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Affiliation(s)
- Sema Baykara
- Department of Psychiatry, School of Medicine, Fırat University, Elazig, Turkey
| | | | - Murat Baykara
- Department of Radiology, School of Medicine, Fırat University, Elazig, Turkey
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The incidence rate of cancer in patients with schizophrenia: A meta-analysis of cohort studies. Schizophr Res 2018; 195:519-528. [PMID: 28943096 DOI: 10.1016/j.schres.2017.08.065] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 08/22/2017] [Accepted: 08/31/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Numerous studies report that cancer prevalence in patients with schizophrenia might be different from the general population, but findings remain controversial. AIM Our updated meta-analysis of cohort studies aims to analyze the data from cohort studies concerning the incidence risk of overall cancer and some site-specific cancers in patients with schizophrenia. METHOD We performed a systemic search through electronic databases. Cohort studies evaluating and describing the cancer incidence among patients with schizophrenia were included. Pooled risk ratios (RRs) were calculated for assessing the incidence risk of cancer. RESULTS There were 16 cohort studies included in this meta-analysis, which combined a total of 480,356 participants with schizophrenia and 41,999 cases of cancer. Results showed that there was a slight significant decreased overall risk ratio of cancer incidence among patients with schizophrenia (RR=0.90, 95% CI 0.81-0.99). When stratified by cancer site and gender, there were significant decreased incidence risk rates of colorectal cancer (RR=0.82, 95% CI 0.69-0.98) and prostate cancer (RR=0.55, 95% CI 0.42-0.71) in those patients, moreover, the incidence rate of colorectal cancer decreased significantly in male patients (RR=0.89, 95% CI 0.81-0.98), and the incidence rate of lung cancer increased significantly in female patients (RR=1.12, 95% CI 1.01-1.25). CONCLUSIONS The incidence risk of some cancers was reduced in patients with schizophrenia. Gender and type of cancer were two important confounding factors contributed to the heterogeneity that required adjustment in our cancer incidence meta-analysis.
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Pedley R, Lovell K, Bee P, Bradshaw T, Gellatly J, Ward K, Woodham A, Wearden A. Collaborative, individualised lifestyle interventions are acceptable to people with first episode psychosis; a qualitative study. BMC Psychiatry 2018; 18:111. [PMID: 29699527 PMCID: PMC5921748 DOI: 10.1186/s12888-018-1692-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 04/16/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The adverse impact of unhealthy lifestyle choices and the prescription of antipsychotic medications contribute to weight gain, poor cardiovascular health and reduced life expectancy for people with psychosis. The present study aimed to explore the acceptability and perceived outcomes of a lifestyle intervention designed to prevent or reduce weight gain in people with first-episode psychosis. METHODS This was a qualitative study using a data-driven approach. People recovering from first-episode psychosis recruited from UK early intervention services and taking part in the active arm of a randomised controlled trial of a lifestyle intervention (the InterACT trial), were interviewed using a semi-structured interview schedule. Interviews were transcribed verbatim and analysed using Framework Analysis. RESULTS Participants valued the collaborative and individualised approach taken by the intervention deliverers, and formed high quality relationships with them. Aspects of the intervention that were positively appraised included goal setting, social opportunities, and progress monitoring. Benefits of the intervention, including increased levels of exercise; improved diet and physical health; increased psychological wellbeing (e.g. confidence, self-esteem); and improved social relationships, were identified by participants, independent of actual weight loss. CONCLUSIONS Future interventions should ensure that workers have the skills to form high quality relationships with users, and to individualise the intervention according to users' needs and preferences. Future trials that test healthy living interventions should consider supplementing physical outcome measures with wider psychosocial outcome assessments, in particular social relationship quality, psychological wellbeing, self-esteem and self-efficacy. TRIAL REGISTRATION Current Controlled Trials: ISRCTN22581937 . Date of registration: 27 October 2010 (retrospectively registered).
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Affiliation(s)
- Rebecca Pedley
- Division of Nursing, Midwifery & Social Work, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Karina Lovell
- 0000000121662407grid.5379.8Division of Nursing, Midwifery & Social Work, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Penny Bee
- 0000000121662407grid.5379.8Division of Nursing, Midwifery & Social Work, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Tim Bradshaw
- 0000000121662407grid.5379.8Division of Nursing, Midwifery & Social Work, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Judith Gellatly
- 0000000121662407grid.5379.8Division of Nursing, Midwifery & Social Work, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Kate Ward
- Mersey Care NHS Foundation Trust, Ashworth High Secure Hospital, Ashworth Research Centre, Parkbourn, Maghull, Liverpool, L31 1HW UK
| | - Adrine Woodham
- 0000000121662407grid.5379.8Division of Population Health, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL UK
| | - Alison Wearden
- 0000000121662407grid.5379.8Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Coupland 1 Building, Oxford Road, Manchester, M13 9PL UK
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Carney R, Bradshaw T, Yung AR. Monitoring of physical health in services for young people at ultra-high risk of psychosis. Early Interv Psychiatry 2018; 12:153-159. [PMID: 26478245 PMCID: PMC5900914 DOI: 10.1111/eip.12288] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 09/21/2015] [Indexed: 11/29/2022]
Abstract
AIM People with schizophrenia have poor physical health and high rates of premature mortality. Risk factors for later cardiovascular disease are present from an early stage, and recording of these factors is recommended in first-episode services. However, it is unclear whether cardiometabolic risk factors are monitored prior to first-episode psychosis. METHODS A retrospective analysis was conducted on case notes of individuals accepted into a specialized early detection service for young people at ultra-high risk for psychosis. Notes were assessed to determine whether the following physical health measures were recorded: height, weight, body mass index, blood pressure, blood glucose and lipids, physical activity levels, smoking status, substance use and alcohol intake. RESULTS Forty individuals were deemed at ultra-high risk for psychosis and accepted into the service. The two measures reported most frequently were whether a person used substances (82.5%) or alcohol (72.5%), but more specific details were not commonly reported. A minority of case files contained information on height (2.5%), weight (7.5%), body mass index (5%), blood glucose (2.5%), smoking status (15%) and physical activity (7.5%). Six case files had no measure of physical health. CONCLUSIONS Physical health and unhealthy lifestyle factors were not assessed routinely in the specialized service. Clear monitoring guidelines should be developed to establish routine assessment of common metabolic risk factors present in this population.
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Affiliation(s)
- Rebekah Carney
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Tim Bradshaw
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Alison R Yung
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
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Küçük L, Kaya H, Çömez T, Kaçar S, Kutlu Y, Zülfikar H. Eating Behaviors and Related Factors in Psychiatric Patients. Arch Psychiatr Nurs 2018; 32:194-199. [PMID: 29579512 DOI: 10.1016/j.apnu.2017.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 01/25/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
Abstract
The aim of this study was to determine the risk of eating disorders and associated risk factors in individuals with psychiatric disorders. Patients who were hospitalized in a psychiatry clinic of the university hospital between the dates of February 2014 and July 2014 constitute sample for the study. The study sample consisted of a total of 216 patients. Data were collected using a questionnaire form and the Eating Attitude Test. The mean age of the patients was 37±0.5, and 56.9% of the patients were female. Problems in eating behavior were observed in 11.6% of the patients, and a statistically significant relationship was found between the risk of eating disorders and diagnosis, gender, exercise and self-perception of weight. The risk of eating disorders was more frequently observed in patients diagnosed with depression, in female patients with a self-perceived weight problem and do not exercise.
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Affiliation(s)
- Leyla Küçük
- Istanbul University, Florence Nightingale Nursing Faculty, Mental Health and Psychiatric Nursing Department, Şişli- Istanbul/Turkey.
| | - Hatice Kaya
- Istanbul University, Florence Nightingale Nursing Faculty, Fundamental Nursing Department, Şişli- Istanbul/Turkey.
| | - Tuba Çömez
- Istanbul University, Health Science Institute, Mental Health and Psychiatric Nursing Department, Cerrahpaşa- Istanbul/Turkey.
| | - Selma Kaçar
- İstanbul Üniversity, Cerrahpaşa Medical Faculty, Mental Health Service, Kocamustafapaşa-İstanbul/Turkey.
| | - Yasemin Kutlu
- Istanbul University, Florence Nightingale Nursing Faculty, Mental Health and Psychiatric Nursing Department, Şişli- Istanbul/Turkey.
| | - Haluk Zülfikar
- Istanbul University, Faculty of Economics, Beyazit- Istanbul/Turkey.
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Praveen KT, Kudlur SNC, Hanabe RP, Egbewunmi AT. Staff attitudes to smoking and the smoking ban. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.bp.107.017673] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodOur aim was to explore attitudes of in-patient mental health staff to smoking and the smoking ban. A questionnaire was distributed to staff (n=450) working at National Health Service psychiatric units in three different locations.ResultsWe obtained 308 responses, at a response rate of 68.4%. Staff were generally less permissive towards smoking in mental health units when compared with previous studies. However, most (78.9%) feared that service users' states would deteriorate if they were not allowed to smoke.Clinical ImplicationsWe found small but noticeable change in staff attitudes following initial reforms in smoking policy. However, there is a need for further significant change in staff attitudes to facilitate implementation of a total smoking ban from July 2008.
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Hamilton R, Harrison M, Naji S, Robertson C. Service innovation: the first year of lifestyle clinics for psychiatric out-patients. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.bp.107.019265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodWe sought to develop and introduce annual physical health checks and offer lifestyle advice for out-patients diagnosed with schizophrenia or bipolar disorder in two semi-rural areas in the north-east of Scotland. the results for the first year of the clinics are presented.ResultsSeventy-eight patients were invited to the clinics in the first year. Attendance rates varied from 76% in one centre to 38% in the other; 75 individual significant physical health problems were identified and highlighted to the patient and their general practitioner.Clinical ImplicationsThe high attendance rate in one half of the catchment area demonstrates the potential for physical health screening for this vulnerable group of patients. the identification of significant levels of previously undiagnosed physical morbidity offers opportunity for intervention. Several innovative lifestyle interventions arose from the project and have been maintained.
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Churchward S, Oxborrow SM, Olotu VO, Thalitaya MD. Setting standards for physical health monitoring in patients on antipsychotics. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.bp.107.019232] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodTo develop standards for physical health monitoring in patients on antipsychotics in a forensic environment. We reviewed recommendations for physical health checks from key publications and then agreed a consensus on what to monitor and how often.ResultsWe developed a standardised form to ensure the requisite minimum monitoring is performed when a patient is newly prescribed an antipsychotic drug or the dose is increased, when an abnormality is detected and for routine annual physical health monitoring.Clinical ImplicationsWe have produced a pragmatic solution to the gap between the recognised risks to physical health of individuals treated with antipsychotic medication and the need for clear, unambiguous standards of physical healthcare.
