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Charles EF, Lambert CG, Kerner B. Bipolar disorder and diabetes mellitus: evidence for disease-modifying effects and treatment implications. Int J Bipolar Disord 2016; 4:13. [PMID: 27389787 PMCID: PMC4936996 DOI: 10.1186/s40345-016-0054-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/18/2016] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND Bipolar disorder refers to a group of chronic psychiatric disorders of mood and energy levels. While dramatic psychiatric symptoms dominate the acute phase of the diseases, the chronic course is often determined by an increasing burden of co-occurring medical conditions. High rates of diabetes mellitus in patients with bipolar disorder are particularly striking, yet unexplained. Treatment and lifestyle factors could play a significant role, and some studies also suggest shared pathophysiology and risk factors. OBJECTIVE In this systematic literature review, we explored data around the relationship between bipolar disorder and diabetes mellitus in recently published population-based cohort studies with special focus on the elderly. METHODS A systematic search in the PubMed database for the combined terms "bipolar disorder" AND "elderly" AND "diabetes" in papers published between January 2009 and December 2015 revealed 117 publications; 7 studies were large cohort studies, and therefore, were included in our review. RESULTS We found that age- and gender- adjusted risk for diabetes mellitus was increased in patients with bipolar disorder and vice versa (odds ratio range between 1.7 and 3.2). DISCUSSION Our results in large population-based cohort studies are consistent with the results of smaller studies and chart reviews. Even though it is likely that heterogeneous risk factors may play a role in diabetes mellitus and in bipolar disorder, growing evidence from cell culture experiments and animal studies suggests shared disease mechanisms. Furthermore, disease-modifying effects of bipolar disorder and diabetes mellitus on each other appear to be substantial, impacting both treatment response and outcomes. CONCLUSIONS The risk of diabetes mellitus in patients with bipolar disorder is increased. Our findings add to the growing literature on this topic. Increasing evidence for shared disease mechanisms suggests new disease models that could explain the results of our study. A better understanding of the complex relationship between bipolar disorder and diabetes mellitus could lead to novel therapeutic approaches and improved outcomes.
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Affiliation(s)
- Ellen F. Charles
- />David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095 USA
| | - Christophe G. Lambert
- />Center for Global Health, Division of Translational Informatics, Department of Internal Medicine, University of New Mexico Health Sciences Center, University of New Mexico, MSC10 5550, Albuquerque, NM 87131 USA
| | - Berit Kerner
- />Semel Institute for Neuroscience and Human Behavior, University of California, 695 Charles E. Young Drive South, Box 951761, Los Angeles, CA 90095 USA
- />Fakultät für Gesundheit, Private Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany
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102
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Daumit GL, McGinty EE, Pronovost P, Dixon LB, Guallar E, Ford DE, Cahoon EK, Boonyasai RT, Thompson D. Patient Safety Events and Harms During Medical and Surgical Hospitalizations for Persons With Serious Mental Illness. Psychiatr Serv 2016; 67:1068-1075. [PMID: 27181736 PMCID: PMC5048490 DOI: 10.1176/appi.ps.201500415] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study explored the risk of patient safety events and associated nonfatal physical harms and mortality in a cohort of persons with serious mental illness. This group experiences high rates of medical comorbidity and premature mortality and may be at high risk of adverse patient safety events. METHODS Medical record review was conducted for medical-surgical hospitalizations occurring during 1994-2004 in a community-based cohort of Maryland adults with serious mental illness. Individuals were eligible if they died within 30 days of a medical-surgical hospitalization and if they also had at least one prior medical-surgical hospitalization within five years of death. All admissions took place at Maryland general hospitals. A case-crossover analysis examined the relationships among patient safety events, physical harms, and elevated likelihood of death within 30 days of hospitalization. RESULTS A total of 790 hospitalizations among 253 adults were reviewed. The mean number of patient safety events per hospitalization was 5.8, and the rate of physical harms was 142 per 100 hospitalizations. The odds of physical harm were elevated in hospitalizations in which 22 of the 34 patient safety events occurred (p<.05), including medical events (odds ratio [OR]=1.5, 95% confidence interval [CI]=1.3-1.7) and procedure-related events (OR=1.6, CI=1.2-2.0). Adjusted odds of death within 30 days of hospitalization were elevated for individuals with any patient safety event, compared with those with no event (OR=3.7, CI=1.4-10.3). CONCLUSIONS Patient safety events were positively associated with physical harm and 30-day mortality in nonpsychiatric hospitalizations for persons with serious mental illness.
