151
|
Jakobs KM, Posthuma A, de Grauw WJC, Schalk BWM, Akkermans RP, Lucassen P, Schermer T, Assendelft WJJ, Biermans MJC. Cardiovascular risk screening of patients with serious mental illness or use of antipsychotics in family practice. BMC FAMILY PRACTICE 2020; 21:153. [PMID: 32727372 PMCID: PMC7391510 DOI: 10.1186/s12875-020-01225-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 07/19/2020] [Indexed: 12/02/2022]
Abstract
Background Patients with serious mental illness (SMI) and patients on antipsychotics (AP) have an elevated risk for cardiovascular diseases. In the Netherlands, the mental healthcare for these patients is increasingly taken care of by family practitioners (FP) as a result of a shift from secondary to primary care. Therefore, it is essential to increase our knowledge regarding the characteristics of this patient group and the (somatic) care provided by their FPs. The aim was to examine the rate of cardiovascular risk screening in patients with SMI or the use of AP in family practice. Methods We performed a retrospective cohort study of 151.238 patients listed in 24 family practices in the Netherlands. From electronic medical records we extracted data concerning diagnoses, measurement values of CVR factors, medication and frequency of visits over a 2 year period. Primary outcome was the rate of patients who were screened for CVR factors. We compared three groups: patients with SMI/AP without diabetes or CVD (SMI/AP-only), patients with SMI/AP and diabetes mellitus (SMI/AP + DM), patients with SMI/AP and a history of cardiovascular disease (SMI/AP + CVD). We explored factors associated with adequate screening using multilevel logistic regression. Results We identified 1705 patients with SMI/AP, 834 with a SMI diagnosis, 1150 using AP. The screening rate for CVR in the SMI/AP-only group (n = 1383) was adequate in 8.5%. Screening was higher in the SMI/AP − +DM (n = 206, 68.4% adequate, OR 24.6 (95%CI, 17.3–35.1) and SMI/AP + CVD (n = 116, 26.7% adequate, OR 4.2 (95%CI, 2.7–6.6). A high frequency of visits, age, the use of AP and a diagnosis of COPD were associated with a higher screening rate. In addition we also examined differences between patients with SMI and patients using AP without SMI. Conclusion CVR screening in patients with SMI/AP is performed poorly in Dutch family practices. Acceptable screening rates were found only among SMI/AP patients with diabetes mellitus as comorbidity. The finding of a large group of AP users without a SMI diagnosis may indicate that FPs often prescribe AP off-label, lack information about the diagnosis, or use the wrong code.
Collapse
Affiliation(s)
- Kirsti M Jakobs
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Anne Posthuma
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Wim J C de Grauw
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Bianca W M Schalk
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Reinier P Akkermans
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Peter Lucassen
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Tjard Schermer
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Willem J J Assendelft
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Marion J C Biermans
- Department of Primary and Community Care (117-ELG), Radboud University Medical Centre, Radboud Institute for Health Sciences, PO Box 9101, 6500, HB, Nijmegen, The Netherlands
| |
Collapse
|
152
|
Are diabetes self-management programmes for the general diabetes population effective for people with severe mental illness?: a systematic review. BMC Psychiatry 2020; 20:386. [PMID: 32711492 PMCID: PMC7382073 DOI: 10.1186/s12888-020-02779-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 07/05/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Diabetes self-management education programmes are effective in improving health outcomes in the general population with diabetes. However, it is not known if these programmes include people who also have a severe mental illness (SMI) and, if so, what their outcomes are. The aim of this review was to examine if evaluations of diabetes self-management education programmes included people with SMI, and if so, whether the interventions were beneficial for this population. METHODS The inclusion criteria for this systematic review, defined by PICOS criteria, were: Population - Adults with type 2 diabetes; Intervention - self-management education programme; Comparator - another active intervention or usual care; Outcomes of interest - inclusion of people with SMI and the clinical, behavioural and psychosocial outcomes in this population; Study design - randomised controlled trials. The following bibliographic databases were searched from January 2004 to April 2018: Cochrane Library, Medline, Embase, PsychINFO, Allied and Complimentary Medicine Database, Health Technology Assessment, NHS Economic Evaluations Database and CINAHL. Data were extracted on study characteristics, inclusion and exclusion criteria, participant and intervention characteristics, number of participants with SMI, and outcomes for people with SMI, if reported. Authors were contacted by email for missing data. RESULTS A total of 410 trials were included. At least 42% of trials did not recruit any participants with SMI. Only nine confirmed inclusion of participants with SMI, of which six provided data on the number recruited. These six trials recruited a total of 1009 participants, of whom 31 (3.1%) had SMI. It was not possible to assess intervention effectiveness for people with SMI as none of the trials reported outcomes for these participants. CONCLUSIONS This systematic review confirms that people with SMI are often excluded from trials of diabetes self-management education, resulting in a lack of an evidence base on which to base treatment paths for this vulnerable population. It cannot be assumed that programmes developed for the general diabetes population meet the needs of people with SMI. Future research needs to examine if and how these programmes could be adapted for people with SMI or if new programmes are required.
Collapse
|
153
|
Agaba DC, Migisha R, Katamba G, Ashaba S. Cardio-metabolic abnormalities among patients with severe mental illness at a Regional Referral Hospital in southwestern Uganda. PLoS One 2020; 15:e0235956. [PMID: 32678850 PMCID: PMC7367467 DOI: 10.1371/journal.pone.0235956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 06/26/2020] [Indexed: 12/12/2022] Open
Abstract
Patients with severe mental illness (SMI) have a higher burden of premature cardio-metabolic abnormalities, including diabetes mellitus, hypertension, hyperlipidemia, and obesity resulting into a 3-fold increase in mortality, and up to 20% reduction in life expectancy compared to the general population. Although over 30% of Ugandans have some form of mental illness, there are no national or hospital-based screening guidelines for cardio-metabolic abnormalities among these patients a general trend in most low-income countries. The screening rates for cardio-metabolic abnormalities in most low-income countries are at only 0.6%. The objective of this study was to describe the cardio-metabolic abnormalities among patients with SMI at Mbarara Regional Referral Hospital. Through a cross-sectional study, we recruited 304 patients with SMI and evaluated them for cardio-metabolic abnormalities using the National Cholesterol Education Programme Adult Treatment Panel III criteria for dyslipidemias, World Health Organisation criteria for diabetes mellitus, obesity, and the Joint national committee criteria for hypertension. We then determined the proportion of participants who met the criteria for each of the individual cardio-metabolic abnormalities. Of the 304 participants, 44.41% were male and 55.59% female with a mean age of 38.56±13.66 years. Almost half (46.38%) of the participants were either overweight or obese, 33.22% had abdominal obesity, 40.46% were hypertensive, 34.11% had low high-density lipoproteins, 37.42% had hypertriglyceridemia and 34.77% had hypercholesterolemia. Based on fasting blood sugar, 11.18% and 9.87% had pre-diabetes and diabetes respectively. There is a high level of cardio-metabolic abnormalities among patients with psychiatric disorders and thus metabolic screening for these abnormalities should be done routinely during psychiatric reviews. There is a need for national guidelines for screening of metabolic abnormalities among patients with SMI so that these abnormalities can be detected early enough at stages where they can be either reversed or delayed to progress to cardiovascular disease.
Collapse
Affiliation(s)
- David Collins Agaba
- Department of Physiology, Mbarara University of Science and Technology, Mbarara, Uganda
- * E-mail:
| | - Richard Migisha
- Department of Physiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Godfrey Katamba
- Department of Physiology, King Ceasor University, Kampala, Uganda
| | - Scholastic Ashaba
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Psychiatry, Kamapala International University, Kampala, Uganda
| |
Collapse
|
154
|
Ertekin H, Uysal S, Aydın M, İlhan B, Ertekin YH. Correlation between vaspin and PANSS scores in schizophrenia patients with obesity. Int J Psychiatry Med 2020; 55:264-280. [PMID: 32050814 DOI: 10.1177/0091217420905463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Metabolic abnormalities such as diabetes, dyslipidemia, abdominal obesity, metabolic syndrome, and abnormal levels of plasma adipokines have been observed in patients with schizophrenia. This study aimed to investigate the differences and correlations of plasma vaspin levels with metabolic parameters in patients with schizophrenia and to compare with healthy controls. METHOD We measured plasma levels of vaspin and metabolic parameters of 100 patients with schizophrenia and 95 healthy controls. Patients with schizophrenia were evaluated with the Positive and Negative Syndrome Scale (PANSS) and The Global Assessment of Functioning. RESULTS Mean levels of body mass index, waist circumference, triglyceride, and low-density lipoprotein cholesterol of the patients were statistically higher than those of the healthy controls (p = 0.002, p < 0.001, p = 0.03, and p = 0.002, respectively). Plasma levels of vaspin were 0.96 ± 0.73 ng/ml in patients with schizophrenia and 0.29 ± 0.15 ng/ml in the healthy controls (p < 0.001). Plasma vaspin levels were statistically higher in patients with schizophrenia than healthy controls both in groups with and without metabolic syndrome and obesity (p < 0.001). Plasma vaspin levels showed a positive correlation with triglyceride in patients with schizophrenia (r = 0.26, p = 0.007). There were positive correlations between vaspin and PANSS scores in schizophrenia patients with obesity (PANSS Positive: r = 0.42, p = 0.01; PANSS Negative: r = 0.42, p = 0.01; PANSS General: r = 0.43, p = 0.01; PANSS Total: r = 0.47, p = 0.006). CONCLUSIONS Our study showed a significant relationship and positive correlation between vaspin and PANSS scores in schizophrenia patients with obesity. Vaspin may play an important role in the metabolic processes of patients with schizophrenia.
Collapse
Affiliation(s)
- Hülya Ertekin
- Department of Psychiatry, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Sema Uysal
- Department of Biochemistry, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Memduha Aydın
- Department of Psychiatry, Selcuk University, Konya, Turkey
| | - Bilge İlhan
- Department of Psychiatry, Health Sciences University, Konya, Turkey
| | - Yusuf Haydar Ertekin
- Department of Family Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| |
Collapse
|
155
|
Hasan A, Falkai P, Lehmann I, Gaebel W. Schizophrenia. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:412-419. [PMID: 32865492 PMCID: PMC7477695 DOI: 10.3238/arztebl.2020.0412] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 05/03/2019] [Accepted: 03/04/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The lifetime prevalence of schizophrenia is 1%. Schizophrenia is among the most severe mental illnesses and gives rise to the highest treatment costs per patient of any disease. It is characterized by frequent relapses, marked impairment of quality of life, and reduced social and work participation. METHODS The group entrusted with the creation of the German clinical practice guideline was chosen to be representative and pluralistic in its composition. It carried out a systematic review of the relevant literature up to March 2018 and identified a total of 13 389 publications, five source guidelines, three other relevant German clinical practice guidelines, and four reference guidelines. RESULTS As the available antipsychotic drugs do not differ to any great extent in efficacy, it is recommended that acute antipsychotic drug therapy should be sideeffect- driven, with a number needed to treat (NNT) of 5 to 8. The choice of treatment should take motor, metabolic, sexual, cardiac, and hematopoietic considerations into account. Ongoing antipsychotic treatment is recommended to prevent relapses (NNT: 3) and should be re-evaluated on a regular basis in every case. It is also recommended, with recommendation grades ranging from strong to intermediate, that disorder- and manifestation-driven forms of psychotherapy and psychosocial therapy, such as cognitive behavioral therapy for positive or negative manifestations (effect sizes ranging from d = 0.372 to d = 0.437) or psycho-education to prevent relapses (NNT: 9), should be used in combination with antipsychotic drug treatment. Further aspects include rehabilitation, the management of special treatment situations, care coordination, and quality management. A large body of evidence is available to provide a basis for guideline recommendations, particularly in the areas of pharmacotherapy and cognitive behavioral therapy. CONCLUSION The evidence-based diagnosis and treatment of persons with schizophrenia should be carried out in a multiprofessional process, with close involvement of the affected persons and the people closest to them.
Collapse
Affiliation(s)
- Alkomiet Hasan
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Faculty of Medicine, University of Augsburg, District Hospital Augsburg, Augsburg
- Department of Psychiatry and Psychotherapy, LMU Medical Center, Munich
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, LMU Medical Center, Munich
| | | | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, LVR Hospital Düsseldorf, Faculty of Medicine, University of Düsseldorf
| |
Collapse
|
156
|
Jacobs R, Aylott L, Dare C, Doran T, Gilbody S, Goddard M, Gravelle H, Gutacker N, Kasteridis P, Kendrick T, Mason A, Rice N, Ride J, Siddiqi N, Williams R. The association between primary care quality and health-care use, costs and outcomes for people with serious mental illness: a retrospective observational study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background
Serious mental illness, including schizophrenia, bipolar disorder and other psychoses, is linked with high disease burden, poor outcomes, high treatment costs and lower life expectancy. In the UK, most people with serious mental illness are treated in primary care by general practitioners, who are financially incentivised to meet quality targets for patients with chronic conditions, including serious mental illness, under the Quality and Outcomes Framework. The Quality and Outcomes Framework, however, omits important aspects of quality.