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Greening J. Physical health of patients in rehabilitation and recovery: a survey of case note records. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.29.6.210] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodThe aim of this survey was to determine details recorded about the physical health of patients in rehabilitation and recovery. All medical and nursing notes from January 1998 to March 2003 were reviewed. Case notes from 63 patients were studied.ResultsThere was mention in less than 13 of the patients' notes (18%) of smoking, diet, exercise or prolactin levels; weight, blood pressure, electrocardiogram, erythrocyte sedimentation rate or lipids were mentioned in less than 20 (30%). A blood sugar test was performed in only 16 patients (25%) in the past year and 38 patients (59%) had a record of a test in the past 5 years. These results suggest that there is inadequate recording of the physical health parameters in patients in rehabilitation and recovery.Clinical ImplicationsThe physical healthcare of patients with schizophrenia is prioritised in the National Institute for Clinical Excellence (NICE) clinical guidelines, which specifically mention the monitoring of endocrine disorders such as diabetes and hyperprolactinaemia, cardiovascular risk factors, such as blood pressure and lipids, and lifestyle factors such as smoking. Routine recording of physical health indices should be mandatory and staff may need further training to enable them to do this.
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Bailey S, Gerada C, Lester H, Shiers D. The cardiovascular health of young people with severe mental illness: addressing an epidemic within an epidemic. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.112.039727] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryFor young people with emerging psychosis, early weight gain and its potential cardiac and metabolic consequences amplify worrying UK public health trends for young people in general. This paper will argue that if clinicians dismiss these changes as of secondary concern in psychiatric treatment for their young patients, they may be inadvertently condoning a first critical step on a path towards physical health inequalities. Greater recognition is needed for this patient population in their 20s and 30s, at ages not normally considered for active primary or secondary cardiovascular prevention, who are at high risk of dying prematurely. The early phase of psychosis presents an important treatment window for protecting cardiometabolic health.
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Abstract
People with schizophrenia die prematurely. Their illness, its treatment and their lifestyle all contribute to the excess morbidity and mortality. Lifestyle ‘choices' (e.g. poor diet, low rates of physical activity and increased likelihood to smoke cigarettes) predispose them to poor physical health and comorbid medical diseases. In addition, weight gain and obesity are a consequence of most antipsychotics, particularly the atypicals. Excessive body weight increases the risk of morbidity and mortality, and is the biggest risk factor for type II diabetes in schizophrenia. Much of the excess mortality of schizophrenia is preventable through lifestyle and risk factor modification and the treatment of common diseases, but the potential for improving outcomes in this area is only starting to be addressed.
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Effects of psychopharmacological treatment with antipsychotic drugs on the vascular system. Vascul Pharmacol 2018; 100:20-25. [DOI: 10.1016/j.vph.2017.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 09/02/2017] [Indexed: 11/18/2022]
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Berry A, Drake RJ, Webb RT, Ashcroft DM, Carr MJ, Yung AR. Investigating the Agreement Between Cardiovascular Disease Risk Calculators Among People Diagnosed With Schizophrenia. Front Psychiatry 2018; 9:685. [PMID: 30631286 PMCID: PMC6315171 DOI: 10.3389/fpsyt.2018.00685] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/26/2018] [Indexed: 12/23/2022] Open
Abstract
Background: People diagnosed with schizophrenia have a much reduced life expectancy compared to the general population, and a more than doubled risk of dying from cardiovascular disease (CVD). Existing CVD risk calculators can be used to detect people with an elevated predicted risk of CVD to inform interventions to reduce risk. Aims: This study aimed to compare four different risk calculators for 10-year predicted CVD risk in a sample of people with schizophrenia. Methods: Thirty participants with a diagnosis of schizophrenia spectrum disorders living within Greater Manchester, United Kingdom took part. Ten-year predicted cardiovascular risk scores were calculated using four different models: QRISK3, Framingham, PRIMROSE BMI, and PRIMROSE lipid. Risk estimates and classified risk categories were compared. Results: QRISK3 identified 11 (39%) as having >10% risk of a CV event within 10 years, 4 (14%) of whom exceeded 20%. The Framingham model identified 4 (14%) as exceeding 10%, none of whom exceeded 20%. PRIMROSE risk calculators identified no participants as having >10% risk of a CV event within 10 years. Pairwise concordance correlation coefficients between types of model ranged 0.22-0.77. Mean (± SD) age was 40 (± 10) years but QRISK3's mean "Heart age" was 58 (± 14) years. Conclusion: Risk calculators generate differing predicted CVD risk scores for patients with schizophrenia. Using one risk calculator might yield different recommended monitoring and treatment plans compared to another. Clinicians should therefore take into account other patient-related factors, such as patients' preferences and other underlying physical conditions when making treatment decisions.
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Affiliation(s)
- Alexandra Berry
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, United Kingdom
| | - Richard J Drake
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Roger T Webb
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, United Kingdom
| | - Darren M Ashcroft
- Division of Pharmacy & Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, United Kingdom
| | - Matthew J Carr
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, United Kingdom
| | - Alison R Yung
- Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), University of Manchester, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom.,Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
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Randomised controlled trial to improve health and reduce substance use in established psychosis (IMPaCT): cost-effectiveness of integrated psychosocial health promotion. BMC Psychiatry 2017; 17:407. [PMID: 29273021 PMCID: PMC5741948 DOI: 10.1186/s12888-017-1570-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 12/05/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is mounting evidence that people with severe mental illness have unhealthy lifestyles, high rates of cardiovascular and metabolic diseases, and greater risk of early mortality. This study aimed to assess the cost-effectiveness of a health promotion intervention seeking to improve physical health and reduce substance use in people with psychosis. METHODS Participants with a psychotic disorder, aged 18-65 years old and registered on an enhanced care approach programme or equivalent were recruited from community mental health teams in six mental health trusts in England. Participants were randomisation to either standard community mental health team care (treatment as usual) or treatment as usual with an integrated health promotion intervention (IMPaCT). Cost-effectiveness and cost-utility analyses from health and social care and societal perspectives were conducted alongside a cluster randomised controlled trial. Total health and social care costs and total societal costs at 12 and 15 months were calculated as well as cost-effectiveness (incremental cost-effectiveness ratios and cost-effectiveness acceptability curves) at 15 months based on quality of life (SF-36 mental and physical health components, primary outcome measures) and quality adjusted life years (QALYs) using two measures, EQ-5D-3 L and SF-36. Data were analysed using bootstrapped regressions with covariates for relevant baseline variables. RESULTS At 12-15 months 301 participants had full data needed to be included in the economic evaluation. There were no differences in adjusted health and social care costs (£95, 95% CI -£1410 to £1599) or societal costs (£675, 95% CI -£1039 to £2388) between the intervention and control arms. Similarly, there were no differences between the groups in the SF-36 mental component (-0.80, 95% CI -3.66 to 2.06), SF-36 physical component (-0.68, 95% CI -3.01 to 1.65), QALYs estimated from the SF-36 (-0.00, -0.01 to 0.00) or QALYs estimated from the EQ-5D-3 L (0.00, 95% CI -0.01 to 0.02). Cost-effectiveness acceptability curves for all four outcomes and from both cost perspectives indicate that the probability of the health promotion intervention being cost-effective does not exceed 0.4 for willingness to pay thresholds ranging from £0-£50,000. CONCLUSIONS Alongside no evidence of additional quality of life/clinical benefit, there is also no evidence of cost-effectiveness. TRIAL REGISTRATION ISRCTN58667926 . Date retrospectively registered: 23/04/2010. Recruitment start date: 01/03/2010.
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Treatment following myocardial infarction in patients with schizophrenia. PLoS One 2017; 12:e0189289. [PMID: 29236730 PMCID: PMC5728533 DOI: 10.1371/journal.pone.0189289] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 11/23/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND A correlation between excess mortality from myocardial infarctions (MI) and schizophrenia has already been established. What remains unclear is whether the initial communication between the treating doctor and the corresponding patient contributes to this excess mortality. AIM The aim of this study is to investigate whether a patient with schizophrenia receives the same offers for examination and treatment following a MI compared to a psychiatric healthy control (PHC). METHODS This cohort study includes patients diagnosed with schizophrenia at the time of their first MI (n = 47) in the years between 1995-2015 matched 1:2 to psychiatric healthy MI patients on gender, age and year of first MI. All existing hospital files for the 141 patients were thoroughly reviewed and the number of offered and accepted examinations and treatments were extracted for comparisons between the two groups. RESULTS In general patients with schizophrenia were less likely to be offered and accept examination and at the same time be offered and accept treatment as compared to PHCs (p<0.01). In addition, there was a statistical trend towards patients with schizophrenia being more likely to decline examination (p = 0.10) and decline treatment (p = 0.09) compared to PHCs, while being offered examination and being offered treatment both contributed statistically insignificantly to the overall discrepancy between the two patient groups. CONCLUSIONS Being diagnosed with schizophrenia limits the treatment received following a first MI compared to PHCs. However, we are unable to pinpoint, whether Physician bias, patient's unwillingness to receive health care or both contribute to the excess mortality seen in these comorbid patients.
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Pawełczyk T, Trafalska E, Pawełczyk A, Kotlicka-Antczak M. Differences in omega-3 and omega-6 polyunsaturated fatty acid consumption in people at ultra-high risk of psychosis, first-episode schizophrenia, and in healthy controls. Early Interv Psychiatry 2017; 11:498-508. [PMID: 26279283 DOI: 10.1111/eip.12267] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 07/12/2015] [Indexed: 01/18/2023]
Abstract
AIM Supplementation with omega-3 PUFA showed efficacy in reducing the risk of transition into psychosis in UHR individuals. It is uncertain whether dietary patterns can be partly responsible for n-3 deficiencies observed in susceptible participants before the diagnosis of schizophrenia. The study was designed to assess differences in omega-3 and omega-6 PUFA consumption in healthy controls (HC), UHR participants and FES patients as well as to verify the hypothesis that dietary changes in PUFA consumption are present before active psychosis develops, that is, in UHR individuals. METHODS Dietary habits during the previous year were assessed in 34 patients at UHR of psychosis, 33 patients diagnosed with FES and 33 HC participants using a validated Food-Frequency Questionnaire and the Polish Food Composition Tables. RESULTS Significant differences in omega-3 and omega-6 PUFA intake were observed between study groups. UHR and FES groups reported significantly higher consumption of omega-6 PUFA in comparison with HC. FES patients also reported a higher consumption of alpha-linolenic acid (omega-3) in comparison with HC. No significant differences were seen in consumption of long-chain marine PUFA. CONCLUSIONS Differences in omega-6 and omega-3 PUFA consumption exist before development of psychotic symptoms, fulfilling the criteria of schizophrenia.
