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Bartels SJ, Pratt SI, Aschbrenner KA, Barre LK, Naslund JA, Wolfe R, Xie H, McHugo GJ, Jimenez DE, Jue K, Feldman J, Bird BL. Pragmatic replication trial of health promotion coaching for obesity in serious mental illness and maintenance of outcomes. Am J Psychiatry 2015; 172:344-52. [PMID: 25827032 PMCID: PMC4537796 DOI: 10.1176/appi.ajp.2014.14030357] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Few studies targeting obesity in serious mental illness have reported clinically significant risk reduction, and none have been replicated in community settings or demonstrated sustained outcomes after intervention withdrawal. The authors sought to replicate positive health outcomes demonstrated in a previous randomized effectiveness study of the In SHAPE program across urban community mental health organizations serving an ethnically diverse population. METHOD Persons with serious mental illness and a body mass index (BMI) >25 receiving services in three community mental health organizations were recruited and randomly assigned either to the 12-month In SHAPE program, which included membership in a public fitness club and weekly meetings with a health promotion coach, or to fitness club membership alone. The primary outcome measures were weight and cardiorespiratory fitness (as measured with the 6-minute walk test), assessed at baseline and at 3, 6, 9, 12, and 18 months. RESULTS Participants (N=210) were ethnically diverse (46% were nonwhite), with a mean baseline BMI of 36.8 (SD=8.2). At 12 months, the In SHAPE group (N=104) had greater reduction in weight and improved fitness compared with the fitness club membership only group (N=106). Primary outcomes were maintained at 18 months. Approximately half of the In SHAPE group (51% at 12 months and 46% at 18 months) achieved clinically significant cardiovascular risk reduction (a weight loss ≥5% or an increase of >50 meters on the 6-minute walk test). CONCLUSIONS This is the first replication study confirming the effectiveness of a health coaching intervention in achieving and sustaining clinically significant reductions in cardiovascular risk for overweight and obese persons with serious mental illness.
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Kritchevsky SB, Beavers KM, Miller ME, Shea MK, Houston DK, Kitzman DW, Nicklas BJ. Intentional weight loss and all-cause mortality: a meta-analysis of randomized clinical trials. PLoS One 2015; 10:e0121993. [PMID: 25794148 PMCID: PMC4368053 DOI: 10.1371/journal.pone.0121993] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 02/10/2015] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Obesity is associated with increased mortality, and weight loss trials show rapid improvement in many mortality risk factors. Yet, observational studies typically associate weight loss with higher mortality risk. The purpose of this meta-analysis of randomized controlled trials (RCTs) of weight loss was to clarify the effects of intentional weight loss on mortality. METHODS 2,484 abstracts were identified and reviewed in PUBMED, yielding 15 RCTs reporting (1) randomization to weight loss or non-weight loss arms, (2) duration of ≥18 months, and (3) deaths by intervention arm. Weight loss interventions were all lifestyle-based. Relative risks (RR) and 95% confidence intervals (95% CI) were estimated for each trial. For trials reporting at least one death (n = 12), a summary estimate was calculated using the Mantel-Haenszel method. Sensitivity analysis using sparse data methods included remaining trials. RESULTS Trials enrolled 17,186 participants (53% female, mean age at randomization = 52 years). Mean body mass indices ranged from 30-46 kg/m2, follow-up times ranged from 18 months to 12.6 years (mean: 27 months), and average weight loss in reported trials was 5.5±4.0 kg. A total of 264 deaths were reported in weight loss groups and 310 in non-weight loss groups. The weight loss groups experienced a 15% lower all-cause mortality risk (RR = 0.85; 95% CI: 0.73-1.00). There was no evidence for heterogeneity of effect (Cochran's Q = 5.59 (11 d.f.; p = 0.90); I2 = 0). Results were similar in trials with a mean age at randomization ≥55 years (RR = 0.84; 95% CI 0.71-0.99) and a follow-up time of ≥4 years (RR = 0.85; 95% CI 0.72-1.00). CONCLUSIONS In obese adults, intentional weight loss may be associated with approximately a 15% reduction in all-cause mortality.
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Affiliation(s)
- Stephen B Kritchevsky
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Kristen M Beavers
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America; Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, United States of America
| | - Michael E Miller
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America; Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - M Kyla Shea
- Human Nutrition Research Center on Aging, Tufts University, Boston, MA, United States of America
| | - Denise K Houston
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Dalane W Kitzman
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
| | - Barbara J Nicklas
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America
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303
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Thomson D, Turner A, Lauder S, Gigler ME, Berk L, Singh AB, Pasco JA, Berk M, Sylvia L. A brief review of exercise, bipolar disorder, and mechanistic pathways. Front Psychol 2015; 6:147. [PMID: 25788889 PMCID: PMC4349127 DOI: 10.3389/fpsyg.2015.00147] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 01/28/2015] [Indexed: 01/09/2023] Open
Abstract
Despite evidence that exercise has been found to be effective in the treatment of depression, it is unclear whether these data can be extrapolated to bipolar disorder. Available evidence for bipolar disorder is scant, with no existing randomized controlled trials having tested the impact of exercise on depressive, manic or hypomanic symptomatology. Although exercise is often recommended in bipolar disorder, this is based on extrapolation from the unipolar literature, theory and clinical expertise and not empirical evidence. In addition, there are currently no available empirical data on program variables, with practical implications on frequency, intensity and type of exercise derived from unipolar depression studies. The aim of the current paper is to explore the relationship between exercise and bipolar disorder and potential mechanistic pathways. Given the high rate of medical co-morbidities experienced by people with bipolar disorder, it is possible that exercise is a potentially useful and important intervention with regard to general health benefits; however, further research is required to elucidate the impact of exercise on mood symptomology.
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Affiliation(s)
- Daniel Thomson
- Department of Applied Sciences, Royal Melbourne Institute of Technology University , Bundoora, VIC, Australia
| | - Alyna Turner
- Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre, School of Medicine, Deakin University , Geelong, VIC, Australia ; Department of Psychiatry, University of Melbourne , Parkville, VIC, Australia ; Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, University of Newcastle , Callaghan, NSW, Australia
| | - Sue Lauder
- Department of Psychiatry, University of Melbourne , Parkville, VIC, Australia ; Federation University Australia , Ballarat, VIC, Australia
| | - Margaret E Gigler
- Department of Psychiatry, Massachusetts General Hospital , Boston, MA, USA
| | - Lesley Berk
- Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre, School of Medicine, Deakin University , Geelong, VIC, Australia ; Mental Health and Wellbeing Strategic Research Centre, School of Psychology, Deakin University , Geelong, VIC, Australia
| | - Ajeet B Singh
- Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre, School of Medicine, Deakin University , Geelong, VIC, Australia
| | - Julie A Pasco
- Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre, School of Medicine, Deakin University , Geelong, VIC, Australia ; Department of Medicine, NorthWest Academic Centre, University of Melbourne , St Albans, VIC, Australia
| | - Michael Berk
- Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre, School of Medicine, Deakin University , Geelong, VIC, Australia ; Department of Psychiatry, University of Melbourne , Parkville, VIC, Australia ; Florey Institute for Neuroscience and Mental Health , Parkville, VIC, Australia ; Orygen, The National Centre of Excellence in Youth Mental Health , Parkville, VIC, Australia
| | - Louisa Sylvia
- Department of Psychiatry, Massachusetts General Hospital , Boston, MA, USA ; Harvard Medical School, Harvard University , Boston, MA, USA
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Teasdale S, Harris S, Rosenbaum S, Watkins A, Samaras K, Curtis J, Ward PB. Individual dietetic consultations in first episode psychosis: a novel intervention to reduce cardiometabolic risk. Community Ment Health J 2015; 51:211-4. [PMID: 25523060 DOI: 10.1007/s10597-014-9787-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 12/04/2014] [Indexed: 01/01/2023]
Abstract
Individual dietetic consultations were trialled in a community-based first-episode psychosis program. Participants received eight individualised dietetic consultations, plus weekly shopping tours and cooking groups. The outcome measure was waist circumference (WC). In total, 30 patients commenced the program. An intention-to-treat analysis revealed, a statistically significant reduction in WC (mean=2.1±5.4 cm, t=2.1, df=29, p=0.04). Similar results were found for the 14 participants who attended all eight sessions (mean WC reduction=2.9±4.7 cm, t=2.3, df=13, p=0.04). Dietetic consultations were feasible and effective in reducing WC, and could enhance programs to reduce cardiometabolic risk in youth with psychosis using lifestyle interventions.
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Affiliation(s)
- Scott Teasdale
- Early Psychosis Programme, The Bondi Centre, South Eastern Sydney Local Health District, 26 Llandaff St, Bondi Junction, NSW, 2022, Australia,
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305
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Cardiovascular risk profile before coronary artery bypass graft surgery in relation to depression and anxiety disorders: An age and sex propensity matched study. Aust Crit Care 2015; 28:24-30. [DOI: 10.1016/j.aucc.2014.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 01/08/2014] [Accepted: 04/22/2014] [Indexed: 12/18/2022] Open
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Annamalai A, Tek C. An overview of diabetes management in schizophrenia patients: office based strategies for primary care practitioners and endocrinologists. Int J Endocrinol 2015; 2015:969182. [PMID: 25878665 PMCID: PMC4386295 DOI: 10.1155/2015/969182] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/11/2015] [Accepted: 03/12/2015] [Indexed: 12/16/2022] Open
Abstract
Diabetes is common and seen in one in five patients with schizophrenia. It is more prevalent than in the general population and contributes to the increased morbidity and shortened lifespan seen in this population. However, screening and treatment for diabetes and other metabolic conditions remain poor for these patients. Multiple factors including genetic risk, neurobiologic mechanisms, psychotropic medications, and environmental factors contribute to the increased prevalence of diabetes. Primary care physicians should be aware of adverse effects of psychotropic medications that can cause or exacerbate diabetes and its complications. Management of diabetes requires physicians to tailor treatment recommendations to address special needs of this population. In addition to behavioral interventions, medications such as metformin have shown promise in attenuating weight loss and preventing hyperglycemia in those patients being treated with antipsychotic medications. Targeted diabetes prevention and treatment is critical in patients with schizophrenia and evidence-based interventions should be considered early in the course of treatment. This paper reviews the prevalence, etiology, and treatment of diabetes in schizophrenia and outlines office based interventions for physicians treating this vulnerable population.
