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Erickson ZD, Kwan CL, Gelberg HA, Arnold IY, Chamberlin V, Rosen JA, Shah C, Nguyen CT, Hellemann G, Aragaki DR, Kunkel CF, Lewis MM, Sachinvala N, Sonza PA, Pierre JM, Ames D. A Randomized, Controlled Multisite Study of Behavioral Interventions for Veterans with Mental Illness and Antipsychotic Medication-Associated Obesity. J Gen Intern Med 2017; 32:32-39. [PMID: 28271424 PMCID: PMC5359155 DOI: 10.1007/s11606-016-3960-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Weight gain and other metabolic sequelae of antipsychotic medications can lead to medication non-adherence, reduced quality of life, increased costs, and premature mortality. Of the approaches to address this, behavioral interventions are less invasive, cost less, and can result in sustained long-term benefits. OBJECTIVE We investigated behavioral weight management interventions for veterans with mental illness across four medical centers within the Veterans Affairs (VA) Healthcare System. DESIGN We conducted a 12-month, multi-site extension of our previous randomized, controlled study, comparing treatment and control groups. PARTICIPANTS Veterans (and some non-veteran women) diagnosed with mental illness, overweight (defined as having a BMI over 25), and required ongoing antipsychotic therapy. INTERVENTIONS One group received "Lifestyle Balance" (LB; modified from the Diabetes Prevention Program) consisting of classes and individual nutritional counseling with a dietitian. A second group received less intensive "Usual Care" (UC) consisting of weight monitoring and provision of self-help. MAIN MEASURES Participants completed anthropometric and nutrition assessments weekly for 8 weeks, then monthly. Psychiatric, behavioral, and physical assessments were conducted at baseline and months 2, 6, and 12. Metabolic and lipid laboratory tests were performed quarterly. KEY RESULTS Participants in both groups lost weight. LB participants had a greater decrease in average waist circumference [F(1,1244) = 11.9, p < 0.001] and percent body fat [F(1,1121) = 4.3, p = 0.038]. Controlling for gender yielded statistically significant changes between groups in BMI [F(1,1246) = 13.9, p < 0.001]. Waist circumference and percent body fat decreased for LB women [F(1,1243) = 22.5, p < 0.001 and F(1,1221) = 4.8, p = 0.029, respectively]. The majority of LB participants kept food and activity journals (92%), and average daily calorie intake decreased from 2055 to 1650 during the study (p < 0.001). CONCLUSIONS Behavioral interventions specifically designed for individuals with mental illness can be effective for weight loss and improve dietary behaviors. "Lifestyle Balance" integrates well with VA healthcare's patient-centered "Whole Health" approach. ClinicalTrials.gov identifier NCT01052714.
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Affiliation(s)
- Zachary D Erickson
- Research Service at VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Crystal L Kwan
- Research Service at VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Hollie A Gelberg
- Research Service at VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Irina Y Arnold
- Research Service at VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Valery Chamberlin
- Mental Health Service at VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. B151H, Los Angeles, CA, 90073, USA
- David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA
| | - Jennifer A Rosen
- Department of Pharmacy at VA Northern California Healthcare System, Martinez, CA, USA
- University of the Pacific School of Pharmacy, Stockton, CA, USA
- University of Southern California School of Pharmacy, Los Angeles, CA, USA
| | - Chandresh Shah
- Mental Health Service at VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. B151H, Los Angeles, CA, 90073, USA
| | - Charles T Nguyen
- Department of Mental Health at VA Medical Center, Long Beach, CA, USA
| | - Gerhard Hellemann
- Semel Institute for Neuroscience & Human Behavior at University of California-Los Angeles, Los Angeles, CA, USA
| | - Dixie R Aragaki
- David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA
- Physical Medicine and Rehabilitation Service at VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Charles F Kunkel
- David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA
- Physical Medicine and Rehabilitation Service at VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Melissa M Lewis
- Mental Health Service at VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. B151H, Los Angeles, CA, 90073, USA
| | - Neena Sachinvala
- Mental Health Service at VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. B151H, Los Angeles, CA, 90073, USA
- David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA
| | - Patrick A Sonza
- Mental Health Service at VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. B151H, Los Angeles, CA, 90073, USA
| | - Joseph M Pierre
- Mental Health Service at VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. B151H, Los Angeles, CA, 90073, USA
- David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA
| | - Donna Ames
- Mental Health Service at VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. B151H, Los Angeles, CA, 90073, USA.