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Affiliation(s)
- Tomasz Pawełczyk
- Department of Affective and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
| | - Elżbieta Trafalska
- Nutrition Hygiene and Epidemiology, Medical University of Lodz, Lodz, Poland
| | - Agnieszka Pawełczyk
- Department of Affective and Psychotic Disorders, Medical University of Lodz, Lodz, Poland
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Hjorth P, Juel A, Hansen MV, Madsen NJ, Viuff AG, Munk-Jørgensen P. Reducing the Risk of Cardiovascular Diseases in Non-selected Outpatients With Schizophrenia: A 30-Month Program Conducted in a Real-life Setting. Arch Psychiatr Nurs 2017; 31:602-609. [PMID: 29179828 DOI: 10.1016/j.apnu.2017.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 07/19/2017] [Accepted: 08/18/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The most common cause of premature death in people with schizophrenia is cardiovascular disease, partially explained by an unhealthy lifestyle, smoking, poor diet and sedentary behavior. We aimed to reduce cardiovascular risk factors. METHOD Naturalistic follow-up study with 54 long-term-treated non-selected outpatients with schizophrenia. The 30-month program consisted of individual guidance, group sessions and normal treatment and care offered in our clinic. RESULTS On average, the participating women reduced their waist circumference by 11.4cm (P=0.037), whereas the participating men increased their waist circumference by 3.3cm (P=0.590). Patients' consumption of fast food was reduced from 1.2 to 0.8 times/week (P=0.016), just as their consumption of soft drinks was reduced from 0.7 to 0.1l/day (P=0.006). Their consumption of coffee increased from 1.6 to 2.5 cups/day (P=0.086). The time women spent on light physical activity increased from 134 to 469min/week (P=0.055). The number of daily cigarettes smoked was reduced by 25.7% for all smokers. CONCLUSIONS Our program showed that it is possible for women but not for men to reduce their risk factors for developing cardiovascular disease. The program is manageable in most outpatient clinics and can be performed by nursing staff interested in physical health with support from and in cooperation with medical doctors, psychiatrist and leaders/managers.
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Affiliation(s)
- Peter Hjorth
- Mental Health Center, Psychiatric Hospital, Randers, Denmark.
| | - Anette Juel
- Aarhus University Hospital, Risskov, Denmark
| | | | | | - Anne Grethe Viuff
- Regional Psychiatric Services West, Central Denmark Region, Herning, Denmark
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Abstract
Mental health service users (MHSUs) have elevated rates of cardiometabolic disturbance. Improvements occur with physical activity (PA) programs. We report the development and evaluation of three innovative peer-developed and peer-led PA programs: 1) walking; 2) fitness; and 3) yoga. Qualitative evaluation with 33 MHSUs in British Columbia, Canada, occurred. These programs yielded improvements for participants, highlighted by powerful narratives of health improvement, and improved social connections. The feasibility and acceptability of innovative peer-developed and peer-led programs were shown. Analyses revealed concepts related to engagement and change. Relating core categories, we theorize effective engagement of MHSUs requires accessibility on three levels (geographic, cost, and program flexibility) and health behavior change occurs within co-constituent relationships (to self, to peers, and to the wider community). This study highlights the benefits of peer involvement in developing and implementing PA programs and provides a theoretical framework of understanding engagement and behavior change in health programs for MHSUs.
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Küçükerdönmez Ö, Urhan M, Altın M, Hacıraifoğlu Ö, Yıldız B. Assessment of the relationship between food addiction and nutritional status in schizophrenic patients. Nutr Neurosci 2017; 22:392-400. [PMID: 29078744 DOI: 10.1080/1028415x.2017.1392429] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Obesity is one of today's most important public health problems. It is suggested that overeating and substance addiction show similarities, and addiction to food may be an important factor in the obesity epidemic. This study aimed to determine the prevalence of food addiction among schizophrenic patients and to examine the relationship between food addiction and anthropometric measurements and dietary nutrient intake. METHODS Study participants included a total of 104 schizophrenic outpatients, 62 females and 42 males. Food addiction was assessed by using the Yale Food Addiction Scale, and the anthropometric measurements of participants and their three-day food consumption were recorded. RESULTS This study found that more than half of the schizophrenic patients (60.6%) had food addiction, and that female schizophrenic patients had a higher prevalence (62.9%) of food addiction than male patients (57.1%). More than one-third of the schizophrenic patients with food addiction (41.3%) were found to be obese and their BMI, body weight, waist circumference, and body-fat ratio were higher than those of schizophrenic patients who did not have food addiction (P > 0.05). Moreover, the schizophrenic patients with food addiction were found to take significantly more energy, carbohydrate, and fat in their diet (P < 0.05). CONCLUSION It was observed that the development of food addiction in schizophrenic patients increased the risk of obesity and cardiovascular diseases, which were found to be at higher levels in these patients. Educational programs should be planned for these patients to acquire health dietary habits and to increase their physical activity levels, and an additional psychosocial support should be provided for patients with food addiction.
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Affiliation(s)
- Özge Küçükerdönmez
- a Faculty of Health Sciences, Department of Nutrition and Dietetics , Ege University , İzmir , Turkey
| | - Murat Urhan
- b Mental Health and Diseases Hospital , Manisa , Turkey
| | - Merve Altın
- c Izmir Atatürk School of Health, Department of Nutrition and Dietetics , Ege University , Izmir , Turkey
| | - Özge Hacıraifoğlu
- c Izmir Atatürk School of Health, Department of Nutrition and Dietetics , Ege University , Izmir , Turkey
| | - Burak Yıldız
- c Izmir Atatürk School of Health, Department of Nutrition and Dietetics , Ege University , Izmir , Turkey
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Black DR, Held ML. Cardiovascular risk screening for individuals with serious mental illness. SOCIAL WORK IN HEALTH CARE 2017; 56:809-821. [PMID: 28771089 DOI: 10.1080/00981389.2017.1354955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Cardiovascular disease (CVD) is a significant health risk for individuals with serious mental illness (SMI). Screening for CVD risk factors is a key strategy to reduce this health disparity. This study examined medical, lifestyle, and access predictors for comprehensive screening. Data on 1036 adults were analyzed from the 2015 National Health Interview Survey. Multivariate multinomial logistic regression was used to examine factors associated with individuals with SMI receiving CVD risk screening in the past 12 months. The presence of a metabolic disorder (diabetes or high cholesterol), increased age, increased outpatient visits, and seeing a primary care provider, either alone or in conjunction with a specialty care provider, were significantly associated with receiving all screening measures. Increasing provider awareness of additional CVD risk factors is an essential step to improving early detection of health risks for individuals with SMI. Integrated health settings that combine traditional primary care and mental health services may reduce the health disparity for this population by increasing odds of early detection and ongoing monitoring for high-risk populations.
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Affiliation(s)
- Denise R Black
- a College of Social Work , University of Tennessee , Knoxville , TN , USA
| | - Mary L Held
- b College of Social Work , University of Tennessee , Nashville , TN , USA
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71
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Firth J, Cotter J, Carney R, Yung AR. The pro-cognitive mechanisms of physical exercise in people with schizophrenia. Br J Pharmacol 2017; 174:3161-3172. [PMID: 28261797 PMCID: PMC5595765 DOI: 10.1111/bph.13772] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/13/2017] [Accepted: 02/21/2017] [Indexed: 01/20/2023] Open
Abstract
Schizophrenia is associated with pervasive cognitive deficits which are unresponsive to antipsychotic medications. Physical exercise has been shown to improve cognitive functioning in people with schizophrenia, although the mechanisms for this are unclear. We conducted a systematic review of all exercise intervention studies which reported changes in brain structure, connectivity or peripheral biomarkers which could underlie cognitive improvements from exercise in schizophrenia. An electronic database search was conducted on 22 September 2016 using keywords relevant to exercise and neurocognition in schizophrenia. The search returned 2342 articles. Sixteen were eligible for inclusion, reporting data from 14 independent trials of 423 patients with schizophrenia. Seven studies used neuroimaging to examine the impact of exercise on brain structure and connectivity in schizophrenia, whereas seven other studies examined peripheral biomarkers to assess the effects of exercise. Imaging studies collectively indicated that exercise can increase brain volume in people with schizophrenia, although the regions which responded to exercise varied across studies. Most biomarker studies assessed the effects of exercise on serum levels of BDNF. Several studies found significant increases from exercise along with positive correlations between BDNF and cognitive enhancements (indicating a mechanistic link), although other studies did not observe this relationship. In conclusion, the cognitive benefits of exercise in schizophrenia may be due to exercise stimulating neurogenesis, perhaps by up-regulating BDNF, although current evidence is insufficient to draw definitive conclusions. Further exploration of the pro-cognitive mechanisms of exercise in schizophrenia would inform the development of optimal interventions for reducing cognitive impairments in this population. Linked Articles This article is part of a themed section on Pharmacology of Cognition: a Panacea for Neuropsychiatric Disease? To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.19/issuetoc.
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Affiliation(s)
- Joseph Firth
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - Jack Cotter
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - Rebekah Carney
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | - Alison R Yung
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
- Greater Manchester West Mental Health NHS Foundation TrustManchesterUK
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Hayes JF, Marston L, Walters K, King MB, Osborn DPJ. Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000-2014. Br J Psychiatry 2017; 211:175-181. [PMID: 28684403 PMCID: PMC5579328 DOI: 10.1192/bjp.bp.117.202606] [Citation(s) in RCA: 265] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/07/2017] [Accepted: 04/14/2017] [Indexed: 12/04/2022]
Abstract
BackgroundBipolar disorder and schizophrenia are associated with increased mortality relative to the general population. There is an international emphasis on decreasing this excess mortality.AimsTo determine whether the mortality gap between individuals with bipolar disorder and schizophrenia and the general population has decreased.MethodA nationally representative cohort study using primary care electronic health records from 2000 to 2014, comparing all patients diagnosed with bipolar disorder or schizophrenia and the general population. The primary outcome was all-cause mortality.ResultsIndividuals with bipolar disorder and schizophrenia had elevated mortality (adjusted hazard ratio (HR) = 1.79, 95% CI 1.67-1.88 and 2.08, 95% CI 1.98-2.19 respectively). Adjusted HRs for bipolar disorder increased by 0.14/year (95% CI 0.10-0.19) from 2006 to 2014. The adjusted HRs for schizophrenia increased gradually from 2004 to 2010 (0.11/year, 95% CI 0.04-0.17) and rapidly after 2010 (0.34/year, 95% CI 0.18-0.49).ConclusionsThe mortality gap between individuals with bipolar disorder and schizophrenia, and the general population is widening.