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Affiliation(s)
- Gail L Daumit
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
| | - Emma E McGinty
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
| | - Peter Pronovost
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
| | - Lisa B Dixon
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
| | - Eliseo Guallar
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
| | - Daniel E Ford
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
| | - Elizabeth K Cahoon
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
| | - Romsai T Boonyasai
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
| | - David Thompson
- Dr. Daumit, Dr. Ford, and Dr. Boonyasai are with the Department of Internal Medicine, and Dr. Pronovost and Dr. Thompson are with the Department of Anesthesiology and the Department of Critical Care Medicine, all at Johns Hopkins University School of Medicine, Baltimore. Dr. Daumit is also with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, where Dr. McGinty is affiliated. Dr. Dixon is with the New York State Psychiatric Institute and the Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York City. Dr. Guallar is with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore. Dr. Cahoon is with the Radiation Epidemiology Branch, National Cancer Institute, Bethesda, Maryland. Send correspondence to Dr. McGinty (e-mail: )
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103
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Diabetes and Cardiovascular Care Among People with Severe Mental Illness: A Literature Review. J Gen Intern Med 2016; 31:1083-91. [PMID: 27149967 PMCID: PMC4978675 DOI: 10.1007/s11606-016-3712-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 03/17/2016] [Accepted: 04/05/2016] [Indexed: 01/20/2023]
Abstract
Close to 19 million US adults have severe mental illnesses (SMI), and they die, on average, 25 years earlier than the general population, most often from cardiovascular disease (CVD). Many of the antipsychotic medications used to treat SMI contribute to CVD risk by increasing risk for obesity, type 2 diabetes, dyslipidemia, and hypertension. Based on compelling evidence, the American Diabetes Association and the American Psychiatric Association developed guidelines for metabolic screening and monitoring during use of these medications.In this manuscript, we have reviewed the evidence on diabetes and other CVD risk screening, prevalence, and management among populations with SMI. We also review differences in screening among subpopulations with SMI (e.g., racial/ethnic minorities, women, and children). We found that despite national guidelines for screening for diabetes and other cardiovascular risk factors, up to 70 % of people taking antipsychotics remain unscreened and untreated. Based on estimates that 20 % of the 19 million US adults with SMI have diabetes and 70 % of them are not screened; it is likely that over 2 million Americans with SMI have unidentified diabetes. Given that undiagnosed diabetes costs over $4,000 per person, this failure to identify diabetes among people with SMI represents a missed opportunity to prevent morbidity and translates to over $8 billion in annual preventable costs to our healthcare system.Given the high burden of disease and significant evidence of suboptimal medical care received by people with SMI, we propose several clinical and policy recommendations to improve diabetes and other CVD risk screening and care for this highly vulnerable population. These recommendations include reducing antipsychotic medication dose or switching antipsychotic medications, enhancing smoking cessation efforts, sharing electronic health records between physical and mental health care systems, and promoting integration of care.
