predictors of Receipt of Physical Health Services in Mental Health Clinics. Community Ment Health J 2019; 55:1279-1287. [PMID: 30963350 PMCID: PMC7338040 DOI: 10.1007/s10597-019-00399-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 04/04/2019] [Indexed: 10/27/2022]
Abstract
To inform efforts to improve physical health care for adults with serious mental illness, this study examines predictors of provision and receipt of physical health services in freestanding mental health clinics in New York state. The number of services provided over the initial 12-months of implementation varied across clinics from 0 to 1407. Receipt of services was associated with a diagnosis of schizophrenia, frequent mental and physical health visits in the prior year, and prescription of antipsychotic medications. Additional support may also be needed to enable clinics to target patients without established patterns of frequent mental health or medical visits.
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Affiliation(s)
- Joshua Breslau
- RAND Corporation, 4570 Fifth Avenue, Pittsburgh, PA, 15213, USA.
| | - Riti Pritam
- New York State Office of Mental Health, 44 Holland Ave, Albany, NY, 12229, USA
| | - Diana Guarasi
- New York State Office of Mental Health, 44 Holland Ave, Albany, NY, 12229, USA
| | | | - Molly Finnerty
- Langone Medical Center, New York University, New York, NY, 10016, USA
| | - Hao Yu
- RAND Corporation, 4570 Fifth Avenue, Pittsburgh, PA, 15213, USA
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71
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Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C, Allan S, Caneo C, Carney R, Carvalho AF, Chatterton ML, Correll CU, Curtis J, Gaughran F, Heald A, Hoare E, Jackson SE, Kisely S, Lovell K, Maj M, McGorry PD, Mihalopoulos C, Myles H, O'Donoghue B, Pillinger T, Sarris J, Schuch FB, Shiers D, Smith L, Solmi M, Suetani S, Taylor J, Teasdale SB, Thornicroft G, Torous J, Usherwood T, Vancampfort D, Veronese N, Ward PB, Yung AR, Killackey E, Stubbs B. The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry 2019; 6:675-712. [PMID: 31324560 DOI: 10.1016/s2215-0366(19)30132-4] [Citation(s) in RCA: 750] [Impact Index Per Article: 150.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Joseph Firth
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Najma Siddiqi
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK; Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain; Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Simon Rosenbaum
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Cherrie Galletly
- Ramsay Health Care Mental Health, Adelaide, SA, Australia; Northern Adelaide Local Health Network, Adelaide, SA, Australia; Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Constanza Caneo
- Departamento de Psiquiatría, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rebekah Carney
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Andre F Carvalho
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Mary Lou Chatterton
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Christoph U Correll
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Jackie Curtis
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Fiona Gaughran
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adrian Heald
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
| | - Erin Hoare
- Food and Mood Centre, Deakin University, Melbourne, VIC, Australia
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Steve Kisely
- School of Medicine, University of Queensland, Brisbane, QLD, Australia; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Patrick D McGorry
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Hannah Myles
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Brian O'Donoghue
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Toby Pillinger
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Medical Research Council London Institute of Medical Sciences, London, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia; The Melbourne Clinic, Melbourne, VIC, Australia
| | - Felipe B Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - David Shiers
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Marco Solmi
- Neurosciences Department and Padua Neuroscience Centre, University of Padua, Padua, Italy
| | - Shuichi Suetani
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Johanna Taylor
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK
| | - Scott B Teasdale
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of General Practice, Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium; University Psychiatric Centre, Katholieke Universiteit Leuven, Kortenberg, Belgium
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Philip B Ward
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Alison R Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Townley G, Terry R, Brusilovskiy E, Snethen G, Salzer MS. Associations Between Physical Health Limitations and Community Participation Among People With and Without Serious Mental Illnesses. Psychiatr Serv 2019; 70:689-695. [PMID: 31010410 DOI: 10.1176/appi.ps.201800407] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Research has suggested that individuals with serious mental illnesses are not as physically healthy as the general population and are more likely to experience physical illnesses such as diabetes, obesity, and cardiovascular and respiratory diseases. Less is known about how physical health may be related to community participation among individuals with serious mental illnesses, although research with adults in the general population has suggested strong negative associations between health impairments and engagement in a variety of activity domains. METHODS In this study, the authors drew from two national data sets to examine the relationship between physical health impairments and community participation among 300 participants with serious mental illnesses and 300 participants without serious mental illnesses. RESULTS For participants in both groups, physical health concerns and use of mobility aids were associated with lower reported rates of community participation. CONCLUSIONS Findings shed light on the complex association between physical health impairments and community participation while also suggesting the need to focus on other potential barriers to participation among individuals with serious mental illnesses.
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Affiliation(s)
- Greg Townley
- Department of Psychology, Portland State University, Portland, Oregon (Townley, Terry); Department of Rehabilitation Sciences (Brusilovskiy, Snethen) and Department of Social and Behavioral Sciences (Salzer), Temple University, Philadelphia
| | - Rachel Terry
- Department of Psychology, Portland State University, Portland, Oregon (Townley, Terry); Department of Rehabilitation Sciences (Brusilovskiy, Snethen) and Department of Social and Behavioral Sciences (Salzer), Temple University, Philadelphia
| | - Eugene Brusilovskiy
- Department of Psychology, Portland State University, Portland, Oregon (Townley, Terry); Department of Rehabilitation Sciences (Brusilovskiy, Snethen) and Department of Social and Behavioral Sciences (Salzer), Temple University, Philadelphia
| | - Gretchen Snethen
- Department of Psychology, Portland State University, Portland, Oregon (Townley, Terry); Department of Rehabilitation Sciences (Brusilovskiy, Snethen) and Department of Social and Behavioral Sciences (Salzer), Temple University, Philadelphia
| | - Mark S Salzer
- Department of Psychology, Portland State University, Portland, Oregon (Townley, Terry); Department of Rehabilitation Sciences (Brusilovskiy, Snethen) and Department of Social and Behavioral Sciences (Salzer), Temple University, Philadelphia
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73
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Wang CH, Lee TY, Hui KC, Chung MH. Mental disorders and medical comorbidities: Association rule mining approach. Perspect Psychiatr Care 2019; 55:517-526. [PMID: 30734309 DOI: 10.1111/ppc.12362] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/28/2018] [Accepted: 01/20/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study explored the medical comorbidities of mental disorders using association rule mining. DESIGN AND METHODS Patients diagnosed with mental disorders between 2002 and 2010 were identified. An equal number of nonmental disorder subjects were randomly selected and matched with case group by age and gender. FINDINGS Sleep disorders and digestive diseases were frequent comorbidities among mental disorders. The specific medical comorbidities were diabetes mellitus, chronic liver disease, extrapyramidal diseases, disorders of stomach function, general symptoms, sleep disturbance, and family circumstances. PRACTICE IMPLICATIONS The results suggest that education of professional knowledge of comorbid conditions should be provided to nurses for caring patients with mental illnesses.
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Affiliation(s)
- Chia-Hui Wang
- Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Tzu-Yin Lee
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - King-Cheung Hui
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Min-Huey Chung
- Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
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74
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Jeleč V, Bajić Ž, Šimunović Filipčić I, Portolan Pajić I, Šentija Knežević M, Miloloža I, Radić-Krišto D, Benjak T, Jakšić N, Šagud M, Wang W, Filipčić I. Utilization of somatic healthcare in Croatian patients with schizophrenia spectrum disorder, major depression, PTSD and the general population. BMC Psychiatry 2019; 19:203. [PMID: 31253196 PMCID: PMC6599369 DOI: 10.1186/s12888-019-2190-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 06/23/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Utilization of somatic healthcare services is highly predictive of the development of chronic physical illnesses and increased mortality risks. The objective of this study was to assess the differences in healthcare utilization among patients with schizophrenia spectrum disorders (SSD), major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) and the general population in Croatia. METHODS We enrolled 566 Croatian participants from the general population, 282 with SSD, 178 with MDD, and 86 with PTSD. The primary outcome was a self-reported specialist consultation for non-psychiatric (e.g., somatic) causes within the previous 12 months. RESULTS Although SSD patients with chronic physical illnesses were significantly more often hospitalized for physical illness than the general population, the proportion of patients who had a specialist consultation were equal in SSD and the general population. MDD and PTSD patients had significantly higher adjusted odds for specialist consultation than the general population and SSD patients (MDD compared to SSD: OR = 2.14; 95% CI 1.27-3.59; PTSD compared to SSD: OR = 2.03; 95% CI 1.00-4.10). CONCLUSIONS SSD patients' utilization of somatic healthcare is equal to the general population, despite their increased healthcare needs. However, their utilization is lower than in MDD and PTSD patients and, therefore, probably not adequate. TRIAL REGISTRATION The study protocol was registered at ClinicalTrials.gov ( NCT02773108 ) on May 16, 2016.