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Affiliation(s)
- Joseph F Hayes
- Joseph F. Hayes, MSc, MB, ChB, Division of Psychiatry, University College London, London; Louise Marston, PhD; Kate Walters, PhD, Department of Primary Care and Population Health, University College London, London; Michael B. King, PhD, David P. J. Osborn, PhD, Division of Psychiatry, University College London, London, UK
| | - Louise Marston
- Joseph F. Hayes, MSc, MB, ChB, Division of Psychiatry, University College London, London; Louise Marston, PhD; Kate Walters, PhD, Department of Primary Care and Population Health, University College London, London; Michael B. King, PhD, David P. J. Osborn, PhD, Division of Psychiatry, University College London, London, UK
| | - Kate Walters
- Joseph F. Hayes, MSc, MB, ChB, Division of Psychiatry, University College London, London; Louise Marston, PhD; Kate Walters, PhD, Department of Primary Care and Population Health, University College London, London; Michael B. King, PhD, David P. J. Osborn, PhD, Division of Psychiatry, University College London, London, UK
| | - Michael B King
- Joseph F. Hayes, MSc, MB, ChB, Division of Psychiatry, University College London, London; Louise Marston, PhD; Kate Walters, PhD, Department of Primary Care and Population Health, University College London, London; Michael B. King, PhD, David P. J. Osborn, PhD, Division of Psychiatry, University College London, London, UK
| | - David P J Osborn
- Joseph F. Hayes, MSc, MB, ChB, Division of Psychiatry, University College London, London; Louise Marston, PhD; Kate Walters, PhD, Department of Primary Care and Population Health, University College London, London; Michael B. King, PhD, David P. J. Osborn, PhD, Division of Psychiatry, University College London, London, UK
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73
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Effects of psychopharmacological treatment with antidepressants on the vascular system. Vascul Pharmacol 2017; 96-98:11-18. [DOI: 10.1016/j.vph.2017.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 07/23/2017] [Indexed: 02/08/2023]
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A Review of the Benefits of Nature Experiences: More Than Meets the Eye. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14080864. [PMID: 28763021 PMCID: PMC5580568 DOI: 10.3390/ijerph14080864] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/24/2017] [Accepted: 07/26/2017] [Indexed: 02/07/2023]
Abstract
Evidence that experiences of nature can benefit people has accumulated rapidly. Yet perhaps because of the domination of the visual sense in humans, most research has focused on the visual aspects of nature experiences. However, humans are multisensory, and it seems likely that many benefits are delivered through the non-visual senses and these are potentially avenues through which a physiological mechanism could occur. Here we review the evidence around these lesser studied sensory pathways—through sound, smell, taste, touch, and three non-sensory pathways. Natural sounds and smells underpin experiences of nature for many people, and this may well be rooted in evolutionary psychology. Tactile experiences of nature, particularly beyond animal petting, are understudied yet potentially fundamentally important. Tastes of nature, through growing and consuming natural foods, have been linked with a range of health and well-being benefits. Beyond the five senses, evidence is emerging for other non-visual pathways for nature experiences to be effective. These include ingestion or inhalation of phytoncides, negative air ions and microbes. We conclude that (i) these non-visual avenues are potentially important for delivering benefits from nature experiences; (ii) the evidence base is relatively weak and often based on correlational studies; and (iii) deeper exploration of these sensory and non-sensory avenues is needed.
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Jahrami HA, Faris MAIE, Saif ZQ, Hammad LH. Assessing dietary and lifestyle risk factors and their associations with disease comorbidities among patients with schizophrenia: A case-control study from Bahrain. Asian J Psychiatr 2017; 28:115-123. [PMID: 28784363 DOI: 10.1016/j.ajp.2017.03.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 03/18/2017] [Accepted: 03/27/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Acquired dietary habits and lifestyle behaviors of patients with schizophrenia may affect their life expectancy, disease complications and prognosis. The objectives of the current study were to assess the dietary habits and other lifestyle behaviors for Bahraini patients with schizophrenia, and to determine their associations with different medical comorbidities. METHOD A case-control study was conducted during the period of March to December 2016. A sample of 120 cases were recruited from the Psychiatric Hospital, Bahrain and age-sex-matched with 120 controls. Controls were recruited from primary health centres, and were free from serious mental illness. Dietary habits and lifestyle behaviors including smoking, alcohol intake and physical activity were assessed using a questionnaire. All medical records were reviewed retrospectively. Logistic regression analysis was used to identify dietary and lifestyle risk factors that are associated with one or more disease comorbidities. RESULTS Cases had higher prevalence of smoking and alcohol intake, excessive dietary intake, and decreased physical activity (all P<0.05) compared with controls. Cases appeared to be at higher risk for developing chronic medical conditions such as obesity, type 2 diabetes, hypertension, cardiovascular disease, and musculoskeletal disorders. Cases were three times more likely to have up to three or more medical comorbidities compared with controls. Excessive dietary intake and decreased physical activity were identified as the main risk factors. CONCLUSION Excessive caloric intake and decreased physical activity represent the main dietary and lifestyle risk factors associated with comorbidities among patients with schizophrenia in Bahrain.
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Affiliation(s)
- Haitham Ali Jahrami
- Psychiatric Hospital, Ministry of Health, Bahrain; College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Mo'ez Al-Islam Ezzat Faris
- Department of Clinical Nutrition and Dietetics, College of Health Sciences/Sharjah Institute for Medical Research (SIMR), University of Sharjah, Sharjah, United Arab Emirates
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Rodrigues-Silva N, Ribeiro L. Impact of medical comorbidity in psychiatric inpatient length of stay. J Ment Health 2017; 29:701-705. [PMID: 28686478 DOI: 10.1080/09638237.2017.1340605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Medical comorbidity is associated with worse psychiatric outcomes, reduced functioning and higher services use, including inpatient psychiatric care.Aim: We explored the relation between medical comorbidity and length of stay, adjusting for potential confounders.Methods: We retrospectively analyzed an administrative database comprising all inpatient admissions between 2005 and 2014 at the Department of Psychiatry and Mental Health at Vila Nova de Gaia/Espinho Healthcare Center, Vila Nova de Gaia - Portugal. Psychiatric diagnosis and medical comorbidity were coded according to single-level and multi-level classification schemes, respectively, as proposed by the Clinical Classification Software.Results: We included a total of 4613 psychiatric inpatient admissions. The prevalence of medical comorbidity was 25.4% and it was associated with an average increase of 3.5 days (p < 0.001) in length of stay, comparing to patients without medical comorbidity. After adjusting for potential confounders, such as age, sex and year of discharge, medical comorbidity was associated with a 13% increase in length of stay.Conclusions: Medical comorbidity has measurable effects in inpatient outcomes, such as the length of stay and should be a major focus for intervention, in ambulatory care but also during psychiatric hospitalization.
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Affiliation(s)
- Nuno Rodrigues-Silva
- Department of Psychiatry and Mental Health, Vila Nova de Gaia/Espinho Healthcare Center, Vila Nova de Gaia, Portugal
| | - Lúcia Ribeiro
- Department of Psychiatry and Mental Health, Vila Nova de Gaia/Espinho Healthcare Center, Vila Nova de Gaia, Portugal
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Reddy G, Rado JT. The Physical Health of Patients with Psychiatric Disorders: What Is the Role of the Psychiatrist? Psychiatr Ann 2017. [DOI: 10.3928/00485713-20170606-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Ward MC, Druss BG. Reverse Integration Initiatives for Individuals With Serious Mental Illness. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2017; 15:271-278. [PMID: 31975857 PMCID: PMC6519558 DOI: 10.1176/appi.focus.20170011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Medical progress has greatly extended the life span of individuals living in the United States, yet certain groups have lagged behind in achieving wellness and longevity. Prominent among these are individuals with serious mental illness. Because of this, various initiatives have been launched at the community, state, and national level to improve the medical care of those with serious mental illness. Many of these initiatives promote "reverse integration," or the provision of collaborative care services in behavioral health locations. Despite significant barriers to implementation, these initiatives have shown moderate success in improving medical outcomes for those with serious mental illness, in both research and "real-life" settings. Additionally, the role of psychiatrists in addressing physical health has been explored, and there is a need for educational opportunities to optimize competency in this area. Overall, work still needs to be done before the mortality gap for those with serious mental illness dissipates.
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Affiliation(s)
- Martha C Ward
- Dr. Ward is with the Department of Psychiatry and Behavioral Sciences and the Department of Medicine, Emory University School of Medicine, Atlanta. Dr. Druss is the Rosalynn Carter Chair in Mental Health, Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
| | - Benjamin G Druss
- Dr. Ward is with the Department of Psychiatry and Behavioral Sciences and the Department of Medicine, Emory University School of Medicine, Atlanta. Dr. Druss is the Rosalynn Carter Chair in Mental Health, Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
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79
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Quintana DS, Dieset I, Elvsåshagen T, Westlye LT, Andreassen OA. Oxytocin system dysfunction as a common mechanism underlying metabolic syndrome and psychiatric symptoms in schizophrenia and bipolar disorders. Front Neuroendocrinol 2017; 45:1-10. [PMID: 28049009 DOI: 10.1016/j.yfrne.2016.12.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 12/14/2016] [Accepted: 12/29/2016] [Indexed: 12/24/2022]
Abstract
There is growing interest in using intranasal oxytocin (OT) to treat social dysfunction in schizophrenia and bipolar disorders (i.e., psychotic disorders). While OT treatment results have been mixed, emerging evidence suggests that OT system dysfunction may also play a role in the etiology of metabolic syndrome (MetS), which appears in one-third of individuals with psychotic disorders and associated with increased mortality. Here we examine the evidence for a potential role of the OT system in the shared risk for MetS and psychotic disorders, and its prospects for ameliorating MetS. Using several studies to demonstrate the overlapping neurobiological profiles of metabolic risk factors and psychiatric symptoms, we show that OT system dysfunction may be one common mechanism underlying MetS and psychotic disorders. Given the critical need to better understand metabolic dysregulation in these disorders, future OT trials assessing behavioural and cognitive outcomes should additionally include metabolic risk factor parameters.
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Affiliation(s)
- Daniel S Quintana
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, and Oslo University Hospital, Oslo, Norway.
| | - Ingrid Dieset
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, and Oslo University Hospital, Oslo, Norway
| | - Torbjørn Elvsåshagen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, and Oslo University Hospital, Oslo, Norway; Department of Neurology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lars T Westlye
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, and Oslo University Hospital, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Ole A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, University of Oslo, and Oslo University Hospital, Oslo, Norway
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Joseph J, Depp C, Shih PAB, Cadenhead KS, Schmid-Schönbein G. Modified Mediterranean Diet for Enrichment of Short Chain Fatty Acids: Potential Adjunctive Therapeutic to Target Immune and Metabolic Dysfunction in Schizophrenia? Front Neurosci 2017; 11:155. [PMID: 28396623 PMCID: PMC5366345 DOI: 10.3389/fnins.2017.00155] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 03/10/2017] [Indexed: 12/14/2022] Open
Abstract
Growing interest in gut and digestive processes and their potential link to brain and peripheral based inflammation or biobehavioral phenotypes has led to an increasing number of basic and translational scientific reports focused on the role of gut microbiota within the context of neuropsychiatric disorders. However, the effect of dietary modification on specific gut metabolites, in association with immune, metabolic, and psychopathological functioning in schizophrenia spectrum disorders has not been well characterized. The short chain fatty acids (SCFA) acetate, butyrate, and propionate, major metabolites derived from fermentation of dietary fibers by gut microbes, interact with multiple immune and metabolic pathways. The specific pathways that SCFA are thought to target, are dysregulated in cardiovascular disease, type II diabetes, and systemic inflammation. Most notably, these disorders are consistently linked to an attenuated lifespan in schizophrenia. Although, unhealthy dietary intake patterns and increased prevalence of immune and metabolic dysfunction has been observed in people with schizophrenia; dietary interventions have not been well utilized to target immune or metabolic illness. Prior schizophrenia patient trials primarily focused on the effects of gluten free diets. Findings from these studies indicate that a diet avoiding gluten benefits a limited subset of patients, individuals with celiac disease or non-celiac gluten sensitivity. Therefore, alternative dietary and nutritional modifications such as high-fiber, Mediterranean style, diets that enrich the production of SCFA, while being associated with a minimal likelihood of adverse events, may improve immune and cardiovascular outcomes linked to premature mortality in schizophrenia. With a growing literature demonstrating that SCFA can cross the blood brain barrier and target key inflammatory and metabolic pathways, this article highlights enriching dietary intake for SCFA as a potential adjunctive therapy for people with schizophrenia.