Objectives
We examined whether or not better quality of primary care for people with serious mental illness improved a range of outcomes.
Design and setting
We used administrative data from English primary care practices that contribute to the Clinical Practice Research Datalink GOLD database, linked to Hospital Episode Statistics, accident and emergency attendances, Office for National Statistics mortality data and community mental health records in the Mental Health Minimum Data Set. We used survival analysis to estimate whether or not selected quality indicators affect the time until patients experience an outcome.
Participants
Four cohorts of people with serious mental illness, depending on the outcomes examined and inclusion criteria.
Interventions
Quality of care was measured with (1) Quality and Outcomes Framework indicators (care plans and annual physical reviews) and (2) non-Quality and Outcomes Framework indicators identified through a systematic review (antipsychotic polypharmacy and continuity of care provided by general practitioners).
Main outcome measures
Several outcomes were examined: emergency admissions for serious mental illness and ambulatory care sensitive conditions; all unplanned admissions; accident and emergency attendances; mortality; re-entry into specialist mental health services; and costs attributed to primary, secondary and community mental health care.
Results
Care plans were associated with lower risk of accident and emergency attendance (hazard ratio 0.74, 95% confidence interval 0.69 to 0.80), serious mental illness admission (hazard ratio 0.67, 95% confidence interval 0.59 to 0.75), ambulatory care sensitive condition admission (hazard ratio 0.73, 95% confidence interval 0.64 to 0.83), and lower overall health-care (£53), primary care (£9), hospital (£26) and mental health-care costs (£12). Annual reviews were associated with reduced risk of accident and emergency attendance (hazard ratio 0.80, 95% confidence interval 0.76 to 0.85), serious mental illness admission (hazard ratio 0.75, 95% confidence interval 0.67 to 0.84), ambulatory care sensitive condition admission (hazard ratio 0.76, 95% confidence interval 0.67 to 0.87), and lower overall health-care (£34), primary care (£9) and mental health-care costs (£30). Higher general practitioner continuity was associated with lower risk of accident and emergency presentation (hazard ratio 0.89, 95% confidence interval 0.83 to 0.97) and ambulatory care sensitive condition admission (hazard ratio 0.77, 95% confidence interval 0.65 to 0.92), but not with serious mental illness admission. High continuity was associated with lower primary care costs (£3). Antipsychotic polypharmacy was not statistically significantly associated with the risk of unplanned admission, death or accident and emergency presentation. None of the quality measures was statistically significantly associated with risk of re-entry into specialist mental health care.
Limitations
There is risk of bias from unobserved factors. To mitigate this, we controlled for observed patient characteristics at baseline and adjusted for the influence of time-invariant unobserved patient differences.
Conclusions
Better performance on Quality and Outcomes Framework measures and continuity of care are associated with better outcomes and lower resource utilisation, and could generate moderate cost savings.
Future work
Future research should examine the impact of primary care quality on measures that capture broader aspects of health and functioning.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 25. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Rowena Jacobs
- Centre for Health Economics, University of York, York, UK
| | - Lauren Aylott
- Expert by experience
- Hull York Medical School, York, UK
| | | | | | - Simon Gilbody
- Hull York Medical School, York, UK
- Department of Health Sciences, University of York, York, UK
| | - Maria Goddard
- Centre for Health Economics, University of York, York, UK
| | - Hugh Gravelle
- Centre for Health Economics, University of York, York, UK
| | - Nils Gutacker
- Centre for Health Economics, University of York, York, UK
| | | | - Tony Kendrick
- Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - Anne Mason
- Centre for Health Economics, University of York, York, UK
| | - Nigel Rice
- Centre for Health Economics, University of York, York, UK
| | - Jemimah Ride
- Centre for Health Economics, University of York, York, UK
| | - Najma Siddiqi
- Hull York Medical School, York, UK
- Department of Health Sciences, University of York, York, UK
- Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Rachael Williams
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
| |
Collapse
|
157
|
Lindekilde N, Scheuer S, Rutters F, Henriksen JE, Rubin KH, Lasgaard M, Andersen GS, Pouwer F. The prevalence of type 2 diabetes in people with psychiatric disorders: an umbrella review protocol. Syst Rev 2020; 9:101. [PMID: 32366297 PMCID: PMC7199336 DOI: 10.1186/s13643-020-01341-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/24/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Many epidemiological studies have investigated the prevalence of type 2 diabetes in individuals with a psychiatric disorder. In an umbrella review, we aim to systematically summarize existing systematic reviews examining the prevalence of type 2 diabetes in people with a psychiatric disorder. When information is available in the identified systematic reviews, comparisons with control groups without a psychiatric disorder will be made. Furthermore, we aim to assess the quality of the included systematic reviews. METHODS The umbrella review will be based on a comprehensive systematic search of systematic reviews of observational (cross-sectional or longitudinal) studies investigating the prevalence of type 2 diabetes in people with a psychiatric disorder. Four electronic databases (Embase, PsycINFO, PubMed, and the Cochrane Database of Systematic Reviews) will be searched. Retrieved papers will be screened for eligibility by two independent reviewers. Furthermore, the reference lists of all included publications will be screened. Data will be extracted by using an a priori developed data extraction form and two independent reviewers will assess the risk of bias in the included systematic reviews using with the Risk of Bias in Systematic Reviews (ROBIS) tool. A narrative data-synthesis and a subsequent meta-analysis based on the primary studies will be made. DISCUSSION For each psychiatric disorder, the data regarding the prevalence of type 2 diabetes will be summarized and discussed. When possible, comparisons with control groups will be reported and discussed. Finally, future implications and recommendations for clinical care will be presented. SYSTEMATIC REVIEW REGISTRATION This protocol was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) on December 9, 2019 (registration number: pending).
Collapse
Affiliation(s)
- N. Lindekilde
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
| | - S. Scheuer
- Clinical Epidemiology, STENO Diabetes Center Copenhagen, Gentofte, Denmark
| | - F. Rutters
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Institute, Amsterdam UMC, location VUMC, Amsterdam, The Netherlands
| | - J. E. Henriksen
- STENO Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - K. H. Rubin
- OPEN - Open Patient data Explorative Network, Department of Clinical Research, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - M. Lasgaard
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - G. S. Andersen
- Clinical Epidemiology, STENO Diabetes Center Copenhagen, Gentofte, Denmark
| | - F. Pouwer
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
- STENO Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- School of Psychology, Deakin University, Geelong, Australia
| |
Collapse
|
158
|
Abstract
Aripiprazole, brexpiprazole and cariprazine differ from all other second-generation antipsychotics due to partial agonism at the dopamine D2 and D3 receptors. In contrast to aripiprazole, brexpiprazole has lower intrinsic dopamine D2 activity and higher affinity for the serotonin 5-HT1A and 5-HT2A receptors, while cariprazine has the highest affinity for the dopamine D3 receptor, and the longest half-life. The main adverse effect of dopamine receptor partial agonists (DRPAs) is akathisia of low-to-moderate severity, which occurs in a small proportion of patients, usually in the first few weeks of treatment. While definitive conclusions concerning differences between the DRPAs require head-to-head comparison studies, on the available evidence, akathisia is probably least likely to occur with brexpiprazole and most likely with cariprazine; the risk of akathisia with aripiprazole lies in between. Weight-gain risk is low with aripiprazole and cariprazine, but moderate with brexpiprazole. Risk of sedation is low with DRPAs, as is risk of insomnia and nausea. Partial dopamine agonism leads to a low risk for hyperprolactinaemia (and probably a low risk of sexual dysfunction). Prolactin concentrations fall in some patients (particularly those with elevated levels prior to initiating the drugs). Rates of discontinuation due to adverse effects in pivotal studies were low, and on the whole, DRPAs are well tolerated. Aripiprazole has been implicated in pathological gambling and other impulse control behaviours, likely due to partial dopamine agonist activity (there have been no reports with brexpiprazole and cariprazine). The risks for diabetes and tardive dyskinesia with DRPAs are unknown, but are likely to be low. On the basis of tolerability, DRPAs should be considered as first-line treatment options, particularly in patients with early schizophrenia.
Collapse
|
159
|
Correll C, Cañas F, Larmo I, Levy P, Montes JM, Fagiolini A, Papageorgiou G, Rossi A, Sturlason R, Zink M. Individualizing antipsychotic treatment selection in schizophrenia: characteristics of empirically derived patient subgroups. Eur Psychiatry 2020; 26:3-16. [DOI: 10.1016/s0924-9338(11)71709-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AbstractTreatment of schizophrenia with antipsychotic drugs is frequently sub-optimal. One reason for this may be heterogeneity between patients with schizophrenia. The objectives of this study were to identify patient, disease and treatment attributes that are important for physicians in choosing an antipsychotic drug, and to identify empirically subgroups of patients who may respond differentially to antipsychotic drugs. The survey was conducted by structured interview of 744 randomly-selected psychiatrists in four European countries who recruited 3996 patients with schizophrenia. Information on 39 variables was collected. Multiple component analysis was used to identify dimensions that explained the variance between patients. Three axes, accounting for 99% of the variance, were associated with disease severity (64%), socioeconomic status (27%) and patient autonomy (8%). These dimensions discriminated between six discrete patient subgroups, identified using ascending hierarchical classification analysis. The six subgroups differed regarding educational level, illness severity, autonomy, symptom presentation, addictive behaviors, comorbidities and cardiometabolic risk factors. Subgroup 1 patients had moderately severe physician-rated disease and addictive behaviours (23.2%); Subgroup 2 patients were well-integrated and autonomous with mild to moderate disease (6.7%); Subgroup 3 patients were less well-integrated with mild to moderate disease, living alone (11.2%); Subgroup 4 patients were women with low education levels (5.4%), Subgroup 5 patients were young men with severe disease (36.8%); and Subgroup 6 patients were poorly-integrated with moderately severe disease, needing caregiver support (16.7%). The presence of these subgroups, which require confirmation and extension regarding potentially identifiable biological markers, may help individualizing treatment in patients with schizophrenia.
Collapse
|
160
|
Abstract
AbstractPurposeTo characterise patients with schizophrenia from four European countries treated with ziprasidone, and to compare these with patients treated with other second generation antipsychotics (SGAs) included in this survey.MethodA randomly selected, representative sample of psychiatrists (N = 744), from Germany, Greece, Italy and Spain, collected data on the five last patients with schizophrenia they had seen in consultation (N = 3996), including up to two patients treated with ziprasidone (N = 1096).ResultsZiprasidone was most frequently prescribed to patients requiring a switch from another antipsychotic. Compared to other surveyed SGAs, ziprasisone was more likely to be prescribed to women than to men (OR: 1.52), to patients with mild disease than to those with severe disease (OR: 1.94) and to outpatients than to inpatients (1.30). The most frequently cited reasons for prescribing ziprasidone were good tolerability and efficacy against positive and negative symptoms. Compared to other SGAs included in this survey, it was more likely to be prescribed due to the low risk of weight gain, metabolic syndrome and extrapyramidal symptoms.ConclusionPatients treated by ziprasidone more frequently belong to subgroups composed of more autonomous patients and those with mild to moderate disease severity.
Collapse
|
161
|
|
162
|
Bresee L, Majumdar S, Patten S, Johnson J. Diabetes, cardiovascular disease, and health care use in people with and without schizophrenia. Eur Psychiatry 2020; 26:327-32. [DOI: 10.1016/j.eurpsy.2010.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 05/12/2010] [Accepted: 05/13/2010] [Indexed: 01/09/2023] Open
Abstract
AbstractPurposeTo compare the prevalence of cardiovascular risk factors (CV-RF) and disease (CV-D) and health care use in people with and without schizophrenia.Subjects/materials and methodsData from the Canadian Community Health Survey (CCHS), cycle 3.1, were used. Prevalence of CV-RF, CV-D, and health care use were compared in those with and without schizophrenia using logistic regression analysis. Sampling weights and bootstrap variance estimates were used to account for survey design.ResultsA total of 399 (0.3%) people with schizophrenia were identified and compared to 120,044 (97.7%) people without. Individuals with schizophrenia were significantly more likely to be obese (34.8% vs. 15.6%) and report diabetes (11.9% vs. 5.3%). After accounting for sociodemographic variables, schizophrenia was not independently associated with diabetes (adjusted odds ratio [aOR]: 0.86; 0.49–1.51). Individuals with schizophrenia were more likely to be hospitalized (21.9% vs. 8.0%; aOR: 2.37; 95% CI: 1.51–3.74) but no more likely to visit their physician (86.7% vs. 85.7%; aOR: 1.23; 95% CI: 0.65–2.35).Discussion/conclusionOur findings suggest that people with schizophrenia access the primary health care system at least as frequently as someone without schizophrenia, and the opportunity for management of modifiable CV-RF exists in this vulnerable population.