- David Geffen School of Medicine at University of California-Los Angeles, Los Angeles, CA, USA.
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Looijmans A, Jörg F, Bruggeman R, Schoevers R, Corpeleijn E. Design of the Lifestyle Interventions for severe mentally ill Outpatients in the Netherlands (LION) trial; a cluster randomised controlled study of a multidimensional web tool intervention to improve cardiometabolic health in patients with severe mental illness. BMC Psychiatry 2017; 17:107. [PMID: 28327086 PMCID: PMC5361714 DOI: 10.1186/s12888-017-1265-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 03/10/2017] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND The cardiometabolic health of persons with a severe mental illness (SMI) is alarming with obesity rates of 45-55% and diabetes type 2 rates of 10-15%. Unhealthy lifestyle behaviours play a large role in this. Despite the multidisciplinary guideline for SMI patients recommending to monitor and address patients' lifestyle, most mental health care professionals have limited lifestyle-related knowledge and skills, and (lifestyle) treatment protocols are lacking. Evidence-based practical lifestyle tools may support both patients and staff in improving patients' lifestyle. This paper describes the Lifestyle Interventions for severe mentally ill Outpatients in the Netherlands (LION) trial, to investigate whether a multidimensional lifestyle intervention using a web tool can be effective in improving cardiometabolic health in SMI patients. METHODS/DESIGN The LION study is a 12-month pragmatic single-blind multi-site cluster randomised controlled trial. 21 Flexible Assertive Community Treatment (ACT) teams and eight sheltered living teams of five mental health organizations in the Netherlands are invited to participate. Per team, nurses are trained in motivational interviewing and use of the multidimensional web tool, covering lifestyle behaviour awareness, lifestyle knowledge, motivation and goal setting. Nurses coach patients to change their lifestyle using the web tool, motivational interviewing and stages-of-change techniques during biweekly sessions in a) assessing current lifestyle behaviour using the traffic light method (healthy behaviours colour green, unhealthy behaviours colour red), b) creating a lifestyle plan with maximum three attainable lifestyle goals and c) discussing the lifestyle plan regularly. The study population is SMI patients and statistical inference is on patient level using multilevel analyses. Primary outcome is waist circumference and other cardiometabolic risk factors after six and twelve months intervention, which are measured as part of routine outcome monitoring using standard protocols. Secondary outcomes include depressive and negative symptoms, cost-effectiveness, and barriers and facilitators in intervention implementation. DISCUSSION Adequate health care should target both mental health and lifestyle behaviours in SMI patients. This trial contributes by studying a 12-month multidimensional lifestyle intervention as a potential evidence based (nursing) tool for targeting multiple lifestyle behaviours in SMI patients. TRIAL REGISTRATION Nederlands Trialregister NTR3765 (trialregister.nl; registered 21 December 2012).