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Affiliation(s)
- Aniyizhai Annamalai
- Departments of Psychiatry and Internal Medicine, Yale School of Medicine, 34 Park Street, New Haven, CT 06519, USA
- *Aniyizhai Annamalai:
| | - Cenk Tek
- Department of Psychiatry, Yale School of Medicine, 34 Park Street, New Haven, CT 06519, USA
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307
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Littman AJ, Damschroder LJ, Verchinina L, Lai Z, Kim HM, Hoerster KD, Klingaman EA, Goldberg RW, Owen RR, Goodrich DE. National evaluation of obesity screening and treatment among veterans with and without mental health disorders. Gen Hosp Psychiatry 2015; 37:7-13. [PMID: 25500194 DOI: 10.1016/j.genhosppsych.2014.11.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 11/10/2014] [Accepted: 11/13/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective was to determine whether obesity screening and weight management program participation and outcomes are equitable for individuals with serious mental illness (SMI) and depressive disorder (DD) compared to those without SMI/DD in Veterans Health Administration (VHA), the largest integrated US health system, which requires obesity screening and offers weight management to all in need. METHODS We used chart-reviewed, clinical and administrative VHA data from fiscal years 2010-2012 to estimate obesity screening and participation in the VHA's weight management program (MOVE!) across groups. Six- and 12-month weight changes in MOVE! participants were estimated using linear mixed models adjusted for confounders. RESULTS Compared to individuals without SMI/DD, individuals with SMI or DD were less frequently screened for obesity (94%-94.7% vs. 95.7%) but had greater participation in MOVE! (10.1%-10.4% vs. 7.4%). MOVE! participants with SMI or DD lost approximately 1 lb less at 6 months. At 12 months, average weight loss for individuals with SMI or neither SMI/DD was comparable (-3.5 and -3.3 lb, respectively), but individuals with DD lost less weight (mean=-2.7 lb). CONCLUSIONS Disparities in obesity screening and treatment outcomes across mental health diagnosis groups were modest. However, participation in MOVE! was low for every group, which limits population impact.
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Affiliation(s)
- Alyson J Littman
- VA Puget Sound Healthcare System, Seattle Division Epidemiologic Research and Information Center (ERIC), Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - Laura J Damschroder
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, USA.
| | - Lilia Verchinina
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, USA.
| | - Zongshan Lai
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, USA; Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109-2800, USA.
| | - Hyungjin Myra Kim
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, USA; Center for Statistical Consultation & Research, University of Michigan, Ann Arbor, MI.
| | - Katherine D Hoerster
- VA Puget Sound Healthcare System, Seattle Division Mental Health Service; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
| | - Elizabeth A Klingaman
- VA Capitol Health Care Network Mental Illness Research, Education, and Clinical Center, Baltimore, MD; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD.
| | - Richard W Goldberg
- VA Capitol Health Care Network Mental Illness Research, Education, and Clinical Center, Baltimore, MD.
| | - Richard R Owen
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR; Department of Psychiatry, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR.
| | - David E Goodrich
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, USA; Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109-2800, USA.
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308
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Siddiqui M, Cooper LA, Appel LJ, Yu A, Charleston J, Gennusa J, Dickerson F, Daumit GL. Recruitment and enrollment of African Americans and Caucasians in a health promotion trial for persons with serious mental illness. Ethn Dis 2015; 25:72-77. [PMID: 25812255 PMCID: PMC4663046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
African Americans with serious mental illness (SMI) continue to experience inadequate representation in clinical trials. Persons with SMI, regardless of race, have an increased burden of all cardiovascular disease (CVD) risk factors including obesity, hypertension, diabetes mellitus, dyslipidemia, metabolic syndrome and tobacco smoking. Having SMI and being African American, however, is each associated with an increased risk of CVD mortality compared to the general population. There is a critical need, therefore, to adapt health promotion interventions for African Americans with SMI. We sought to examine overall recruitment into a randomized clinical trial of CVD prevention among persons with SMI, and to examine racial differences in interest, enrollment, and potential barriers to participation. Although similar levels of interest in participation were seen between African Americans and Caucasians in signing screening consent, 9.6% fewer African Americans enrolled due to inability to complete initial data collection. Further work is needed to better understand the nature of the barriers encountered by African Americans with SMI who otherwise may be interested in participating within clinical trials.
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309
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Leutwyler H, Hubbard E, Cooper B, Dowling G. The Impact of a Videogame-Based Pilot Physical Activity Program in Older Adults with Schizophrenia on Subjectively and Objectively Measured Physical Activity. Front Psychiatry 2015; 6:180. [PMID: 26733891 PMCID: PMC4685058 DOI: 10.3389/fpsyt.2015.00180] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 12/07/2015] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES The purpose of this report is to describe the impact of a videogame-based pilot physical activity program using the Kinect for Xbox 360 game system (Microsoft, Redmond, WA, USA) on physical activity in older adults with schizophrenia. METHODS In this one group pre-test, post-test pilot study, 20 participants played an active videogame for 30 min, once a week for 6 weeks. Physical activity was measured by self-report with the Yale Physical Activity Survey and objectively with the Sensewear Pro armband at enrollment and at the end of the 6-week program. RESULTS There was a significant increase in frequency of self-reported vigorous physical activity. We did not detect a statistically significant difference in objectively measured physical activity although increase in number of steps and sedentary activity were in the desired direction. CONCLUSION These results suggest participants' perception of physical activity intensity differs from the intensity objectively captured with a valid and reliable physical activity monitor.
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Affiliation(s)
- Heather Leutwyler
- Physiological Nursing, University of California San Francisco , San Francisco, CA , USA
| | - Erin Hubbard
- Physiological Nursing, University of California San Francisco , San Francisco, CA , USA
| | - Bruce Cooper
- School of Nursing, University of California San Francisco , San Francisco, CA , USA
| | - Glenna Dowling
- Physiological Nursing, University of California San Francisco , San Francisco, CA , USA
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310
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Green CA, Yarborough BJH, Leo MC, Yarborough MT, Stumbo SP, Janoff SL, Perrin NA, Nichols GA, Stevens VJ. The STRIDE weight loss and lifestyle intervention for individuals taking antipsychotic medications: a randomized trial. Am J Psychiatry 2015; 172:71-81. [PMID: 25219423 PMCID: PMC4282602 DOI: 10.1176/appi.ajp.2014.14020173] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The STRIDE study assessed whether a lifestyle intervention, tailored for individuals with serious mental illnesses, reduced weight and diabetes risk. The authors hypothesized that the STRIDE intervention would be more effective than usual care in reducing weight and improving glucose metabolism. METHOD The study design was a multisite, parallel two-arm randomized controlled trial in community settings and an integrated health plan. Participants who met inclusion criteria were ≥18 years old, were taking antipsychotic agents for ≥30 days, and had a body mass index ≥27. Exclusions were significant cognitive impairment, pregnancy/breastfeeding, recent psychiatric hospitalization, bariatric surgery, cancer, heart attack, or stroke. The intervention emphasized moderate caloric reduction, the DASH (Dietary Approaches to Stop Hypertension) diet, and physical activity. Blinded staff collected data at baseline, 6 months, and 12 months. RESULTS Participants (men, N=56; women, N=144; mean age=47.2 years [SD=10.6]) were randomly assigned to usual care (N=96) or a 6-month weekly group intervention plus six monthly maintenance sessions (N=104). A total of 181 participants (90.5%) completed 6-month assessments, and 170 (85%) completed 12-month assessments, without differential attrition. Participants attended 14.5 of 24 sessions over 6 months. Intent-to-treat analyses revealed that intervention participants lost 4.4 kg more than control participants from baseline to 6 months (95% CI=-6.96 kg to -1.78 kg) and 2.6 kg more than control participants from baseline to 12 months (95% CI=-5.14 kg to -0.07 kg). At 12 months, fasting glucose levels in the control group had increased from 106.0 mg/dL to 109.5 mg/dL and decreased in the intervention group from 106.3 mg/dL to 100.4 mg/dL. No serious adverse events were study-related; medical hospitalizations were reduced in the intervention group (6.7%) compared with the control group (18.8%). CONCLUSIONS Individuals taking antipsychotic medications can lose weight and improve fasting glucose levels. Increasing reach of the intervention is an important future step.
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311
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Shin JK, Shortridge-Baggett LM, Sachmechi I, Barron C, Chiu YL, Bajracharya B, Bang H. Screening for type 2 diabetes mellitus in patients with mental illness: application of a self-assessment score for diabetes mellitus risk. Psychiatry Res 2014; 220:1037-42. [PMID: 25223258 DOI: 10.1016/j.psychres.2014.08.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 08/12/2014] [Accepted: 08/25/2014] [Indexed: 11/17/2022]
Abstract
Various methods for diabetes risk assessment have been developed over a decade, but they were not evaluated in patients with mental illness. This study examined the feasibility and utility of a self-assessment score for type 2 diabetes mellitus (DM2) risk among patients with mental illness. DM2 risk was assessed by patients with mental illness as well as clinicians via a self-assessment questionnaire, and the resulting scores were compared to each other as well as with actual diagnosis. Of 100 patients, nine patients were newly revealed to have DM2 and 34 patients have pre-DM2. Patients tended to underreport risk factors - obesity and physical activity - so perceived to have lower risk. Sensitivity of the self-assessment score was different when used by patients and by clinicians despite correlation coefficient of 0.82. Based on positive predictive values, we may expect one out of two patients who have high scores actually have DM2 or pre-DM2. Also, the discrimination capability was reasonably high (AUC=0.79), comparable to its performance observed in general populations. The self-assessment score has potential as a simple and adjunct tool to identify a high risk group of DM2/pre-DM2 among persons with mental illness, especially, when used together with health care providers.
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Affiliation(s)
- Jinah K Shin
- Department of Psychiatry, Elmhurst Hospital Center, 79-01, Broadway, Elmhurst, NY 11373, USA.
| | | | - Issac Sachmechi
- Department of Medicine, Queens Hospital Center, Queens, NY, USA
| | - Charles Barron
- Department of Psychiatry, Elmhurst Hospital Center, 79-01, Broadway, Elmhurst, NY 11373, USA
| | - Ya-Lin Chiu
- Everest Clinical Research, 150 Clove Road, Little Fall, NJ, USA
| | - Bhavana Bajracharya
- Department of Endocrinology, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California at Davis, Davis, CA, USA
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312
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Naslund JA, Aschbrenner KA, Barre LK, Bartels SJ. Feasibility of popular m-health technologies for activity tracking among individuals with serious mental illness. Telemed J E Health 2014; 21:213-6. [PMID: 25536190 DOI: 10.1089/tmj.2014.0105] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Obesity prevalence is nearly double among individuals with serious mental illness (SMI), including schizophrenia spectrum disorders, bipolar disorder, or major depressive disorder, compared with the general population. Emerging mobile health (m-health) technologies are increasingly available and offer the potential to support lifestyle interventions targeting weight loss, yet the practical feasibility of using these technologies in this high-risk group has not been established. We evaluated the feasibility and acceptability of popular m-health technologies for activity tracking among overweight and obese individuals with SMI. We provided wearable activity monitoring devices (FitBit [San Francisco, CA] Zip™ or Nike Inc. [Beaverton, OR] FuelBand) and smartphones (Apple [Cupertino, CA] iPhone(®) 4S) for accessing the smartphone application for each device to participants with SMI enrolled in a weight loss program. Feasibility of these devices was measured by the frequency of use over time. Acceptability was measured through qualitative follow-up interviews with participants. Ten participants with SMI wore the devices for a mean of 89% (standard deviation=13%) of the days in the study. Five participants wore the devices 100% of the time. Participants reported high satisfaction, stating the devices were easy to use, helpful for setting goals, motivational, and useful for self-monitoring. Several participants liked the social connectivity feature of the devices where they could see each other's progress on the smartphone application, noting that "friendly" competition increased motivation to be more physically active. This study supports using popular m-health technologies for activity tracking among individuals with SMI. These findings can inform the design of weight loss interventions targeting this vulnerable patient population.