Collapse
|
163
|
Country differences in patient characteristics and treatment in schizophrenia: data from a physician-based survey in Europe. Eur Psychiatry 2020; 26:17-28. [DOI: 10.1016/s0924-9338(11)71710-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
AbstractSchizophrenia is a frequent psychiatric disorder whose prevalence appears to be relatively stable across different patient groups. However, attitudes to care and resources devoted to mental health care may differ between countries. The objective of this analysis was to compare sociodemographic and psychopathological features of patients, antipsychotic treatment and frequency of hospitalisation between four European countries (Germany, Greece, Italy and Spain) collected as part of a large survey of the characteristics of patients with schizophrenia. The survey was conducted by structured interview of 744 randomly-selected psychiatrists in four European countries who recruited 3996 patients. Information on 39 variables was collected. A number of between-country differences were observed which tended to distinguish Germany on the one hand, from the Mediterranean countries, and Greece in particular, on the other. While demographic features and clinical features were essentially similar, more patients in Germany were considered to have severe disease by their psychiatrist (59.0% versus 35.9% in Greece) and to be hospitalised (49.3% versus 15.0%). 46.7% of German patients were living alone compared to less than 20% in the Mediterranean countries and 50.2% were living with their family (versus over70% elsewhere). Smoking and addictive behaviours were more frequently reported for patients in Spain. With regard to empirically derived patient subgroups, Subgroup 2, corresponding to well-integrated and autonomous patients with mild to moderate disease severity was most highly represented in Greece (23.6% of patients compared to less than 10% elsewhere) elsewhere, Subgroup 6 (poorly-integrated patients with moderately severe disease who require caregiver support) was under-represented in Germany (4.5% versus over 17% elsewhere). Patterns of treatment were essentially similar, although quetiapine was more frequently prescribed and paliperidone less frequently prescribed in Germany than elsewhere. Reasons for treatment choice were comparable between countries, primarily related to good tolerability and control of positive symptoms. The differences observed may be attributed to differences in mental health care resource provision, socio-cultural or educational differences or to resource issues.
Collapse
|
164
|
European Psychiatric Association (EPA) guidance on quality assurance in mental healthcare. Eur Psychiatry 2020; 30:360-87. [DOI: 10.1016/j.eurpsy.2015.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 01/28/2015] [Accepted: 01/28/2015] [Indexed: 01/09/2023] Open
Abstract
AbstractPurpose:To advance the quality of mental healthcare in Europe by developing guidance on implementing quality assurance.Methods:We performed a systematic literature search on quality assurance in mental healthcare and the 522 retrieved documents were evaluated by two independent reviewers (B.J. and J.Z.). Based on these evaluations, evidence tables were generated. As it was found that these did not cover all areas of mental healthcare, supplementary hand searches were performed for selected additional areas. Based on these findings, fifteen graded recommendations were developed and consented by the authors. Review by the EPA Guidance Committee and EPA Board led to two additional recommendations (on immigrant mental healthcare and parity of mental and physical healthcare funding).Results:Although quality assurance (measures to keep a certain degree of quality), quality control and monitoring (applying quality indicators to the current degree of quality), and quality management (coordinated measures and activities with regard to quality) are conceptually distinct, in practice they are frequently used as if identical and hardly separable. There is a dearth of controlled trials addressing ways to optimize quality assurance in mental healthcare. Altogether, seventeen recommendations were developed addressing a range of aspects of quality assurance in mental healthcare, which appear usable across Europe. These were divided into recommendations about structures, processes and outcomes. Each recommendation was assigned to a hierarchical level of analysis (macro-, meso- and micro-level).Discussion:There was a lack of evidence retrievable by a systematic literature search about quality assurance of mental healthcare. Therefore, only after further topics and search had been added it was possible to develop recommendations with mostly medium evidence levels.Conclusion:Evidence-based graded recommendations for quality assurance in mental healthcare were developed which should next be implemented and evaluated for feasibility and validity in some European countries. Due to the small evidence base identified corresponding to the practical obscurity of the concept and methods, a European research initiative is called for by the stakeholders represented in this Guidance to improve the educational, methodological and empirical basis for a future broad implementation of measures for quality assurance in European mental healthcare.
Collapse
|
165
|
Hert MD, Hudyana H, Dockx L, Bernagie C, Sweers K, Tack J, Leucht S, Peuskens J. Second-generation antipsychotics and constipation: A review of the literature. Eur Psychiatry 2020; 26:34-44. [DOI: 10.1016/j.eurpsy.2010.03.003] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Revised: 01/27/2010] [Accepted: 03/04/2010] [Indexed: 01/01/2023] Open
Abstract
AbstractAntipsychotics are the cornerstone in the management of psychotic disorders and schizophrenia. They are effective agents but also have a wide range of side effects. In the recent literature constipation as possible side effect has received little attention. A review of the literature concerning constipation associated with antipsychotics was performed. Overall constipation is a rarely studied or reported side effect of antipsychotic medication. Nevertheless constipation is a common side effect. Antipsychotic agents differ in their liability to induce constipation. Constipation can be severe and can lead to serious consequences such as paralytic ileus, bowel occlusion and death. Active screening, monitoring and treatment are recommended. Further research on incidence, prevalence, underlying mechanisms and preventive measures is required.
Collapse
|
166
|
Chiliza B, Asmal L, Oosthuizen P, van Niekerk E, Erasmus R, Kidd M, Malhotra A, Emsley R. Changes in Body Mass and Metabolic Profiles in Patients with First-Episode Schizophrenia Treated for 12 Months with A First-Generation Antipsychotic. Eur Psychiatry 2020; 30:277-83. [DOI: 10.1016/j.eurpsy.2014.11.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 11/26/2014] [Accepted: 11/27/2014] [Indexed: 12/11/2022] Open
Abstract
AbstractObjectives:To assess changes in body mass and metabolic profiles in patients with first-episode schizophrenia receiving standardised, assured treatment and to identify predictors and moderators of the effects.Methods:We investigated the changes in body mass, fasting blood glucose and lipids in 107 largely antipsychotic naïve, first-episode schizophrenia patients who were treated according to a standard algorithm with long-acting injectable flupenthixol decanoate over 12 months.Results:Eighty-three (78%) participants completed the 12 months of treatment, and 104 (97%) received 100% of the prescribed injections during their participation. There were significant increases in BMI (P < .0001), waist circumference (P = 0.0006) and triglycerides (P = 0.03) and decrease in HDL (P = 0.005), while systolic (P = 0.7) and diastolic blood pressure (P = 0.8), LDL (P = 0.1), cholesterol (P = 0.3), and glucose (P = 0.9) values did not change over time. The triglyceride: HDL ratio increased by 91%. Change in BMI was only correlated with change in triglycerides (P = .008). The only significant predictor of BMI increase was non-substance abuse (P = .002).Conclusions:The risks of weight gain and metabolic syndrome associated with antipsychotic treatment in first-episode schizophrenia are not restricted to second generation antipsychotics. This is a global problem, and developing communities may be particularly susceptible.
Collapse
|
167
|
Gaebel W, Becker T, Janssen B, Munk-Jorgensen P, Musalek M, Rössler W, Sommerlad K, Tansella M, Thornicroft G, Zielasek J. EPA guidance on the quality of mental health services. Eur Psychiatry 2020; 27:87-113. [DOI: 10.1016/j.eurpsy.2011.12.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 12/10/2011] [Accepted: 12/13/2011] [Indexed: 01/13/2023] Open
Abstract
AbstractThe main aim of this guidance of the European Psychiatric Association is to provide evidence-based recommendations on the quality of mental health services in Europe. The recommendations were derived from a systematic search of the best available evidence in the scientific literature, supplemented by information from documents retrieved upon reviewing the identified articles. While most recommendations could be based on empirical studies (although of varying quality), some had to be based on expert opinion alone, but were deemed necessary as well. Another limitation was that the wide variety of service models and service traditions for the mentally ill worldwide often made generalisations difficult. In spite of these limitations, we arrived at 30 recommendations covering structure, process and outcome quality both on a generic and a setting-specific level. Operationalisations for each recommendation with measures to be considered as denominators and numerators are given as well to suggest quality indicators for future benchmarking across European countries. Further pan-European research will need to show whether the implementation of this guidance will lead to improved quality of mental healthcare, and may help to develop useful country-specific cutoffs for the suggested quality indicators.
Collapse
|
168
|
Mackin P, Waton T, Watkinson H, Gallagher P. A four-year naturalistic prospective study of cardiometabolic disease in antipsychotic-treated patients. Eur Psychiatry 2020; 27:50-5. [DOI: 10.1016/j.eurpsy.2010.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 08/25/2010] [Accepted: 08/31/2010] [Indexed: 02/02/2023] Open
Abstract
AbstractThe relationship between antipsychotic use and cardiovascular morbidity and mortality is controversial. There is a lack of long-term prospective studies investigating changes in cardiometabolic risk in patients treated with antipsychotic drugs. We report data from a 4-year prospective study. Patients (89) underwent detailed metabolic and cardiovascular risk assessment at 4-years which included anthropometric assessment, blood pressure, lipid profile, and an oral glucose tolerance test. We used the homeostatic model assessment to determine insulin resistance, and calculated 10-year cardiovascular risk scores. Mean age of subjects was 44.7 (±11.5) years, and 52% were male. The prevalence of type 2 diabetes was 8%, and 38.4% fulfilled diagnostic criteria for the metabolic syndrome. With the exception of increased central adiposity over the 4-year follow-up period (p < 0.001), other cardiometabolic parameters were generally unchanged. There was a high prevalence of dyslipidaemia, but only 16.9% were prescribed lipid-lowering treatment. Commencing lipid-lowering therapy was associated with a reduction in cardiovascular risk score (OR 7.9, 95% CI = 1.3 to 48.7; p = 0.02). Patients established on longer-term antipsychotic treatment show less dramatic metabolic changes than those occurring in the early stages of treatment, but have a high burden of cardiovascular risk. Lipid-lowering therapy is associated with a significant reduction in cardiovascular risk.
Collapse
|
169
|
Bobes J, Arango C, Aranda P, Carmena R, Garcia-Garcia M, Rejas J. Cardiovascular and metabolic risk in outpatients with schizoaffective disorder treated with antipsychotics: Results from the CLAMORS study. Eur Psychiatry 2020; 27:267-74. [DOI: 10.1016/j.eurpsy.2010.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 09/02/2010] [Accepted: 09/04/2010] [Indexed: 10/18/2022] Open
Abstract
AbstractAimTo assess the coronary heart disease (CHD) risk and prevalence of the metabolic syndrome (MS) in patients with schizoaffective disorder (SD) receiving antipsychotics.MethodsPatients meeting DSM-IV criteria for SD and receiving antipsychotic treatment were recruited in a retrospective, cross-sectional, multicenter study (the CLAMORS study). MS was defined as at least three of the following components: waist circumference greater than 102cm (men)/greater than 88cm (women); serum triglycerides greater or equal to 150mg/dl; HDL cholesterol less than 40mg/dl (men)/less than 50mg/dl (women); blood pressure greater or equal to 130/85mmHg; fasting blood glucose greater or equal to 110mg/dl. The 10-year CHD risk was assessed by the Systematic coronary risk evaluation (SCORE) (cardiovascular mortality) and Framingham (any cardiovascular event) functions. Clinical severity was assessed using the PANSS and CGI-S scales.ResultsA total of 268 valuable patients with SD (127 men, 48.1%), 41.9±12.3years (mean±S.D.), were analyzed. The 10-year overall cardiovascular mortality and CV-event risk were 0.8±1.6 (SCORE) and 6.5±6.8 (Framingham), respectively. A high/very high risk of any CV event (Framingham≥10%) was associated with severity [CGI-S=3–4; OR: 4.32 (1.15–16.26), P = 0.03)]. MS was present in 26.5% (95%CI: 21.2–31.8) of subjects, without gender differences, but significantly associated with patient's impression of severity: CGI=3–4; OR=1.90 (0.83–4.36), and CGI=5–7; OR=3.13 (1.06–9.24), P = 0<0.001, and age [OR=1.91 (1.09–3.34), P<0.024)].ConclusionsCHD risk and MS prevalence were high among patients with SD, being MS prevalence associated with age and severity of disease.