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104
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Affiliation(s)
- Haiden A Huskamp
- From the Department of Health Care Policy, Harvard Medical School, Boston (H.A.H.). Mr. Iglehart is a national correspondent for the Journal
| | - John K Iglehart
- From the Department of Health Care Policy, Harvard Medical School, Boston (H.A.H.). Mr. Iglehart is a national correspondent for the Journal
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105
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Vancampfort D, Stubbs B, Sienaert P, Wyckaert S, De Hert M, Richards J, Kinyanda E, Probst M. Depressive symptoms and muscular fitness contribute independently to the ability to perform daily life activities in people with bipolar disorder. Nord J Psychiatry 2016; 70:477-82. [PMID: 27049347 DOI: 10.3109/08039488.2016.1161072] [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: 01/29/2023]
Abstract
BACKGROUND Compared with healthy controls, people with bipolar disorder experience muscle weakness. The extent to which muscle weakness influences the performance of daily life activities such as walking in people with bipolar disorder requiring hospitalization is unclear. AIMS The primary aim of the current study was to explore whether depressive symptoms and muscular fitness independently contribute to the walking capacity in people with bipolar disorder. A secondary aim was to identify variables that could explain the variability in muscular fitness. METHODS Forty-two inpatients with bipolar disorder performed a standing broad jump test (SBJ), a measure of muscular performance, and the six minute walk test (6MWT) in addition to the International Physical Activity Questionnaire (IPAQ), the Depressive Symptomatology Self Report (QIDS) and a full-fasting metabolic screening. RESULTS The correlation between the 6MWT (595.0 ± 127.3m) and SBJ (126.2 ± 48.6m) was high (r = 0.72, p < 0.001). In backward regression analyzes, 82.3% of the variance in 6MWT was explained by SJB, QIDS (7.6 ± 5.1) and the presence of metabolic syndrome (n = 16; 38%), while 83.0% of the variance in SBJ-score was explained by age, and the QIDS and IPAQ (1435.3 ± 1179.8 MET-min/week) scores. CONCLUSIONS Depressive symptoms and muscular fitness contribute independently to daily life functioning in people with bipolar disorder. Thus, muscular rehabilitation strategies might offer a strategy for improving performance of daily life activities in this group.
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Affiliation(s)
- Davy Vancampfort
- a Department of Rehabilitation Sciences , KU Leuven - University of Leuven , Leuven , Belgium ;,b KU Leuven - University of Leuven, University Psychiatric Center KU Leuven , Leuven , Kortenberg , Belgium
| | - Brendon Stubbs
- c Physiotherapy Department , South London and Maudsley NHS Foundation Trust , London , UK ;,d Health Service and Population Research Department , Institute of Psychiatry, Psychology and Neuroscience, King's College London , De Crespigny Park , London , UK
| | - Pascal Sienaert
- b KU Leuven - University of Leuven, University Psychiatric Center KU Leuven , Leuven , Kortenberg , Belgium
| | - Sabine Wyckaert
- b KU Leuven - University of Leuven, University Psychiatric Center KU Leuven , Leuven , Kortenberg , Belgium
| | - Marc De Hert
- b KU Leuven - University of Leuven, University Psychiatric Center KU Leuven , Leuven , Kortenberg , Belgium
| | - Justin Richards
- e School of Public Health & Charles Perkins Centre , University of Sydney , Australia
| | - Eugene Kinyanda
- f Department of Psychiatry , Makerere University College of Health Sciences, School of Health Sciences , Kampala , Uganda ;,g MRC/UVRI Uganda Research Unit on AIDS , Entebbe , Uganda
| | - Michel Probst
- a Department of Rehabilitation Sciences , KU Leuven - University of Leuven , Leuven , Belgium
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106
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Bridging the gap: What have we done and what more can we do to reduce the burden of avoidable death in people with psychotic illness? Epidemiol Psychiatr Sci 2016; 25:205-10. [PMID: 26768358 PMCID: PMC6998739 DOI: 10.1017/s2045796015001043] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Despite overwhelming evidence demonstrating a persisting gap in life expectancy between those with psychotic illness and the general population, there has been no widespread implementation of interventions to improve the physical wellbeing of people with psychotic illness. This article explores opportunities to 'Bridge the Gap' in life expectancy. We describe an Australian evidence-based intervention that has substantially improved the physical health of young people recently commenced on antipsychotic medication. Further epidemiological research, accompanied by cultural change within mental health services, is an essential precursor to the implementation of effective and sustainable lifestyle interventions. There are other relatively neglected areas of physical wellbeing for people with psychotic illness, such as screening and diagnosis of malignancies, which need more research and clinical attention. While there has been progress with intervention development and evaluation, translation of evidence-based short-term intervention studies into feasible and sustainable system-wide changes within routine mental health service settings remains a challenge. Developing an implementation framework to support such change is an urgent priority so as to bridge the persisting premature mortality in people living with psychotic illness.