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Affiliation(s)
- Vjekoslav Jeleč
- Department of Neurosurgery, Dubrava University Hospital, Zagreb, Croatia
- City Office for Health, Zagreb, Croatia
| | - Žarko Bajić
- Psychiatric Hospital "Sveti Ivan", Zagreb, Croatia
| | | | | | | | - Ivan Miloloža
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Delfa Radić-Krišto
- Division of Hematology, Merkur University Hospital, Zagreb, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | | | - Nenad Jakšić
- Department of Psychiatry, University Hospital Center Zagreb, Zagreb, Croatia
| | - Marina Šagud
- Department of Psychiatry, University Hospital Center Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Wei Wang
- Department of Clinical Psychology and Psychiatry, Zhejiang University College of Medicine, Hangzhou, China
| | - Igor Filipčić
- Psychiatric Hospital "Sveti Ivan", Zagreb, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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75
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Kennedy-Hendricks A, Daumit GL, Choksy S, Linden S, McGinty EE. Measuring Variation Across Dimensions of Integrated Care: The Maryland Medicaid Health Home Model. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 45:888-899. [PMID: 29696576 DOI: 10.1007/s10488-018-0871-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Despite the proliferation of initiatives to integrate services for people with serious mental illness (SMI), measures of distinct dimensions of integration, such as spatial arrangement and care team expertise, are lacking. Such measures are needed to support organizations' assessment of progress toward integrated service delivery. We developed measures characterizing integration of behavioral, somatic, and social services to operationalize the integrated care dimensions conceived by the Agency for Healthcare Research and Quality. In a survey fielded to 46 Maryland Medicaid health homes (response rate: 96%) serving adults with SMI during 2015-2016, we found that these measures provided a useful description of variation across dimensions of integration.
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Affiliation(s)
- Alene Kennedy-Hendricks
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Center for Mental Health and Addiction Policy Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Gail L Daumit
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Mental Health and Addiction Policy Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Seema Choksy
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sarah Linden
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Mental Health and Addiction Policy Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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76
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Tseng E, Dalcin AT, Jerome GJ, Gennusa JV, Goldsholl S, Cook C, Appel LJ, Maruthur NM, Daumit GL, Wang NY. Effect of a Behavioral Weight Loss Intervention in People With Serious Mental Illness and Diabetes. Diabetes Care 2019; 42:804-809. [PMID: 30765433 PMCID: PMC6489111 DOI: 10.2337/dc18-2201] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/21/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Given the high prevalence of obesity and diabetes in patients with serious mental illness (SMI) and the lack of evidence on the effects of weight loss programs in SMI patients with diabetes, we evaluated the effectiveness of a behavioral weight loss intervention among SMI participants with and without diabetes. RESEARCH DESIGN AND METHODS Using data from ACHIEVE, a randomized controlled trial to evaluate the effects of a behavioral weight loss intervention among overweight/obese people with SMI, we assessed and compared weight change from baseline to 18 months in participants with and without diabetes using a longitudinal mixed-effects model. RESULTS Of the 291 trial participants, 82 (28.2%) participants had diabetes (34 and 48 in intervention and control groups, respectively) at baseline. Participants with diabetes were more likely to be taking antipsychotics (31.7% vs. 18.7%, P = 0.02). At 18 months, participants in the control group with diabetes lost 1.2 lb (0.6%) of body weight compared with 0.8 lb (0.7%) among those without diabetes. In the intervention group, participants with diabetes lost 13.7 lb (6.6%) of their initial body weight compared with 5.4 lb (2.9%) for those without diabetes. Corresponding net effects (intervention minus control) were 4.6 lb (2.2%) and 12.5 lb (6.0%) net weight reduction over 18 months in the no diabetes and the diabetes subgroups, respectively. However, the between-group difference in intervention effects was statistically nonsignificant (absolute weight change: P-interaction = 0.08; % weight change: P-interaction = 0.10). CONCLUSIONS A behavioral weight loss intervention is effective among overweight and obese individuals with SMI regardless of their diabetes status.
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Affiliation(s)
- Eva Tseng
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD .,Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD
| | - Arlene T Dalcin
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD
| | | | - Joseph V Gennusa
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stacy Goldsholl
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Courtney Cook
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lawrence J Appel
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD.,Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Nisa M Maruthur
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD.,Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Gail L Daumit
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD.,Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Mental Health, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Nae-Yuh Wang
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD.,Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.,Department of Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
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Alexander E, McGinty EE, Wang NY, Dalcin A, Jerome GJ, Miller ER, Dickerson F, Charleston J, Young DR, Gennusa JV, Goldsholl S, Cook C, Appel LJ, Daumit GL. Effects of a behavioural weight loss intervention in people with serious mental illness: Subgroup analyses from the ACHIEVE trial. Obes Res Clin Pract 2019; 13:205-210. [PMID: 30852244 PMCID: PMC7255457 DOI: 10.1016/j.orcp.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/01/2019] [Accepted: 02/08/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Persons with serious mental illnesses (SMI) such as schizophrenia and bipolar disorder have an increased risk of obesity and related chronic diseases and die 10-20years earlier than the overall population, primarily due to cardiovascular disease. In the ACHIEVE trial, a behavioural weight loss intervention led to clinically significant weight loss in persons with SMI. As the field turns its attention to intervention scale-up, it is important to understand whether the effectiveness of behavioural weight loss interventions for people with SMI, like ACHIEVE, differ for specific subgroups. METHODS This study examined whether the effectiveness of the ACHIEVE intervention differed by participant characteristics (e.g. age, sex, race, psychiatric diagnosis, body mass index) and/or their weight-related attitudes and behaviours (e.g. eating, food preparation, and shopping habits). We used likelihood-based mixed effects models to examine whether the baseline to 18 month effects of the ACHIEVE intervention differed across subgroups. RESULTS No statistically significant differences were found in the effectiveness of the ACHIEVE intervention across any of the subgroups examined. CONCLUSIONS These findings suggest that the ACHIEVE behavioural weight loss intervention is broadly applicable to the diverse population of individuals with SMI.
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Affiliation(s)
- Eleanore Alexander
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, United States.
| | - Emma E McGinty
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, United States
| | - Nae-Yuh Wang
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, United States; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
| | - Arlene Dalcin
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
| | - Gerald J Jerome
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Department of Kinesiology, Towson University, Baltimore, MD, 21252, United States
| | - Edgar R Miller
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
| | - Faith Dickerson
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD 21204, United States
| | - Jeanne Charleston
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
| | - Deborah R Young
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91024, United States
| | - Joseph V Gennusa
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States
| | - Stacy Goldsholl
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States
| | - Courtney Cook
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
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Abstract
Schizophrenia is often accompanied by somatic comorbidities, which make the management challenge of such patients more difficult. In this study, we proposed to identify the sociodemographic and clinical factors correlating with somatic comorbidities in patients with schizophrenia to facilitate screening and prevention. It was a retrospective descriptive study of 78 schizophrenia patients in clinical remission and followed in outpatient psychiatry. In addition to the acquired records, other data were provided by the clinical and biological examinations performed for each patient. The evaluation of the therapeutic adherence was carried out using the Drug Attitude Inventory (DAI).Seventy-six patients (97.4%) had somatic comorbidities with a mean of 3.83 (± 1.81). This number increased significantly in males, older patients, couples, urban patients, and those receiving a combination therapy. According to a multivariate study, the four predictors of an increased risk of comorbidities were age, use of psychoactive substances, waist size and therapeutic adherence.Our findings focus on somatic comorbidities risk in schizophrenia patients, requiring particular vigilance in their follow-up, and suggest some modifiable clinical factors that might be a preferred target for reducing or preventing the occurrence of such disorders.