Collapse
|
170
|
Pini S, Abelli M, Gesi C, Lari L, Cardini A, Di Paolo L, Felice F, Di Stefano R, Mazzotta G, Oligeri C, Bovenzi F, Borelli L, Bertoli D, Michi P, Muccignat A, Micchi J, Balbarini A. Frequency and clinical correlates of bipolar features in acute coronary syndrome patients. Eur Psychiatry 2020; 29:253-8. [DOI: 10.1016/j.eurpsy.2013.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 06/24/2013] [Accepted: 06/30/2013] [Indexed: 01/01/2023] Open
Abstract
AbstractBackground:Depression and acute coronary syndrome (ACS) are both extremely prevalent diseases. Studies aimed at evaluating whether depression is an independent risk factor for cardiac events provided no definitive results. In most of these studies, depression has been broadly defined with no differentiation between unipolar (MDD) versus bipolar forms (BD). The aim of this study was to evaluate the frequency of DSM-IV BD (bipolar I and bipolar II subtypes, cyclothymia), as well as temperamental or isolated bipolar features in a sample of 171 patients hospitalized for ACS. We also explored whether these psychopathological conditions were associated with some clinical characteristics of ACS.Methods:Patients with ACS admitted to three neighboring Cardiac Intensive Care Units (CICUs) in a 12-month continuative period of time were eligible for inclusion if they met the criteria for either acute myocardial infarct with or without ST-segment elevation or unstable angina, verified by standard ACS criteria. All patients underwent standardized cardiological and psychopathological evaluations.Results:Of the 171 ACS patients enrolled, 37 patients (21.7%) were found to have a DSM-IV mood disorder. Of these, 20 (11.7%) had bipolar type I or type II or cyclothymia, while 17 (10%) were the cases of MDD. Rapid mood switches ranged from 11% of ACS patients with no mood disorders, to 47% of those with MDD to 55% of those with BD. Linear regression analysis showed that a diagnosis of BD (p = .023), but not that of MDD (p = .721), was associated with a significant younger age at the index episode of ACS. A history of previous coronary events was more frequent in ACS patients with BD than in those with MDD.Conclusions:Our data indicate that bipolar features and diagnosis are frequent in ACS patients. Bipolar disorder has a negative impact on cardiac symptomatology. Further research in this area is warranted.
Collapse
|
171
|
Kelly PJ, Baker AL, Fagan NL, Turner A, Deane F, McKetin R, Callister R, Collins C, Ingram I, Wolstencroft K, Townsend C, Osborne BA, Zimmermann A. Better Health Choices: Feasability and preliminary effectiveness of a peer delivered healthy lifestyle intervention in a community mental health setting. Addict Behav 2020; 103:106249. [PMID: 31881407 DOI: 10.1016/j.addbeh.2019.106249] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/29/2019] [Accepted: 11/28/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND To reduce smoking and improve other health behaviours of people living with severe mental illness, healthy lifestyle interventions have been recommended. One approach to improving the availability of these types of interventions is to utilise the mental health peer workforce. The current study aimed to evaluate the feasibility of peer-workers facilitating a telephone delivered healthy lifestyle intervention within community based mental health settings. The study also examined preliminary outcomes of the intervention. METHODS The study was conducted as a randomised controlled feasibility trial. In addition to treatment as usual, participants randomised to the Treatment Condition were offered BHC. This was an 8-session telephone delivered coaching intervention that encouraged participants to decrease their smoking, increase their intake of fruit and vegetables, and reduce their leisure screen time. Participants in the waitlist Control Condition continued to complete treatment as usual. All participants were engaged with Neami National, an Australian community mental health organisation. Peer-workers were also current employees of Neami National. RESULTS Forty-three participants were recruited. The average number of sessions completed by participants in the Treatment Condition was 5.7 (SD = 2.6; out of 8-sessions). Seventeen participants (77%) completed at least half of the sessions, and nine participants (40%) completed all eight sessions. Participant satisfaction was high, with all participants followed up rating the quality of the service they received as 'good' or 'excellent'. When compared to the Control Condition, people in the Treatment Condition demonstrated greater treatment effects on smoking and leisure screen time. There was only a negligible effect on servings of fruit and vegetable. CONCLUSIONS Results were promising regarding the feasibility of peer-workers delivering BHC. Good retention rates and high consumer satisfaction ratings in the Treatment Condition demonstrated that peer-workers were capable of delivering the intervention to the extent that consumers found it beneficial. The current results suggest that a sufficiently powered, peer delivered randomised controlled trial of BHC is warranted. STUDY REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR; Trial ID ACTRN123615000564550).
Collapse
|
172
|
Trastornos afectivos y salud física, implicaciones de la comorbilidad con enfermedades médicas: una revisión de la literatura. REVISTA MÉDICA CLÍNICA LAS CONDES 2020. [DOI: 10.1016/j.rmclc.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
173
|
Korpela H, Miettunen J, Rautio N, Isohanni M, Järvelin MR, Jääskeläinen E, Auvinen J, Keinänen-Kiukaanniemi S, Nordström T, Seppälä J. Early environmental factors and somatic comorbidity in schizophrenia and nonschizophrenic psychoses: A 50-year follow-up of the Northern Finland Birth Cohort 1966. Eur Psychiatry 2020; 63:e24. [PMID: 32146919 PMCID: PMC7315879 DOI: 10.1192/j.eurpsy.2020.25] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background. We studied the cumulative incidence of physical illnesses, and the effect of early environmental factors (EEFs) on somatic comorbidity in schizophrenia, in nonschizophrenic psychosis and among nonpsychotic controls from birth up to the age of 50 years. Methods. The sample included 10,933 members of the Northern Finland Birth Cohort 1966, of whom, 227 had schizophrenia and 205 had nonschizophrenic psychosis. Diagnoses concerning physical illnesses were based on nationwide registers followed up to the end of 2016 and classified into 13 illness categories. Maternal education and age, family type at birth and paternal socioeconomic status were studied as EEFs of somatic illnesses. Results. When adjusted by gender and education, individuals and especially women with nonschizophrenic psychosis had higher risk of morbidity in almost all somatic illness categories compared to controls, and in some categories, compared to individuals with schizophrenia. The statistically significant adjusted hazard ratios varied from 1.27 to 2.42 in nonschizophrenic psychosis. Regarding EEFs, single-parent family as the family type at birth was a risk factor for a higher somatic score among men with schizophrenia and women with nonschizophrenic psychosis. Maternal age over 35 years was associated with lower somatic score among women with nonschizophrenic psychosis. Conclusions. Persons with nonschizophrenic psychoses have higher incidence of somatic diseases compared to people with schizophrenia and nonpsychotic controls, and this should be noted in clinical work. EEFs have mostly weak association with somatic comorbidity in our study.
Collapse
Affiliation(s)
- Hanna Korpela
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Cancer Research and Translational Medicine Research Unit, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Nina Rautio
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland
| | - Matti Isohanni
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Marjo-Riitta Järvelin
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland.,Department of Epidemiology and Biostatistics, MRC-PHE Center for Environment & Health, School of Public Health, Imperial College London, London, United Kindom.,Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Erika Jääskeläinen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Juha Auvinen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland
| | - Sirkka Keinänen-Kiukaanniemi
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland
| | - Tanja Nordström
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Jussi Seppälä
- Center for Life Course Health Research, University of Oulu, Oulu, Finland.,Department of Psychiatry and Substance Use, South Karelia Social and Health Care District, Lappeenranta, Finland
| |
Collapse
|
174
|
Martland R, Mondelli V, Gaughran F, Stubbs B. Can high intensity interval training improve health outcomes among people with mental illness? A systematic review and preliminary meta-analysis of intervention studies across a range of mental illnesses. J Affect Disord 2020; 263:629-660. [PMID: 31780128 DOI: 10.1016/j.jad.2019.11.039] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 11/04/2019] [Accepted: 11/09/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND High intensity interval training (HIIT) may have beneficial effects among people with mental illnesses. The aim of this systematic review was to establish the benefits, safety and adherence of HIIT interventions across all categories of mental illness. METHODS Major databases were searched from inception to 18/2/2019 for intervention studies investigating HIIT among people with mental illnesses. Study quality was assessed via the PEDro scale, intervention characteristics were reported using the TIDier and CERT checklists and findings narratively summarised. A preliminary meta-analysis was undertaken where possible. RESULTS 12 intervention studies, (including 7 RCTs), were included. Evidence suggested HIIT improved cardiorespiratory fitness (5/8 intervention studies,63%), anthropometric variables (3/4,75%), mental health outcomes (9/12, 75%), cardiovascular fitness (5/9,56%), physical fitness (1/1,100%) and motor skills (1/1,100%), compare to pre-training. The preliminary meta-analysis of pre-post changes found HIIT reduced depression severity (Standardised mean difference (SMD):-1.36 [95%CI-1.63;-1.089], p<0.0001) and possibly improved VO2max (SMD:0.18 [95%CI -0.02; 0.37], p = 0.08) in people with depression. HIIT increased High-Density-Lipoprotein (SMD:0.373 [95%CI 0.18; 0.57], p = 0.0002) and possibly reduced general psychopathology (SMD:-1.58 [95%CI -3.35; 0.18], p = 0.08) in people with schizophrenia-spectrum disorders. No acute injuries were reported, mean adherence to HIIT sessions ranged from 64-94%, and dropout ranged from 0--50%. LIMITATIONS Results were limited to a small number of low-to-moderate quality intervention studies. CONCLUSION These findings suggest HIIT may improve a range of physical and mental health outcomes among people with mental illnesses. Nonetheless, high-quality well-powered trials are needed to reaffirm these findings, and future research should address the seemingly high rate of dropout.
Collapse
Affiliation(s)
- Rebecca Martland
- Department of Psychosis Studies, King's College London, London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom.
| | - Valeria Mondelli
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom
| | - Fiona Gaughran
- Department of Psychosis Studies, King's College London, London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom; South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
| | - Brendon Stubbs
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), London, United Kingdom; South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
| |
Collapse
|
175
|
Tanioka R, Yasuhara Y, Osaka K, Kai Y, Zhao Y, Tanioka T, Takase K, Dino MJS, Locsin RC. Autonomic nervous activity of patient with schizophrenia during Pepper CPGE-led upper limb range of motion exercises. ENFERMERIA CLINICA 2020. [DOI: 10.1016/j.enfcli.2019.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
176
|
Nestsiarovich A, Kerner B, Mazurie AJ, Cannon DC, Hurwitz NG, Zhu Y, Nelson SJ, Oprea TI, Crisanti AS, Tohen M, Perkins DJ, Lambert CG. Diabetes mellitus risk for 102 drugs and drug combinations used in patients with bipolar disorder. Psychoneuroendocrinology 2020; 112:104511. [PMID: 31744781 DOI: 10.1016/j.psyneuen.2019.104511] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/28/2019] [Accepted: 11/07/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To compare the largest set of bipolar disorder pharmacotherapies to date (102 drugs and drug combinations) for risk of diabetes mellitus (DM). METHODS The IBM MarketScan® database was used to retrospectively analyze data on 565,253 adults with bipolar disorder without prior glucose metabolism-related diagnoses. The pharmacotherapies compared were lithium, mood-stabilizing anticonvulsants, antipsychotics, and antidepressants (monotherapy and multi-class polypharmacy). Cox regression modeling included fixed pre-treatment covariates and time-varying drug exposure covariates to estimate the hazard ratio (HR) of each treatment versus "No drug". RESULTS The annual incidence of new-onset diabetes during the exposure period was 3.09 % (22,951 patients). The HR of drug-dependent DM ranged from 0.79 to 2.37. One-third of the studied pharmacotherapies, including most of the antipsychotic-containing regimens, had a significantly higher risk of DM compared to "No drug". A significantly lower DM risk was associated with lithium, lamotrigine, oxcarbazepine and bupropion monotherapies, selective serotonin reuptake inhibitors (SSRI) mono-class therapy and several drug combinations containing bupropion and an SSRI. As additional drugs were combined in more complex polypharmacy, higher HRs were consistently observed. CONCLUSIONS There is an increased risk of diabetes mellitus associated with antipsychotic and psychotropic polypharmacy use in bipolar disorder. The evidence of a lower-than-baseline risk of DM with lamotrigine, oxcarbazepine, lithium, and bupropion monotherapy should be further investigated.