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Affiliation(s)
- Jamie Joseph
- Department of Psychiatry, University of CaliforniaSan Diego, La Jolla, CA, USA
| | - Colin Depp
- Department of Psychiatry, University of CaliforniaSan Diego, La Jolla, CA, USA
- Department of Psychology, VA San Diego Healthcare SystemSan Diego, CA, USA
| | - Pei-an B. Shih
- Department of Psychiatry, University of CaliforniaSan Diego, La Jolla, CA, USA
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Carney R, Yung AR, Amminger GP, Bradshaw T, Glozier N, Hermens DF, Hickie IB, Killackey E, McGorry P, Pantelis C, Wood SJ, Purcell R. Substance use in youth at risk for psychosis. Schizophr Res 2017; 181:23-29. [PMID: 27590573 DOI: 10.1016/j.schres.2016.08.026] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 08/26/2016] [Accepted: 08/26/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND People with schizophrenia have high rates of substance use which contributes to co-morbidity and premature mortality. Some evidence suggests people at-risk for psychosis have high rates of substance use. We aimed to assess substance use in a help-seeking cohort, comparing those at-risk and not at-risk for psychosis, and to establish any relationship with clinical symptoms. METHOD Participants were help-seeking youth presenting to mental health services in Sydney and Melbourne. 279 (34.8%) were at-risk for psychosis, and 452 (56.4%) did not meet criteria for a psychotic disorder or risk for psychosis. The excluded individuals were made up of 59 (7.4%) young people who met criteria for a psychotic disorder and 11 (1.4%) who were unable to be evaluated. We assessed the association of substance use involvement with risk status and clinical symptoms using multivariate regression. RESULTS Individuals at-risk for psychosis had significantly higher tobacco, alcohol and cannabis use than those not at-risk. Multivariate analysis revealed at-risk status was significantly associated with higher alcohol involvement scores when adjusting for age and gender, but no association was found for cannabis or tobacco. At-risk status was no longer associated with alcohol involvement when cannabis or tobacco use was added into the analysis. CONCLUSION Tobacco smoking, alcohol consumption and cannabis use are common in help-seeking youth, particularly those at-risk for psychosis. It is important to consider co-occurring use of different substances in adolescents. Early substance misuse in this phase of illness could be targeted to improve physical and mental health in young people.
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Affiliation(s)
- R Carney
- Institute of Brain, Behaviour and Mental Health, University of Manchester, UK.
| | - A R Yung
- Institute of Brain, Behaviour and Mental Health, University of Manchester, UK; Greater Manchester West Mental Health NHS Foundation Trust, UK
| | - G P Amminger
- Orygen - The National Centre of Excellence in Youth Mental Health, University of Melbourne, Victoria, Australia; The Centre for Youth Mental Health, The University of Melbourne, Australia
| | - T Bradshaw
- School of Nursing, Midwifery and Social Work, University of Manchester, UK
| | - N Glozier
- Brain & Mind Centre, University of Sydney, New South Wales, Australia
| | - D F Hermens
- Brain & Mind Centre, University of Sydney, New South Wales, Australia
| | - I B Hickie
- Brain & Mind Centre, University of Sydney, New South Wales, Australia
| | - E Killackey
- Orygen - The National Centre of Excellence in Youth Mental Health, University of Melbourne, Victoria, Australia
| | - P McGorry
- Orygen - The National Centre of Excellence in Youth Mental Health, University of Melbourne, Victoria, Australia
| | - C Pantelis
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Victoria, Australia
| | - S J Wood
- Melbourne Neuropsychiatry Centre, University of Melbourne and Melbourne Health, Victoria, Australia; School of Psychology, University of Birmingham, UK
| | - R Purcell
- Orygen - The National Centre of Excellence in Youth Mental Health, University of Melbourne, Victoria, Australia
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Heald A, Pendlebury J, Anderson S, Narayan V, Guy M, Gibson M, Haddad P, Livingston M. Lifestyle factors and the metabolic syndrome in Schizophrenia: a cross-sectional study. Ann Gen Psychiatry 2017; 16:12. [PMID: 28289436 PMCID: PMC5310063 DOI: 10.1186/s12991-017-0134-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 02/01/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Cardiometabolic disease is more common in patients with schizophrenia than the general population. AIM The purpose of the study was to assess lifestyle factors, including diet and exercise, in patients with schizophrenia and estimate the prevalence of metabolic syndrome. METHODS This is a cross-sectional study of a representative group of outpatients with schizophrenia in Salford, UK. An interview supplemented by questionnaires was used to assess diet, physical activity, and cigarette and alcohol use. Likert scales assessed subjects' views of diet and activity. A physical examination and relevant blood tests were conducted. RESULTS Thirty-seven people were included in the study. 92% of men had central adiposity, as did 91.7% of women (International Diabetes Federation Definition). The mean age was 46.2 years and mean illness duration was 11.6 years. 67.6% fulfilled criteria for the metabolic syndrome. The mean number of fruit and vegetable portions per day was 2.8 ± 1.8. Over a third did not eat any fruit in a typical week. 42% reported doing no vigorous activity in a typical week. 64.9% smoked and in many cigarette use was heavy. The Likert scale showed that a high proportion of patients had insight into their unhealthy lifestyles. CONCLUSIONS Within this sample, there was a high prevalence of poor diet, smoking and inadequate exercise. Many did not follow national recommendations for dietary intake of fruit and vegetables and daily exercise. These factors probably contribute to the high prevalence of metabolic syndrome. Many had insight into their unhealthy lifestyles. Thus, there is potential for interventions to improve lifestyle factors and reduce the risk of cardiometabolic disease.
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Affiliation(s)
- Adrian Heald
- Department of Medicine, Leighton Hospital, Crewe, CW1 4QJ Cheshire UK.,The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, M13 9PT UK
| | - John Pendlebury
- Greater Manchester West Mental Health NHS Foundation Trust, Greater Manchester, UK
| | - Simon Anderson
- Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Vinesh Narayan
- Greater Manchester West Mental Health NHS Foundation Trust, Greater Manchester, UK
| | - Mark Guy
- Department of Clinical Biochemistry, Salford Royal Hospital, Salford, M6 8HD UK
| | - Martin Gibson
- The School of Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, M13 9PT UK
| | - Peter Haddad
- Greater Manchester West Mental Health NHS Foundation Trust, Greater Manchester, UK
| | - Mark Livingston
- Department of Blood Sciences, Walsall Manor Hospital, Walsall, WS2 9PS UK
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Rekhi G, Khyne TT, Lee J. Estimating 10-year cardiovascular disease risk in Asian patients with schizophrenia. Gen Hosp Psychiatry 2016; 43:46-50. [PMID: 27796257 DOI: 10.1016/j.genhosppsych.2016.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 09/16/2016] [Accepted: 09/20/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVE This study aims to describe the cardiovascular risk profile of Asian patients with schizophrenia. METHODS Data was extracted from the databases of 139 patients with schizophrenia and 206 controls from two previous studies conducted at the Institute for Mental Health (IMH), Singapore. Their medical and smoking histories were obtained, and anthropometric parameters measured. Framingham risk score (FRS) calculator using body mass index was used to compute the 10-year cardiovascular disease risk (FRSBMI) and the vascular age (VABMI) for each participant. Data on fasting lipids were available for 80 patients and all the controls; hence the FRS for lipids (FRSlipids) and VA (VAlipids) were also computed. The difference between VA and actual age was computed as VAdiff. RESULTS The 10-year CVD risk and VAdiff based on lipids as well as BMI were significantly higher for patients compared to controls (all p<0.01). There was a strong correlation between FRSlipids and FRSBMI (r=0.97, p<0.001). Significantly higher numbers of patients than controls were smokers and obese; and reported having dyslipidaemia. CONCLUSIONS We found a high risk of CVD in patients with schizophrenia as compared to controls; and conclude that patients with schizophrenia need regular physical health monitoring, especially for cardiovascular risk factors.
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Affiliation(s)
- Gurpreet Rekhi
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore.
| | - Toe Toe Khyne
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Jimmy Lee
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore; Department of General Psychiatry 1, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore; Office of Clinical Sciences, Duke-National University of Singapore Graduate Medical School, 8 College Road, Singapore 169857, Singapore
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Stubbs B, Firth J, Berry A, Schuch FB, Rosenbaum S, Gaughran F, Veronesse N, Williams J, Craig T, Yung AR, Vancampfort D. How much physical activity do people with schizophrenia engage in? A systematic review, comparative meta-analysis and meta-regression. Schizophr Res 2016; 176:431-440. [PMID: 27261419 DOI: 10.1016/j.schres.2016.05.017] [Citation(s) in RCA: 226] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 04/15/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Physical activity (PA) improves health outcomes in people with schizophrenia. It is unclear how much PA people with schizophrenia undertake and what influences PA participation. We conducted a meta-analysis to investigate PA levels and predictors in people with schizophrenia. METHOD Major databases were searched from inception till 02/2016 for articles measuring PA (self-report questionnaire (SRQ) or objective measure (e.g. accelerometer)) in people with schizophrenia, including first episode psychosis (FEP). A random effects meta-analysis and meta-regression analysis were conducted. RESULTS 35 studies representing 3453 individuals with schizophrenia (40.0years; 64.0% male) were included. Engagement in light PA was 80.44min (95% CI 68.32-92.52, n=2658), 47.1min moderate-vigorous PA (95% CI 31.5-62.8, n=559) and 1.05min (95% CI 0.48-1.62, n=2533) vigorous PA per day. People with schizophrenia engaged in significantly less moderate (hedges g=-0.45, 95% CI -0.79 to -0.1, p=0.01) and vigorous PA (g=-0.4, 95% CI -0.60 to -0.18) versus controls. Higher light to moderate, but lower vigorous PA levels were observed in outpatients and in studies utilizing objective measures versus SRQ. 56.6% (95% CI 45.8-66.8, studies=12) met the recommended 150min of moderate physical activity per week. Depressive symptoms and older age were associated with less vigorous PA in meta-regression analyses. CONCLUSIONS Our data confirm that people with schizophrenia engage in significantly less moderate and vigorous PA versus controls. Interventions aiming to increase PA, regardless of intensity are indicated for people with schizophrenia, while specifically increasing moderate-vigorous PA should be a priority given the established health benefits.