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79
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Linman S, Benjenk I, Chen J. The medical home functions of primary care practices that care for adults with psychological distress: a cross-sectional study. BMC Health Serv Res 2019; 19:21. [PMID: 30626378 PMCID: PMC6327378 DOI: 10.1186/s12913-018-3845-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 12/19/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Primary care practices are changing the way that they provide care by increasing their medical home functionality. Medical home functionality can improve access to care and increase patient-centeredness, which is essential for persons with mental health issues. This study aims to explore the degree to which medical home functions have been implemented by primary care practices that care for adults with psychological distress. METHODS Analysis of the 2015 Medical Expenditure Panel Survey Household Component and Medical Organizations Survey. This unique data set links data from a nationally representative sample of US households to the practices in which they receive primary care. This study focused on adults aged 18 and above. RESULTS As compared to adults without psychological distress, adults with psychological distress had significantly higher rates of chronic illness and poverty. Adults with psychological distress were more likely to receive care from practices that include advanced practitioners and are non-profit or hospital-based. Multivariate models that were adjusted for patient-level and practice-level characteristics indicated that adults with psychological distress are as likely to receive primary care from practices with medical home functionality, including case management, electronic health records, flexible scheduling, and PCMH certification, as adults without psychological distress. CONCLUSIONS Practices that care for adults with mental health issues have not been left behind in the transition towards medical home models of primary care. Policy makers should continue to prioritize adults with mental health issues to receive primary care through this model of delivery due to this population's great potential to benefit from improved access and care coordination. TRIAL REGISTRATION This study does not report the results of a health care intervention on human subject's participants.
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Affiliation(s)
- Shawn Linman
- School of Public Health, University of Maryland, 4200 Valley Dr #2242, College Park, MD 20742 USA
| | - Ivy Benjenk
- School of Public Health, University of Maryland, 4200 Valley Dr #2242, College Park, MD 20742 USA
| | - Jie Chen
- School of Public Health, University of Maryland, 4200 Valley Dr #2242, College Park, MD 20742 USA
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80
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McKinnon CR, Garvin JT. Weight Reduction Goal Achievement Among Veterans With Mental Health Diagnoses. J Am Psychiatr Nurses Assoc 2019; 25:257-265. [PMID: 30239250 DOI: 10.1177/1078390318800594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: Despite the use of weight management programs among veterans, the impact of mental health diagnoses on weight reduction goal achievement is unknown. AIMS: We aimed to describe the prevalence and association of mental health diagnoses with a 5% weight reduction goal achievement. METHODS: Logistic regression was used to describe the association between mental health diagnoses and weight reduction goal achievement at 6, 12, and 24 months among 402 veterans enrolled in a weight management program. RESULTS: More than 43% of veterans had a mental health diagnoses, with depressive disorders, posttraumatic stress disorder (PTSD), and substance use disorders being the most prevalent. At all three times, simply having a mental health diagnosis was not associated with weight reduction goal achievement. Specific diagnoses were associated with a greater likelihood of achieving weight reduction goals at 12 months (PTSD and Drug Use Disorder) and 24 months (Anxiety Disorder and Other Mental Health Diagnosis). CONCLUSION: The findings suggest that unhealthy weight is quite common for individuals with mental health diagnoses; however, weight reduction goal achievement may be equally likely for those with and without mental health diagnoses. The prevalence of mental health diagnoses among veterans seeking weight reduction suggests that psychiatric nurses should be aware of this common comorbidity.
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Affiliation(s)
- Caroline R McKinnon
- 1 Caroline R. McKinnon, PhD, CNS/PMH-BC, Augusta University College of Nursing, Augusta, GA, USA
| | - Jane T Garvin
- 2 Jane T. Garvin, PhD, APRN, FNP-BC, University of St. Augustine for Health Sciences, St. Augustine, FL, USA
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81
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Filipčić I, Šimunović Filipčić I, Grošić V, Bakija I, Šago D, Benjak T, Uglešić B, Bajić Ž, Sartorius N. Patterns of chronic physical multimorbidity in psychiatric and general population. J Psychosom Res 2018; 114:72-80. [PMID: 30314582 DOI: 10.1016/j.jpsychores.2018.09.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 09/24/2018] [Accepted: 09/24/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE A growing body of evidence has demonstrated the high prevalence and complexity of chronic physical multimorbidity defined as ≥2 chronic physical illness in people with psychiatric disorders. The present study aimed to assess differences in the prevalence and patterns of self-reported chronic physical illness and multimorbidity in the general and psychiatric populations. METHODS We performed a latent class analysis of 15 self-reported chronic physical illnesses on a sample of 1060 psychiatric patients and 837 participants from the general population. RESULTS Self-reported chronic physical illness and multimorbidity were significantly more prevalent in the population of psychiatric patients than in the general population (P < .001). Psychiatric patients had 27% (CI95% 24% - 30%) higher age-standardized relative risk for chronic physical illness and a 31% (CI95% 28% - 34%) higher for multimorbidity (P < .001). The number of chronic physical illnesses combinations was 52% higher in the psychiatric than in general population (255 vs 161 combinations respectively; P < .001). We identified four distinct latent classes: "Relatively healthy", "Musculoskeletal", "Hypertension and obesity", and "Complex multimorbidity" with no significant differences in the nature of multimorbidity latent classes patterns. The class "Relatively healthy" was significantly less (ARI = -25% (CI95% -30% -21%), and the class "Hypertension and obesity" was significantly more prevalent in the population of psychiatric patients (ARI = 20% (CI95% 17% - 23%). CONCLUSIONS These findings indicate that mental disorders are associated with an increased risk of a wide range of chronic physical illnesses and multimorbidity. There is an urgent need for the development of the guidelines regarding the physical healthcare of all individuals with mental disorders with multimorbidity in focus.
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Affiliation(s)
- Igor Filipčić
- Psychiatric Hospital "Sveti Ivan", Zagreb, Croatia; Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia.
| | | | | | - Ivana Bakija
- Psychiatric Hospital "Sveti Ivan", Zagreb, Croatia
| | - Daniela Šago
- Psychiatric Hospital "Sveti Ivan", Zagreb, Croatia
| | | | - Boran Uglešić
- Department of Psychiatry, University Hospital Center Split, Split, Croatia
| | - Žarko Bajić
- Psychiatric Hospital "Sveti Ivan", Zagreb, Croatia
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
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82
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Germack HD, Caron A, Solomon R, Hanrahan NP. Medical-surgical readmissions in patients with co-occurring serious mental illness: A systematic review and meta-analysis. Gen Hosp Psychiatry 2018; 55:65-71. [PMID: 30414592 DOI: 10.1016/j.genhosppsych.2018.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/07/2018] [Accepted: 09/12/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To estimate the relationship between comorbid serious mental illness (SMI) diagnosis and 30-day medical-surgical readmissions. METHODS In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) we searched five databases (2012 to 2017) to identify relevant articles on the relationship between SMI diagnosis and readmissions. We used the National Institute of Health's Quality Appraisal Tool for Observational Cohort and Cross-Sectional Studies guidelines to appraise studies and assess risk of bias. Data were narratively synthesized and a pooled random effects unadjusted odds ratio was estimated using meta-analysis. Heterogeneity was investigated using subgroup analysis and meta-regression. RESULTS Our search yielded 424 articles after removing duplicates. Nine met inclusion criteria. All studies were retrospective observational cohort studies. The meta-analysis showed that people with SMI have greater odds of readmission than people without SMI (pooled OR 1.38, CI 1.23-1.56, I2 = 98.6%). There was heterogeneity in patient cohorts, study methodology, and definition of SMI. No significant possibility of publication bias was detected (Classic fail-safe N = 3480). CONCLUSION There is a meaningful relationship between SMI diagnosis and medical-surgical readmissions. Given the prevalence of SMI in patients hospitalized for medical-surgical problems and the heterogeneity of evidence, further research on sources of variation in outcomes is critically needed.