Collapse
Affiliation(s)
- Anastasiya Nestsiarovich
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Berit Kerner
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | | | | | | | - Yiliang Zhu
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Stuart J Nelson
- University of New Mexico Health Sciences Library and Informatics Center, Albuquerque, NM, USA; Translational Informatics Division, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Tudor I Oprea
- Translational Informatics Division, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Annette S Crisanti
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Mauricio Tohen
- Department of Psychiatry & Behavioral Sciences, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Douglas J Perkins
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Christophe G Lambert
- Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA; Translational Informatics Division, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
| |
Collapse
|
177
|
Lee K, Choi HS, Han M. Effects of therapeutic lifestyle change mentoring on cardio-metabolic factors for schizophrenia. Arch Psychiatr Nurs 2020; 34:19-26. [PMID: 32035584 DOI: 10.1016/j.apnu.2019.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/27/2019] [Accepted: 12/12/2019] [Indexed: 10/25/2022]
Abstract
Considering that the prevalence of cardio-metabolic syndrome in patients with chronic schizophrenia is two or three times higher than the general population, this study aimed to provide patients with schizophrenia using community psychiatric rehabilitation services with therapeutic lifestyle change (TLC) mentoring using a smartphone application and provide inpatients in a psychiatric ward with structured TLC mentoring, to compare improvement in cardio-metabolic factors between the two groups. The home-based community service users using a TLC application were more likely to experience an improvement in their cardio-metabolic factors than the inpatients provided with the structured TLC program.
Collapse
Affiliation(s)
- Kyunghee Lee
- College of Nursing, Keimyung University, Daegu City, Republic of Korea.
| | | | - Mihwa Han
- Department of Nursing, Sunlin University, Pohang, Republic of Korea
| |
Collapse
|
178
|
Kung FP, Tsai CF, Lu CL, Huang LC, Lu CH. Diabetes pay-for-performance program can reduce all-cause mortality in patients with newly diagnosed type 2 diabetes mellitus. Medicine (Baltimore) 2020; 99:e19139. [PMID: 32049836 PMCID: PMC7035087 DOI: 10.1097/md.0000000000019139] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
This study aimed to examine the effect of a diabetes pay-for-performance (P4P) program on all-cause mortality in patients with newly diagnosed type 2 diabetes mellitus. Using a Taiwanese representative nationwide cohort, we recruited 5478 patients with newly diagnosed type 2 diabetes enrolled in the P4P program within 5 years after a diagnosis of diabetes between January 1, 2002 and December 31, 2010 and individuals not enrolled in the P4P program were recruited as the control group matched 1:1 with the study group. We used multivariate Cox proportional hazard models analysis to investigate the effect of the P4P program and adherence on all-cause mortality. A total of 250 patients died in the P4P group compared to 395 in the control group (mortality rate 104 vs 169 per 10,000 person-years, respectively, P < .0001). The control group also had more comorbidities. Patients enrolled in the P4P program demonstrated significant long-term survival benefits, of which the adjusted hazard ratio (aHR) for all-cause mortality was 0.58 [95% CI (0.48-0.69)]. In the study group, better adherence to the P4P program resulted in a greater reduction in mortality, with aHRs [95% CI] of 0.48 [0.38-0.62] and 0.36 [0.26-0.49] in subjects with a minimum 1-year and 2-year good P4P adherence, respectively. Participating in the P4P program within 5 years after the diagnosis of diabetes resulted in a significant reduction in all-cause mortality, and this effect was particularly pronounced in the patients with better adherence to the P4P program.
Collapse
Affiliation(s)
- Fang-Ping Kung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ditmanson Chia-Yi Christian Hospital
| | - Ching-Fang Tsai
- Department of Medical Research, Ditmanson Chia-Yi Christian Hospital, Chia-Yi City
| | - Chin-Li Lu
- Department of Medical Research, Ditmanson Chia-Yi Christian Hospital, Chia-Yi City
- Graduate Institute of Food Safety, College of Agriculture and Natural Resources, National Chung-Hsing University, Taichung
| | - Li-Chung Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ditmanson Chia-Yi Christian Hospital
- Division of Psychiatry, Ditmanson Chia-Yi Christian Hospital, Chia-Yi City
| | - Chieh-Hsiang Lu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Ditmanson Chia-Yi Christian Hospital
- Kaohsiung Christian Hospital, Kaohsiung City, Taiwan
| |
Collapse
|
179
|
Affiliation(s)
- Tamar S Polonsky
- Department of Medicine, University of Chicago Medicine, IL (T.S.P.)
| | - Michael D Miedema
- Minneapolis Heart Institute (M.D.M.), MN.,Minneapolis Heart Institute Foundation (M.D.M.), MN
| |
Collapse
|
180
|
Teshome T, Kassa DH, Hirigo AT. Prevalence and Associated Factors of Metabolic Syndrome Among Patients with Severe Mental Illness at Hawassa, Southern-Ethiopia. Diabetes Metab Syndr Obes 2020; 13:569-579. [PMID: 32161483 PMCID: PMC7051251 DOI: 10.2147/dmso.s235379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 02/16/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients with severe mental disorders have a high risk of metabolic-related complications like metabolic syndrome (MetS), diabetes mellitus (DM), hypertension and lipid derangements, and these factors may predispose them to a high mortality rate. Data is very scarce regarding MetS among patients with severe mental illness in Ethiopia. Therefore, this study aimed to assess the prevalence of MetS and its associated factors among patients with severe mental illness. METHODS A cross-sectional study was conducted in Hawassa University Comprehensive Specialized Hospital from January to June 2019 among adult patients attending a psychiatric outpatient department, Southern Ethiopia. A systematic random sampling technique was used to select 245 study subjects. Socio-demographic and other data were collected using a structured questionnaire. Both the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) and International Diabetes Federation (IDF) guidelines were used to define MetS. RESULTS The prevalence of MetS was 24.5% and 26.9% by NCEP-ATP and IDF criteria respectively. In both definitions, females had significantly higher MetS when compared to males (31.4% vs 19.6%; p=0.03 by NCEP), and (34.3% vs 21.7%; p =0.03 by IDF), respectively. Duration >5 years with mental illness indicated higher MetS when compared to duration ≤ 5 years (42.9% vs 19.9%, p=0.001; and 46.9% vs 21.9%, p<0.0001) in NCEP and IDF, respectively. In addition, marital status [AOR (95% CI): 2.4 (1.1-5.3)], and BMI [AOR (95% CI): 8.4(4.0-17.6)], duration > 5 years with mental illness [AOR (95% CI): 2.8(1.2-6.5)], and age >40 years [AOR (95% CI): 2.7(1.2-6.1)] were significantly associated factors of MetS by NCEP. While BMI, age >40 years and duration > 5 years with mental illness were associated with MetS by IDF. CONCLUSION Long-time experience with severe mental illness and antipsychotic therapy might predispose patients to metabolic complications with significant risks of cardiovascular events. Therefore, intensive screening of patients for MetS/components is required during follow-up based on national non-communicable diseases guideline. Besides, the proper intervention of patients concerning lifestyle changes and averting risk full behaviors is mandatory.
Collapse
Affiliation(s)
- Tesfaye Teshome
- Hawassa University, College of Medicine and Health Science, Faculty of Medicine, Physiology Unit, Hawassa City, Southern-Ethiopia
- Correspondence: Tesfaye Teshome Hawassa University College of Medicine and Health Science, Faculty of Medicine, Physiology Unit, P.O. Box 1560, Hawassa City, Southern-EthiopiaTel +251-925-112625 Email
| | - Dejene Hailu Kassa
- Hawassa University, College of Medicine and Health Science, Faculty of Health Science, School of Public Health, Hawassa City, Southern-Ethiopia
| | - Agete Tadewos Hirigo
- Hawassa University, College of Medicine and Health Science, School of Medical Laboratory Sciences, Hawassa City, Southern-Ethiopia
| |
Collapse
|
181
|
Fernández Guijarro S, Miguel García C, Pomarol-Clotet E, Egea López EN, Burjales Martí MD, Rigol Cuadra MA. Metabolic Syndrome Screening in People With Severe Mental Illness: Results From Two Spanish Community Mental Health Centers. J Am Psychiatr Nurses Assoc 2020; 26:162-171. [PMID: 30741068 DOI: 10.1177/1078390319826686] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The excess of mortality in people with severe mental illness is due to unnatural causes such as accidents or suicides and natural causes such as metabolic syndrome. The presence of modifiable risk factors like tobacco consumption increases cardiovascular and metabolic risk. AIMS: The purpose of this study was to identify the prevalence of metabolic syndrome and other cardiovascular risk factors in people with severe mental illness. This study also aimed to identify the prevalence of patients receiving treatment for any metabolic syndrome risk factor. METHOD: A cross-sectional descriptive study was performed. A total of 125 participants from two community mental health centers in Spain were recruited. RESULTS: More than half of the participants (58.4%) were active smokers. The prevalence of metabolic syndrome was 60%. A total of 16.8% received previous treatment for hypertension, 17.6% for hypertriglyceridemia, and 11.2% for diabetes. No differences were found between centers (22.7% vs. 18.7%, p = .9). CONCLUSIONS: The findings underscore the importance of monitoring the physical health of patients on antipsychotic therapy. The identification and management of cardiovascular and metabolic risks factors is an essential part of nursing care for people with severe mental illness. Mental health nurses are ideally positioned to carry out this task by performing physical health screening, health education, and lifestyle interventions.
Collapse
Affiliation(s)
| | | | - Edith Pomarol-Clotet
- Edith Pomarol-Clotet, MD, PhD, FIDMAG Hermanas Hospitalarias Research Foundation, Barcelona, Spain
| | | | | | | |
Collapse
|
182
|
Tian Y, Liu D, Wang D, Wang J, Xu H, Dai Q, Andriescue EC, Wu HE, Xiu M, Chen D, Wang L, Chen Y, Yang R, Wu A, Wei CW, Zhang X. Obesity in Chinese patients with chronic schizophrenia: Prevalence, clinical correlates and relationship with cognitive deficits. Schizophr Res 2020; 215:270-276. [PMID: 31653580 DOI: 10.1016/j.schres.2019.10.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 12/18/2022]
Abstract
The prevalence of obesity in schizophrenia patients is high, especially in chronic and medicated patients. Few studies have explored the relationships between obesity, cognition and clinical correlates in patients with schizophrenia. This study was designed to assess the prevalence and clinical correlates of obesity and its relationship to cognitive impairment in Chinese patients with schizophrenia. We recruited 633 inpatients and collected clinical, demographic data and lipid parameters. The Positive and Negative Syndrome Scale (PANSS) and its five-factor model were adopted for psychopathological symptoms. The prevalence of comorbid obesity in schizophrenia patients was 16.4%. The plasma levels of glucose, triglyceride, low density lipoprotein (LDL), apolipoprotein B, and cholesterol were higher, but high density lipoprotein (HDL) levels were lower in obese patients than those in non-obese patients (all p < 0.05). Furthermore, obese patients had lower PANSS negative symptom, cognitive factor and total scores than non-obese patients (all p < 0.05). Correlation analysis showed a significant correlation between BMI and the following variables: age, marriage, gender, negative symptoms, general psychopathological symptoms, cognitive factor, PANSS total score, glucose, triglycerides, HDL, LDL, cholesterol and apolipoprotein B (all p < 0.05). Further multiple regression showed that PANSS cognitive factor, PANSS total score, and triglyceride were important independent predictors of obesity. Our results indicate a high prevalence of obesity in Chinese patients with chronic schizophrenia. Multiple demographics, clinical variables, and lipid parameters are associated with obesity in schizophrenia. Moreover, obesity appears to be a protective factor for psychological symptoms. However, not having objective assessments for cognition in this study is a limitation.
Collapse
Affiliation(s)
- Yang Tian
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dianying Liu
- Departtment of Psychiatry, The Third People's Hospital of Ganzhou City, Ganzhou, Jiangxi Province, China
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Jiesi Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Hang Xu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Qilong Dai
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Elena C Andriescue
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hanjing E Wu
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Meihong Xiu
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Dachun Chen
- Beijing HuiLongGuan Hospital, Peking University, Beijing, China
| | - Li Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yiwen Chen
- Departtment of Psychiatry, The Third People's Hospital of Ganzhou City, Ganzhou, Jiangxi Province, China
| | - Ruilang Yang
- Departtment of Psychiatry, The Third People's Hospital of Ganzhou City, Ganzhou, Jiangxi Province, China
| | - Anshi Wu
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Chang Wei Wei
- Department of Anesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
| | - Xiangyang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
| |
Collapse
|
183
|
Rivera-Segarra E, Varas-Díaz N, Santos-Figueroa A. "That's all Fake": Health professionals stigma and physical healthcare of people living with Serious Mental Illness. PLoS One 2019; 14:e0226401. [PMID: 31851706 PMCID: PMC6919598 DOI: 10.1371/journal.pone.0226401] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 11/26/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND People living with a Serious Mental Illness (SMI) die earlier than the general population due to preventable medical conditions. Latinos living with SMI are a particularly vulnerable population with higher prevalence of chronic medical conditions. Stigma has been identified as a factor that fosters health inequities for Latinos/as with SMI, particularly Puerto Ricans. Although personal and social consequences of stigmatization have been well documented, research regarding the role of cultural factors on healthcare interactions is scarce. Furthermore, little research has focused on addressing stigma from the perspective of healthcare professionals. METHODS We investigated this process through a qualitative design using semi-structured individual interviews with 11 healthcare professionals (8 physicians and 3 nurses) in Puerto Rico. We conducted a thematic analysis to analyze the data. RESULTS Following a thematic analysis, we found three main themes and nine sub-themes related to the stigmatization process. Some participants reported perceptions of dangerousness and uneasiness, social distance and inadequate care. Participants also emphasized a lack of medical training regarding SMI within the Puerto Rican context. CONCLUSIONS These findings support the need to develop culturally appropriate public health interventions targeting healthcare professionals in order to address stigma and eliminate health disparities among Latinos/as with SMI.