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Affiliation(s)
- Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom; The Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South London Psychosis Research Team, United Kingdom.
| | - Joseph Firth
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Alexandra Berry
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Felipe B Schuch
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Programa de Pós Graduação em Ciências Médicas: Psiquiatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Simon Rosenbaum
- Department of Exercise Physiology, School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Fiona Gaughran
- The Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South London Psychosis Research Team, United Kingdom; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Nicola Veronesse
- Department of Medicine, Geriatrics Section, University of Padova, Italy
| | - Julie Williams
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom; The Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South London Psychosis Research Team, United Kingdom
| | - Tom Craig
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom; The Collaboration for Leadership in Applied Health Research and Care (CLAHRC), South London Psychosis Research Team, United Kingdom
| | - Alison R Yung
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Leuven-Kortenberg, Belgium
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85
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Wolfe RM, Reeves LE, Gibson LE, Cooper S, Ellman LM. Attenuated Positive Psychotic Symptoms in Relation to Cigarette Smoking in a Nonclinical Population. Nicotine Tob Res 2016; 19:124-128. [PMID: 27651478 DOI: 10.1093/ntr/ntw240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 09/08/2016] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This study explored the association between cigarette smoking and attenuated positive psychotic symptoms in a young adult nonclinical sample. METHODS Undergraduates (N = 930), aged 18-35 years (26.3% male), completed a battery of self-report measures assessing subthreshold psychotic symptoms, cigarette smoking behavior/dependence, and drug use. RESULTS Individuals endorsing a greater number of attenuated positive psychotic symptoms were more likely to be smokers. Exploratory analyses indicated that the odds of being a smoker were two times greater for those at potential higher risk for psychosis compared with individuals at lower risk. Results were consistent after adjusting for sex and other drug use. CONCLUSIONS In line with findings from psychotic populations, results suggest that attenuated positive psychotic symptoms, particularly those endorsed as distressing in a nonclinical, undergraduate population, are related to cigarette smoking. IMPLICATIONS Even in nonclinical, undergraduate populations, subthreshold psychotic symptoms are related to cigarette smoking, and cigarette smokers are twice as likely to be considered at potentially higher risk for psychosis compared with noncigarette smokers. In summary, there may be a threshold whereby psychotic symptoms confer increased risk for nicotine consumption, with endorsement of a greater number of distressing subthreshold psychotic symptoms increasing the likelihood of cigarette use.
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Affiliation(s)
- Rebecca M Wolfe
- Department of Psychology, Temple University, Philadelphia, PA
| | - Lauren E Reeves
- Department of Psychology, Temple University, Philadelphia, PA
| | - Lauren E Gibson
- Department of Psychology, Temple University, Philadelphia, PA
| | - Shanna Cooper
- Department of Psychology, Temple University, Philadelphia, PA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA
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86
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Cooper SJ, Reynolds GP, Barnes T, England E, Haddad PM, Heald A, Holt R, Lingford-Hughes A, Osborn D, McGowan O, Patel MX, Paton C, Reid P, Shiers D, Smith J. BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment. J Psychopharmacol 2016; 30:717-48. [PMID: 27147592 DOI: 10.1177/0269881116645254] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Excess deaths from cardiovascular disease are a major contributor to the significant reduction in life expectancy experienced by people with schizophrenia. Important risk factors in this are smoking, alcohol misuse, excessive weight gain and diabetes. Weight gain also reinforces service users' negative views of themselves and is a factor in poor adherence with treatment. Monitoring of relevant physical health risk factors is frequently inadequate, as is provision of interventions to modify these. These guidelines review issues surrounding monitoring of physical health risk factors and make recommendations about an appropriate approach. Overweight and obesity, partly driven by antipsychotic drug treatment, are important factors contributing to the development of diabetes and cardiovascular disease in people with schizophrenia. There have been clinical trials of many interventions for people experiencing weight gain when taking antipsychotic medications but there is a lack of clear consensus regarding which may be appropriate in usual clinical practice. These guidelines review these trials and make recommendations regarding appropriate interventions. Interventions for smoking and alcohol misuse are reviewed, but more briefly as these are similar to those recommended for the general population. The management of impaired fasting glycaemia and impaired glucose tolerance ('pre-diabetes'), diabetes and other cardiovascular risks, such as dyslipidaemia, are also reviewed with respect to other currently available guidelines.These guidelines were compiled following a consensus meeting of experts involved in various aspects of these problems. They reviewed key areas of evidence and their clinical implications. Wider issues relating to primary care/secondary care interfaces are discussed but cannot be resolved within guidelines such as these.
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Affiliation(s)
- Stephen J Cooper
- Professor of Psychiatry (Emeritus), Queen's University Belfast, UK Clinical Lead for the National Audit of Schizophrenia, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Gavin P Reynolds
- Professor (Emeritus), Queen's University Belfast, UK Honorary Professor of Neuroscience, Sheffield Hallam University, Sheffield, UK
| | | | - Tre Barnes
- Professor of Psychiatry, The Centre for Mental Health, Imperial College London, London, UK
| | - E England
- General Practitioner, Laurie Pike Health Centre, Birmingham, UK
| | - P M Haddad
- Honorary Clinical Professor of Psychiatry, University of Manchester, Manchester, UK Consultant Psychiatrist, Greater Manchester West Mental Health NHS Foundation Trust, Salford, UK
| | - A Heald
- Consultant Physician, Leighton and Macclesfield Hospitals, Cheshire, UK Research Fellow, University of Manchester, Manchester, UK
| | - Rig Holt
- Professor in Diabetes and Endocrinology, Human Development and Health Academic Unit, University of Southampton, Southampton, UK
| | - A Lingford-Hughes
- Professor of Addiction Biology, Imperial College, London, UK Consultant Psychiatrist, CNWL NHS Foundation Trust, London, UK
| | - D Osborn
- Professor of Psychiatric Epidemiology and Honorary Consultant Psychiatrist, Division of Psychiatry UCL, London, UK
| | - O McGowan
- Trainee in Psychiatry, Hairmyres Hospital, Glasgow, UK
| | - M X Patel
- Honorary Senior Lecturer, King's College London, IOPPN, Department of Psychosis Studies PO68, London, UK
| | - C Paton
- Chief Pharmacist, Oxleas NHS Foundation Trust, Dartford, UK Joint-Head, Prescribing Observatory for Mental Health, CCQI, Royal College of Psychiatrists, London, UK
| | - P Reid
- Policy Manager, Rethink Mental Illness, London, UK
| | - D Shiers
- Primary Care Lead for the National Audit of Schizophrenia, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - J Smith
- Professor of Early Intervention and Psychosis, University of Worcester, Worcester, UK
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87
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Abdallah N, Conn R, Latif Marini A. Improving physical health monitoring for patients with chronic mental health problems who receive antipsychotic medications. BMJ QUALITY IMPROVEMENT REPORTS 2016; 5:bmjquality_uu210300.w4189. [PMID: 27559474 PMCID: PMC4994095 DOI: 10.1136/bmjquality.u210300.w4189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 06/15/2016] [Indexed: 11/07/2022]
Abstract
Physical health monitoring is an integral part of caring for patients with mental health problems. It is proven that serious physical health problems are more common among patients with severe mental health illness (SMI), this monitoring can be challenging and there is a need for improvement. The project aimed at improving the physical health monitoring among patients with SMI who are receiving antipsychotic medications. The improvement process focused on ensuring there is a good communication with general practitioners (GPs) as well as patient's education and education of care home staff. GP letters requesting physical health monitoring were updated; care home staff and patients were given more information about the value of regular physical health monitoring. There was an improvement in patients' engagement with the monitoring and the monitoring done by GPs was more adherent to local and national guidelines and was communicated with the mental health service.
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Affiliation(s)
- Nihad Abdallah
- Barnet, Enfield and Haringey Mental Health Trust, London, UK
| | - Rory Conn
- Barnet, Enfield and Haringey Mental Health Trust, London, UK
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88
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Sado J, Kitamura T, Noma N, Saito M, Azuma H, Azuma T, Sobue T, Kitamura Y. Socio-environmental factors associated with diabetes mellitus among patients hospitalized with schizophrenia in Japan. Environ Health Prev Med 2016; 21:460-469. [PMID: 27448295 DOI: 10.1007/s12199-016-0550-2] [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: 03/01/2016] [Accepted: 07/03/2016] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE This study aimed to examine epidemiologically socio-environmental factors associated with diabetes mellitus among patients hospitalized with schizophrenia in Japan. METHODS This was a cross-sectional study from a single psychiatric hospital. Study patients were adults aged ≥20 years who were hospitalized with schizophrenia one or more times between January 2013 and December 2014. From electronic medical records or health insurance claims, we extracted schizophrenia patients with an F2 code according to ICD-10, and assessed the association of various factors with diabetes mellitus among these patients in a multivariable analysis. RESULTS During the 2-year period, there were 1899 patients hospitalized with a psychiatric disorder one or more times. Of them, a total of 770 adults with schizophrenia (285 men and 485 women) were eligible for our analysis. The standardized prevalence ratio of diabetes mellitus was 2.0 [95 % confidence interval (CI) 1.6-2.5] among men and 3.0 (95 % CI 2.5-3.6) among women in this hospital. There were no socio-environmental factors associated with diabetes mellitus among men. Among women, factors such as a 730-day hospitalization [adjusted odds ratio (OR) 3.82: 95 % confidence interval (CI) 1.52-9.64], and a medical protection/compulsory/discrimination hospitalization (adjusted OR 0.60, 95 % CI 0.36-0.99) were associated with diabetes mellitus. Compared with women living alone, those who were unmarried and lived together with someone had a significantly lower adjusted OR (0.41, 95 % CI 0.21-0.81). CONCLUSIONS Socio-environmental factors such as length of hospitalization, type of hospitalization, and marital status and living arrangement were associated with diabetes mellitus among hospitalized women with schizophrenia.
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Affiliation(s)
- Junya Sado
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita, 565-0871, Osaka, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita, 565-0871, Osaka, Japan
| | - Norio Noma
- Social Welfare Corporation, Kosaka Hospital, 2-7-30 Eiwa, Higashi-Osaka, 577-0809, Osaka, Japan
| | - Makiko Saito
- Social Welfare Corporation, Kosaka Hospital, 2-7-30 Eiwa, Higashi-Osaka, 577-0809, Osaka, Japan
| | - Hitoshi Azuma
- Social Welfare Corporation, Kosaka Hospital, 2-7-30 Eiwa, Higashi-Osaka, 577-0809, Osaka, Japan
| | - Tsukasa Azuma
- Social Welfare Corporation, Kosaka Hospital, 2-7-30 Eiwa, Higashi-Osaka, 577-0809, Osaka, Japan
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita, 565-0871, Osaka, Japan
| | - Yuri Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita, 565-0871, Osaka, Japan.
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89
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Abstract
This article presents findings from a study that evaluated the utility of Protection Motivation Theory to explain cardiovascular health behaviors among people with schizophrenia ( n = 83) and depression ( n = 70). Results indicated that the prevalence of overweight, cigarette smoking and a sedentary lifestyle were greater among people with a mental illness compared to individuals without a mental illness. Major predictors were high levels of fear of cardiovascular disease, lack of knowledge of correct dietary principles, lower self-efficacy, limited social support and psychiatric symptoms. Implications of these results are discussed in designing education and preventive health programs for individuals with schizophrenia and Mental Depressive Disorder (MDD).