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Affiliation(s)
- Hayley D Germack
- University of Pittsburgh, School of Nursing, Department of Acute & Tertiary Care, 3500 Victoria Street Victoria Building Room 315a, Pittsburgh, PA 15261, USA.
| | - Abigail Caron
- Northeastern University, School of Nursing, Robinson Hall 336 Huntington Ave, Boston, MA 02115, USA.
| | - Rachel Solomon
- Northeastern University, School of Nursing, Robinson Hall 336 Huntington Ave, Boston, MA 02115, USA.
| | - Nancy P Hanrahan
- University of Massachusetts Boston, College of Nursing and Health Sciences, 100 Morrissey Blvd, Boston, MA 02125, USA
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Siantz E, Henwood B, Baezcondi-Garbanati L. From Physical Wellness to Cultural Brokering: Unpacking the Roles of Peer Providers in Integrated Health Care Settings. Community Ment Health J 2018; 54:1127-1135. [PMID: 30109582 PMCID: PMC6202154 DOI: 10.1007/s10597-018-0320-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 08/07/2018] [Indexed: 11/29/2022]
Abstract
This qualitative study explored peer provider experiences working in newly integrated mental health and primary care pilot programs within a large public mental health system. Nineteen peer providers participated in semistructured interviews that focused on experiences delivering care within integrated teams. Interviews were analyzed using constant comparative methods informed by grounded theory. Findings were organized into three themes that speak to variation in the definition and function of peers; lack of clarity in the peer role; and relating to other providers. Integrated settings need ongoing support to ensure clarity in the peer role and an inclusive work environment.
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Affiliation(s)
- Elizabeth Siantz
- Department of Family Medicine and Public Health, University of California, San Diego, 9500, Gilman Drive #0622, La Jolla, CA 92093-0901,
| | - Benjamin Henwood
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 1149 S. Hill, St., 14th Floor, Los Angeles, CA 90026;
| | - Lourdes Baezcondi-Garbanati
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California; SSB 302M 2001 N. Soto Street Health Sciences Campus, Los Angeles;
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Keers RN, Plácido M, Bennett K, Clayton K, Brown P, Ashcroft DM. What causes medication administration errors in a mental health hospital? A qualitative study with nursing staff. PLoS One 2018; 13:e0206233. [PMID: 30365509 PMCID: PMC6203370 DOI: 10.1371/journal.pone.0206233] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/09/2018] [Indexed: 11/19/2022] Open
Abstract
Objective Medication administration errors (MAEs) are a common risk to patient safety in mental health hospitals, but an absence of in-depth studies to understand the underlying causes of these errors limits the development of effective remedial interventions. This study aimed to investigate the causes of MAEs affecting inpatients in a mental health National Health Service (NHS) hospital in the North West of England. Methods Registered and student mental health nurses working in inpatient psychiatric units were identified using a combination of direct advertisement and incident reports and invited to participate in semi-structured interviews utilising the critical incident technique. Interviews were designed to capture the participants’ experiences of inpatient MAEs. All interviews were transcribed verbatim and subject to framework analysis to illuminate the underlying active failures, error/violation-provoking conditions and latent failures according to Reason’s model of accident causation. Results A total of 20 participants described 26 MAEs (including 5 near misses) during the interviews. The majority of MAEs were skill-based slips and lapses (n = 16) or mistakes (n = 5), and were caused by a variety of interconnecting error/violation-provoking conditions relating to the patient, medicines used, medicines administration task, health care team, individual nurse and working environment. Some of these local conditions had origins in wider organisational latent failures. Recurrent and influential themes included inadequate staffing levels, unbalanced staff skill mix, interruptions/distractions, concerns with how the medicines administration task was approached and problems with communication. Conclusions To our knowledge this is the first published in-depth qualitative study to investigate the underlying causes of specific MAEs in a mental health hospital. Our findings revealed that MAEs may arise due to multiple interacting error and violation provoking conditions and latent ‘system’ failures, which emphasises the complexity of this everyday task facing practitioners in clinical practice. Future research should focus on developing and testing interventions which address key local and wider organisational ‘systems’ failures to reduce error.
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Affiliation(s)
- Richard N. Keers
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, MAHSC, University of Manchester, Manchester, United Kingdom
- Medicines Management Team, Greater Manchester Mental Health NHS Foundation Trust, Park House Hospital, North Manchester General Hospital, Manchester, United Kingdom
- * E-mail:
| | - Madalena Plácido
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, United Kingdom
| | - Karen Bennett
- Medicines Management Team, Greater Manchester Mental Health NHS Foundation Trust, Park House Hospital, North Manchester General Hospital, Manchester, United Kingdom
- School of Health and Human Sciences, University of Bolton, Bolton, United Kingdom
| | - Kristen Clayton
- Medicines Management Team, Greater Manchester Mental Health NHS Foundation Trust, Park House Hospital, North Manchester General Hospital, Manchester, United Kingdom
| | - Petra Brown
- Medicines Management Team, Greater Manchester Mental Health NHS Foundation Trust, Park House Hospital, North Manchester General Hospital, Manchester, United Kingdom
| | - Darren M. Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, MAHSC, University of Manchester, Manchester, United Kingdom
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Moulin A, Evans EJ, Xing G, Melnikow J. Substance Use, Homelessness, Mental Illness and Medicaid Coverage: A Set-up for High Emergency Department Utilization. West J Emerg Med 2018; 19:902-906. [PMID: 30429919 PMCID: PMC6225935 DOI: 10.5811/westjem.2018.9.38954] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/21/2018] [Accepted: 09/27/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction Frequent users of emergency departments (ED) account for 21–28% of all ED visits nationwide. The objective of our study was to identify characteristics unique to patients with psychiatric illness who are frequent ED users for mental health care. Understanding unique features of this population could lead to better care and lower healthcare costs. Methods This retrospective analysis of adult ED visits for mental healthcare from all acute care hospitals in California from 2009–2014 used patient-level data from California’s Office of Statewide Health Planning and Development. We calculated patient demographic and visit characteristics for patients with a primary diagnosis of a mental health disorder as a percentage of total adult ED visits. Frequent ED users were defined as patients with more than four visits in a 12-month period. We calculated adjusted rate ratios (aRR) to assess the association between classification as an ED frequent user and patient age, sex, payer, homelessness, and substance use disorder. Results In the study period, 846,867 ED visits for mental healthcare occurred including 238,892 (28.2%) visits by frequent users. Patients with a primary mental health diagnosis and a co-occurring substance use diagnosis in the prior 12 months (77% vs. 37%, aRR [4.02], 95% confidence interval [CI] [3.92–4.12]), homelessness (2.9% vs 1.1%, odds ratio [1.35], 95% [CI] [1.27–1.43]) were more likely to be frequent users. Those covered by Medicare (aRR [3.37], 95% CI [3.20–3.55]) or the state’s Medicaid program Medi-Cal (aRR [3.10], 95% CI [2.94–3.25]) were also more likely to be frequent users compared with those with private insurance coverage. Conclusion Patients with substance use disorders, homelessness and public healthcare coverage are more likely to be frequent users of EDs for mental illness. Substance use and housing needs are important factors to address in this population.