Collapse
Affiliation(s)
- Eliut Rivera-Segarra
- School of Behavioral and Brain Sciences, Ponce Health Sciences University, Ponce, Puerto Rico
- * E-mail:
| | - Nelson Varas-Díaz
- Department of Global and Sociocultural Studies, Florida International University, Miami, United States of America
| | - Axel Santos-Figueroa
- Department of Psychology, University of Puerto Rico, Mayagüez Campus, Mayagüez, Puerto Rico
| |
Collapse
|
184
|
Zhuravleva EO, Vel’ts NY, Snegireva II, Kutekhova GV, Alyautdin RN. Pharmacogenetic Tests for Antipsychotic-Induced Weight Gain. Pharm Chem J 2019. [DOI: 10.1007/s11094-019-02059-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
185
|
Fernández Guijarro S, Pomarol-Clotet E, Rubio Muñoz MC, Miguel García C, Egea López E, Fernández Guijarro R, Castán Pérez L, Rigol Cuadra MA. Effectiveness of a community-based nurse-led lifestyle-modification intervention for people with serious mental illness and metabolic syndrome. Int J Ment Health Nurs 2019; 28:1328-1337. [PMID: 31411375 DOI: 10.1111/inm.12644] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2019] [Indexed: 11/29/2022]
Abstract
The development of metabolic syndrome negatively affects the quality of life of people with serious mental illness. Experts agree on the need to evaluate the physical health of patients and intervene in modifiable risk factors, with emphasis on the promotion of healthy lifestyles. Interventions should include nutritional counselling and physical activity. This 24-week randomized trial evaluated the effects of a community-based nurse-led lifestyle-modification intervention in people with serious mental illness meeting metabolic syndrome criteria, and its impact on health-related quality of life and physical activity. Sixty-one participants from two community mental health centres were randomly assigned to the intervention or control group. The intervention consisted of weekly group sessions, with 20 min of theoretical content and 60 min of nurse-led physical activity. Postintervention results between groups showed no differences in weight, waist circumference, fasting glucose, and systolic blood pressure. Differences in body mass index, triglyceride concentrations, and diastolic blood pressure were found to be significant (P = 0.010, P = 0.038, and P = 0.017). Participants who performed the intervention reported an increase in physical activity, which did not occur in the control group (P = 0.035), and also reported better health status (P < 0.001). Our intervention showed positive effects reducing participants' cardiovascular and metabolic risks and improving their physical activity and quality of life. To our knowledge, this is the first clinical trial led and carried out by mental health nurses in community mental health centres which takes into account the effects of a lifestyle intervention on every metabolic syndrome criterion, health-related quality of life, and physical activity.
Collapse
|
186
|
Naderyan Fe'li S, Yassini Ardekani SM, Fallahzadeh H, Dehghani A. Metabolic syndrome and 10-year risk of cardiovascular events among schizophrenia inpatients treated with antipsychotics. Med J Islam Repub Iran 2019; 33:97. [PMID: 31696091 PMCID: PMC6825382 DOI: 10.34171/mjiri.33.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Indexed: 12/02/2022] Open
Abstract
Background: The metabolic syndrome is highly prevalent among patients with schizophrenia. This study was conducted to determine the prevalence of metabolic syndrome and the risk of cardiovascular disease in the next 10 years among schizophrenic patients. Methods: This cross sectional study was performed on 100 Iranian patients with schizophrenia in 2016. The prevalence of metabolic syndrome was determined by adult treatment panel III criteria, and 10-year cardiovascular risk was calculated by Framingham Risk Score. SPSS software was used to perform statistical analysis. Chi-square and Fisher's exact or extended Fisher's exact tests were used to compare dichotomous variables. Also, Mann-Whitney U test was applied to compare the quantitative variables. Significance level was considered to be less than or equal to 0.05. Results: In this study, 83 participants (83%) were male and 17 (17%) were female. The prevalence of metabolic syndrome was 27% (21.7% in males and 52.9% in females, p=0.015). Among all components of metabolic syndrome, low HDL-C in men and abdominal obesity in females were the most common disorders. Based on Framingham Risk Score, 76%, 16%, and 8% of patients had low, intermediate, and high level of risk, respectively. A significant difference was observed between the level of risk among participants with and without metabolic syndrome (p=0.042). Conclusion: In this study, patients with schizophrenia showed a high prevalence of metabolic syndrome, but most of them had low risk of developing cardiovascular disease. These results suggest regular screening and early interventions to modify the risk factors of metabolic syndrome.
Collapse
Affiliation(s)
- Shadi Naderyan Fe'li
- Department of Biostatistics and Epidemiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Hosein Fallahzadeh
- Department of Biostatistics and Epidemiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ali Dehghani
- Department of Biostatistics and Epidemiology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| |
Collapse
|
187
|
Smith R, Han L, Ali S, Prady SL, Taylor J, Hughes T, Ajjan RA, Siddiqi N, Doran T. Glucose, cholesterol and blood pressure in type II diabetes: A longitudinal observational study comparing patients with and without severe mental illness. J Psychiatr Ment Health Nurs 2019; 26:347-357. [PMID: 31287193 DOI: 10.1111/jpm.12546] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 06/26/2019] [Accepted: 07/05/2019] [Indexed: 12/20/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: People with severe mental illness (SMI) have a life expectancy of 15-20 years less than the general population, partly due to increased risk of physical disease, including type II diabetes (T2DM) and cardiovascular disease. Little is known about changes in cardiovascular risk factors over time in people with both T2DM and SMI compared to those with T2DM and no SMI. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: We investigated whether levels of cardiovascular risk factors, cholesterol, HbA1c, systolic and diastolic blood pressure associated with adverse clinical outcomes are different in T2DM patients with and without SMI. We found significant differences in systolic blood pressure and HbA1c between the two groups. Fifty-five percent and twenty-nine percent of T2DM patients with comorbid SMI are at increased risk of adverse clinical outcomes due to sub-optimal HbA1c and systolic blood pressure levels, respectively. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Many patients with T2DM and SMI have higher levels of cardiovascular risk compared to patients with T2DM only, and good management of risk factors is therefore particularly important in patients with both conditions. Achieving better control of HbA1c levels is likely to be central to addressing inequalities in outcomes for patients with both SMI and T2DM. Abstract Introduction Patients with both severe mental illness (SMI) and type II diabetes (T2DM) have lower life expectancy than patients with T2DM alone, partly due to poor control of cardiovascular risk factors in comorbid patients. Aim To compare levels of cholesterol, HbA1c and blood pressure in T2DM patients with and without SMI. Method We analysed longitudinal clinical records of 30,353 people with T2DM (657 with SMI; 29,696 controls without SMI) between 2001 and 2013 using the Clinical Practice Research Datalink (CPRD). We used mixed-effects regression models to compare cardiovascular risk factors between SMI and controls. Results Patients with SMI had lower mean systolic blood pressure (SBP; β: -2.49; SE = .45 p = <.01) and were more likely to have extreme (high and low) values of HbA1c and SBP (OR: 1.38, 95% CI: 1.16, 1.64 and 1.76:1.40, 2.21, respectively). Discussion People with T2DM and SMI have similar average values of cardiovascular risk factors to people with T2DM alone but are more likely to have values of HbA1c and SBP indicating increased risk of adverse clinical outcomes. Implications for Practice Improved management of cardiovascular risk factors in general, glycaemic control in particular, is central to addressing the increased risk of adverse outcomes in people with both SMI and T2DM.
Collapse
Affiliation(s)
- Robert Smith
- Department of Health Sciences, University of York, York, UK.,School of Nursing, University of Hong Kong, Pokfulam, Hong Kong
| | - Lu Han
- Department of Health Sciences, University of York, York, UK
| | - Shehzad Ali
- Department of Health Sciences, University of York, York, UK.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | | | - Joanne Taylor
- Department of Health Sciences, University of York, York, UK
| | - Tom Hughes
- St Mary's Hospital, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Ramzi A Ajjan
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, UK
| | - Tim Doran
- Department of Health Sciences, University of York, York, UK
| |
Collapse
|
188
|
Morell R, Curtis J, Watkins A, Poole J, Fibbins H, Rossimel E, Gerrard M, White A, Teasdale S, Ward PB, Lappin J. Cardio-metabolic risk in individuals prescribed long-acting injectable antipsychotic medication. Psychiatry Res 2019; 281:112606. [PMID: 31629301 DOI: 10.1016/j.psychres.2019.112606] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 12/24/2022]
Abstract
People living with severe mental illness (SMI) experience significant physical health co-morbidity. Few studies have focused on physical health outcomes for those prescribed long-acting injectable (LAI) antipsychotics. This observational cross-sectional study aimed to assess the prevalence of metabolic syndrome (MetS) and other cardio-metabolic risk factors in a large cohort prescribed LAI and managed by community mental health services. For participants with elevated cardio-metabolic risk factors, the proportion receiving appropriate management was assessed. Of the 301 eligible participants, many met the full criteria for MetS (44%) and its components. Cardio-metabolic risk factors were largely under- or un-treated. Smoking rates were very high (62%) along with reported high rates of physical inactivity and poor dietary intake. The vast majority (89%) reported seeing their general practitioner in the preceding twelve months. Individuals prescribed LAI have a very high prevalence of MetS and potentially modifiable risk factors for cardiovascular disease. Routine monitoring accompanied by evidence-based treatment of cardiometabolic abnormalities which contribute to significant morbidity, disability and premature death should be prioritised. Better collaboration between mental health services and primary care providers should be pursued to optimise the delivery of effective physical health care to individuals living with SMI.
Collapse
Affiliation(s)
- Rachel Morell
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia; School of Psychiatry, UNSW Sydney, Kensington, NSW, Australia.
| | - Jackie Curtis
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia; School of Psychiatry, UNSW Sydney, Kensington, NSW, Australia
| | - Andrew Watkins
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia
| | - Josephine Poole
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia
| | - Hamish Fibbins
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia; School of Psychiatry, UNSW Sydney, Kensington, NSW, Australia
| | - Elisa Rossimel
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia
| | - Mark Gerrard
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia
| | - Annette White
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia
| | - Scott Teasdale
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia; School of Psychiatry, UNSW Sydney, Kensington, NSW, Australia
| | - Philip B Ward
- School of Psychiatry, UNSW Sydney, Kensington, NSW, Australia; Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, NSW, Austraila
| | - Julia Lappin
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia; School of Psychiatry, UNSW Sydney, Kensington, NSW, Australia
| |
Collapse
|
189
|
Richardson A, Richard L, Gunter K, Derrett S. Interventions to integrate care for people with serious mental illness and substance use disorders: a systematic scoping review protocol. BMJ Open 2019; 9:e031122. [PMID: 31666268 PMCID: PMC6830830 DOI: 10.1136/bmjopen-2019-031122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION People with serious mental illness (SMI) and/or substance use disorders (SUDs) have an elevated risk of premature mortality compared with the general population. This has been attributed to higher rates of chronic illness among these individuals, but also to inequities in healthcare access and treatment. Integrated care has the potential to improve the health of people with SMI/SUDs. The aims of this scoping review are to: (1) identify empirical investigations of interventions designed to integrate care for people with SMI/SUDs; (2) describe the underlying theories, models and frameworks of integrated care that informed their development; and (3) determine the degree to which interventions address dimensions of a comprehensive and validated framework of integrated care. METHODS AND ANALYSIS Guidelines for best practice and reporting of scoping reviews will be followed using the framework of Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses scoping review checklist. An iterative and systematic search of peer-reviewed publications reporting empirical research findings will be conducted. This literature will be identified by searching five databases: Medline (Ovid), PsycINFO, CINAHL, Embase (Ovid) and Scopus. The search will be restricted to articles published between January 2000 and April 2019. Two reviewers will independently screen publications in two successive stages of title and abstract screening, followed by full-text screening of eligible publications. A tabular summary and narrative synthesis will be completed using data extracted from each included study. A framework synthesis will also be conducted, with descriptions of interventions mapped against a theoretical framework of integrated care. ETHICS AND DISSEMINATION This review will identify the extent and nature of empirical investigations evaluating interventions to integrate care for people with SMI/SUDs. Ethical approval was not required. A team of relevant stakeholders, including people with lived experience of mental health conditions, has been established. This team will be engaged throughout the review and will ensure that the findings are widely disseminated. Dissemination will include publication of the review in a peer-reviewed journal. The review protocol has been registered through Open Science Framework and can be accessed at https://osf.io/njkph/.