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Affiliation(s)
- John A Naslund
- 1 The Dartmouth Institute for Health Policy and Clinical Practice , Dartmouth College, Lebanon , New Hampshire
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Altman M, Wilfley DE. Evidence update on the treatment of overweight and obesity in children and adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2014; 44:521-37. [PMID: 25496471 DOI: 10.1080/15374416.2014.963854] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Childhood obesity is associated with increased medical and psychosocial consequences and mortality and effective interventions are urgently needed. Effective interventions are urgently needed. This article reviews the evidence for psychological treatments of overweight and obesity in child and adolescent populations. Studies were identified through searches of online databases and reference sections of relevant review articles and meta-analyses. Treatment efficacy was assessed using established criteria, and treatments were categorized as well-established, probably efficacious, possibly efficacious, experimental, or of questionable efficacy. Well-established treatments included family-based behavioral treatment (FBT) and Parent-Only Behavioral Treatment for children. Possibly efficacious treatments include Parent-Only Behavioral Treatment for adolescents, FBT-Guided Self-Help for children, and Behavioral Weight Loss treatment with family involvement for toddlers, children, and adolescents. Appetite awareness training and regulation of cues treatments are considered experimental. No treatments are considered probably efficacious, or of questionable efficacy. All treatments considered efficacious are multicomponent interventions that include dietary and physical activity modifications and utilize behavioral strategies. Treatment is optimized if family members are specifically targeted in treatment. Research supports the use of multicomponent lifestyle interventions, with FBT and Parent-Only Behavioral Treatment being the most widely supported treatment types. Additional research is needed to test a stepped care model for treatment and to establish the ideal dosage (i.e., number and length of sessions), duration, and intensity of treatments for long-term sustainability of healthy weight management. To improve access to care, the optimal methods to enhance the scalability and implementability of treatments into community and clinical settings need to be established.
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Affiliation(s)
- Myra Altman
- a Department of Psychology , Washington University in St. Louis
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314
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Bruins J, Jörg F, Bruggeman R, Slooff C, Corpeleijn E, Pijnenborg M. The effects of lifestyle interventions on (long-term) weight management, cardiometabolic risk and depressive symptoms in people with psychotic disorders: a meta-analysis. PLoS One 2014; 9:e112276. [PMID: 25474313 PMCID: PMC4256304 DOI: 10.1371/journal.pone.0112276] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 10/04/2014] [Indexed: 12/21/2022] Open
Abstract
AIMS The aim of this study was to estimate the effects of lifestyle interventions on bodyweight and other cardiometabolic risk factors in people with psychotic disorders. Additionally, the long-term effects on body weight and the effects on depressive symptoms were examined. MATERIAL AND METHODS We searched four databases for randomized controlled trials (RCTs) that compared lifestyle interventions to control conditions in patients with psychotic disorders. Lifestyle interventions were aimed at weight loss or weight gain prevention, and the study outcomes included bodyweight or metabolic parameters. RESULTS The search resulted in 25 RCTs -only 4 were considered high quality- showing an overall effect of lifestyle interventions on bodyweight (effect size (ES) = -0.63, p<0.0001). Lifestyle interventions were effective in both weight loss (ES = -0.52, p<0.0001) and weight-gain-prevention (ES = -0.84, p = 0.0002). There were significant long-term effects, two to six months post-intervention, for both weight-gain-prevention interventions (ES = -0.85, p = 0.0002) and weight loss studies (ES = -0.46, p = 0.02). Up to ten studies reported on cardiometabolic risk factors and showed that lifestyle interventions led to significant improvements in waist circumference, triglycerides, fasting glucose and insulin. No significant effects were found for blood pressure and cholesterol levels. Four studies reported on depressive symptoms and showed a significant effect (ES = -0.95, p = 0.05). CONCLUSION Lifestyle interventions are effective in treating and preventing obesity, and in reducing cardiometabolic risk factors. However, the quality of the studies leaves much to be desired.
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Affiliation(s)
- Jojanneke Bruins
- University of Groningen, University Medical Center Groningen, University Center Psychiatry, Rob Giel Research center, Groningen, The Netherlands
| | - Frederike Jörg
- University of Groningen, University Medical Center Groningen, University Center Psychiatry, Rob Giel Research center, Groningen, The Netherlands
- Friesland Mental Health Services, Research Department, Leeuwarden, Friesland, The Netherlands
| | - Richard Bruggeman
- University of Groningen, University Medical Center Groningen, University Center Psychiatry, Rob Giel Research center, Groningen, The Netherlands
| | - Cees Slooff
- University of Groningen, University Medical Center Groningen, University Center Psychiatry, Rob Giel Research center, Groningen, The Netherlands
- GGZ Drenthe, Department of Psychotic Disorders, Assen, Drenthe, The Netherlands
| | - Eva Corpeleijn
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, The Netherlands
| | - Marieke Pijnenborg
- GGZ Drenthe, Department of Psychotic Disorders, Assen, Drenthe, The Netherlands
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, Groningen, The Netherlands
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315
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Crawford MJ, Jayakumar S, Lemmey SJ, Zalewska K, Patel MX, Cooper SJ, Shiers D. Assessment and treatment of physical health problems among people with schizophrenia: national cross-sectional study. Br J Psychiatry 2014; 205:473-7. [PMID: 25323141 DOI: 10.1192/bjp.bp.113.142521] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND In the UK and other high-income countries, life expectancy in people with schizophrenia is 20% lower than in the general population. AIMS To examine the quality of assessment and treatment of physical health problems in people with schizophrenia. Method Retrospective audit of records of people with schizophrenia or schizoaffective disorder aged ⩾18. We collected data on nine key aspects of physical health for 5091 patients and combined these with a cross-sectional patient survey. RESULTS Body mass index was recorded in 2599 (51.1%) patients during the previous 12 months and 1102 (21.6%) had evidence of assessment of all nine key measures. Among those with high blood sugar, there was recorded evidence of 53.5% receiving an appropriate intervention. Among those with dyslipidaemia, this was 19.9%. Despite this, most patients reported that they were satisfied with the physical healthcare they received. CONCLUSIONS Assessment and treatment of common physical health problems in people with schizophrenia falls well below acceptable standards. Cooperation and communication between primary and secondary care services needs to improve if premature mortality in this group is to be reduced.
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Affiliation(s)
- Mike J Crawford
- Mike J. Crawford, MD, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK and Centre for Mental Health, Imperial College London, UK; Simone Jayakumar, BSc, Suzie J. Lemmey, MSc, Krysia Zalewska, BSc, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK; Maxine X. Patel, BSc, MBBS, MSc, MD, FRCPsych, Institute of Psychiatry, King's College London, UK; Stephen J. Cooper, MD, David Shiers, MBChB, MRCGP, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Simone Jayakumar
- Mike J. Crawford, MD, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK and Centre for Mental Health, Imperial College London, UK; Simone Jayakumar, BSc, Suzie J. Lemmey, MSc, Krysia Zalewska, BSc, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK; Maxine X. Patel, BSc, MBBS, MSc, MD, FRCPsych, Institute of Psychiatry, King's College London, UK; Stephen J. Cooper, MD, David Shiers, MBChB, MRCGP, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Suzie J Lemmey
- Mike J. Crawford, MD, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK and Centre for Mental Health, Imperial College London, UK; Simone Jayakumar, BSc, Suzie J. Lemmey, MSc, Krysia Zalewska, BSc, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK; Maxine X. Patel, BSc, MBBS, MSc, MD, FRCPsych, Institute of Psychiatry, King's College London, UK; Stephen J. Cooper, MD, David Shiers, MBChB, MRCGP, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Krysia Zalewska
- Mike J. Crawford, MD, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK and Centre for Mental Health, Imperial College London, UK; Simone Jayakumar, BSc, Suzie J. Lemmey, MSc, Krysia Zalewska, BSc, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK; Maxine X. Patel, BSc, MBBS, MSc, MD, FRCPsych, Institute of Psychiatry, King's College London, UK; Stephen J. Cooper, MD, David Shiers, MBChB, MRCGP, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Maxine X Patel
- Mike J. Crawford, MD, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK and Centre for Mental Health, Imperial College London, UK; Simone Jayakumar, BSc, Suzie J. Lemmey, MSc, Krysia Zalewska, BSc, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK; Maxine X. Patel, BSc, MBBS, MSc, MD, FRCPsych, Institute of Psychiatry, King's College London, UK; Stephen J. Cooper, MD, David Shiers, MBChB, MRCGP, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - Stephen J Cooper
- Mike J. Crawford, MD, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK and Centre for Mental Health, Imperial College London, UK; Simone Jayakumar, BSc, Suzie J. Lemmey, MSc, Krysia Zalewska, BSc, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK; Maxine X. Patel, BSc, MBBS, MSc, MD, FRCPsych, Institute of Psychiatry, King's College London, UK; Stephen J. Cooper, MD, David Shiers, MBChB, MRCGP, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
| | - David Shiers
- Mike J. Crawford, MD, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK and Centre for Mental Health, Imperial College London, UK; Simone Jayakumar, BSc, Suzie J. Lemmey, MSc, Krysia Zalewska, BSc, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK; Maxine X. Patel, BSc, MBBS, MSc, MD, FRCPsych, Institute of Psychiatry, King's College London, UK; Stephen J. Cooper, MD, David Shiers, MBChB, MRCGP, Centre for Quality Improvement, Royal College of Psychiatrists, London, UK
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316
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Managing the side effects associated with commonly used treatments for bipolar depression. J Affect Disord 2014; 169 Suppl 1:S34-44. [PMID: 25533913 DOI: 10.1016/s0165-0327(14)70007-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/08/2014] [Accepted: 09/03/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND The most commonly used pharmacologic therapies for bipolar depression are mood stabilizers, atypical antipsychotics, and antidepressants. This paper reviews common side effects associated with these medications and provides recommendations for managing adverse medication effects in clinical practice. METHODS Narrative review based on literature searches of Medline and evidence-based treatment guidelines for agents that have been approved by the US Food and Drug Administration and/or are commonly used to treat bipolar depression. RESULTS Side effects of bipolar depression pharmacotherapies are common and vary by medication, with weight gain, metabolic dysregulation, sedation/somnolence, and akathisia among those observed most frequently. These adverse events (weight gain and sedation/somnolence, in particular) negatively affect treatment adherence in patients with bipolar disorder. Furthermore, endocrine and metabolic comorbidities, weight gain, and obesity may reduce the likelihood of positive clinical responses to pharmacologic therapies. Clinicians may consider switching patients to bipolar depression medication(s) with a lower propensity for sedation or adverse metabolic effects. Lifestyle modification (e.g., dietary changes, exercise) is an important component in the treatment of weight gain/obesity, dyslipidemia, hypertension, and hyperglycemia; in addition, a wide range of medications are available as therapeutic options for patients in whom non-pharmacologic management strategies are insufficient. The use of adjunctive medication may also reduce treatment-related sedation and somnolence. LIMITATIONS The selection of relevant studies from the literature search relied primarily on the author's expertise in the area of bipolar depression and knowledge of the issues addressed. CONCLUSION Successful treatment of bipolar depression extends beyond managing mood symptoms to also monitoring adverse medication events and managing associated medical disorders.