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Affiliation(s)
- Anne Looijmans
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO box 30.001, 9700 RB Groningen, The Netherlands
- Rob Giel Research Centre, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frederike Jörg
- Rob Giel Research Centre, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Research Department, Friesland Mental Health Services, Leeuwarden, The Netherlands
| | - Richard Bruggeman
- Rob Giel Research Centre, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert Schoevers
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, PO box 30.001, 9700 RB Groningen, The Netherlands
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53
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Taylor J, Böhnke JR, Wright J, Kellar I, Alderson SL, Hughes T, Holt RIG, Siddiqi N. A core outcome set for evaluating self-management interventions in people with comorbid diabetes and severe mental illness: study protocol for a modified Delphi study and systematic review. Trials 2017; 18:70. [PMID: 28196512 PMCID: PMC5309993 DOI: 10.1186/s13063-017-1805-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 01/14/2017] [Indexed: 12/31/2022] Open
Abstract
Background People with diabetes and comorbid severe mental illness (SMI) form a growing population at risk of increased mortality and morbidity compared to those with diabetes or SMI alone. There is increasing interest in interventions that target diabetes in SMI in order to help to improve physical health and reduce the associated health inequalities. However, there is a lack of consensus about which outcomes are important for this comorbid population, with trials differing in their focus on physical and mental health. A core outcome set, which includes outcomes across both conditions that are relevant to patients and other key stakeholders, is needed. Methods This study protocol describes methods to develop a core outcome set for use in effectiveness trials of self-management interventions for adults with comorbid type-2 diabetes and SMI. We will use a modified Delphi method to identify, rank, and agree core outcomes. This will comprise a two-round online survey and multistakeholder workshops involving patients and carers, health and social care professionals, health care commissioners, and other experts (e.g. academic researchers and third sector organisations). We will also select appropriate measurement tools for each outcome in the proposed core set and identify gaps in measures, where these exist. Discussion The proposed core outcome set will provide clear guidance about what outcomes should be measured, as a minimum, in trials of interventions for people with coexisting type-2 diabetes and SMI, and improve future synthesis of trial evidence in this area. We will also explore the challenges of using online Delphi methods for this hard-to-reach population, and examine differences in opinion about which outcomes matter to diverse stakeholder groups. Trial registration COMET registration: http://www.comet-initiative.org/studies/details/911. Registered on 1 July 2016
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Affiliation(s)
- Johanna Taylor
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Jan R Böhnke
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9LJ, UK
| | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, LS2 9JT, UK
| | - Sarah L Alderson
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9LJ, UK
| | - Tom Hughes
- Leeds and York Partnership NHS Foundation Trust, 2150 Century Way, Thorpe Park, Leeds, LS15 8ZB, UK
| | - Richard I G Holt
- Diabetes and Endocrinology, Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK.,University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, UK
| | - Najma Siddiqi
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, YO10 5DD, UK.,Bradford District Care NHS Foundation Trust, New Mill, Victoria Road, Saltaire, Bradford, BD18 3LD, UK
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54
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Naslund JA, Aschbrenner KA, Scherer EA, Pratt SI, Bartels SJ. Health Promotion for Young Adults With Serious Mental Illness. Psychiatr Serv 2017; 68:137-143. [PMID: 27799016 PMCID: PMC5425088 DOI: 10.1176/appi.ps.201600091] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Young adulthood represents a critical time to address elevated obesity rates and the risk of early mortality, particularly among people with serious mental illness. Few studies have assessed the benefits of lifestyle interventions targeting weight loss among these young adults. This study examined the impact of the 12-month In SHAPE lifestyle intervention on weight loss and fitness among overweight and obese young adults with serious mental illness (ages 21-30) compared with participants over age 30. METHODS Data were combined from three trials of the 12-month In SHAPE program delivered through community mental health centers. In SHAPE includes weekly fitness trainer meetings, a gym membership, and nutrition education. Primary outcomes were weight loss and change in fitness at 12 months. RESULTS Participants (N=194) had a schizophrenia spectrum disorder (53%) or a mood disorder (47%). The overall sample achieved significant weight loss and improved fitness; differences between young adults (N=29) and participants over age 30 (N=165) were not significant. An important finding was that 42% of young adults achieved clinically significant reductions in cardiovascular risk, defined as ≥5% weight loss or improved fitness (>50-m increase on the 6-Minute Walk Test), compared with 54% of adults over age 30 (a nonsignificant difference between age groups). CONCLUSIONS Among persons enrolled in a lifestyle intervention, overweight and obese young adults experienced benefits comparable with those of adults over age 30. Young adults with serious mental illness face high risk of gaining weight, but a meaningful proportion of these individuals can achieve clinically significant cardiovascular risk reduction, thus highlighting the need to promote lifestyle intervention participation in this group.