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Affiliation(s)
- Aimee Moulin
- University of California, Davis, Department of Emergency Medicine, Department of Psychiatry, Davis, California
| | - Ethan J Evans
- University of California, Davis, Center for Healthcare Policy and Research, Davis, California
| | - Guibo Xing
- University of California, Davis, Center for Healthcare Policy and Research, Davis, California
| | - Joy Melnikow
- University of California, Davis, Center for Healthcare Policy and Research, Davis, California.,University of California, Davis, Department of Family and Community Medicine, Davis, California
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86
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Brown C, Geiszler LC, Lewis KJ, Arbesman M. Effectiveness of Interventions for Weight Loss for People With Serious Mental Illness: A Systematic Review and Meta-Analysis. Am J Occup Ther 2018; 72:7205190030p1-7205190030p9. [PMID: 30157007 DOI: 10.5014/ajot.2018.033415] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We examined the effectiveness of weight loss interventions in community-based settings for people with serious mental illness (SMI). METHOD Four databases were searched for randomized controlled trials published in 2008 or later that met the criteria for the research question and used weight loss as an outcome measure. Data were extracted, and weight loss was analyzed using a meta-analysis. Similarities and differences in interventions were analyzed qualitatively. RESULTS Seventeen studies and a total of 1,874 participants with various diagnoses of SMI were included in the meta-analysis. The various lifestyle-focused interventions had a significant effect on weight loss with an overall effect size of -0.308 (p < .001). CONCLUSION Community-based interventions for people with SMI are effective for weight loss. Occupational therapists can be involved in the provision of weight loss interventions and in the development and study of intervention components that are most effective.
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Affiliation(s)
- Catana Brown
- Catana Brown, PhD, OTR/L, FAOTA, is Professor, Midwestern University-Glendale, Glendale, AZ;
| | - Lydia C Geiszler
- Lydia C. Geiszler, MOT, OTR/L, is Occupational Therapist, Mayo Clinic Hospital, Saint Mary's Campus, Rochester, MN
| | - Kelsie J Lewis
- Kelsie J. Lewis, MOT, OTR/L, is Occupational Therapist, Carondelet St. Mary's, Tucson, AZ
| | - Marian Arbesman
- Marian Arbesman, PhD, OTR/L, FAOTA, is Adjunct Associate Professor, Department of Clinical Research and Leadership, George Washington University School of Medicine and Health Sciences, Washington, DC, and President, ArbesIdeas, Inc., Williamsville, NY
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87
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Burden of Schizophrenia or Psychosis-Related Symptoms in Adults Undergoing Substance Abuse Evaluation. J Nerv Ment Dis 2018; 206:528-536. [PMID: 29905667 DOI: 10.1097/nmd.0000000000000835] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study evaluated the biopsychosocial characteristics of adults undergoing substance abuse evaluation with potential schizophrenia/psychotic disorder, or possible schizophrenia/psychosis-like symptoms, compared with those with no schizophrenia/psychosis-like symptoms. A cross-sectional, observational study examined 170,201 adults, aged 18 to 30, who completed the Addiction Severity Index-Multimedia Version (ASI-MV). Approximately 10% were classified as having possible schizophrenia/psychosis-like symptoms or potential schizophrenia/psychotic disorder. These patients were more likely to exhibit moderate to extreme severity on employment, medical, legal, substance use, social, and psychiatric status than nonsymptomatic patients. The potential schizophrenia or psychotic disorder cohort was also more likely to have ever experienced physical abuse (odds ratio [OR] = 4.30, 95% confidence interval [CI] = 4.12-4.48) and/or sexual abuse (OR = 4.32, 95% CI = 4.15-4.51) versus the no schizophrenia/psychosis-like symptoms cohort. Findings support a recommendation for routine screening for mental health issues, particularly schizophrenia/psychosis-like symptoms, for adults entering substance use disorder treatment settings. This may increase the likelihood of appropriate and earlier intervention.
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88
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Taylor C, Fertal JC, Liao S. Refractory Schizophrenia, Attempted Suicide, and Withdrawal of Life Support: A Clinical Ethics Case Report. J Pain Symptom Manage 2018; 56:153-157. [PMID: 29496535 DOI: 10.1016/j.jpainsymman.2018.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 02/16/2018] [Accepted: 02/19/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Withdrawal of life support for an individual with refractory schizophrenia after attempted suicide remains controversial. Discussion regarding prognosis of mental illness and the distinction between somatic and mental illness brings out many ethical issues. This article will examine the role and weight of severe persistent mental illness in the withdrawal of life support after attempted suicide. CASE DESCRIPTION A 30-year-old gentleman with deafness and schizophrenia was admitted with multiple self-inflicted visceral stab wounds. He developed postoperative complications necessitating ongoing critical care. The parties involved were as follows: the patient, his parents, the critical care trauma service, the palliative and psychiatry consult services, and the ethics committee. Over the patient's hospital course, his parents struggled to reconcile his poor preinjury quality of life with his ongoing need for intensive medical intervention. The primary and consulting teams were required to integrate differing perspectives on the patient's past responsiveness to treatment and the extent to which additional efforts might advance his quality of life and limit his future suffering and suicidality. The patient's surrogate decision makers unanimously requested withdrawal of life support. An ethics committee convened to address the question of whether refractory schizophrenia can produce so poor a quality of life as to merit the withdrawal of life-sustaining measures after a suicide attempt. Consensus was achieved, and life-sustaining measures were subsequently withdrawn, allowing the patient to pass away peacefully in an inpatient hospice facility.
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Affiliation(s)
- Cory Taylor
- University of Kansas School of Medicine, Kansas City, Kansas, USA.
| | | | - Solomon Liao
- UC Irvine Medical Center, Orange, California, USA
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89
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Lycett K, McNamara C, Mensah FK, Burgner D, Kerr JA, Muller J, Wake M. Associations of mental health with cardiovascular risk phenotypes and adiposity in adolescence: A cross-sectional community-based study. J Paediatr Child Health 2018; 54:677-684. [PMID: 29779266 DOI: 10.1111/jpc.13943] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 03/21/2018] [Indexed: 12/20/2022]
Abstract
AIM Cardiovascular disease and mental illness commonly co-occur in later life, but it is unknown how early these associations arise. We aimed to determine the extent to which: (i) childhood mental health is associated with functional and structural cardiovascular risk phenotypes and adiposity in late childhood/adolescence, and (ii) associations between mental health and cardiovascular phenotypes may be explained by differential body mass index. METHODS This cross-sectional study drew on three longitudinal community-based cohort studies (two enriched for overweight/obesity) in metropolitan Melbourne, Australia, with harmonized follow-up in 2014. Mental health exposures included emotional and behavioural problems (Strength and Difficulties Questionnaire) and psychosocial health and general well-being (Pediatric Quality of Life Inventory (PedsQL)), which were assessed by self- and parent-proxy report. Cardiovascular risk phenotypes and adiposity measures included mean arterial pressure, pulse wave velocity, carotid artery intima-media thickness, retinal arterioleto-venule ratio, waist circumference, % body fat, and BMI z-score. We used multivariable linear regression models, adjusting for age, sex and neighbourhood disadvantage, to examine associations. RESULTS Of the 364 participants (mean age 14.7, standard deviation 2.0, years), 30% were overweight and 16% obese. All adiposity indicators were positively associated with higher behavioural/emotional problems and poorer psychosocial health and negatively associated with better ratings of positive general well-being, as reported by parents and children (all P ≤ 0.03). However, there was little evidence that cardiovascular functional or structural phenotypes varied by mental health. CONCLUSIONS By late childhood/adolescence, mental health is strongly associated with adiposity but not with cardiovascular structure or function. This suggests that the known relationship between these constructs may not develop until early or mid-adulthood.