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Affiliation(s)
- Loranie Leas
- School of Psychology, Deakin University, Burwood, Victoria, Australia
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90
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Hansen MV, Hjorth P, Kristiansen CB, Vandborg K, Gustafsson LN, Munk-Jørgensen P. Reducing cardiovascular risk factors in non-selected outpatients with schizophrenia. Int J Soc Psychiatry 2016; 62:400-7. [PMID: 27261497 DOI: 10.1177/0020764016629494] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Cardiovascular diseases are the most common causes of premature death in patients with schizophrenia. We aimed at reducing cardiovascular risk factors in non-selected outpatients with schizophrenia using methods proven effective in short-term trials. Furthermore, we examined whether any baseline characteristics were associated with positive outcomes. METHODS All outpatients treated for schizophrenia at two Danish hospitals were included in this 1-year follow-up study. The patients were offered health interventions both individually and in groups. Weight, waist circumference, blood glucose and lipids and information on smoking and alcohol were obtained. RESULTS On average, small significant increases in body mass index (BMI) and waist circumferences were observed while small non-significant improvements in other cardiovascular risk factors were seen. Patients with high baseline BMI and patients with duration of treated illness beyond 2 years had significantly better intervention outcomes. CONCLUSION Our results show that it was difficult to improve physical health in a group of non-selected patients with schizophrenia as part of routine care. The patients were not easily motivated to participate in the interventions, and it was difficult to monitor the recommended metabolic risk measures in the patient group. Future research should focus on simple strategies in health promotion that can be integrated into routine care.
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Affiliation(s)
- Mette Vinther Hansen
- Department of Organic Psychiatric Disorders and Emergency Ward (Dept. M), Aarhus University Hospital Risskov, Risskov, Denmark
| | | | - Christina Blanner Kristiansen
- Department of Organic Psychiatric Disorders and Emergency Ward (Dept. M), Aarhus University Hospital Risskov, Risskov, Denmark
| | | | - Lea Nørgaard Gustafsson
- Department of Organic Psychiatric Disorders and Emergency Ward (Dept. M), Aarhus University Hospital Risskov, Risskov, Denmark
| | - Povl Munk-Jørgensen
- Department of Organic Psychiatric Disorders and Emergency Ward (Dept. M), Aarhus University Hospital Risskov, Risskov, Denmark
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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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92
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Hansen MV, Hjorth P, Kristiansen CB, Vandborg K, Gustafsson LN, Munk-Jørgensen P. Reducing cardiovascular risk factors in non-selected outpatients with schizophrenia. Int J Soc Psychiatry 2016; 62:369-76. [PMID: 27009914 DOI: 10.1177/0020764016636277] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Cardiovascular diseases are the most common causes of premature death in patients with schizophrenia. We aimed at reducing cardiovascular risk factors in non-selected outpatients with schizophrenia using methods proven effective in short-term trials. Furthermore, we examined whether any baseline characteristics were associated with positive outcomes. METHODS All outpatients treated for schizophrenia at two Danish hospitals were included in this 1-year follow-up study. The patients were offered health interventions both individually and in groups. Weight, waist circumference, blood glucose, serum lipids, and information on smoking and alcohol were obtained. RESULTS On average, small significant increases in body mass index (BMI) and waist circumferences were observed while small non-significant improvements in other cardiovascular risk factors were seen. Patients with high baseline BMI and patients with duration of treated illness beyond 2 years had significantly better intervention outcomes. CONCLUSIONS Our results show that it was difficult to improve physical health in a group of non-selected patients with schizophrenia as part of routine care. The patients were not easily motivated to participate in the interventions, and it was difficult to monitor the recommended metabolic risk measures in the patient group. Future research should focus on simple strategies in health promotion that can be integrated into routine care.
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Affiliation(s)
- Mette Vinther Hansen
- Department of Organic Psychiatric Disorders and Emergency Ward (Dept. M), Aarhus University Hospital Risskov, Risskov, Denmark
| | | | - Christina Blanner Kristiansen
- Department of Organic Psychiatric Disorders and Emergency Ward (Dept. M), Aarhus University Hospital Risskov, Risskov, Denmark
| | | | - Lea Nørgaard Gustafsson
- Department of Organic Psychiatric Disorders and Emergency Ward (Dept. M), Aarhus University Hospital Risskov, Risskov, Denmark
| | - Povl Munk-Jørgensen
- Department of Organic Psychiatric Disorders and Emergency Ward (Dept. M), Aarhus University Hospital Risskov, Risskov, Denmark
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Foguet-Boreu Q, Fernandez San Martin MI, Flores Mateo G, Zabaleta Del Olmo E, Ayerbe García-Morzon L, Perez-Piñar López M, Martin-López LM, Montes Hidalgo J, Violán C. Cardiovascular risk assessment in patients with a severe mental illness: a systematic review and meta-analysis. BMC Psychiatry 2016; 16:141. [PMID: 27176477 PMCID: PMC4866037 DOI: 10.1186/s12888-016-0833-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 04/25/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Cardiovascular risk (CVR) has been observed to be higher in patients with severe mental illness (SMI) than in the general population. However, some studies suggest that CVR is not equally increased in different subgroups of SMI. The purposes of this review are to summarise CVR scores of SMI patients and to determine the differences in CVR between patients with different SMIs and between SMI patients and the control-population. METHODS MEDLINE (via PubMed) was searched for literature published through August 28, 2014, followed by a snowball search in the Web of Science. Observational and experimental studies that reported CVR assessments in SMI patients using validated tools were included. The risk of bias was reported using STROBE and CONSORT criteria. Pooled continuous data were expressed as standardized mean differences (SMD) with 95% confidence intervals (CI). Two reviewers independently selected studies, extracted data and assessed methodological quality. RESULTS A total of 3,608 articles were identified, of which 67 full text papers were assessed for eligibility and 35 were finally included in our review, in which 12,179 psychiatric patients and 225,951 comparative patients had been assessed. The most frequent diagnoses were schizophrenia and related diagnoses (45.7%), depressive disorders (14.7%), SMI (11.4%) and bipolar disorders (8.6%). The most frequent CVR assessment tool used was the Framingham risk score. Subgroups analysis showed a higher CVR in schizophrenia than in depressive disorder or in studies that included patients with multiple psychiatric diagnoses (SMD: 0.63, 0.03, and 0.02, respectively). Six studies were included in the meta-analysis. Total overall CVR did not differ between SMI patients and controls (SMD: 0.35 [95% CI:-0.02 to 0.71], p = 0.06); high heterogeneity was observed (I (2) = 93%; p < 0.001). CONCLUSIONS The summary of results from studies that assessed CVR using validated tools in SMI patients did not find sufficient data (except for limited evidence associated with schizophrenia) to permit any clear conclusions about increased CVR in this group of patients compared to the general population. The systematic review is registered in PROSPERO CRD42013003898 .
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Affiliation(s)
- Quintí Foguet-Boreu
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Universitat Autònoma de Barcelona, Gran Via Corts Catalanes, 587 àtic, 08007, Barcelona, Spain.
- Department of Medical Sciences, School of Medicine, University of Girona, Emili Grahit, 77, 17071, Girona, Spain.
| | - Maria Isabel Fernandez San Martin
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Universitat Autònoma de Barcelona, Gran Via Corts Catalanes, 587 àtic, 08007, Barcelona, Spain
- Técnica de Salud ICS, Unitat Docent AFiC, Sardenya, 375, Entl., 08025, Barcelona, Spain
| | - Gemma Flores Mateo
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Universitat Autònoma de Barcelona, Gran Via Corts Catalanes, 587 àtic, 08007, Barcelona, Spain
| | - Edurne Zabaleta Del Olmo
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Universitat Autònoma de Barcelona, Gran Via Corts Catalanes, 587 àtic, 08007, Barcelona, Spain
- Faculty of Nursing, University of Girona, Emili Grahit, 77, 17071, Girona, Spain
| | - Luís Ayerbe García-Morzon
- The Westborough Road Health Centre, 258 Westborough Road, Westcliff-on-Sea, SS0 9PT, United Kingdom
- Centre of Primary Care and Public Health, Queen Mary University of London, Yvone Carter Building 58 Tuner Street, E1 2AB, London, United Kingdom
| | - Maria Perez-Piñar López
- The Westborough Road Health Centre, 258 Westborough Road, Westcliff-on-Sea, SS0 9PT, United Kingdom
| | - Luis Miguel Martin-López
- Departamento de Psiquiatría y Medicina Legal, Instituto de Neuropsiquiatría y Adicciones (INAD), Hospital del Mar Parc de Salut Mar., Universidad Autónoma de Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - Javier Montes Hidalgo
- Gimbernat School of Nursing, Universitat Autònoma de Barcelona, Avinguda de la Generalitat, 202-206, Sant Cugat del Vallès, 08174, Barcelona, Spain
| | - Concepción Violán
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Universitat Autònoma de Barcelona, Gran Via Corts Catalanes, 587 àtic, 08007, Barcelona, Spain
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Cheng KY, Chen SY, Lin CY. Mortality among patients with schizophrenia and vocational rehabilitation program services under Taiwan's psychiatric care reform. Int J Ment Health Syst 2016; 10:32. [PMID: 27073413 PMCID: PMC4828847 DOI: 10.1186/s13033-016-0063-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 03/31/2016] [Indexed: 11/10/2022] Open
Abstract
Background Vocational rehabilitation programs are implemented to enhance the occupational functioning of long-stay patients with schizophrenia. Unemployment is associated with a higher risk of death. Schizophrenia patients who participate in vocational rehabilitation programs may have better health outcomes with participation in employment. Aim To evaluate the relationship between mortality among schizophrenia patients and vocational rehabilitation program services under Taiwan’s psychiatric care reform. Methods A total of 2457 long-stay schizophrenia patients were followed-up retrospectively from 1998 to 2008 at Taipei Veterans General Hospital Yuli Branch in Taiwan. We collected data on annual measurements of effectiveness and the human resources utilized in the vocational rehabilitation program. Pearson’s correlations between the above-collected data and the crude death rates for all patients were examined. We also assessed the association between participation in supported or sheltered employment and death. Results Most of the patients were male (81.3 %). The mean ± SD age of the patients was 57.8 ± 17.0 years. The annual crude death rate averaged 5.3 %. Both the number of community workplaces and the total wages earned from sheltered and supported employment had significantly negative linear correlations with the crude death rate among all patients (both γ ≤ −0.64, p < 0.05). After controlling the confounding factors, participation in supported or sheltered employment was significantly associated with a lower risk of death (n = 2174, HR = 0.22, 95 % CI 0.16–0.29). Conclusions Under psychiatric care reform, the vocational rehabilitation program was more effective and there was less patient mortality. Patients who had experienced sheltered or supported employment had a lower risk of death than those who had not.