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Affiliation(s)
- John A Naslund
- Mr. Naslund is with the Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Dr. Aschbrenner, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry and Dr. Scherer is with the Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Kelly A Aschbrenner
- Mr. Naslund is with the Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Dr. Aschbrenner, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry and Dr. Scherer is with the Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Emily A Scherer
- Mr. Naslund is with the Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Dr. Aschbrenner, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry and Dr. Scherer is with the Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Sarah I Pratt
- Mr. Naslund is with the Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Dr. Aschbrenner, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry and Dr. Scherer is with the Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Stephen J Bartels
- Mr. Naslund is with the Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Dr. Aschbrenner, Dr. Pratt, and Dr. Bartels are with the Department of Psychiatry and Dr. Scherer is with the Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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55
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Liu NH, Daumit GL, Dua T, Aquila R, Charlson F, Cuijpers P, Druss B, Dudek K, Freeman M, Fujii C, Gaebel W, Hegerl U, Levav I, Munk Laursen T, Ma H, Maj M, Elena Medina‐Mora M, Nordentoft M, Prabhakaran D, Pratt K, Prince M, Rangaswamy T, Shiers D, Susser E, Thornicroft G, Wahlbeck K, Fekadu Wassie A, Whiteford H, Saxena S. Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas. World Psychiatry 2017; 16:30-40. [PMID: 28127922 PMCID: PMC5269481 DOI: 10.1002/wps.20384] [Citation(s) in RCA: 431] [Impact Index Per Article: 61.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Excess mortality in persons with severe mental disorders (SMD) is a major public health challenge that warrants action. The number and scope of truly tested interventions in this area remain limited, and strategies for implementation and scaling up of programmes with a strong evidence base are scarce. Furthermore, the majority of available interventions focus on a single or an otherwise limited number of risk factors. Here we present a multilevel model highlighting risk factors for excess mortality in persons with SMD at the individual, health system and socio-environmental levels. Informed by that model, we describe a comprehensive framework that may be useful for designing, implementing and evaluating interventions and programmes to reduce excess mortality in persons with SMD. This framework includes individual-focused, health system-focused, and community level and policy-focused interventions. Incorporating lessons learned from the multilevel model of risk and the comprehensive intervention framework, we identify priorities for clinical practice, policy and research agendas.
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Affiliation(s)
- Nancy H. Liu
- World Health OrganizationGenevaSwitzerland,University of CaliforniaBerkeleyCAUSA
| | | | - Tarun Dua
- World Health OrganizationGenevaSwitzerland
| | | | - Fiona Charlson
- Queensland Centre for Mental Health ResearchWacolQLDAustralia
| | - Pim Cuijpers
- Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | | | | | | | - Chiyo Fujii
- National Institute of Mental HealthTokyoJapan
| | | | | | | | | | - Hong Ma
- Institute of Mental HealthBeijingP.R. China
| | - Mario Maj
- Department of PsychiatryUniversity of Naples SUNNaplesItaly
| | | | | | | | | | - Martin Prince
- Institute of Psychiatry, King's College LondonLondonUK
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Ivbijaro G. Excess mortality in severe mental disorder: the need for an integrated approach. World Psychiatry 2017; 16:48-49. [PMID: 28127904 PMCID: PMC5269685 DOI: 10.1002/wps.20382] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Gabriel Ivbijaro
- PresidentWorld Federation of Mental HealthWalthamstowLondonUK,Wood Street Medical CentreWalthamstowLondonUK