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317
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Shiers D, Curtis J. Cardiometabolic health in young people with psychosis. Lancet Psychiatry 2014; 1:492-4. [PMID: 26361295 DOI: 10.1016/s2215-0366(14)00072-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 10/08/2014] [Indexed: 11/19/2022]
Affiliation(s)
- David Shiers
- Stackstones, School Lane, Longsdon, Stoke-on-Trent, ST9 9QS, UK.
| | - Jackie Curtis
- The Bondi Centre, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia; School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
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318
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Looijmans A, Jörg F, Schoevers RA, Bruggeman R, Stolk RP, Corpeleijn E. Changing the obesogenic environment of severe mentally ill residential patients: ELIPS, a cluster randomised study design. BMC Psychiatry 2014; 14:293. [PMID: 25422085 PMCID: PMC4248468 DOI: 10.1186/s12888-014-0293-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 10/13/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Severe mentally ill (SMI) patients have a reduced life expectancy of 13-30 years compared to the general population, largely due to an increased risk of cardiovascular mortality. Unhealthy lifestyle behaviours in SMI patients contribute to this increased risk. The obesogenic living environment of patients in residential facilities may even pose an extra risk. Although several studies have shown positive effects of lifestyle interventions on SMI patients' weight status, studies including residential patients and their obesogenic environment are scarce. This paper describes the Effectiveness of Lifestyle Interventions in PSychiatry trial (ELIPS). The goal of this trial is to improve cardiometabolic health in severe mentally ill residential patients by addressing the obesogenic environment. METHODS/DESIGN The ELIPS study is a multi-site cluster randomised controlled trial (RCT) based on the principles of a pragmatic RCT. All residential and long-term clinical care teams of two large mental health care organisations in the North of the Netherlands serving SMI patients are invited to participate. The intervention is aimed at team level. Lifestyle coaches first develop a team specific lifestyle plan that tailors the ELIPS goals and protocol and then train teams on how to create a healthy environment and stimulate healthy behaviours in patients. After three months, teams take over the intervention after they have set out goals to achieve in the following nine months. In this phase, adherence to the lifestyle plan and pre-set goals is monitored. Patients in the control arm receive care as usual. Primary outcome measure is waist circumference at three and 12 months after baseline. DISCUSSION ELIPS is different from previously published lifestyle intervention studies in three ways. First, it follows the principles of a pragmatic design, which enables the examination of effects in everyday practice. Second, by implementing the intervention at team level, we expect lifestyle activities to be maintained when interventionists leave. Last, by targeting the obesogenic environment we create a prerequisite for any sustainable health improvement, as patients can only make healthy choices in a healthy living environment. TRIAL REGISTRATION Nederlands Trialregister NTR2720 (Dutch Trial Register, www.trialregister.nl). Registered 27 January 2011.
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Affiliation(s)
- Anne Looijmans
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, FA 40, PO box 30.001, 9700 RB Groningen, The Netherlands
| | - Frederike Jörg
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands ,Research Department, Friesland Mental Health Services, Leeuwarden, The Netherlands
| | - Robert A Schoevers
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ronald P Stolk
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, FA 40, PO box 30.001, 9700 RB Groningen, The Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, FA 40, PO box 30.001, 9700 RB Groningen, The Netherlands
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319
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Musil R, Obermeier M, Russ P, Hamerle M. Weight gain and antipsychotics: a drug safety review. Expert Opin Drug Saf 2014; 14:73-96. [PMID: 25400109 DOI: 10.1517/14740338.2015.974549] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Second-generation antipsychotics (SGAs) are widely used in several psychiatric disease entities and exert to a different extent a risk for antipsychotic-induced weight gain (AIWG). As AIWG is associated with an increase in metabolic syndrome or cardiovascular events, knowledge of these risks is crucial for further monitoring and the initiation of counteractive measures. AREAS COVERED We searched PubMed and Web of Sciences for randomized-controlled trials and naturalistic observational studies published between 2010 and 2014 with sample sizes exceeding 100, including all marketed SGAs apart from zotepine, and providing data on weight increase. We also summarized relevant systematic reviews and meta-analyses of head-to-head comparisons. EXPERT OPINION Recently published data still support the hierarchical ranking of SGAs already proposed in previous reviews ranking clozapine and olanzapine as having the highest risk, followed by amisulpride, asenapine, iloperidone, paliperidone, quetiapine, risperidone and sertindole in the middle, and aripiprazole, lurasidone and ziprasidone with the lowest risk. Number needed to harm varied considerably in our meta-analysis. Younger patients and patients with a lower baseline body mass index are most vulnerable. The greatest amount of weight gain occurs within the first weeks of treatment. AIWG occurs in all diagnostic groups and is also common in treatment with first-generation antipsychotics; therefore, awareness of this adverse event is essential for anyone prescribing antipsychotics.
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Affiliation(s)
- Richard Musil
- Ludwig-Maximilians-University Munich, Department of Psychiatry and Psychotherapy , Nussbaumstraße 7, 80336 Munich , Germany +1 0049 89 4400 55888 ; +1 0049 89 4400 55188 ;
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320
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Curtis J, Shiers D. Progress towards parity: improving the physical health of long-term psychiatric inpatients. Aust N Z J Psychiatry 2014; 48:1060-1. [PMID: 25128226 DOI: 10.1177/0004867414547056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jackie Curtis
- Early Psychosis Programme, The Bondi Centre, South Eastern Sydney Local Health District, Bondi Junction, Australia School of Psychiatry, University of New South Wales, Randwick, Australia
| | - David Shiers
- GP (retired), North Staffordshire; former joint lead to National Early Intervention in Psychosis Programme (2004-10), National Mental Health Development Unit, London, UK
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321
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A 12-week weight reduction intervention for overweight individuals taking antipsychotic medications. Community Ment Health J 2014; 50:974-80. [PMID: 24566560 DOI: 10.1007/s10597-014-9716-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 02/16/2014] [Indexed: 10/25/2022]
Abstract
People taking antipsychotic medications are at increased risk for obesity, diabetes, and early mortality. Few weight loss interventions have targeted this population. Thirty-six individuals were randomized to an evidence-based 12-week weight loss intervention (PREMIER with DASH diet, n = 18) or to usual care (n = 18) in this feasibility trial. Average attendance was 8.6 of 12 sessions. Intent-to-treat analyses of covariance, adjusted for baseline weight, showed significant changes in weight: Mean weight in intervention participants declined from 213.3 to 206.6 pounds, while control participants' weight was unchanged. It is possible to recruit, assess, intervene with, and retain participants taking antipsychotic medications in a dietary and exercise lifestyle change trial. Participants reported high levels of satisfaction with the intervention.
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322
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Lee H, Kane I, Brar J, Sereika S. Telephone-delivered physical activity intervention for individuals with serious mental illness: a feasibility study. J Am Psychiatr Nurses Assoc 2014; 20:389-97. [PMID: 25421781 DOI: 10.1177/1078390314561497] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Obesity is prevalent in individuals with serious mental illness (SMI). OBJECTIVE The purpose of this study is to examine the feasibility of a telephone-delivered physical activity (PA) intervention for outpatients with serious mental illness to maintain PA and to explore the preliminary efficacy of the intervention on health status. DESIGN This study used a randomized experimental design. The treatment group received pedometers and eight weekly phone calls; the control group received written information regarding PA. Descriptive statistics were used to analyze data collected at baseline and 8 weeks. RESULTS Twenty-two subjects with SMI (mean age = 44.09 ± 7.6 years; 54.5% were male) were recruited and 16 subjects completed the study in 8 weeks. PA (z = -2.37, p = .02) increased in the treatment group (n = 8) whereas the control group (n = 8) maintained baseline PA level (z = -1.61, p = .11). Health outcomes were not changed (ps > .05). CONCLUSION Telephone-delivered intervention is feasible and has the potential to improve PA in individuals with SMI.
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Affiliation(s)
- Heeyoung Lee
- Heeyoung Lee, PhD, PMHNP-BC, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Irene Kane
- Irene Kane, PhD, RN, CNAA, HFI, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Jaspreet Brar
- Jaspreet Brar, MD, PhD, MPH, Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute & Clinic, Pittsburgh, PA, USA
| | - Susan Sereika
- Susan Sereika, PhD, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
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323
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Shulman M, Miller A, Misher J, Tentler A. Managing cardiovascular disease risk in patients treated with antipsychotics: a multidisciplinary approach. J Multidiscip Healthc 2014; 7:489-501. [PMID: 25382979 PMCID: PMC4222620 DOI: 10.2147/jmdh.s49817] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background The use of antipsychotic medication in the United States and throughout the world has greatly increased over the last fifteen years. These drugs have significant side effect burdens, many of them relating to cardiovascular health. Objective To review the available evidence on the major cardiovascular issues that arise in patients taking antipsychotic medication. Method A PubMed literature review was performed to identify recent meta-analyses, review articles, and large studies. Further articles were identified through cited papers and based on expert consultation when necessary. Results Clinical guidance on the following adverse effects and antipsychotics was reviewed: electrocardiogram (ECG) changes, (specifically, prolonged QT and risk of torsades de pointes), weight gain, dyslipidemia, metabolic syndrome, and myocarditis. Specific attention was paid to monitoring guidelines and treatment options in the event of adverse events, including dose change, medication switch, or adjuvant therapy.
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Affiliation(s)
- Matisyahu Shulman
- Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Avraham Miller
- The Ruth and Bruce Rappaport Faculty of Medicine, The Technion Israel Institute of Technology, Haifa, Israel
| | - Jason Misher
- Department of Medicine, Hofstra North Shore-LIJ School of Medicine, Hempstead, NY, USA
| | - Aleksey Tentler
- Department of Internal Medicine, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
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324
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A randomized, double-blind, placebo-controlled pilot study of naltrexone to counteract antipsychotic-associated weight gain: proof of concept. J Clin Psychopharmacol 2014; 34:608-12. [PMID: 25102328 PMCID: PMC4149840 DOI: 10.1097/jcp.0000000000000192] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Patients with schizophrenia experience higher rates of obesity as well as related morbidity and mortality than the general population does. Women with schizophrenia are at particular risk for antipsychotic-associated weight gain, obesity, and related medical disorders such as diabetes and cardiovascular disease. Given preclinical studies revealing the role of the endogenous opioid systems in human appetite and the potential of antipsychotic medications to interfere with this system, we hypothesized that opioid antagonists may be beneficial in arresting antipsychotic-associated weight gain and promoting further weight loss in women with schizophrenia. In the present study, 24 overweight women with a diagnosis of schizophrenia or schizoaffective disorder were randomized to placebo or naltrexone (NTX) 25 mg/d for 8 weeks. The primary outcome measure was a change in body weight from baseline. The patients in the NTX group had significant weight loss (-3.40 kg) compared with weight gain (+1.37 kg) in the patients in the placebo group. Mainly, nondiabetic subjects lost weight in the NTX arm. These data support the need to further investigate the role of D2 blockade in reducing food reward-based overeating. A larger study addressing the weaknesses of this pilot study is currently underway.