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Affiliation(s)
- Kate Lycett
- Community Health Services Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Clare McNamara
- Community Health Services Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Fiona K Mensah
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Clinical Epidemiology and Biostatistics Unit, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - David Burgner
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Jessica A Kerr
- Community Health Services Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Josh Muller
- Community Health Services Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Melissa Wake
- Community Health Services Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Department of Paediatrics, Liggins Institute, University of Auckland, Auckland, New Zealand
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90
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Dickerson F, Origoni A, Schroeder J, Adamos M, Katsafanas E, Khushalani S, Savage CLG, Schweinfurth LAB, Stallings C, Sweeney K, Yolken R. Natural cause mortality in persons with serious mental illness. Acta Psychiatr Scand 2018; 137:371-379. [PMID: 29603145 DOI: 10.1111/acps.12880] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To identify the determinants of natural cause mortality in a cohort of individuals with serious mental illness assessed prospectively. METHOD Persons with schizophrenia (n = 789) and bipolar disorder (n = 498), mean age of 38 (s.d. 12.6) years, underwent an in-person clinical assessment. They also had a blood sample drawn from which infectious disease markers were measured. Mortality was subsequently determined utilizing data from the National Death Index following a period of up to 16.9 years. RESULTS A total of 6.8% (87 of 1287) of persons died of natural causes. Mortality was predicted in a multivariate model by baseline cigarette smoking (RR = 6.29, 95% CI 1.41, 3.72, P = 0.00076); divorced or widowed status (RR = 1.90, CI 1.21, 2.99); reduced cognitive score (RR = 0.73, CI 0.61, 0.87); receipt of antidepressant medication (RR = 1.74, CI 1.12, 2.71); elevated levels of antibodies to Epstein-Barr virus (EBV) (RR = 1.29, CI 1.01, 1.66); and a genitourinary (RR = 1.82, CI 1.16, 2.86), respiratory (RR = 1.82, CI 1.16, 2.86), or cardiac (RR = 2.09, CI 1.33, 3.29) condition. There was an additive effect of smoking and both a cardiac and a respiratory condition but not elevated EBV antibody levels. CONCLUSION Smoking is a modifiable behaviour which is associated with mortality in this population.
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Affiliation(s)
- F Dickerson
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - A Origoni
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - J Schroeder
- Schroeder Statistical Consulting, Ellicott City, MD, USA
| | - M Adamos
- Congruent Counseling Services, Columbia, MD, USA
| | - E Katsafanas
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - S Khushalani
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - C L G Savage
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - L A B Schweinfurth
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - C Stallings
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - K Sweeney
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD, USA
| | - R Yolken
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
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91
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Druss BG, Singh M, von Esenwein SA, Glick GE, Tapscott S, Tucker SJ, Lally CA, Sterling EW. Peer-Led Self-Management of General Medical Conditions for Patients With Serious Mental Illnesses: A Randomized Trial. Psychiatr Serv 2018; 69:529-535. [PMID: 29385952 PMCID: PMC5930018 DOI: 10.1176/appi.ps.201700352] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Individuals with serious mental illnesses have high rates of general medical comorbidity and challenges in managing these conditions. A growing workforce of certified peer specialists is available to help these individuals more effectively manage their health and health care. However, few studies have examined the effectiveness of peer-led programs for self-management of general medical conditions for this population. METHODS This randomized study enrolled 400 participants with a serious mental illness and one or more chronic general medical conditions across three community mental health clinics. Participants were randomly assigned to the Health and Recovery Peer (HARP) program, a self-management program for general medical conditions led by certified peer specialists (N=198), or to usual care (N=202). Assessments were conducted at baseline and three and six months. RESULTS At six months, participants in the intervention group demonstrated a significant differential improvement in the primary study outcome, health-related quality of life. Specifically, compared with the usual care group, intervention participants had greater improvement in the Short-Form Health Survey physical component summary (an increase of 2.7 versus 1.4 points, p=.046) and mental component summary (4.6 versus 2.5 points, p=.039). Significantly greater six-month improvements in mental health recovery were seen for the intervention group (p=.02), but no other between-group differences in secondary outcome measures were significant. CONCLUSIONS The HARP program was associated with improved physical health- and mental health-related quality of life among individuals with serious mental illness and comorbid general medical conditions, suggesting the potential benefits of more widespread dissemination of peer-led disease self-management in this population.
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Affiliation(s)
- Benjamin G Druss
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Manasvini Singh
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Silke A von Esenwein
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Gretl E Glick
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Stephanie Tapscott
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Sherry Jenkins Tucker
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Cathy A Lally
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Evelina W Sterling
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
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92
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McNamara B, Same A, Rosenwax L, Kelly B. Palliative care for people with schizophrenia: a qualitative study of an under-serviced group in need. BMC Palliat Care 2018; 17:53. [PMID: 29580230 PMCID: PMC5870335 DOI: 10.1186/s12904-018-0309-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 03/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background People with schizophrenia are at risk of receiving poorer end of life care than other patients. They are often undertreated, avoid treatment and are about half as likely to access palliative care. There are limited options for end of life care for this under-serviced group in need. This study aims to address the paucity of research by documenting possible need, experiences of health care service use and factors affecting palliative care use for people with schizophrenia who have advanced life limiting illness. Methods Semi-structured interviews were undertaken with 16 experienced health professionals caring for people with schizophrenia in Western Australia. The interviews focussed on their perceptions and experiences of end of life care, their patients’ unmet needs, palliative care options, and suggested services to support this vulnerable group and improve health care provision. The research used a qualitative design and thematic analyses. Results The participants all advocated strongly for their patients and recognised their extreme vulnerability. They identified a range of challenges and unmet needs experienced by people with schizophrenia at the end of life including: illness factors such as the impact of schizophrenia on information processing and communication; social factors such as stigma, isolation and the absence of a carer; and health care factors such as late diagnosis, delayed access to care, and mismanagement in care. Four themes were organised into two domains with the first exploring the individual and social circumstances of people with schizophrenia, including the challenges they experience in the health care system. The second domain covers themes that discuss barriers and facilitators to people with schizophrenia receiving palliative care and key features in palliative care provision, including recognising declining health, communication and planning, and collaboration and capacity building in the broader health, mental health and palliative care sectors. Conclusions To ensure people with schizophrenia are well supported at the end of life a model of palliative care is required that offers both specialised services and capacity building within the pre-existing health workforce. Resources are needed to address the stigma and lack of services faced by this vulnerable group.
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Affiliation(s)
- Beverley McNamara
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Kent Street, Bentley, WA, Australia.
| | - Anne Same
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Kent Street, Bentley, WA, Australia
| | - Lorna Rosenwax
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Kent Street, Bentley, WA, Australia
| | - Brian Kelly
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, Australia
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93
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Warren KR, Wehring HJ, Liu F, McMahon RP, Chen S, Chester C, Kelly DL. Effects of intranasal oxytocin on satiety signaling in people with schizophrenia. Physiol Behav 2018. [PMID: 29524451 DOI: 10.1016/j.physbeh.2018.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Overweight and obesity in schizophrenia are prevalent, affecting half to three-quarters of people with schizophrenia. Hyperphagia and increased meal size have also been implicated as significant contributors to the weight gain problem. Oxytocin has shown to play a role in appetite control in humans and is considered an anorexigenic peptide. This two-day, within-subjects, challenge study involved the examination of satiety after administration of 24 IU oxytocin (intranasal) vs. placebo in participants with a DSM-IV diagnosis of schizophrenia (N = 16). Self reported satiety along with a preload-test meal paradigm were utilized as well as related laboratory measures (insulin, glucose, and leptin), and measures of taste and smell. There were no statistically significant differences between the groups on self-reported satiety or test meal consumption, insulin or glucose levels, or sensory measures. A significant treatment difference was found (F = 5.22, df = 1,97.6, p = 0.025), with a decrease in leptin in the oxytocin group post-administration, but no time effect (F = 1.67, df = 6,95.1, p = 0.180) or treatment by time interaction (F = 1.36. df = 3,4.16, p = 0.261). Despite the small sample and mostly negative findings, we encourage more work to use higher and repeated doses of oxytocin, and to further examine the effect of oxytocin on leptin in schizophrenia as this may be important for understanding both weight control and psychopathology.