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57
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The Effectiveness of Pharmacological and Non-Pharmacological Interventions for Improving Glycaemic Control in Adults with Severe Mental Illness: A Systematic Review and Meta-Analysis. PLoS One 2017; 12:e0168549. [PMID: 28056018 PMCID: PMC5215855 DOI: 10.1371/journal.pone.0168549] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 12/02/2016] [Indexed: 12/17/2022] Open
Abstract
People with severe mental illness (SMI) have reduced life expectancy compared with the general population, which can be explained partly by their increased risk of diabetes. We conducted a meta-analysis to determine the clinical effectiveness of pharmacological and non-pharmacological interventions for improving glycaemic control in people with SMI (PROSPERO registration: CRD42015015558). A systematic literature search was performed on 30/10/2015 to identify randomised controlled trials (RCTs) in adults with SMI, with or without a diagnosis of diabetes that measured fasting blood glucose or glycated haemoglobin (HbA1c). Screening and data extraction were carried out independently by two reviewers. We used random effects meta-analysis to estimate effectiveness, and subgroup analysis and univariate meta-regression to explore heterogeneity. The Cochrane Collaboration’s tool was used to assess risk of bias. We found 54 eligible RCTs in 4,392 adults (40 pharmacological, 13 behavioural, one mixed intervention). Data for meta-analysis were available from 48 RCTs (n = 4052). Both pharmacological (mean difference (MD), -0.11mmol/L; 95% confidence interval (CI), [-0.19, -0.02], p = 0.02, n = 2536) and behavioural interventions (MD, -0.28mmol//L; 95% CI, [-0.43, -0.12], p<0.001, n = 956) were effective in lowering fasting glucose, but not HbA1c (pharmacological MD, -0.03%; 95% CI, [-0.12, 0.06], p = 0.52, n = 1515; behavioural MD, 0.18%; 95% CI, [-0.07, 0.42], p = 0.16, n = 140) compared with usual care or placebo. In subgroup analysis of pharmacological interventions, metformin and antipsychotic switching strategies improved HbA1c. Behavioural interventions of longer duration and those including repeated physical activity had greater effects on fasting glucose than those without these characteristics. Baseline levels of fasting glucose explained some of the heterogeneity in behavioural interventions but not in pharmacological interventions. Although the strength of the evidence is limited by inadequate trial design and reporting and significant heterogeneity, there is some evidence that behavioural interventions, antipsychotic switching, and metformin can lead to clinically important improvements in glycaemic measurements in adults with SMI.
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58
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Renn BN, Thakur A, Trahan LH, Stanley MA, Dubbert P, Evans-Hudnall G. Leveraging Spousal Support to Improve Health Promotion in Serious Mental Illness. Clin Case Stud 2016. [DOI: 10.1177/1534650116678481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although the majority of Veterans are overweight or obese, and many have comorbid mental health disorders, little is known about the most effective way to intervene in this complex population. This case describes a telephone-based cognitive-behavioral treatment for depression and weight management with an obese Veteran with bipolar disorder. His wife joined sessions to leverage spousal support. The Veteran evidenced variable levels of physical activity and mood fluctuations during treatment; although he reported some degree of positive behavior change and improved social support, he did not lose weight. He continued to endorse moderate levels of depressive symptomatology at the end of the nine-session intervention. This case illustrates the complexity of treating those with chronic serious mental illness and multimorbidities. Further research is needed to inform interventions that concurrently improve mental health symptomatology and weight-related outcomes in chronic, complex cases.