Collapse
Affiliation(s)
- Amy Richardson
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Lauralie Richard
- Department of General Practice & Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Kathryn Gunter
- Chicago Center for Diabetes Translation Research, The University of Chicago, Department of Medicine, Chicago, Illinois, USA
| | - Sarah Derrett
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| |
Collapse
|
190
|
Marteene W, Winckel K, Hollingworth S, Kisely S, Gallagher E, Hahn M, Ebdrup BH, Firth J, Siskind D. Strategies to counter antipsychotic-associated weight gain in patients with schizophrenia. Expert Opin Drug Saf 2019; 18:1149-1160. [PMID: 31564170 DOI: 10.1080/14740338.2019.1674809] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: Patients living with schizophrenia have a marked risk of clinically significant weight gain and obesity compared to the general population. The risks have been highlighted following the introduction of second-generation antipsychotics. In turn, obesity is associated with a higher prevalence of cardiovascular disease, the most common cause of premature mortality in patients with schizophrenia.Areas covered: In this review, the authors outline possible mechanisms that induce obesity in patients with schizophrenia taking antipsychotics. The authors discuss the safety and effectiveness of three main approaches for attenuating antipsychotic-associated weight gain (AAWG), including lifestyle interventions, switching antipsychotics, and augmentation with other medications.Expert opinion: When selecting antipsychotics, effective treatment of psychotic symptoms should be highest priority but obesity and related metabolic comorbidities associated with antipsychotics should not be neglected. Further research into mechanisms of weight gain associated with antipsychotics will guide future treatments for AAWG and development of antipsychotics that produce minimal metabolic adverse effects. With current strategies only producing modest weight loss in already overweight and obese individuals, clinicians should transition to an approach where they aim to prevent weight gain when initiating antipsychotic treatment.
Collapse
Affiliation(s)
- Wade Marteene
- University of Queensland School of Pharmacy, Brisbane, Australia
| | - Karl Winckel
- University of Queensland School of Pharmacy, Brisbane, Australia.,Department of Pharmacy, Princess Alexandra Hospital, Brisbane, Australia
| | - Sam Hollingworth
- University of Queensland School of Pharmacy, Brisbane, Australia
| | - Steve Kisely
- Metro South Addiction and Mental Health Service, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Erin Gallagher
- Metro South Addiction and Mental Health Service, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Margaret Hahn
- Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada
| | - Bjørn H Ebdrup
- Center for Neuropsychiatric Schizophrenia Research, CNSR, and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Joseph Firth
- NICM Health Research Institute, Western Sydney University, Westmead, Australia.,Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| |
Collapse
|
191
|
Analysis of Gut Microbiota and Their Metabolic Potential in Patients with Schizophrenia Treated with Olanzapine: Results from a Six-Week Observational Prospective Cohort Study. J Clin Med 2019; 8:jcm8101605. [PMID: 31623359 PMCID: PMC6832832 DOI: 10.3390/jcm8101605] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/17/2019] [Accepted: 09/25/2019] [Indexed: 12/14/2022] Open
Abstract
Accumulating evidence indicates the potential effect of microbiota on the pathogenesis and course of schizophrenia. However, the effects of olanzapine, second-generation antipsychotics, on gut microbiota have not been investigated in humans. This study aimed to analyze fecal microbiota in schizophrenia patients treated with olanzapine during six weeks of their hospital stay. After a seven-day washout from all psychotropic medications, microbiota compositions were evaluated at baseline and after six weeks of hospitalization using 16S rRNA sequencing. The study was conducted in 20 inpatients, who followed the same hospital routine and received 5–20 mg daily doses of olanzapine. Olanzapine treatment was associated with clinical improvements in all patients and significant increases in body mass index in females, but not changes in gut microbiota compositions and predicted function. The severity of symptoms at the beginning of treatment varied in accordance with the predicted metabolic activity of the bacteria. The present findings indicate that the microbiota of schizophrenia patients is highly individual and has different taxonomical (Type 1, with a predominance of Prevotella, and Type 2 with a higher abundance of Bacteroides, Blautia and Clostridium) and functional clusters, and it does not change following six weeks of olanzapine therapy; in addition, the microbiota is not associated with either the weight gain observed in women or the effectiveness of olanzapine therapy.
Collapse
|
192
|
Reininghaus B, Riedrich K, Dalkner N, Lehner LA, Rieger A, Hamm C, Dorn M, Gradauer L, Hufnagl A, Mayr-Mauhart M, Miniberger G, Schachner A, Wagger K, Birner A, Platzer M, Fellendorf F, Queissner R, Bengesser S, Reininghaus E. Physical health in individuals with psychiatric disorders in Austria. J Affect Disord 2019; 257:38-44. [PMID: 31299403 DOI: 10.1016/j.jad.2019.06.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 06/18/2019] [Accepted: 06/30/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The association between severe psychiatric disorders and metabolic syndrome is well documented and goes along with a reduced life expectancy. The prevalence of medical comorbidities in individuals suffering from psychiatric disorders in Austria has not yet been examined; aim of this study was to analyze the prevalence of comorbid somatic disorder in individuals diagnosed with psychiatric disorders in Austria. METHODS Patients (n = 600) with a life-time diagnosis of mood and anxiety disorders undergoing a six-week course of intensive treatment in a psychiatric rehabilitation center were recruited. Prevalent somatic and psychological conditions, anamnestic data, medical history, blood samples, clinical and psychological tests as well as medication were examined to determine somatic and psychiatric diagnoses. RESULTS Metabolic disorders were highly prevalent especially in individuals diagnosed with affective disorders, respectively in bipolar disorder. Furthermore, obesity and thyroid dysfunction were found in about 40% of individuals diagnosed with bipolar disorder in the present study. Significant gender differences were found in CVD and hypertension with higher prevalence in men, while thyroid dysfunction occurred more often in women also compared to the general female population. CONCLUSIONS Characterizing somatic comorbidity in individuals with psychiatric disorders can stimulate research to better understand possible shared etiologic factors and has public health implications for improving models of care. This could have a positive effect on the course of mental disorders, and additionally improve social integration and life expectancy. Knowledge about sex differences should be used to further improve individualized treatment of individuals with psychiatric disorders.
Collapse
Affiliation(s)
- Bernd Reininghaus
- Therapiezentrum Justuspark, Bad Hall, 4540, Austria; Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| | - Karin Riedrich
- Therapiezentrum Justuspark, Bad Hall, 4540, Austria; Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| | - Nina Dalkner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria.
| | | | - Alexandra Rieger
- Therapiezentrum Justuspark, Bad Hall, 4540, Austria; Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| | - Carlo Hamm
- Therapiezentrum Justuspark, Bad Hall, 4540, Austria; Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| | | | | | | | | | | | | | | | - Armin Birner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| | - Martina Platzer
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| | - Frederike Fellendorf
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| | - Robert Queissner
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| | - Susanne Bengesser
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| | - Eva Reininghaus
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Austria
| |
Collapse
|
193
|
Cocoman AM, Gallagher D. A Retrospective Chart Review of Screening on the Prevalence of Metabolic Syndrome (MetS) in an Irish Community Mental Health Service. Issues Ment Health Nurs 2019; 40:895-901. [PMID: 31295053 DOI: 10.1080/01612840.2019.1609636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Individuals who are treated with antipsychotic medications are at risk of developing metabolic syndrome (MetS). The comorbidity of a severe mental illness (SMI) and a physical illness has a major impact on the quality of life of these individuals. We conducted a retrospective chart review (RCR) of 214 individuals with a diagnosis of schizophrenia who had been receiving antipsychotic medications for at least 6 months, in five clinical settings in an Irish community mental health service. The aim was to determine the presence of MetS to assist in improving screening practices and directing future practice. The National Cholesterol Education Program High Blood Cholesterol Adult Treatment Panel 111 (NCEP ATP 111) metabolic diagnostic criteria were utilised to determine prevalence. After examining 214 charts we observed that waist circumference varied from 68 to 142 cm, elevated waist circumference over the recommended parameters was recorded in 145 charts. Forty-five percent (n = 98) had blood pressure (BP) readings over 130/85. The range for body mass index (BMI)'s varied from 16 to 54, BMIs over 25 was recorded in 44% (n = 95) of charts. Elevated triglycerides (TG) were recorded in 37% (n = 80) and 45% (n = 97) had reduced HDL-C levels. Elevated glucose levels were found in 25% (n = 54) of the charts examined. The chart review found an overall prevalence rate of 44% (n = 94) for this sample. Regular audit of screening data used for the presence of MetS in individuals with SMI is essential in the detection of physical comorbidities and to improving the quality of life and prevention of premature deaths.
Collapse
Affiliation(s)
- Angela M Cocoman
- Faculty of Science and Health, School of Nursing and Human Sciences, Dublin City University , Dublin , Ireland
| | - Darren Gallagher
- Faculty of Science and Health, School of Nursing and Human Sciences, Dublin City University , Dublin , Ireland
| |
Collapse
|
194
|
Aschbrenner KA, Naslund JA, Gill L, Hughes T, O’Malley AJ, Bartels SJ, Brunette MF. Qualitative analysis of social network influences on quitting smoking among individuals with serious mental illness. J Ment Health 2019; 28:475-481. [PMID: 28675331 PMCID: PMC5876150 DOI: 10.1080/09638237.2017.1340600] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 03/17/2017] [Accepted: 04/14/2017] [Indexed: 10/19/2022]
Abstract
Objective: The prevalence of cigarette smoking among adults with serious mental illness (SMI) remains high in the United States despite the availability of effective smoking cessation treatment. Identifying social influences on smoking and smoking cessation may help enhance intervention strategies to help smokers with SMI quit. The objective of this qualitative study was to explore social network influences on efforts to quit smoking among adults with SMI enrolled in a cessation treatment program. Methods: Participants were 41 individuals with SMI enrolled in a Medicaid Demonstration Project of smoking cessation at community mental health centers. A convenience sampling strategy was used to recruit participants for social network interviews exploring the influence of family, friends, peers, and significant others on quitting smoking. A team-based analysis of qualitative data involved descriptive coding, grouping coded data into categories, and identifying themes across the data. Results: Social barriers to quitting smoking included pro-smoking social norms, attitudes, and behaviors of social network members, and negative interactions with network members, either specific to smoking or that triggered smoking. Social facilitators to quitting included quitting with network members, having cessation role models, and social support for quitting from network members. Conclusions: Similar to the general population, social factors appear to influence efforts to quit smoking among individuals with SMI enrolled in cessation treatment. Interventions that leverage positive social influences on smoking cessation have the potential to enhance strategies to help individuals with SMI quit smoking.
Collapse
Affiliation(s)
- Kelly A. Aschbrenner
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - John A. Naslund
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Lydia Gill
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | | | - Alistair J. O’Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Stephen J. Bartels
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Mary F. Brunette
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| |
Collapse
|
195
|
Kar SK, Roy P, Singh J, Tripathi A, Dalal PK. Clinical profile and correlates of hospital stay in patients with severe mental illness. Asian J Psychiatr 2019; 45:41-43. [PMID: 31493623 DOI: 10.1016/j.ajp.2019.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/27/2019] [Accepted: 08/27/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, U.P, India.
| | - Pritha Roy
- Department of Geriatric Mental Health, King George's Medical University, Lucknow, U.P, India.
| | - Jai Singh
- Department of Psychiatry, King George's Medical University, Lucknow, U.P, India.
| | - Adarsh Tripathi
- Department of Psychiatry, King George's Medical University, Lucknow, U.P, India.
| | - Pronob Kumar Dalal
- Department of Psychiatry, King George's Medical University, Lucknow, U.P, India.
| |
Collapse
|
196
|
Kraal AZ, Moll AC, Arvanitis NR, Ward KM, Dougherty RJ, Grove TB, Burghardt KJ, Ellingrod VL. Metabolic syndrome is negatively associated with cognition among endothelial nitric oxide synthase (eNOS)- 786C carriers in schizophrenia-spectrum disorders. J Psychiatr Res 2019; 117:142-147. [PMID: 31421598 PMCID: PMC6707862 DOI: 10.1016/j.jpsychires.2019.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/30/2019] [Accepted: 07/25/2019] [Indexed: 02/08/2023]
Abstract
Although metabolic syndrome and cognitive inefficiencies are well-described common complications of schizophrenia, their association remains inconsistent, potentially due to poorly understood mechanisms underlying their relationship. Variability in the endothelial nitric oxide synthase (eNOS) gene, specifically the T-786C variant, has been separately associated with cognition and metabolic syndrome, with worse outcomes for eNOS-786C carriers likely occurring via negative effects on blood vessel functioning. However, the interaction between eNOS and metabolic syndrome in cognition among adults with schizophrenia is unknown. This study aimed to test the main and interaction effects of the eNOS-786C allele in cognition using hierarchical regression analyses controlling for age, sex, education, race, and antipsychotic exposure. Metabolic syndrome, eNOS T-786C genotype, and cognitive performance were assessed in 226 community-dwelling participants with chronic schizophrenia-spectrum disorders. Results demonstrated a significant interaction between metabolic syndrome and the eNOS-786C allele. Specifically, among eNOS-786C carriers only, metabolic syndrome was independently associated with lower scores in processing speed and verbal fluency, and predicted 12.5% and 15.8% of variance in performance, respectively. These results suggest that the additive negative effects of eNOS-786C and metabolic syndrome on blood vessel functioning may be severe enough to negatively impact cognition. The finding that metabolic syndrome is associated with worse cognition only in the presence of the eNOS-786C allele may clarify extant inconsistencies in the literature. These findings provide preliminary evidence that may inform interventions to reduce cognitive morbidity among adults with schizophrenia.