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Affiliation(s)
- Kan-Yuan Cheng
- Department of Psychiatry, Taipei Veterans' General Hospital Yuli Branch, No. 91, XinXing Rd., Yuli Township, 980 Hualien County Taiwan
| | - Shu-Yuan Chen
- Department of Public Health, Tzu Chi University, No. 701, Zhongyang Rd., Sec. 3, Hualien City, 970 Hualien County Taiwan
| | - Chih-Yuan Lin
- Department of Psychiatry, Taipei Veterans' General Hospital Yuli Branch, No. 91, XinXing Rd., Yuli Township, 980 Hualien County Taiwan
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95
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A nutrition intervention is effective in improving dietary components linked to cardiometabolic risk in youth with first-episode psychosis. Br J Nutr 2016; 115:1987-93. [DOI: 10.1017/s0007114516001033] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
AbstractSevere mental illness is characterised by a 20-year mortality gap due to cardiometabolic disease. Poor diet in those with severe mental illness is an important and modifiable risk factor. The present study aimed to (i) examine baseline nutritional intake in youth with first-episode psychosis (FEP), (ii) evaluate the feasibility and acceptability of nutritional intervention early in FEP and (iii) to evaluate the effectiveness of early dietary intervention on key nutritional end points. Participants were recruited over a 12-month period from a community-based programme specifically targeting young people aged 15–25 years with newly diagnosed FEP. Individual dietetic consultations and practical group sessions were offered as part of a broader lifestyle programme. Dietary assessments were conducted before and at the end of the 12-week intervention. Participants exceeded recommended energy and Na intakes at baseline. Retention within the nutrition intervention was 67 %, consistent with other interventions offered to FEP clients. There was a 47 % reduction in discretionary food intake (−94 g/d,P<0·001) and reductions in daily energy (−24 %,P<0·001) and Na (−26 %,P<0·001) intakes. Diet quality significantly improved, and the mean change was 3·6 (95 % CI 0·2, 6·9,P<0·05), although this finding was not significant after Bonferroni’s correction. Increased vegetable intake was the main factor contributing to improved diet quality. Nutrition intervention delivered shortly after initiation of antipsychotic medication is feasible, acceptable and effective in youth with FEP. Strategies to prevent weight gain and metabolic decline will contribute to prevent premature cardiometabolic disease in this vulnerable population.
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96
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Bartlem KM, Bowman J, Freund M, Wye PM, Barker D, McElwaine KM, Wolfenden L, Campbell EM, McElduff P, Gillham K, Wiggers J. Effectiveness of an intervention in increasing the provision of preventive care by community mental health services: a non-randomized, multiple baseline implementation trial. Implement Sci 2016; 11:46. [PMID: 27039077 PMCID: PMC4818909 DOI: 10.1186/s13012-016-0408-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 03/09/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Relative to the general population, people with a mental illness are more likely to have modifiable chronic disease health risk behaviours. Care to reduce such risks is not routinely provided by community mental health clinicians. This study aimed to determine the effectiveness of an intervention in increasing the provision of preventive care by such clinicians addressing four chronic disease risk behaviours. METHODS A multiple baseline trial was undertaken in two groups of community mental health services in New South Wales, Australia (2011-2014). A 12-month practice change intervention was sequentially implemented in each group. Outcome data were collected continuously via telephone interviews with a random sample of clients over a 3-year period, from 6 months pre-intervention in the first group, to 6 months post intervention in the second group. Outcomes were client-reported receipt of assessment, advice and referral for tobacco smoking, harmful alcohol consumption, inadequate fruit and/or vegetable consumption and inadequate physical activity and for the four behaviours combined. Logistic regression analyses examined change in client-reported receipt of care. RESULTS There was an increase in assessment for all risks combined following the intervention (18 to 29 %; OR 3.55, p = 0.002: n = 805 at baseline, 982 at follow-up). No significant change in assessment, advice or referral for each individual risk was found. CONCLUSIONS The intervention had a limited effect on increasing the provision of preventive care. Further research is required to determine how to increase the provision of preventive care in community mental health services. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12613000693729.
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Affiliation(s)
- Kate M. Bartlem
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
| | - Jenny Bowman
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
| | - Megan Freund
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Paula M. Wye
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Daniel Barker
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Kathleen M. McElwaine
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Luke Wolfenden
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Elizabeth M. Campbell
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Patrick McElduff
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Karen Gillham
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
| | - John Wiggers
- Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, NSW 2287 Australia
- Hunter Medical Research Institute, Clinical Research Centre, Level 3 John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305 Australia
- School of Medicine and Public Health, Faculty of Health, The University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
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Abstract
BACKGROUND People with serious mental illness have consistently higher levels of mortality and morbidity than the general population. They have greater levels of cardiovascular disease, metabolic disease, diabetes, and respiratory illness. Although genetics may have a role in the physical health problems of these people, lifestyle and environmental factors such as smoking, obesity, poor diet, and low levels of physical activity play a prominent part. OBJECTIVES To review the effects of dietary advice for schizophrenia and schizophrenia-like psychosis. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Trials Register (September 09, 2013 and February 24, 2016). SELECTION CRITERIA We planned to include all randomised clinical trials focusing on dietary advice versus standard care. DATA COLLECTION AND ANALYSIS The review authors (RP, KTP) independently screened search results but did not identify any studies that fulfilled the review's criteria. MAIN RESULTS We did not identify any studies that met our inclusion criteria. AUTHORS' CONCLUSIONS Dietary advice has been shown to improve the dietary intake of the general population. Research is needed to determine whether dietary advice can have a similar benefit in people with serious mental illness.
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Affiliation(s)
- Robert Pearsall
- Monklands HospitalDepartment of PsychiatryMonkscourt AvenueAirdrieUKML6 0JS
| | - Kudlar Thyarappa Praveen
- South West Yorkshire Mental Health NHS trustCrisis resolution teamFieldhead hospital, Ouchthorpe LaneWakefieldUKWF1 3SP
| | - Anthony Pelosi
- St John's HospitalRegional Eating Disorders UnitLivingstoneUK
| | - John Geddes
- University of Oxford/Warneford HospitalDepartment of PsychiatryOxfordUKOX3 7JX
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98
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Carney R, Cotter J, Bradshaw T, Firth J, Yung AR. Cardiometabolic risk factors in young people at ultra-high risk for psychosis: A systematic review and meta-analysis. Schizophr Res 2016; 170:290-300. [PMID: 26794596 DOI: 10.1016/j.schres.2016.01.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 12/09/2015] [Accepted: 01/04/2016] [Indexed: 01/30/2023]
Abstract
BACKGROUND The physical health of people with schizophrenia is poor, and associated with increased morbidity and mortality. Unhealthy lifestyles and side-effects of antipsychotic medication contribute to cardiometabolic dysfunction. Yet it is unclear when this unhealthy profile starts. We aimed to see if people at ultra-high risk for psychosis (UHR) have increased rates of cardiometabolic risk factors. METHOD An electronic search of MEDLINE, PsycINFO, Embase and the Cochrane Central Register of Controlled Trials was conducted on 1st May 2015 using terms associated with the ultra-high risk state and health. Eligible studies were peer-reviewed English language research articles with populations that met at-risk diagnostic criteria and reported cardiometabolic risk factors. A meta-analysis was conducted on smoking data, the cardiometabolic risk factor that yielded the most studies. RESULTS Forty-seven eligible studies were identified. UHR samples had low levels of physical activity, and high rates of smoking and alcohol abuse compared with controls. No differences were found for body mass index. An overall pooled rate of smoking for UHR participants was 33% (95% CI=0.24-0.42) and significantly more UHR individuals smoked compared with controls with a pooled odds ratio of 2.3 (P<0.05; 95% CI=-1.48-3.48). CONCLUSIONS UHR samples display cardiometabolic risk factors which are largely modifiable. The UHR phase is an important opportunity for early intervention services to improve physical health.
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Affiliation(s)
- Rebekah Carney
- Institute of Brain, Behaviour and Mental Health, University of Manchester, M13 9PL, UK.
| | - Jack Cotter
- Institute of Brain, Behaviour and Mental Health, University of Manchester, M13 9PL, UK
| | - Tim Bradshaw
- School of Nursing, Midwifery and Social Work, University of Manchester, M13 9PL, UK
| | - Joseph Firth
- Institute of Brain, Behaviour and Mental Health, University of Manchester, M13 9PL, UK
| | - Alison R Yung
- Institute of Brain, Behaviour and Mental Health, University of Manchester, M13 9PL, UK
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99
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McGinty EE, Baller J, Azrin ST, Juliano-Bult D, Daumit GL. Interventions to Address Medical Conditions and Health-Risk Behaviors Among Persons With Serious Mental Illness: A Comprehensive Review. Schizophr Bull 2016; 42. [PMID: 26221050 PMCID: PMC4681556 DOI: 10.1093/schbul/sbv101] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
People with serious mental illness (SMI) have mortality rates 2 to 3 times higher than the overall US population, largely due to cardiovascular disease. The prevalence of cardiovascular risk factors such as obesity and diabetes mellitus and other conditions, such as HIV/AIDS, is heightened in this group. Based on the recommendations of a National Institute of Mental Health stakeholder meeting, we conducted a comprehensive review examining the strength of the evidence surrounding interventions to address major medical conditions and health-risk behaviors among persons with SMI. Peer-reviewed studies were identified using 4 major research databases. Randomized controlled trials and observational studies testing interventions to address medical conditions and risk behaviors among persons with schizophrenia and bipolar disorder between January 2000 and June 2014 were included. Information was abstracted from each study by 2 trained reviewers, who also rated study quality using a standard tool. Following individual study review, the quality of the evidence (high, medium, low) and the effectiveness of various interventions were synthesized. 108 studies were included. The majority of studies examined interventions to address overweight/obesity (n = 80). The strength of the evidence was high for 4 interventions: metformin and behavioral interventions had beneficial effects on weight loss; and bupropion and varenicline reduced tobacco smoking. The strength of the evidence was low for most other interventions reviewed. Future studies should test long-term interventions to cardiovascular risk factors and health-risk behaviors. In addition, future research should study implementation strategies to effectively translate efficacious interventions into real-world settings.
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Affiliation(s)
- Emma E. McGinty
- Departments of Health Policy and Management and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;,*To whom correspondence should be addressed; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 359, Baltimore, MD 21205, US; tel: 410-614-4018, e-mail:
| | - Julia Baller
- Departments of Health Policy and Management and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Gail L. Daumit
- Division of General Internal Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
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Owen-Smith A, Stewart C, Green C, Ahmedani BK, Waitzfelder BE, Rossom R, Copeland LA, Simon GE. Adherence to common cardiovascular medications in patients with schizophrenia vs. patients without psychiatric illness. Gen Hosp Psychiatry 2016; 38:9-14. [PMID: 26423559 PMCID: PMC4698196 DOI: 10.1016/j.genhosppsych.2015.07.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 07/27/2015] [Accepted: 07/27/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of the study was to examine whether individuals with diagnoses of schizophrenia were differentially adherent to their statin or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) medications compared to individuals without psychiatric illness. METHOD Using electronic medical record data across 13 Mental Health Research Network sites, individuals with diagnoses of schizophrenia or schizoaffective disorder receiving two or more medication dispensings of a statin or an ACEI/ARB in 2011 (N=710) were identified and matched on age, sex and Medicare status to controls with no documented mental illness and two or more medication dispensings of a statin in 2011 (N=710). Medication adherence, and sociodemographic and clinical characteristics of the study population were assessed. RESULTS Multivariable models indicated that having a schizophrenia diagnosis was associated with increased odds of statin medication adherence; the odds ratio suggested a small effect. After adjustment for medication regimen, schizophrenia no longer showed an association with statin adherence. Having a schizophrenia diagnosis was not associated with ACEI/ARB medication adherence. CONCLUSIONS Compared to patients without any psychiatric illness, individuals with schizophrenia were marginally more likely to be adherent to their statin medications. Given that patterns of adherence to cardioprotective medications may be different from patterns of adherence to antipsychotic medications, improving adherence to the former may require unique intervention strategies.
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