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Affiliation(s)
- Kimberly R Warren
- Maryland Psychiatric Research Center, University of Maryland, School of Medicine, PO Box 21247, Baltimore, MD 21228, United States; Morgan State University, Department of Psychology, 1700 East Cold Spring Lane, Baltimore, MD 21215, United States
| | - Heidi J Wehring
- Maryland Psychiatric Research Center, University of Maryland, School of Medicine, PO Box 21247, Baltimore, MD 21228, United States
| | - Fang Liu
- Maryland Psychiatric Research Center, University of Maryland, School of Medicine, PO Box 21247, Baltimore, MD 21228, United States
| | - Robert P McMahon
- Maryland Psychiatric Research Center, University of Maryland, School of Medicine, PO Box 21247, Baltimore, MD 21228, United States
| | - Shuo Chen
- Maryland Psychiatric Research Center, University of Maryland, School of Medicine, PO Box 21247, Baltimore, MD 21228, United States
| | - Charlene Chester
- Morgan State University, Department of Psychology, 1700 East Cold Spring Lane, Baltimore, MD 21215, United States
| | - Deanna L Kelly
- Maryland Psychiatric Research Center, University of Maryland, School of Medicine, PO Box 21247, Baltimore, MD 21228, United States.
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Breslau J, Leckman-Westin E, Yu H, Han B, Pritam R, Guarasi D, Horvitz-Lennon M, Scharf DM, Pincus HA, Finnerty MT. Impact of a Mental Health Based Primary Care Program on Quality of Physical Health Care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 45:276-285. [PMID: 28884234 PMCID: PMC6443568 DOI: 10.1007/s10488-017-0822-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We examine the impact of mental health based primary care on physical health treatment among community mental health center patients in New York State using propensity score adjusted difference in difference models. Outcomes are quality indicators related to outpatient medical visits, diabetes HbA1c monitoring, and metabolic monitoring of antipsychotic treatment. Results suggest the program improved metabolic monitoring for patients on antipsychotics in one of two waves, but did not impact other quality indicators. Ceiling effects may have limited program impacts. More structured clinical programs to may be required to achieve improvements in quality of physical health care for this population.
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Affiliation(s)
- Joshua Breslau
- RAND Corporation, 4570 Fifth Avenue, Pittsburgh, PA, 15213, USA.
| | | | - Hao Yu
- RAND Corporation, 4570 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Bing Han
- RAND Corporation, 1776 Main St., Santa Monica, CA, 90401, USA
| | - Riti Pritam
- New York State Office of Mental Health, 44 Holland Ave, Albany, NY, 12229, USA
| | - Diana Guarasi
- New York State Office of Mental Health, 44 Holland Ave, Albany, NY, 12229, USA
| | | | - Deborah M Scharf
- Faculty of Education, Lakehead University, 500 University Avenue, Orillia, ON, L3V 0B9, Canada
| | - Harold A Pincus
- Department of Psychiatry, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Molly T Finnerty
- New York State Office of Mental Health, 330 5th Ave, 9th floor, New York, NY, 10001, USA
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95
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Analyzing the genes related to nicotine addiction or schizophrenia via a pathway and network based approach. Sci Rep 2018; 8:2894. [PMID: 29440730 PMCID: PMC5811491 DOI: 10.1038/s41598-018-21297-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/31/2018] [Indexed: 01/02/2023] Open
Abstract
The prevalence of tobacco use in people with schizophrenia is much higher than in general population, which indicates a close relationship between nicotine addiction and schizophrenia. However, the molecular mechanism underlying the high comorbidity of tobacco smoking and schizophrenia remains largely unclear. In this study, we conducted a pathway and network analysis on the genes potentially associated with nicotine addiction or schizophrenia to reveal the functional feature of these genes and their interactions. Of the 276 genes associated with nicotine addiction and 331 genes associated with schizophrenia, 52 genes were shared. From these genes, 12 significantly enriched pathways associated with both diseases were identified. These pathways included those related to synapse function and signaling transduction, and drug addiction. Further, we constructed a nicotine addiction-specific and schizophrenia-specific sub-network, identifying 11 novel candidate genes potentially associated with the two diseases. Finally, we built a schematic molecular network for nicotine addiction and schizophrenia based on the results of pathway and network analysis, providing a systematic view to understand the relationship between these two disorders. Our results illustrated that the biological processes underlying the comorbidity of nicotine addiction and schizophrenia was complex, and was likely induced by the dysfunction of multiple molecules and pathways.
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Björk Brämberg E, Torgerson J, Norman Kjellström A, Welin P, Rusner M. Access to primary and specialized somatic health care for persons with severe mental illness: a qualitative study of perceived barriers and facilitators in Swedish health care. BMC FAMILY PRACTICE 2018; 19:12. [PMID: 29316894 PMCID: PMC5759233 DOI: 10.1186/s12875-017-0687-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 12/08/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Persons with severe mental illness (e.g. schizophrenia, bipolar disorder) have a high prevalence of somatic conditions compared to the general population. Mortality data in the Nordic countries reveal that these persons die 15-20 years earlier than the general population. Some factors explaining this high prevalence may be related to the individuals in question; others arise from the health care system's difficulty in offering somatic health care to these patient groups. The aim of the present study was therefore to explore the experiences and views of patients, relatives and clinicians regarding individual and organizational factors which facilitate or hinder access to somatic health care for persons with severe mental illness. METHODS Flexible qualitative design. Data was collected by means of semi-structured individual interviews with patients with severe mental illness, relatives and clinicians representing primary and specialized health care. In all, 50 participants participated. RESULTS The main barrier to accessing somatic care is the gap between the organization of the health care system and the patients' individual health care needs. This is observed at both individual and organizational level. The health care system seems unable to support patients with severe mental illness and their psychiatric-somatic comorbidity. The main facilitators are the links between severe mental illness patients and medical departments. These links take the form of functions (i.e. systems which ensure that patients receive regular reminders), or persons (i.e. professional contacts who facilitate patients' access the health care). CONCLUSIONS Health care services for patients with severe mental illness need reorganization. Organizational structures and systems that facilitate cooperation between different departments must be put in place, along with training for health care professionals about somatic disease among psychiatric patients. The links between individual and organizational levels could be strengthened by introducing professional contacts, such as liaison physicians and case managers. This is also important to reduce stress and responsibility among relatives.
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Affiliation(s)
- Elisabeth Björk Brämberg
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska institutet, 171 77, Stockholm, Sweden. .,Närhälsan Eriksberg Primary Health Care Centre, Sjöporten 4, 417 64, Göteborg, Sweden.
| | - Jarl Torgerson
- Department of Psychosis, Sahlgrenska University Hospital, 431 80, Mölndal, Sweden
| | - Anna Norman Kjellström
- Department of Data Management and Analysis, Head Office, Region Västra Götaland, 541 80, Skövde, Sweden
| | - Peder Welin
- Centre for Equity in Health, Region Västra Götaland, Regionens Hus, 405 44, Göteborg, Sweden
| | - Marie Rusner
- Department of Research, Södra Älvsborgs Hospital, Brämhultsvägen 52, 501 82, Borås, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, 405 30, Gothenburg, Sweden
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97
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McGinty EE, Gudzune KA, Dalcin A, Jerome GJ, Dickerson F, Gennusa J, Goldsholl S, Young D, Daumit GL. Bringing an Effective Behavioral Weight Loss Intervention for People With Serious Mental Illness to Scale. Front Psychiatry 2018; 9:604. [PMID: 30515109 PMCID: PMC6256009 DOI: 10.3389/fpsyt.2018.00604] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/29/2018] [Indexed: 11/23/2022] Open
Abstract
People with serious mental illnesses (SMIs) die 10-20 years earlier than the general population, mainly due to cardiovascular disease. Obesity is a key driver of cardiovascular risk in this group. Because behavioral weight loss interventions tailored to the needs of people with SMI have been shown to lead to clinically significant weight loss, achieving widespread implementation of these interventions is a public health priority. In this Perspective, we consider strategies for scaling the ACHIEVE behavioral weight loss intervention for people with SMI, shown to be effective in a randomized clinical trial (RCT), to mental health programs in the U.S. and internationally. Given the barriers to high-fidelity implementation of the complex, multi-component ACHIEVE intervention in often under-resourced mental health programs, we posit that substantial additional work is needed to realize the full public health potential of this intervention for people with SMI. We discuss considerations for successful "scale-up," or efforts to expand ACHIEVE to similar settings and populations as those included in the RCT, and "scale-out," or efforts to expand the intervention to different mental health program settings/sub-populations with SMI. For both, we focus on considerations related (1) intervention adaptation and (2) implementation strategy development, highlighting four key domains of implementation strategies that we believe need to be developed and tested: staff capacity building, leadership engagement, organizational change, and policy strategies. We conclude with discussion of the types of future research needed to support ACHIEVE scale-up/out, including hybrid trial designs testing the effectiveness of intervention adaptations and/or implementations strategies.