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325
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Krill RA, Kumra S. Metabolic consequences of second-generation antipsychotics in youth: appropriate monitoring and clinical management. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2014; 5:171-82. [PMID: 25298741 PMCID: PMC4186493 DOI: 10.2147/ahmt.s49807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective To review the metabolic consequences of second-generation antipsychotics in youth and current monitoring and intervention guidelines for optimal treatment. Background Second-generation antipsychotics have largely replaced the use of first-generation antipsychotics in treating psychotic disorders in youth. In addition, there has been a dramatic increase in using these medications to treat a variety of nonpsychotic disorders. These medications have significant metabolic side effects, including weight gain. This raises concern, given the problem of pediatric obesity. Materials and methods A review of current literature looking at prescribing practices and possible reasons for the increased use of second-generation antipsychotics in children and adolescents was conducted. Review of the mechanisms for why youth may be particularly vulnerable to the metabolic consequences (particularly weight gain) was similarly completed. In addition, data supporting the efficacy, rationale, and unique side-effect profile of each individual second-generation drug were evaluated to help inform providers on when and what to prescribe, along with current monitoring practices. The current evidence base for possible interventions regarding the management of antipsychotic-induced weight gain was also evaluated. Results and conclusion On the basis of the literature review, there are several speculated reasons for the increase in prescriptions of second-generation antipsychotics. The choice of antipsychotic for youth should be based upon the disorder being treated along with the unique side-effect profile for the most commonly used second-generation antipsychotics. Monitoring strategies are also individualized to each antipsychotic. The current interventions recommended for antipsychotic-induced weight gain include lifestyle management, switching medication to a drug with a lower propensity for weight gain, and pharmacologic (particularly metformin) treatment.
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Affiliation(s)
- Rebecca A Krill
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Sanjiv Kumra
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
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326
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McKenna B, Furness T, Wallace E, Happell B, Stanton R, Platania-Phung C, Edward KL, Castle D. The effectiveness of specialist roles in mental health metabolic monitoring: a retrospective cross-sectional comparison study. BMC Psychiatry 2014; 14:234. [PMID: 25196125 PMCID: PMC4156616 DOI: 10.1186/s12888-014-0234-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 08/07/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with serious mental illness (SMI) exhibit a high prevalence of cardiovascular diseases. Mental health services have a responsibility to address poor physical health in their consumers. One way of doing this is to conduct metabolic monitoring (MM) of risk factors for cardiovascular diseases. This study compares two models of MM among consumers with SMI and describes referral pathways for those at high risk of cardiovascular diseases. METHODS A retrospective cross-sectional comparison design was used. The two models were: (1) MM integrated with case managers, and (2) MM integrated with case managers and specialist roles. Retrospective data were collected for all new episodes at two community mental health services (CMHS) over a 12-month period (September 2012 - August 2013). RESULTS A total of 432 consumers with SMI across the two community mental health services were included in the analysis. At the service with the specialist roles, MM was undertaken for 78% of all new episode consumers, compared with 3% at the mental health service with case managers undertaking the role. Incomplete MM was systemic to both CMHS, although all consumers identified with high risk of cardiovascular diseases were referred to a general practitioner or other community based health services. The specialist roles enabled more varied referral options. CONCLUSIONS The results of this study support incorporating specialist roles over case manager only roles for more effective MM among new episode consumers with SMI.
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Affiliation(s)
- Brian McKenna
- NorthWestern Mental Health, The Royal Melbourne Hospital, Level 1 North, City Campus, Grattan Street, Parkville, Victoria 3050 Australia ,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 115 Victoria Parade, Fitzroy, Victoria 3065 Australia
| | - Trentham Furness
- NorthWestern Mental Health, The Royal Melbourne Hospital, Level 1 North, City Campus, Grattan Street, Parkville, Victoria 3050 Australia ,School of Nursing, Midwifery and Paramedicine, Australian Catholic University, 115 Victoria Parade, Fitzroy, Victoria 3065 Australia
| | - Elizabeth Wallace
- NorthWestern Mental Health, The Royal Melbourne Hospital, Level 1 North, City Campus, Grattan Street, Parkville, Victoria 3050 Australia
| | - Brenda Happell
- Institute for Health and Social Science Research Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, CQUniversity, Bruce Highway, Rockhampton, Queensland 4702 Australia
| | - Robert Stanton
- Institute for Health and Social Science Research Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, CQUniversity, Bruce Highway, Rockhampton, Queensland 4702 Australia
| | - Chris Platania-Phung
- Institute for Health and Social Science Research Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, CQUniversity, Bruce Highway, Rockhampton, Queensland 4702 Australia
| | - Karen-leigh Edward
- St. Vincent’s Private Hospital Melbourne Nursing Research Unit, St. Vincent’s Private Hospital Melbourne, 59-61 Victoria Parade, Fitzroy, Victoria 3065 Australia ,Faculty of Health Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, Victoria 3065 Australia
| | - David Castle
- Faculty of Health Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, Victoria 3065 Australia ,St. Vincent’s Hospital Mental Health, St. Vincent’s Private Hospital Melbourne, 59-61 Victoria Parade, Fitzroy, Victoria 3065 Australia ,Department of Psychiatry, University of Melbourne, Grattan Street, Parkville, Victoria 3050 Australia
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327
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Abstract
This review provides clinicians and individuals with bipolar disorder (BD) with an overview of evidence-based skills shown to be effective in BD and amenable to self-management including psychoeducation; monitoring moods, medications, and social function; sleep hygiene; setting goals and relapse plans; and healthy lifestyles (physical activity, healthy eating, weight loss and management, medical comorbidities). Currently available self-management resources for BD are summarized by mode of delivery (workbooks, mobile technologies, internet, and peer-led interventions). Regardless of the self-management intervention/topic, the research suggests that personally tailored interventions of longer duration and greater frequency may be necessary to achieve the maximal benefit among individuals with BD. Means to support these self-management interventions as self-sustaining identities are critically needed. Hopefully, the recent investment in patient-centered research and care will result in best practices for the self-management of BD by mode of delivery. Since self-management of BD should complement rather than replace medical care, clinicians need to partner with their patients to incorporate and support advances in self-management for individuals with BD.
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328
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Hjorth P, Davidsen AS, Kilian R, Pilgaard Eriksen S, Jensen SOW, Sørensen HØ, Munk-Jørgensen P. Improving the physical health of long-term psychiatric inpatients. Aust N Z J Psychiatry 2014; 48:861-70. [PMID: 24810873 DOI: 10.1177/0004867414533011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients with psychiatric illness have increased somatic morbidity and increased mortality. Knowledge of how to integrate the prevention and care of somatic illness into the treatment of psychiatric patients is required. The aims of this study were to investigate whether an intervention programme to improve physical health is effective. METHODS An extension of the European Network for Promoting the Health of Residents in Psychiatric and Social Care Institutions (HELPS) project further developed as a 12-month controlled cluster-randomized intervention study in the Danish centre. Waist circumference was a proxy of unhealthy body fat in view of the increased risk of cardiovascular diseases and type 2 diabetes. RESULTS Waist circumference was 108 cm for men and 108 cm for women. Controlled for cluster randomization, sex, age, and body fat, the intervention group showed a small, but not significant, reduction in waist circumference, while participants in the control group showed a significant increase in waist circumference. CONCLUSIONS The intervention had a positive effect on the physical health of the patients measured by a reduction in the increase of waist circumference.
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Affiliation(s)
- Peter Hjorth
- Aarhus University Hospital, Aalborg Psychiatric Hospital, Aalborg, Denmark
| | | | - Reinhold Kilian
- Ulm University, klinik für Psychiatrie und Psychotherapie, Günzburg, Germany
| | | | - Signe O W Jensen
- Aarhus University Hospital, Aalborg Psychiatric Hospital, Aalborg, Denmark
| | - Helle Ø Sørensen
- Aarhus University Hospital, Aalborg Psychiatric Hospital, Aalborg, Denmark
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329
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Abstract
This scoping review aims to explore the contributions of rehabilitation interventions and programs to the management of obesity. Studies and review papers describing weight management for patients in rehabilitation programs were identified. Rehabilitation populations for which weight loss interventions were reported included spinal cord injury, osteoarthritis, cardiac, and psychiatric. Evidence exists to support the promotion of weight loss in patients with obesity receiving rehabilitation services. Outcomes associated with weight loss in obese rehabilitation patients include reduced pain, improved mobility, improved performance of activities of daily living, increased self-efficacy for stair climbing and walking and, increased participation in leisure activities. Despite the prevalence of obesity among groups of patients with physical and psychiatric disabilities and the evidence to support weight loss as beneficial to improve function more research is needed to determine the best way in which to provide weight loss interventions to groups of patients with neurological, musculoskeletal, and psychiatric disabilities. Research is needed to gain knowledge about discipline specific interventions and their impact on obesity management in rehabilitation populations.
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Affiliation(s)
- Mary Forhan
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-64 Corbett Hall, Edmonton, AB, Canada, T6G 2G4.
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330
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Assies J, Mocking RJT, Lok A, Ruhé HG, Pouwer F, Schene AH. Effects of oxidative stress on fatty acid- and one-carbon-metabolism in psychiatric and cardiovascular disease comorbidity. Acta Psychiatr Scand 2014; 130:163-80. [PMID: 24649967 PMCID: PMC4171779 DOI: 10.1111/acps.12265] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Cardiovascular disease (CVD) is the leading cause of death in severe psychiatric disorders (depression, schizophrenia). Here, we provide evidence of how the effects of oxidative stress on fatty acid (FA) and one-carbon (1-C) cycle metabolism, which may initially represent adaptive responses, might underlie comorbidity between CVD and psychiatric disorders. METHOD We conducted a literature search and integrated data in a narrative review. RESULTS Oxidative stress, mainly generated in mitochondria, is implicated in both psychiatric and cardiovascular pathophysiology. Oxidative stress affects the intrinsically linked FA and 1-C cycle metabolism: FAs decrease in chain length and unsaturation (particularly omega-3 polyunsaturated FAs), and lipid peroxidation products increase; the 1-C cycle shifts from the methylation to transsulfuration pathway (lower folate and higher homocysteine and antioxidant glutathione). Interestingly, corresponding alterations were reported in psychiatric disorders and CVD. Potential mechanisms through which FA and 1-C cycle metabolism may be involved in brain (neurocognition, mood regulation) and cardiovascular system functioning (inflammation, thrombosis) include membrane peroxidizability and fluidity, eicosanoid synthesis, neuroprotection and epigenetics. CONCLUSION While oxidative-stress-induced alterations in FA and 1-C metabolism may initially enhance oxidative stress resistance, persisting chronically, they may cause damage possibly underlying (co-occurrence of) psychiatric disorders and CVD. This might have implications for research into diagnosis and (preventive) treatment of (CVD in) psychiatric patients.