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Affiliation(s)
- Brenna N. Renn
- Baylor College of Medicine, Houston, TX, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA
| | - Aishwarya Thakur
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA
- Rice University, Houston, TX, USA
| | | | - Melinda A. Stanley
- Baylor College of Medicine, Houston, TX, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, TX, USA
| | - Patricia Dubbert
- VA South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, TX, USA
- University of Arkansas for Medical Sciences, Little Rock, USA
| | - Gina Evans-Hudnall
- Baylor College of Medicine, Houston, TX, USA
- VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, USA
- VA South Central Mental Illness Research, Education and Clinical Center (A Virtual Center), Houston, TX, USA
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Wang Q, Polimanti R, Kranzler HR, Farrer LA, Zhao H, Gelernter J. Genetic factor common to schizophrenia and HIV infection is associated with risky sexual behavior: antagonistic vs. synergistic pleiotropic SNPs enriched for distinctly different biological functions. Hum Genet 2016; 136:75-83. [PMID: 27752767 DOI: 10.1007/s00439-016-1737-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/01/2016] [Indexed: 12/29/2022]
Abstract
Schizophrenia (SZ) and HIV infection are serious disorders with a complex phenotypic relationship. Observational studies have described their comorbidity; their genetic correlation is not well studied. We performed extensive analysis in search of common genetic factors for SZ and HIV, and their relationship with risky sexual behavior (RSB). Summary statistics from genome-wide association studies of HIV infection and schizophrenia were obtained and 2379 European Americans were genotyped and assessed for RSB score. Genetic relationships between traits were analyzed in three ways: linkage disequilibrium (LD) score regression to estimate genetic correlation; GPA (Genetic analysis incorporating Pleiotropy and Annotation) to test pleiotropy and identify pleiotropic loci; polygenic risk scores (PRS) of SZ and HIV to predict RSB using linear regression. We found significant pleiotropy (p = 5.31E - 28) and a positive genetic correlation (cor = 0.17, p = 0.002) for SZ and HIV infection. Pleiotropic SNPs with opposite effect directions (antagonistic) and SNPs with the same effect direction (synergistic) were enriched for distinctly different biological functions. SZ PRS computed with antagonistically pleiotropic SNPs consistently predicted RSB score with nominal significance, but SZ PRS based on either synergistically pleiotropic SNPs or all SNPs did not predict RSB. The epidemiologic correlation between schizophrenia and HIV can partly be explained by overlapping genetic risk factors, which are related to risky sexual behavior.
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Affiliation(s)
- Qian Wang
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA.,Department of Psychiatry, Yale University School of Medicine, 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA.,VA CT Healthcare Center, New Haven, CT, USA
| | - Renato Polimanti
- Department of Psychiatry, Yale University School of Medicine, 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA.,VA CT Healthcare Center, New Haven, CT, USA
| | - Henry R Kranzler
- Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania and VISN 4 MIRECC, Crescenz VAMC, Philadelphia, PA, USA
| | - Lindsay A Farrer
- Department of Medicine (Biomedical Genetics), Boston University School of Medicine, Boston, MA, USA.,Department of Neurology, Boston University School of Medicine, Boston, MA, USA.,Department of Ophthalmology, Boston University School of Medicine, Boston, MA, USA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Hongyu Zhao
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA.,Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA.,Department of Genetics, Yale University School of Medicine, New Haven, CT, USA.,VA Cooperative Studies Program Coordinating Center, New Haven, CT, USA
| | - Joel Gelernter
- Department of Psychiatry, Yale University School of Medicine, 116A2, 950 Campbell Avenue, West Haven, CT, 06516, USA. .,VA CT Healthcare Center, New Haven, CT, USA. .,Department of Genetics, Yale University School of Medicine, New Haven, CT, USA. .,Department of Neuroscience, Yale University School of Medicine, New Haven, CT, USA.
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Manseau M, Bogenschutz M. Substance Use Disorders and Schizophrenia. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2016; 14:333-342. [PMID: 31975814 PMCID: PMC6526786 DOI: 10.1176/appi.focus.20160008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Substance use disorders are prevalent co-occurring problems among people with schizophrenia, with lifetime rates approaching 80% in this population when tobacco use is taken into account. Substance use disorders are associated with significant adverse effects among people with schizophrenia, including worse psychiatric symptoms, lower functioning, and increased medical morbidity and mortality compared with schizophrenia patients without co-occurring substance use. The etiology of this relationship is multifactorial, involving neurobiological, genetic, and environmental factors. The substances most commonly used by people with schizophrenia are tobacco, alcohol, cannabis, and cocaine. Screening, diagnosis, and treatment of substance use disorders are important and can have significant effects on clinical outcomes. Treatments for comorbid disorders include psychopharmacological, psychotherapeutic, and multidisciplinary interventions. Several medications have been approved by the U.S. Food and Drug Administration for the treatment of substance use disorders, which also appear to be helpful for patients with schizophrenia, although few controlled trials have been conducted specifically in this population. Psychosocial and psychological interventions have been adapted for use among patients with schizophrenia as well. Treatment of both psychotic illness and substance use disorders in an integrated way improves functional and clinical outcomes.