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Affiliation(s)
- Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kimberly A Gudzune
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Arlene Dalcin
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Gerald J Jerome
- Department of Kinesiology, Towson University, Towson, MD, United States
| | | | - Joseph Gennusa
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Stacy Goldsholl
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Deborah Young
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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98
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Breslau J, Leckman-Westin E, Han B, Pritam R, Guarasi D, Horvitz-Lennon M, Scharf D, Finnerty M, Yu H. Impact of a mental health based primary care program on emergency department visits and inpatient stays. Gen Hosp Psychiatry 2018; 52:8-13. [PMID: 29475010 PMCID: PMC5936476 DOI: 10.1016/j.genhosppsych.2018.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/10/2018] [Accepted: 02/14/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Integrating primary care services into specialty mental health clinics has been proposed as a method for improving health care utilization for medical conditions by adults with serious mental illness. This paper examines the impact of a mental health based primary care program on emergency department (ED) visits and hospitalizations. METHOD The program was implemented in seven New York City outpatient mental health clinics in two waves. Medicaid claims were used to identify patients treated in intervention clinics and a control group of patients treated in otherwise similar clinics in New York City. Impacts of the program were estimated using propensity score adjusted difference-in-differences models on a longitudinally followed cohort. RESULTS Hospital stays for medical conditions increased significantly in intervention clinics relative to control clinics in both waves (ORs = 1.21 (Wave 1) and 1.33 (Wave 2)). ED visits for behavioral health conditions decreased significantly relative to controls in Wave 1 (OR = 0.89), but not in Wave 2. No other significant differences in utilization trends between the intervention and control clinics were found. CONCLUSION Introducing primary care services into mental health clinics may increase utilization of inpatient services, perhaps due to newly identified unmet medical need in this population.
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Affiliation(s)
- Joshua Breslau
- RAND Corporation, 4570 Fifth Avenue, Suite, Pittsburgh, PA 15213, USA.
| | | | - Bing Han
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA.
| | - Riti Pritam
- New York State Office of Mental Health, 44 Holland Ave, Albany, NY 12229, USA.
| | - Diana Guarasi
- New York State Office of Mental Health, 44 Holland Ave, Albany, NY 12229, USA.
| | | | - Deborah Scharf
- Lakehead University, Faculty of Education, 500 University Avenue, Orillia, ON L3V 0B9 Canada
| | - Molly Finnerty
- New York University, Langone Medical Center, New York, NY 10016 USA
| | - Hao Yu
- RAND Corporation, 4570 Fifth Avenue, Suite, Pittsburgh, PA 15213, USA.
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99
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Panchaud A, Hernandez-Diaz S, Freeman MP, Viguera AC, MacDonald SC, Sosinsky AZ, Cohen LS. Use of atypical antipsychotics in pregnancy and maternal gestational diabetes. J Psychiatr Res 2017; 95:84-90. [PMID: 28810177 DOI: 10.1016/j.jpsychires.2017.07.025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/24/2017] [Accepted: 07/27/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Second generation antipsychotic medications (SGAs) are widely used by reproductive-age women to treat a number of psychiatric illnesses. Some SGAs have been associated with an increased risk of developing diabetes, although information regarding their diabetogenic effect in pregnant women is scarce. OBJECTIVE To evaluate the risk of gestational diabetes (GDM) among women treated with SGA. METHOD The Massachusetts General Hospital (MGH) National Pregnancy Registry for Atypical Antipsychotics (NPRAA) collects data on drug use, pregnancy outcomes, and other characteristics from pregnant women, ages 18-45 years, using 3 phone interviews conducted at (1) enrollment during pregnancy, (2) 7 months' gestation, and (3) 2-3 months postpartum. Information on GDM was abstracted from obstetric and delivery medical records. The study population was restricted to women without pre-gestational diabetes. Pregnancies exposed to SGAs during the first trimester were compared with a reference group of women with psychiatric conditions but not treated with SGAs during pregnancy. Generalized linear models were used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) for GDM. RESULTS Of 303 women exposed to SGAs, 33 (10.9%) had GDM compared to 16 (10.7%) in the 149 non-exposed women. The crude OR of GDM for SGA was 1.02 (95% CI, 0.54-1.91). After adjustment for maternal age, race, marital status, employment status, level of education, smoking, and primary psychiatric diagnosis, the OR moved to 0.79 (0.40-1.56). CONCLUSIONS Findings did not suggest an increased risk of GDM associated with exposure to SGAs during pregnancy in women who had used SGA before pregnancy without developing diabetes, compared to psychiatrically ill women who were not exposed to SGA. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01246765.
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Affiliation(s)
- Alice Panchaud
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, USA.
| | - Sonia Hernandez-Diaz
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, USA
| | - Marlene P Freeman
- Ammon-Pinizzotto Center for Women's Mental Health, Department of Psychiatry Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Adele C Viguera
- Ammon-Pinizzotto Center for Women's Mental Health, Department of Psychiatry Massachusetts General Hospital, Harvard Medical School, Boston, USA; Cleveland Clinic, Cleveland Clinic Neurological Institute, Cleveland, OH, USA
| | - Sarah C MacDonald
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, USA
| | - Alexandra Z Sosinsky
- Ammon-Pinizzotto Center for Women's Mental Health, Department of Psychiatry Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Lee S Cohen
- Ammon-Pinizzotto Center for Women's Mental Health, Department of Psychiatry Massachusetts General Hospital, Harvard Medical School, Boston, USA
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100
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Dysregulation of glucose metabolism since young adulthood increases the risk of cardiovascular diseases in patients with bipolar disorder. Kaohsiung J Med Sci 2017; 33:630-636. [PMID: 29132553 DOI: 10.1016/j.kjms.2017.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/04/2017] [Accepted: 07/21/2017] [Indexed: 11/23/2022] Open
Abstract
Aging patients with bipolar disorder (BD) are at a high risk of cardiovascular diseases (CVDs). However, few studies have directly examined the association between metabolic risks and CVDs in patients with BD across the lifespan. Therefore, the aim of this study was to determine lifetime metabolic risk factors for CVDs in patients with BD. We recruited BD-I patients who were more than 50 years old and had had at least one psychiatric hospitalization. Patients who had a cardiologist-confirmed CVD diagnosis (ICD-9 code 401-414) were assigned to the case group. Fifty-five cases were matched with 55 control patient without CVDs based on age and sex. Clinical data were obtained by retrospectively reviewing 30 years of hospital records. Compared to control subjects, a significantly higher proportion of cases had impaired fasting glucose between ages 31 and 40 (44.0% versus 17.4%, p = 0.046), diabetes mellitus between ages 41 and 50 (25.6% versus 8.6%, p = 0.054), and diabetes mellitus after age 51 (36.3% versus 12.7%, p = 0.005). No significant difference was found in overweight, obesity, or dyslipidemia. After adjusting for years of education, first episode as mania, and second generation antipsychotic use, lifetime diabetes mellitus remained a risk factor for CVDs (OR = 4.45, 95% CI = 1.89-10.66, p = 0.001). The findings suggest that glucose dysregulation across the adult age span is probably the major metabolic risk contributing to CVDs in patients with BD. Clinicians therefore have to notice the serum fasting glucose levels of BD patients since young adulthood.
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