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Affiliation(s)
- J Assies
- Program for Mood Disorders, Department of Psychiatry, Academic Medical Center, Amsterdam
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331
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Viron M, Zioto K, Schweitzer J, Levine G. Behavioral Health Homes: an opportunity to address healthcare inequities in people with serious mental illness. Asian J Psychiatr 2014; 10:10-6. [PMID: 25042945 DOI: 10.1016/j.ajp.2014.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Revised: 02/14/2014] [Accepted: 03/05/2014] [Indexed: 11/28/2022]
Abstract
People with serious mental illness (SMI) face striking reductions in lifespan versus the general population, in part due to the inadequacy of healthcare systems in meeting the substantial physical health needs of this group. Integrated care, the strategic combination and coordination of behavioral health and primary care services, has been proposed as a potential healthcare service delivery solution to address these care gaps. Inspired by the primary care Patient-Centered Medical Home concept, Behavioral Health Homes bring primary care services into the community mental health center in various ways. In this paper the authors review the literature describing Behavioral Health Home interventions and highlight an integration project that provides co-located and coordinated primary care and wellness services in a community mental health center. Such approaches hold great promise for improving the health and healthcare of people with SMI.
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Affiliation(s)
- Mark Viron
- Massachusetts Mental Health Center, Boston, MA, USA; Beth Israel Deaconess Medical Center, Department of Psychiatry, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Kathryn Zioto
- Harvard Medical School, Boston, MA, USA; Harvard Longwood Psychiatry Residency Training Program, Boston, MA, USA
| | - Jason Schweitzer
- Harvard Medical School, Boston, MA, USA; Harvard Longwood Psychiatry Residency Training Program, Boston, MA, USA
| | - Gail Levine
- Massachusetts Mental Health Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Brigham and Women's Hospital, Boston, MA, USA
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332
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Kilbourne AM, Bramlet M, Barbaresso MM, Nord KM, Goodrich DE, Lai Z, Post EP, Almirall D, Verchinina L, Duffy SA, Bauer MS. SMI life goals: description of a randomized trial of a collaborative care model to improve outcomes for persons with serious mental illness. Contemp Clin Trials 2014; 39:74-85. [PMID: 25083802 DOI: 10.1016/j.cct.2014.07.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/19/2014] [Accepted: 07/21/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Persons with serious mental illnesses (SMI) are more likely to die earlier than the general population, primarily due to increased medical burden, particularly from cardiovascular disease (CVD). Life Goals Collaborative Care (LG-CC) is designed to improve health outcomes in SMI through self-management, care management, and provider support. This single-blind randomized controlled effectiveness study will determine whether patients with SMI receiving LG-CC compared to usual care (UC) experience improved physical health in 12 months. METHODS Patients diagnosed with SMI and at least one CVD risk factor receiving care at a VA mental health clinic were randomized to LG-CC or UC. LG-CC included five self-management sessions covering mental health symptom management reinforced through health behavior change, care coordination and health monitoring via a registry, and provider feedback. The primary outcome is change in physical health-related quality of life score (VR-12) from baseline to 12 months. Secondary outcomes include changes in mental health-related quality of life, CVD risk factors (blood pressure, BMI), and physical activity from baseline to 12 months later. RESULTS Out of 304 enrolled, 139 were randomized to LG-CC and 145 to UC. Among patients completing baseline assessments (N = 284); the mean age was 55.2 (SD = 10.9; range 28-75 years), 15.6% were women, the majority (62%) were diagnosed with depression, and the majority (63%) were diagnosed with hypertension or were overweight (BMI mean ± SD = 33.3 ± 6.3). Baseline VR-12 physical health component score was below population norms (50.0 ± SD = 10) at 33.4 ± 11.0. CONCLUSIONS Findings from this trial may inform initiatives to improve physical health for SMI patient populations.
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Affiliation(s)
- Amy M Kilbourne
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA; Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109-2800, USA.
| | - Margretta Bramlet
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA.
| | - Michelle M Barbaresso
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA.
| | - Kristina M Nord
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA; Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109-2800, USA.
| | - David E Goodrich
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA; Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109-2800, USA.
| | - Zongshan Lai
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA; Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI 48109-2800, USA.
| | - Edward P Post
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA; Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Daniel Almirall
- Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI 48104-2321, USA.
| | - Lilia Verchinina
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA.
| | - Sonia A Duffy
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI 48105, USA; University of Michigan School of Nursing, Division of Health Promotion and Risk Reduction, 400 N Ingalls Bldg, Rm 3178, Ann Arbor, MI 48109-5482, USA.
| | - Mark S Bauer
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System 152M, 150 South Huntington Avenue, Boston, MA 02130, USA; Department of Psychiatry, Harvard Medical School, 2 West, Room 305, 401 Park Drive, Boston, MA 02215, USA.
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333
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Krogh J, Speyer H, Nørgaard HCB, Moltke A, Nordentoft M. Can exercise increase fitness and reduce weight in patients with schizophrenia and depression? Front Psychiatry 2014; 5:89. [PMID: 25120495 PMCID: PMC4112783 DOI: 10.3389/fpsyt.2014.00089] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 07/10/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Psychiatric patients have a reduced life expectancy of 15-20 years compared with the general population. Most years of lost life are due to the excess mortality from somatic diseases. Sedentary lifestyle and medication is partly responsible for the high frequency of metabolic syndrome in this patient group and low levels of physical activity is associated with increased risk of cardiovascular disease, diabetes, and all-cause mortality. This study aimed to review trials allocating patients with either schizophrenia or depression to exercise interventions for effect on cardiovascular fitness, strength, and weight. METHODS We searched PubMed, Embase, and PsycINFO including randomized clinical trial allocating patients with either schizophrenia or depression to isolated exercise interventions. RESULTS We identified five trials including patients with schizophrenia (n = 94) and found little evidence that exercise could increase cardiovascular fitness or decrease weight. Nine exercise trials for patients with depression (n = 892) were identified increasing cardiovascular fitness by 11-30% and strength by 33-37%. No evidence in favor of exercise for weight reduction was found. CONCLUSION Based on the current evidence isolated exercise interventions are unlikely to improve cardiovascular fitness or induce weight loss in patients with schizophrenia. In patients with depression, exercise interventions are likely to induce clinically relevant short term effects, however, due to lack of reporting, little is known about the effect on weight reduction and cardiovascular fitness. Future exercise trials regarding patients with mental illness should preferably measure changes in cardiovascular strength, repetition maximum, and anthropometric outcomes. Ideally, participants should be assessed beyond the intervention to identify long lasting effects.
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Affiliation(s)
- Jesper Krogh
- Mental Health Centre Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Endocrinology, Herlev University Hospital, Copenhagen, Denmark
| | - Helene Speyer
- Mental Health Centre Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Ane Moltke
- Mental Health Centre Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Research Center for Health Promotion, University of Roskilde, Roskilde, Denmark
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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334
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Morgan VA, McGrath JJ, Jablensky A, Badcock JC, Waterreus A, Bush R, Carr V, Castle D, Cohen M, Galletly C, Harvey C, Hocking B, McGorry P, Neil AL, Saw S, Shah S, Stain HJ, Mackinnon A. Psychosis prevalence and physical, metabolic and cognitive co-morbidity: data from the second Australian national survey of psychosis. Psychol Med 2014; 44:2163-76. [PMID: 24365456 PMCID: PMC4045165 DOI: 10.1017/s0033291713002973] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 11/05/2013] [Accepted: 11/09/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND There are insufficient data from nationwide surveys on the prevalence of specific psychotic disorders and associated co-morbidities. METHOD The 2010 Australian national psychosis survey used a two-phase design to draw a representative sample of adults aged 18-64 years with psychotic disorders in contact with public treatment services from an estimated resident population of 1 464 923 adults. This paper is based on data from 1642 participants with an International Classification of Diseases (ICD)-10 psychotic disorder. Its aim is to present estimates of treated prevalence and lifetime morbid risk of psychosis, and to describe the cognitive, physical health and substance use profiles of participants. RESULTS The 1-month treated prevalence of psychotic disorders was 3.10 cases per 1000 population aged 18-64 years, not accounting for people solely accessing primary care services; lifetime morbid risk was 3.45 per 1000. Mean premorbid intelligence quotient was approximately 0.5 s.d.s below the population mean; current cognitive ability (measured with a digit symbol coding task) was 1.6 s.d.s below the population mean. For both cognitive tests, higher scores were significantly associated with better independent functioning. The prevalence of the metabolic syndrome was high, affecting 60.8% of participants, and pervasive across diagnostic groups. Of the participants, two-thirds (65.9%) were current smokers, 47.4% were obese and 32.4% were sedentary. Of the participants, half (49.8%) had a lifetime history of alcohol abuse/dependence and 50.8% lifetime cannabis abuse/dependence. CONCLUSIONS Our findings highlight the need for comprehensive, integrative models of recovery to maximize the potential for good health and quality of life for people with psychotic illness.
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Affiliation(s)
- V. A. Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
| | - J. J. McGrath
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
- Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - A. Jablensky
- Centre for Clinical Research in Neuropsychiatry, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
| | - J. C. Badcock
- School of Psychology, The University of Western Australia, Crawley, Western Australia
- Clinical Research Centre, North Metropolitan Health Service-Mental Health, Mount Claremont, WA, Australia
| | - A. Waterreus
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
| | - R. Bush
- School of Population Health, The University of Queensland, Ipswich, QLD, Australia
| | - V. Carr
- School of Psychiatry, The University of New South Wales, Sydney, NSW, Australia
- Schizophrenia Research Institute, Sydney, NSW, Australia
| | - D. Castle
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
- St Vincent's Hospital, Melbourne, VIC, Australia
| | - M. Cohen
- Hunter New England Mental Health, Newcastle, NSW, Australia
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - C. Galletly
- School of Medicine, University of Adelaide, Adelaide, SA, Australia
- Ramsay Health Care (SA) Mental Health Services, Adelaide, SA, Australia
- Northern Sector, Adelaide Metro Mental Health Directorate, Adelaide, SA, Australia
| | - C. Harvey
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
- Psychosocial Research Centre, North West Area Mental Health Services, Coburg, VIC, Australia
| | - B. Hocking
- SANE Australia, Melbourne, VIC, Australia
| | - P. McGorry
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
- Orygen Youth Health Research Centre, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - A. L. Neil
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
| | - S. Saw
- Australian Government Department of Health and Ageing, Canberra, ACT, Australia
| | - S. Shah
- Neuropsychiatric Epidemiology Research Unit, School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia
| | - H. J. Stain
- Centre for Rural and Remote Mental Health, University of Newcastle, Newcastle, NSW, Australia
- School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| | - A. Mackinnon
- Orygen Youth Health Research Centre, Melbourne, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
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335
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Blanchard E, Samaras K. Double jeopardy: diabetes and severe mental illness. Addressing the special needs of this vulnerable group. ACTA ACUST UNITED AC 2014. [DOI: 10.2217/dmt.14.24] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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336
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Davis MC, Fuller MA, Strauss ME, Konicki PE, Jaskiw GE. Discontinuation of clozapine: a 15-year naturalistic retrospective study of 320 patients. Acta Psychiatr Scand 2014; 130:30-9. [PMID: 24299466 DOI: 10.1111/acps.12233] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Clozapine is underutilized in the management of treatment-resistant schizophrenia. To understand contributing factors, we analyzed the frequency and causes of clozapine discontinuations that occurred over a 15-year period in a clinical setting. METHOD Data were extracted from computerized records and from mandatory termination reports for discontinuation events 1993-2007. The reasons for termination were analyzed. RESULTS Over half of the patients (n = 183/320; 57%) had at least one discontinuation (median time 609 days). The two most common causes for discontinuation were non-adherence (35%) and side-effects (28%). Hematological side-effects accounted for 45% of all side-effect associated discontinuations; most such patients remained eligible for clozapine treatment, and a significant fraction remained on clozapine after rechallenge. Central nervous system side-effects accounted for 35% of side-effect induced discontinuations. General factors significantly associated with discontinuation were African American race, older age at initiation of clozapine and less improvement in psychiatric symptoms. CONCLUSION In addition to anticipating and addressing causes of non-adherence, psychiatrists should consider clozapine rechallenge in eligible patients and implement measures to mitigate clozapine-associated sedation, seizures, and other side-effects. Future studies should particularly address why African American and older patients may be more likely to discontinue clozapine.