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107
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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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108
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Abstract
PURPOSE OF REVIEW Type 2 diabetes mellitus (T2DM) negatively affects brain structure and function. Meta-analytical data show that relative to age and sex matched non-psychiatric controls, patients with bipolar disorders have double the risk of T2DM. We review the evidence for association between T2DM and adverse clinical and brain imaging changes in bipolar disorders and summarize studies investigating effects of diabetes treatment on psychiatric and brain outcomes. RECENT FINDINGS Participants with bipolar disorders and T2DM or insulin resistance demonstrate greater morbidity, chronicity and disability, and lower treatment response to Li. Bipolar disorders complicated by insulin resistance/T2DM are associated with smaller hippocampal and cortical gray matter volumes and lower prefrontal N-acetyl aspartate (neuronal marker). Treatment of T2DM yields preservation of brain gray matter and insulin sensitizers, such as pioglitazone, improve symptoms of depression in unipolar or bipolar disorders. SUMMARY T2DM or insulin resistance frequently cooccur with bipolar disorders and are associated with negative psychiatric clinical outcomes and compromised brain health. This is clinically concerning, as patients with bipolar disorders have an increased risk of metabolic syndrome and yet often receive suboptimal medical care. At the same time treatment of T2DM and insulin resistance has positive effects on psychiatric and brain outcomes. These findings create a rich agenda for future research, which could enhance psychiatric pharmacopeia and directly impact patient care.
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109
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Hobkirk AL, Towe SL, Lion R, Meade CS. Primary and Secondary HIV Prevention Among Persons with Severe Mental Illness: Recent Findings. Curr HIV/AIDS Rep 2015; 12:406-12. [PMID: 26428958 PMCID: PMC4812670 DOI: 10.1007/s11904-015-0294-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Persons with severe mental illness (SMI) have been disproportionately affected by the HIV epidemic, with higher rates of HIV prevalence and morbidity than the general population. Recent research has advanced our understanding of the complex factors that influence primary and secondary HIV prevention for those with SMI. Sex risk in this population is associated with socioeconomic factors (e.g., low income, history of verbal violence) and other health risk behaviors (e.g., substance use, no prior HIV testing). Several interventions are effective at reducing risk behavior, and reviews highlight the need for more well-controlled studies that assess long-term outcomes. Recent research has elucidated barriers that interfere with HIV treatment for SMI populations, including individual (e.g., apathy, substance use), social (e.g., stigma), and system factors (e.g., transportation, clinic wait times). Interventions that coordinate HIV care for individuals with SMI show promise as cost-effective methods for improving medication adherence and quality of life.
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Affiliation(s)
- Andréa L Hobkirk
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 90519, Durham, NC, 27708, USA.
| | - Sheri L Towe
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 90519, Durham, NC, 27708, USA.
| | - Ryan Lion
- Duke Global Health Institute, Duke University, 310 Trent Drive, Trent Hall, Durham, NC, 27708, USA.
| | - Christina S Meade
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Box 90519, Durham, NC, 27708, USA.
- Duke Global Health Institute, Duke University, 310 Trent Drive, Trent Hall, Durham, NC, 27708, USA.
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110
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Managing Mentally Ill Patients in Primary Care. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_31-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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