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Affiliation(s)
- Marc Manseau
- Dr. Manseau is a clinical assistant professor of psychiatry and Dr. Bogenschutz is a professor of psychiatry with the Department of Psychiatry, New York University School of Medicine, New York City
| | - Michael Bogenschutz
- Dr. Manseau is a clinical assistant professor of psychiatry and Dr. Bogenschutz is a professor of psychiatry with the Department of Psychiatry, New York University School of Medicine, New York City
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Speyer H, Christian Brix Nørgaard H, Birk M, Karlsen M, Storch Jakobsen A, Pedersen K, Hjorthøj C, Pisinger C, Gluud C, Mors O, Krogh J, Nordentoft M. The CHANGE trial: no superiority of lifestyle coaching plus care coordination plus treatment as usual compared to treatment as usual alone in reducing risk of cardiovascular disease in adults with schizophrenia spectrum disorders and abdominal obesity. World Psychiatry 2016; 15:155-65. [PMID: 27265706 PMCID: PMC4911772 DOI: 10.1002/wps.20318] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Life expectancy in patients with schizophrenia is reduced by 20 years for men and 15 years for women compared to the general population. About 60% of the excess mortality is due to physical illnesses, with cardiovascular disease being dominant. CHANGE was a randomized, parallel-group, superiority, multi-centre trial with blinded outcome assessment, testing the efficacy of an intervention aimed to improve cardiovascular risk profile and hereby potentially reduce mortality. A total of 428 patients with schizophrenia spectrum disorders and abdominal obesity were recruited and centrally randomized 1:1:1 to 12 months of lifestyle coaching plus care coordination plus treatment as usual (N=138), or care coordination plus treatment as usual (N=142), or treatment as usual alone (N=148). The primary outcome was 10-year risk of cardiovascular disease assessed post-treatment and standardized to age 60. At follow-up, the mean 10-year risk of cardiovascular disease was 8.4 ± 6.7% in the group receiving lifestyle coaching, 8.5 ± 7.5% in the care coordination group, and 8.0 ± 6.5% in the treatment as usual group (p=0.41). We found no intervention effects for any secondary or exploratory outcomes, including cardiorespiratory fitness, physical activity, weight, diet and smoking. In conclusion, the CHANGE trial did not support superiority of individual lifestyle coaching or care coordination compared to treatment as usual in reducing cardiovascular risk in patients with schizophrenia spectrum disorders and abdominal obesity.
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Affiliation(s)
- Helene Speyer
- Mental Health Centre CopenhagenCopenhagen University HospitalCopenhagenDenmark,Institute of Clinical Medicine, Faculty of Health Sciences, University of CopenhagenDenmark
| | - Hans Christian Brix Nørgaard
- Psychosis Research UnitAarhus University HospitalRisskovDenmark,Department of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Merete Birk
- Psychosis Research UnitAarhus University HospitalRisskovDenmark
| | - Mette Karlsen
- Mental Health Centre CopenhagenCopenhagen University HospitalCopenhagenDenmark
| | - Ane Storch Jakobsen
- Mental Health Centre CopenhagenCopenhagen University HospitalCopenhagenDenmark,Institute of Clinical Medicine, Faculty of Health Sciences, University of CopenhagenDenmark
| | - Kamilla Pedersen
- Psychosis Research UnitAarhus University HospitalRisskovDenmark,Centre for Health Sciences EducationAarhus UniversityAarhusDenmark
| | - Carsten Hjorthøj
- Mental Health Centre CopenhagenCopenhagen University HospitalCopenhagenDenmark
| | - Charlotta Pisinger
- Research Centre for Prevention and Health, Department 84‐85Glostrup University HospitalGlostrupDenmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, RigshospitaletCopenhagen University HospitalCopenhagenDenmark
| | - Ole Mors
- Psychosis Research UnitAarhus University HospitalRisskovDenmark
| | - Jesper Krogh
- Mental Health Centre CopenhagenCopenhagen University HospitalCopenhagenDenmark
| | - Merete Nordentoft
- Mental Health Centre CopenhagenCopenhagen University HospitalCopenhagenDenmark,Institute of Clinical Medicine, Faculty of Health Sciences, University of CopenhagenDenmark