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Affiliation(s)
- M C Davis
- VA VISN-22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, 90073, USA
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337
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Foley DL, Mackinnon A, Morgan VA, Watts GF, McGrath JJ, Castle DJ, Waterreus A, Galletly CA. Predictors of type 2 diabetes in a nationally representative sample of adults with psychosis. World Psychiatry 2014; 13:176-83. [PMID: 24890070 PMCID: PMC4102290 DOI: 10.1002/wps.20130] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Antipsychotic drugs such as clozapine and olanzapine are associated with an increased risk for type 2 diabetes, but relatively little is known about the relationship between risk factors for type 2 diabetes established in the general population and type 2 diabetes in people with psychosis. We estimated the prevalence of established risk factors and their association with type 2 diabetes in a nationally representative sample of people with an ICD-10 psychosis (N=1642) who gave a fasting blood sample (N=1155). Logistic regression was used to summarize associations adjusted for age and sex. In this sample, whose mean duration of psychosis was 14.7 years, 12.1% (13.1% of women and 11.5% of men) had type 2 diabetes at age 18-64 years based on current fasting blood glucose levels or treatment with a hypoglycaemic drug. Risk was greatly increased in young adults compared with the general population and peaked in middle age. Risk factors in the general population were common in people with psychosis and strongly associated with type 2 diabetes in those people. Treatment with clozapine was associated with an increased risk and treatment with olanzapine with a decreased risk for type 2 diabetes. The development of diabetes or pre-diabetes may therefore influence the likelihood of treatment with olanzapine over time. The strongest predictors of type 2 diabetes in a multivariate model were a body mass index of at least 40 and treated hypercholesterolemia, followed by a body mass index between 35 and 39.9, a family history of diabetes and treated hypertension. There was minimal to no confounding of the association between type 2 diabetes and current clozapine or olanzapine treatment, but neither association remained significant after adjustment for other predictors. Longitudinal relationships among predictors are likely to be complex, and previous antipsychotic drug treatment may at least partly explain risks associated with severe obesity, dyslipidemia and hypertension. A focus on weight loss is warranted in people with psychosis, but prevention strategies for type 2 diabetes should be broadened to include those with emerging dyslipidemia, hypertension and a family history of diabetes.
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Affiliation(s)
- Debra L Foley
- Orygen Youth Health Research Centre and Centre for Youth Mental Health, University of Melbourne35 Poplar Road, Parkville, VIC, 3052, Australia
| | - Andrew Mackinnon
- Orygen Youth Health Research Centre and Centre for Youth Mental Health, University of Melbourne35 Poplar Road, Parkville, VIC, 3052, Australia
| | - Vera A Morgan
- School of Psychiatry and Clinical Neurosciences, University of Western AustraliaCrawley, WA, Australia
| | - Gerald F Watts
- Lipid Disorders Clinic, Metabolic Research Centre and Department of Internal Medicine, Royal Perth Hospital and School of Medicine and Pharmacology, University of Western AustraliaCrawley, WA, Australia
| | - John J McGrath
- Queensland Brain Institute, University of Queensland and Queensland Centre for Mental Health Research, Park Centre for Mental HealthSt. Lucia, QLD, Australia
| | - David J Castle
- St Vincent's Hospital, Melbourne and Department of Psychiatry, University of MelbourneVIC, Australia
| | - Anna Waterreus
- School of Psychiatry and Clinical Neurosciences, University of Western AustraliaCrawley, WA, Australia
| | - Cherrie A Galletly
- Discipline of Psychiatry, School of Medicine, University of Adelaide and Ramsay Health Care, Mental Health Services and Northern Adelaide Local Health NetworkAdelaide, SA, Australia
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338
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Affiliation(s)
- Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington School of MedicineSeattle, WA, USA
| | - Cenk Tek
- Department of Psychiatry, Yale University School of MedicineNew Haven, CT, USA
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339
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Leutwyler H, Hubbard EM, Dowling GA. Adherence to a Videogame-Based Physical Activity Program for Older Adults with Schizophrenia. Games Health J 2014; 3:227-33. [PMID: 26192371 DOI: 10.1089/g4h.2014.0006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Adults with schizophrenia are a growing segment of the older adult population. Evidence suggests that they engage in limited physical activity. Interventions are needed that are tailored around their unique limitations. An active videogame-based physical activity program that can be offered at a treatment facility can overcome these barriers and increase motivation to engage in physical activity. The purpose of this report is to describe the adherence to a videogame-based physical activity program using the Kinect(®) for Xbox(®) 360 game system (Microsoft(®), Redmond, WA) in older adults with schizophrenia. MATERIALS AND METHODS This was a descriptive longitudinal study among 34 older adults with schizophrenia to establish the adherence to an active videogame-based physical activity program. In our ongoing program, once a week for 6 weeks, participants played an active videogame, using the Kinect for Xbox 360 game system, for 30 minutes. Adherence was measured with a count of sessions attended and with the total minutes attended out of the possible total minutes of attendance (180 minutes). RESULTS Thirty-four adults with schizophrenia enrolled in the study. The mean number of groups attended was five out of six total (standard deviation=2), and the mean total minutes attended were 139 out of 180 possible (standard deviation=55). Fifty percent had perfect attendance. CONCLUSIONS Older adults with schizophrenia need effective physical activity programs. Adherence to our program suggests that videogames that use the Kinect for Xbox 360 game system are an innovative way to make physical activity accessible to this population.
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Affiliation(s)
- Heather Leutwyler
- Department of Physiological Nursing, University of California , San Francisco, San Francisco, California
| | - Erin M Hubbard
- Department of Physiological Nursing, University of California , San Francisco, San Francisco, California
| | - Glenna A Dowling
- Department of Physiological Nursing, University of California , San Francisco, San Francisco, California
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Larsen JR, Vedtofte L, Holst JJ, Oturai P, Kjær A, Corell CU, Vilsbøll T, Fink-Jensen A. Does a GLP-1 receptor agonist change glucose tolerance in patients treated with antipsychotic medications? Design of a randomised, double-blinded, placebo-controlled clinical trial. BMJ Open 2014; 4:e004227. [PMID: 24667381 PMCID: PMC3975765 DOI: 10.1136/bmjopen-2013-004227] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Metabolic disturbances, obesity and life-shortening cardiovascular morbidity are major clinical problems among patients with antipsychotic treatment. Especially two of the most efficacious antipsychotics, clozapine and olanzapine, cause weight gain and metabolic disturbances. Additionally, patients with schizophrenia-spectrum disorders not infrequently consume alcohol. Glucagon-like peptide-1 (GLP-1) has shown to improve glycaemic control and reduce alcohol intake among patients with type 2 diabetes. OBJECTIVES To investigate whether the beneficial effects of GLP-1 analogues on glycaemic control and alcohol intake, in patients with type 2 diabetes, can be extended to a population of pre-diabetic psychiatric patients receiving antipsychotic treatment. METHODS AND ANALYSIS Trial design, intervention and participants: The study is a 16-week, double-blinded, randomised, parallel-group, placebo-controlled clinical trial, designed to evaluate the effects of the GLP-1 analogue liraglutide on glycaemic control and alcohol intake compared to placebo in patients who are prediabetic, overweight (body mass index ≥27 kg/m(2)), diagnosed with a schizophrenia-spectrum disorder and on stable treatment with either clozapine or olanzapine. OUTCOMES The primary endpoint is the change in glucose tolerance from baseline (measured by area under the curve for the plasma glucose excursion following a 4 h 75 g oral glucose tolerance test) to follow-up at week 16. The secondary endpoints include changes of dysglycaemia, body weight, waist circumference, blood pressure, secretion of incretin hormones, insulin sensitivity and β cell function, dual-energy X-ray absorption scan (body composition), lipid profile, liver function and measures of quality of life, daily functioning, severity of the psychiatric disease and alcohol consumption from baseline to follow-up at week 16. Status: Currently recruiting patients. ETHICS AND DISSEMINATION Ethical approval has been obtained. Before screening, all patients will be provided oral and written information about the trial. The study will be disseminated by peer-review publications and conference presentations. TRIAL REGISTRATION NUMBER ClinicalTrials.gov: NCT01845259, EudraCT: 2013-000121-31.
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Affiliation(s)
- Julie Rask Larsen
- Psychiatric Centre Copenhagen and Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
| | - Louise Vedtofte
- Diabetes Research Division, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
| | - Jens Juul Holst
- Department of Medical Physiology, The Panum Institute, University of Copenhagen, Copenhagen, Denmark
| | - Peter Oturai
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Christoph U Corell
- Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, New York, USA
| | - Tina Vilsbøll
- Diabetes Research Division, Copenhagen University Hospital Gentofte, Copenhagen, Denmark
| | - Anders Fink-Jensen
- Psychiatric Centre Copenhagen and Department of Neuroscience and Pharmacology, University of Copenhagen, Copenhagen, Denmark
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341
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Graves KD, Hay JL, O'Neill SC. The promise of using personalized genomic information to promote behavior change: is the debate over, or just beginning? Per Med 2014; 11:173-185. [PMID: 29751381 DOI: 10.2217/pme.13.110] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Over recent years, significant debate has centered on whether and how communication of personalized genomic risk information can positively influence health behavior change. Several thoughtful commentaries have cautioned that efforts to incorporate genomic risk feedback to motivate health behavior change have had little success. As a field, we should consider the reasons for this limited success and be strategic in the next steps for this line of research. In this article, we consider several reasons that prior research that integrates personalized genomic information has had relative degrees of success in changing or maintaining health behaviors. We suggest ways forward and outline the possibilities presented by emerging technologies and novel approaches in translational genomic research.
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Affiliation(s)
- Kristi D Graves
- Department of Oncology, Jess & Mildred Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Jennifer L Hay
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Suzanne C O'Neill
- Department of Oncology, Jess & Mildred Fisher Center for Familial Cancer Research, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
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342
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Abstract
Fifty years have elapsed since the passage of the Community Mental Health Centers (CMHC) Act in 1963 that reflected the legislative peak of the community mental healthcare movement in the US Progress of the last 10 years is represented both by expansions of evidence-based practices (EBPs) and the development of emerging practices and fundamental shifts in the orientation of the system stimulated by the consumer-driven recovery movement. Established EBPs have accumulated expanded evidence, new EBPs have been developed and emerging EBPs are gaining increased acceptance. While the lack of widespread implementation of EBPs as well as the limitations of these technologies produces unnecessary suffering and disability, we believe that the growth of evidence for treatments and services justifies optimism for the future.