Collapse
Affiliation(s)
- A. Zarina Kraal
- Department of Psychology, College of Literature, Science, and the Arts, University of Michigan,Department of Clinical Pharmacy, College of Pharmacy, University of Michigan
| | - Allison C. Moll
- Department of Psychology, College of Literature, Science, and the Arts, University of Michigan
| | - Nicole R. Arvanitis
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan
| | - Kristen M. Ward
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan
| | - Ryan J. Dougherty
- Department of Social Welfare, Luskin School of Public Affairs, University of California Los Angeles
| | - Tyler B. Grove
- Department of Psychiatry, School of Medicine, University of Michigan
| | - Kyle J. Burghardt
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University
| | - Vicki L. Ellingrod
- Department of Psychology, College of Literature, Science, and the Arts, University of Michigan,Department of Clinical Pharmacy, College of Pharmacy, University of Michigan,Department of Psychiatry, School of Medicine, University of Michigan
| |
Collapse
|
197
|
Vance MC, Wiitala WL, Sussman JB, Pfeiffer P, Hayward RA. Increased Cardiovascular Disease Risk in Veterans With Mental Illness. Circ Cardiovasc Qual Outcomes 2019; 12:e005563. [DOI: 10.1161/circoutcomes.119.005563] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background:
Although previous studies have demonstrated an association between various mental illnesses and cardio-cerebrovascular disease (CVD) risk, few have compared the strength of association between different mental illnesses and CVD risk.
Methods and Results:
We assessed the association of psychiatric diagnoses (psychosis, bipolar disorder, depression, anxiety, and posttraumatic stress disorder) with major CVD outcomes (CVD events and CVD mortality) over 5 years, using a national primary prevention cohort of military veterans receiving care in the Department of Veterans Affairs. Data were linked from the Department of Veterans Affairs, Centers for Medicare and Medicaid Services, and Centers for Disease Control and Prevention National Death Index databases. We used multiple logistic regression to examine how the presence of a psychiatric diagnosis at baseline (2005–2009) was associated with CVD outcomes over the next 5 years (January 1, 2010, to December 31, 2014) stratified by sex, adjusting for other psychiatric diagnoses, as well as age, race, conventional CVD risk factors as calculated by the Veterans Affairs Risk Score-CVD, and antipsychotic and anticonvulsant/mood stabilizer medication prescriptions. Approximately 1.52 million men and over 94 000 women met our inclusion criteria. In the fully adjusted model, among men, we found that depression, psychosis, and bipolar disorder were predictive of both CVD events and CVD mortality, with psychosis having the largest effect size (eg, adjusted odds ratio, 1.48; CI, 1.41–1.56;
P
<0.001 for psychosis and CVD mortality). Among women, only psychosis and bipolar disorder were predictive of both CVD events and CVD mortality, again with psychosis having the largest effect size (eg, adjusted odds ratio, 1.97; CI, 1.52–2.57;
P
<0.001 for psychosis and CVD mortality). Anxiety was associated with only CVD mortality in men, and depression was associated with only CVD events in women.
Conclusions:
Consistent with the hypothesis that chronic stress leads to greater CVD risk, multiple mental illnesses were associated with an increased risk of CVD outcomes, with more severe mental illnesses (eg, primary psychotic disorders) having the largest effect sizes even after controlling for other psychiatric diagnoses, conventional CVD risk factors, and psychotropic medication use.
Collapse
Affiliation(s)
- Mary C. Vance
- From the Department of Psychiatry, Uniformed Services University, Bethesda, MD (M.C.V.)
| | - Wyndy L. Wiitala
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, MI (W.L.W., J.B.S., P.P., R.A.H.)
| | - Jeremy B. Sussman
- Department of Internal Medicine (J.B.S., R.A.H.), University of Michigan, Ann Arbor
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, MI (W.L.W., J.B.S., P.P., R.A.H.)
| | - Paul Pfeiffer
- Department of Psychiatry (P.P.), University of Michigan, Ann Arbor
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, MI (W.L.W., J.B.S., P.P., R.A.H.)
| | - Rodney A. Hayward
- Department of Internal Medicine (J.B.S., R.A.H.), University of Michigan, Ann Arbor
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, MI (W.L.W., J.B.S., P.P., R.A.H.)
| |
Collapse
|
198
|
Abrahamian H, Kautzky-Willer A, Rießland-Seifert A, Fasching P, Ebenbichler C, Kautzky A, Hofmann P, Toplak H. [Mental disorders and diabetes mellitus (Update 2019)]. Wien Klin Wochenschr 2019; 131:186-195. [PMID: 30980168 DOI: 10.1007/s00508-019-1458-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Psychiatric disorders and psychological problems are common in patients with diabetes mellitus. There is a twofold increase in depression which is associated with suboptimal glycemic control and increased morbidity and mortality. Other psychiatric disorders with a higher incidence of diabetes mellitus are cognitive impairment, dementia, disturbed eating behavior, anxiety disorders, schizophrenia, bipolar disorders and borderline personality disorder. The coincidence of mental disorders and diabetes mellitus has unfavorable influences on metabolic control and micro- and macroangiopathic complications. Improvement of therapeutic outcome is a challenge in the modern health care system. The intentions behind this position paper are to rise awareness of this special set of problems, to intensify cooperation between involved health care providers and to reduce incidence of diabetes mellitus as well as morbidity and mortality from diabetes in this patient group.
Collapse
Affiliation(s)
- Heidemarie Abrahamian
- Internistisches Zentrum, Sozialmedizinisches Zentrum Baumgartner Höhe, Otto-Wagner-Spital, 1140, Wien, Österreich.
| | - Alexandra Kautzky-Willer
- Gender Medicine Unit, Klinische, Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Angelika Rießland-Seifert
- 1. Psychiatrische Abteilung mit Zentrum für Psychotherapie und Psychosomatik, Sozialmedizinisches Zentrum Baumgartner Höhe, Otto-Wagner-Spital, Wien, Österreich
| | - Peter Fasching
- 5. Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Wilhelminenspital der Stadt Wien, Wien, Österreich
| | - Christoph Ebenbichler
- Universitätsklinik für Innere Medizin I, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Alexander Kautzky
- Klinische Abteilung für Sozialpsychiatrie, Medizinische Universitätsklinik für Psychiatrie und Psychotherapie, Wien, Österreich
| | - Peter Hofmann
- Universitätsklinik für Psychiatrie und Psychotherapeutische Medizin, Medizinische Universität Graz, Graz, Österreich
| | - Hermann Toplak
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich
| |
Collapse
|
199
|
Mitchell AJ, Vancampfort D, Manu P, Correll CU, Wampers M, van Winkel R, Yu W, De Hert M. Which clinical and biochemical predictors should be used to screen for diabetes in patients with serious mental illness receiving antipsychotic medication? A large observational study. PLoS One 2019; 14:e0210674. [PMID: 31513598 PMCID: PMC6742458 DOI: 10.1371/journal.pone.0210674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/28/2018] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE We aimed to investigate which clinical and metabolic tests offer optimal accuracy and acceptability to help diagnose diabetes among a large sample of people with serious mental illness in receipt of antipsychotic medication. METHODS A prospective observational study design of biochemical and clinical factors was used. Biochemical measures were fasting glucose, insulin and lipids, oral glucose tolerance testing (OGTT), hemoglobin A1c, and insulin resistance assessed with the homeostatic model (HOMA-IR) were determined in a consecutive cohort of 798 adult psychiatric inpatients receiving antipsychotics. Clinical variables were gender, age, global assessment of functioning (GAF), mental health clinicians' global impression (CGI), duration of severe mental illness, height, weight, BMI and waist/hip ratio. In addition, we calculated the risk using combined clinical predictors using the Leicester Practice Risk Score (LPRS) and the Topics Diabetes Risk Score (TDRS). Diabetes was defined by older criteria (impaired fasting glucose (IFG) or OGTT) as well as2010 criteria (IFG or OGTT or Glycated haemoglobin (HBA1c)) at conventional cut-offs. RESULTS Using the older criteria, 7.8% had diabetes (men: 6.3%; women: 10.3%). Using the new criteria, 10.2% had diabetes (men: 8.2%, women: 13.2%), representing a 30.7% increase (p = 0.02) in the prevalence of diabetes. Regarding biochemical predictors, conventional OGTT, IFG, and HbA1c thresholds used to identify newly defined diabetes missed 25%, 50% and 75% of people with diabetes, respectively. The conventional HBA1c cut-point of ≥6.5% (48 mmol/mol) missed 7 of 10 newly defined cases of diabetes while a cut-point of ≥5.7% improved sensitivity from 44.4% to up to 85%. Specific algorithm approaches offered reasonable accuracy. Unfortunately no single clinical factor was able to accurately rule-in a diagnosis of diabetes. Three clinical factors were able to rule-out diabetes with good accuracy namely: BMI, waist/hip ratio and height. A BMI < 30 had a 92% negative predictive value in ruling-out diabetes. Of those not diabetic, 20% had a BMI ≥ 30. However, for complete diagnosis a specific biochemical protocol is still necessary. CONCLUSIONS Patients with SMI maintained on antipsychotic medication cannot be reliably screened for diabetes using clinical variables alone. Accurate assessment requires a two-step algorithm consisting of HBA1c ≥5.7% followed by both FG and OGTT which does not require all patients to have OGTT and FG.
Collapse
Affiliation(s)
| | - Davy Vancampfort
- University Psychiatric Center, Catholic University Leuven, Kortenberg, Belgium
| | - Peter Manu
- University Psychiatric Center, Kortenberg, Belgium
- School of Mental Health and Neuroscience (EURON), University Medical Center, Maastricht, The Netherlands
| | - Christoph U. Correll
- Zucker Hillside Hospital, Glen Oaks, New York, United States
- Hofstra North Shore–LIJ School of Medicine, Hempstead, New York, United States
| | - Martien Wampers
- University Psychiatric Center, Catholic University Leuven, Kortenberg, Belgium
| | - Ruud van Winkel
- University Psychiatric Center, Catholic University Leuven, Kortenberg, Belgium
| | - Weiping Yu
- University Psychiatric Center, Catholic University Leuven, Kortenberg, Belgium
| | - Marc De Hert
- University Psychiatric Center, Catholic University Leuven, Kortenberg, Belgium
| |
Collapse
|
200
|
Abstract
PURPOSE OF REVIEW The prevalence of diabetes is 2-3-fold higher in people with severe mental illness than the general population. There are concerns that antipsychotics increase the risk of diabetes. This review will examine the latest epidemiological studies linking antipsychotics and diabetes, as well as the mechanisms underlying the association and the clinical implications to minimise the impact of antipsychotics on metabolic health. RECENT FINDINGS Although there is an increased risk of diabetes in people with first-episode psychosis, the prevalence increases rapidly after antipsychotics are started. Antipsychotics likely increase the risk of diabetes through weight gain and directly by adversely affecting insulin sensitivity and secretion. It is important to implement measures to prevent diabetes, to screen for diabetes to ensure prompt diagnosis and to provide effective diabetes care. Further research is needed to understand how antipsychotics cause diabetes and to improve the clinical management of diabetes in people with severe mental illness.
Collapse
Affiliation(s)
- Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
- University Hospital Southampton NHS Trust, The IDS Building (MP887), Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| |
Collapse
|