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Taylor J, Siddiqi N. Improving health outcomes for adults with severe mental illness and comorbid diabetes: is supporting diabetes self-management the right approach? J Psychiatr Ment Health Nurs 2016; 23:322-30. [PMID: 27307263 DOI: 10.1111/jpm.12307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2016] [Indexed: 01/02/2023]
Affiliation(s)
- J Taylor
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK
| | - N Siddiqi
- Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, UK.,Bradford District Care NHS Foundation Trust, York, UK
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Blixen CE, Kanuch S, Perzynski AT, Thomas C, Dawson NV, Sajatovic M. Barriers to Self-management of Serious Mental Illness and Diabetes. Am J Health Behav 2016; 40:194-204. [PMID: 26931751 PMCID: PMC4928189 DOI: 10.5993/ajhb.40.2.4] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Individuals with serious mental illness (SMI) (major depressive disorder, bipolar disorder, schizophrenia), and diabetes (DM), face significant challenges in managing their physical and mental health. The objective of this study was to assess perceived barriers to self-management among patients with both SMI and DM in order to inform healthcare delivery practices. METHODS We conducted 20 in-depth interviews with persons who had diagnoses of both SMI and DM. All interviews were audiotaped, transcribed verbatim, and analyzed using content analysis with an emphasis on dominant themes. RESULTS Transcript-based analysis generated 3 major domains of barriers to disease self-management among patients with both DM and SMI: (1) personal level barriers (stress, isolation, stigma); (2) family and community level barriers (lack of support from family and friends); and (3) provider and health care system level barriers (poor relationships and communication with providers, fragmentation of care). CONCLUSIONS Care approaches that provide social support, help in managing stress, optimize communication with providers, and reduce compartmentalization of medical and psychiatric care are needed to help these vulnerable individuals avoid health complications and premature mortality.
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Affiliation(s)
- Carol E Blixen
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA.
| | - Stephanie Kanuch
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Adam T Perzynski
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Charles Thomas
- Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Neal V Dawson
- Epidemiology & Biostatistics, Center for Health Care Research and Policy, Case Western Reserve University, MetroHealth Medical Center, Cleveland, OH, USA
| | - Martha Sajatovic
- Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
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64
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Abstract
People with schizophrenia have 2- to 5-fold higher risk of type 2 diabetes than the general population. The traditional risk factors for type 2 diabetes, especially obesity, poor diet, and sedentary lifestyle, are common in people with schizophrenia already early in the course of illness. People with schizophrenia also often have low socioeconomic status and income, which affects their possibilities to make healthy lifestyle choices. Antipsychotic medications increase the risk of type 2 diabetes both directly by affecting insulin sensitivity and indirectly by causing weight gain. Lifestyle modification interventions for prevention of diabetes should be an integral part of treatment of patients with schizophrenia. In the treatment of type 2 diabetes in patients with schizophrenia, communication and collaboration between medical care and psychiatric treatment providers are essential.
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Affiliation(s)
- Jaana Suvisaari
- Mental Health Unit, National Institute for Health and Welfare, P.O.BOX 30, 00271, Helsinki, Finland.
| | - Jaakko Keinänen
- Mental Health Unit, National Institute for Health and Welfare, P.O.BOX 30, 00271, Helsinki, Finland.
| | - Saana Eskelinen
- Mental Health Unit, National Institute for Health and Welfare, P.O.BOX 30, 00271, Helsinki, Finland.
- Kellokoski Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Outi Mantere
- Mental Health Unit, National Institute for Health and Welfare, P.O.BOX 30, 00271, Helsinki, Finland.
- Douglas Mental Health University Institute, Pavillon Newman - 6875, boul. laSalle, Montréal, Québec, Canada, H4H 1R3.
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