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343
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Rose LE, Sawyer AL, Everett A. Cardiovascular health literacy and treatment adherence in persons with serious mental illness. Issues Ment Health Nurs 2014; 35:88-99. [PMID: 24502466 DOI: 10.3109/01612840.2013.843622] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Persons with serious mental illnesses have shorter life spans than the general population, and their earlier death is often related to cardiovascular disease. This study examined health literacy and cardiovascular medication adherence in a sample of 98 participants with serious mental illness. Sixty-two percent of the participants had adequate health literacy as measured by the Test of Functional Health Literacy in Adults. The association between health literacy and medication adherence was not significant after controlling for education. There was a significant association between health literacy and education level, health literacy and site, and health literacy and the sodium intake subscale of the Hill-Bone adherence scale.
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Affiliation(s)
- Linda E Rose
- Johns Hopkins University, School of Nursing , Baltimore, Maryland , USA
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344
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Colom F. The evolution of psychoeducation for bipolar disorder: from lithium clinics to integrative psychoeducation. World Psychiatry 2014; 13:90-2. [PMID: 24497258 PMCID: PMC3918029 DOI: 10.1002/wps.20091] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Francesc Colom
- Barcelona Bipolar Disorders Unit; IDIBAPS-CIBERSAM, Institute of Neurosciences, Hospital Clinic; Villarroel 170 Barcelona 08036 Spain
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345
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Prochaska JJ, Fromont SC, Delucchi K, Young-Wolff KC, Benowitz NL, Hall S, Bonas T, Hall SM. Multiple risk-behavior profiles of smokers with serious mental illness and motivation for change. Health Psychol 2014; 33:1518-29. [PMID: 24467257 DOI: 10.1037/a0035164] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Individuals with serious mental illness (SMI) are dying on average 25 years prematurely. The leading causes are chronic preventable diseases. In the context of a tobacco-treatment trial, this exploratory study examined the behavioral risk profiles of adults with SMI to identify broader interventional needs. METHOD Recruited from five acute inpatient psychiatry units, participants were 693 adult smokers (recruitment rate = 76%, 50% male, 45% Caucasian, age M = 39, 49% had income < $10,000) diagnosed with mood disorders (71%), substance-use disorders (63%), posttraumatic stress disorder (39%), psychotic disorders (25%), and attention deficit-hyperactivity disorder (25%). The Staging Health Risk Assessment, the primary measure used in this study, screened for risk status and readiness to change 11 health behaviors, referencing the period prior to acute hospitalization. RESULTS Participants averaged 5.2 (SD = 2.1) risk behaviors, including smoking (100%), high-fat diet (68%), inadequate fruits/vegetables (67%), poor sleep (53%), physical inactivity (52%), and marijuana use (46%). The percent prepared to change ranged from 23% for tobacco and marijuana to 76% for depression management. Latent class analysis differentiated three risk groups: the global higher risk group included patients elevated on all risk behaviors; the global lower risk group was low on all risks; and a mood and metabolic risk group, characterized by inactivity, unhealthy diet, sleep problems, and poor stress and depression management. The global higher risk group (11% of sample) was younger, largely male, and had the greatest number of risk behaviors and mental health diagnoses; had the most severe psychopathologies, addiction-treatment histories, and nicotine dependence; and the lowest confidence for quitting smoking and commitment to abstinence. CONCLUSION Most smokers with SMI engaged in multiple risks. Expanding targets to treat co-occurring risks and personalizing treatment to individuals' multibehavioral profiles may increase intervention relevance, interest, and impact on health.
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Affiliation(s)
- Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University
| | | | - Kevin Delucchi
- Department of Psychiatry, University of California-San Francisco
| | - Kelly C Young-Wolff
- Stanford Prevention Research Center, Department of Medicine, Stanford University
| | - Neal L Benowitz
- Division of Clinical Pharmacology, Departments of Medicine and Bioengineering & Therapeutic Sciences, University of California-San Francisco
| | - Stephen Hall
- Department of Psychiatry, University of California-San Francisco
| | | | - Sharon M Hall
- Department of Psychiatry, University of California-San Francisco
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346
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Foley DL, Mackinnon A, Watts GF, Shaw JE, Magliano DJ, Castle DJ, McGrath JJ, Waterreus A, Morgan VA, Galletly CA. Cardiometabolic risk indicators that distinguish adults with psychosis from the general population, by age and gender. PLoS One 2013; 8:e82606. [PMID: 24367528 PMCID: PMC3867369 DOI: 10.1371/journal.pone.0082606] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 11/05/2013] [Indexed: 11/29/2022] Open
Abstract
Individuals with psychosis are more likely than the general community to develop obesity and to die prematurely from heart disease. Interventions to improve cardiovascular outcomes are best targeted at the earliest indicators of risk, at the age they first emerge. We investigated which cardiometabolic risk indicators distinguished those with psychosis from the general population, by age by gender, and whether obesity explained the pattern of observed differences. Data was analyzed from an epidemiologically representative sample of 1,642 Australians with psychosis aged 18–64 years and a national comparator sample of 8,866 controls aged 25–64 years from the general population. Cubic b-splines were used to compare cross sectional age trends by gender for mean waist circumference, body mass index [BMI], blood pressure, fasting blood glucose, triglycerides, LDL, HDL, and total cholesterol in our psychosis and control samples. At age 25 individuals with psychosis had a significantly higher mean BMI, waist circumference, triglycerides, glucose [women only], and diastolic blood pressure and significantly lower HDL-cholesterol than controls. With the exception of triglycerides at age 60+ in men, and glucose in women at various ages, these differences were present at every age. Differences in BMI and waist circumference between samples, although dramatic, could not explain all differences in diastolic blood pressure, HDL-cholesterol or triglycerides but did explain differences in glucose. Psychosis has the hallmarks of insulin resistance by at least age 25. The entire syndrome, not just weight, should be a focus of intervention to reduce mortality from cardiovascular disease.
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Affiliation(s)
- Debra L. Foley
- Orygen Youth Health Research Centre and Centre for Youth Mental Health, University of Melbourne, VIC Australia
- * E-mail:
| | - Andrew Mackinnon
- Orygen Youth Health Research Centre and Centre for Youth Mental Health, University of Melbourne, VIC Australia
| | - Gerald F. Watts
- Lipid Disorders Clinic, Metabolic Research Centre and Department of Internal Medicine, Royal Perth Hospital & School of Medicine and Pharmacology, University of Western Australia, WA Australia
| | - Jonathan E. Shaw
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, VIC Australia
| | - Dianna J. Magliano
- Department of Clinical Diabetes and Epidemiology, Baker IDI Heart and Diabetes Institute, Melbourne, VIC Australia
| | - David J. Castle
- St Vincent's Hospital, Melbourne & Department of Psychiatry, University of Melbourne, VIC Australia
| | - John J. McGrath
- Queensland Brain Institute, University of Queensland & Queensland Centre for Mental Health Research, The Park Centre for Mental Health, QLD Australia
| | - Anna Waterreus
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, WA Australia
| | - Vera A. Morgan
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, WA Australia
| | - Cherrie A. Galletly
- Discipline of Psychiatry, School of Medicine, University of Adelaide & Ramsay Health Care, Mental Health Services & Northern Adelaide Local Health Network, SA Australia
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347
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Abstract
Schizophrenia is often referred to as one of the most severe mental disorders, primarily because of the very high mortality rates of those with the disorder. This article reviews the literature on excess early mortality in persons with schizophrenia and suggests reasons for the high mortality as well as possible ways to reduce it. Persons with schizophrenia have an exceptionally short life expectancy. High mortality is found in all age groups, resulting in a life expectancy of approximately 20 years below that of the general population. Evidence suggests that persons with schizophrenia may not have seen the same improvement in life expectancy as the general population during the past decades. Thus, the mortality gap not only persists but may actually have increased. The most urgent research agenda concerns primary candidates for modifiable risk factors contributing to this excess mortality, i.e., side effects of treatment and lifestyle factors, as well as sufficient prevention and treatment of physical comorbidity.
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Affiliation(s)
- Thomas Munk Laursen
- National Center for Register-Based Research, Aarhus University, 8210 Aarhus V, Denmark;
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348
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Giannopoulou I, Botonis P, Kostara C, Skouroliakou M. Diet and exercise effects on aerobic fitness and body composition in seriously mentally ill adults. Eur J Sport Sci 2013; 14:620-7. [DOI: 10.1080/17461391.2013.862871] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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349
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Dalle Grave R, Calugi S, El Ghoch M. Lifestyle modification in the management of obesity: achievements and challenges. Eat Weight Disord 2013; 18:339-49. [PMID: 23893662 DOI: 10.1007/s40519-013-0049-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 07/17/2013] [Indexed: 02/04/2023] Open
Abstract
Lifestyle modification therapy for overweight and obese patients combines specific recommendations on diet and exercise with behavioral and cognitive procedures and strategies. In completers it produces a mean weight loss of 8-10 % in about 30 weeks of treatment. However, two main issues still to be resolved are how to improve dissemination of this approach, and how to help patients maintain the healthy behavioral changes and avoid weight gain in the long term. In recent years, several strategies for promoting and maintaining lifestyle modification have been evaluated, and promising results have been achieved by individualising the treatment, delivering the intervention by phone and internet or in a community setting, and combining lifestyle modification programs with residential treatment and bariatric surgery. These new strategies raise optimistic expectations for the effective management of obesity through lifestyle modification.
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Affiliation(s)
- Riccardo Dalle Grave
- Department of Eating and Weight Disorders, Villa Garda Hospital, Via Montebaldo, 89, 37016, Garda (VR), Italy,
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350
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Henwood BF, Cabassa LJ, Craig CM, Padgett DK. Permanent supportive housing: addressing homelessness and health disparities? Am J Public Health 2013; 103 Suppl 2:S188-92. [PMID: 24148031 DOI: 10.2105/ajph.2013.301490] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Permanent supportive housing (PSH) is an intervention to address long-term homelessness. Evidence has resulted in a shift in US policy toward using PSH rather than shelters and transitional housing. Despite recognizing that individuals transitioning from homelessness to PSH experience a high burden of disease and health disparities, public health research has not considered whether and how PSH improves physical health outcomes. Based on diverse areas of research, we argue that in addition to improved access to quality health care, social determinants of health (including housing itself, neighborhood characteristics, and built environment) affect health outcomes. We identify implications for practice and research, and conclude that federal and local efforts to end long-term homelessness can interact with concurrent efforts to build healthy communities.
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Affiliation(s)
- Benjamin F Henwood
- Benjamin F. Henwood, is with the School of Social Work, University of Southern California, Los Angeles. Leopoldo J. Cabassa is with the School of Social Work, Columbia University, New York, NY. At the time of the study, Catherine M. Craig was with Community Solutions, Washington, DC. Deborah K. Padgett is with the Silver School of Social Work and the Global Institute of Public Health, New York University, New York, NY
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