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Russell MJ, Urichuk L, Parker N, Agyapong VIO, Rittenbach K, Dyson MP, Hilario C. Youth mental health care use during the COVID-19 pandemic in Alberta, Canada: an interrupted time series, population-based study. Child Adolesc Psychiatry Ment Health 2024; 18:101. [PMID: 39127668 DOI: 10.1186/s13034-024-00785-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 07/12/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, youth had rising mental health needs and changes in service accessibility. Our study investigated changes in use of mental health care services for Canadian youth in Alberta before and during the COVID-19 pandemic. We also investigated how youth utilization patterns differed for subgroups based on social factors (i.e., age, gender, socioeconomic status, and geography) previously associated with health care access. METHODS We used cross-sectional population-based data from Alberta, Canada to understand youth (15-24 year) mental health care use from 2018/19 to 2021/22. We performed interrupted time series design, segmented regression modeling on type of mental health care use (i.e., general physician, psychiatrist, emergency room, and hospitalization) and diagnosis-related use. We also investigated the characteristics of youth who utilized mental health care services and stratified diagnosis-related use patterns by youth subgroups. RESULTS The proportion of youth using mental health care significantly increased from 15.6% in 2018/19 to 18.8% in 2021/22. Mental health care use showed an immediate drop in April 2020 when the COVID-19 pandemic was declared and public health protections were instituted, followed by a steady rise during the next 2 years. An increase was significant for general physician and psychiatrist visits. Most individual diagnoses included in this study showed significant increasing trends during the pandemic (i.e., anxiety, adjustment, ADHD, schizophrenia, and self-harm), with substance use showing an overall decrease. Mortality rates greatly increased for youth being seen for mental health reasons from 71 per 100,000 youth in 2018/19 to 163 per 100,000 in 2021/22. In addition, there were clear shifts over time in the characteristics of youth using mental health care services. Specifically, there was increased utilization for women/girls compared to men/boys and for youth from wealthier neighborhoods. Increases over time in the utilization of services for self-harm were limited to younger youth (15-16 year). CONCLUSIONS The study provides evidence of shifts in mental health care use during the COVID-19 pandemic. Findings can be used to plan for ongoing mental health needs of youth, future pandemic responses, and other public health emergencies.
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Affiliation(s)
| | - Liana Urichuk
- PolicyWise for Children & Families, 9925 109 St NW, Edmonton, AB, T5K 2J8, Canada
- Department of Psychiatry, University of Alberta, 4-142A Katz Group Centre for Research, 11315 - 87 Ave NW, Edmonton, AB, T6G 2H5, Canada
| | - Naomi Parker
- Faculty of Social Work, University of Calgary, 2500 University Dr NW MacKimmie Tower (MT) 301, Calgary, AB, T2N 1N4, Canada
| | - Vincent Israel Opoku Agyapong
- Department of Psychiatry, University of Alberta, 4-142A Katz Group Centre for Research, 11315 - 87 Ave NW, Edmonton, AB, T6G 2H5, Canada
- Faculty of Medicine, Dalhousie University, Abbie J Lane Building, 5909 Veterans Memorial Ln, Halifax, NS, B3H 2E2, Canada
| | - Katherine Rittenbach
- Department of Psychiatry, University of Alberta, 4-142A Katz Group Centre for Research, 11315 - 87 Ave NW, Edmonton, AB, T6G 2H5, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Michele P Dyson
- Department of Psychiatry, University of Alberta, 4-142A Katz Group Centre for Research, 11315 - 87 Ave NW, Edmonton, AB, T6G 2H5, Canada
- Provincial Addiction and Mental Health, Alberta Health Services, 10th Floor, South Tower, 10030-107 Street NW, Edmonton, AB, T5J 3E4, Canada
| | - Carla Hilario
- Department of Psychiatry, University of Alberta, 4-142A Katz Group Centre for Research, 11315 - 87 Ave NW, Edmonton, AB, T6G 2H5, Canada.
- School of Nursing, The University of British Columbia-Okanagan, ART360 (ARTS Building), 1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
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McIntyre RS, Kwan ATH, Rosenblat JD, Teopiz KM, Mansur RB. Psychotropic Drug-Related Weight Gain and Its Treatment. Am J Psychiatry 2024; 181:26-38. [PMID: 38161305 DOI: 10.1176/appi.ajp.20230922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Psychotropic drug-related weight gain (PDWG) is a common occurrence and is highly associated with non-initiation, discontinuation, and dissatisfaction with psychiatric drugs. Moreover, PDWG intersects with the elevated risk for obesity and associated morbidity that has been amply reported in the psychiatric population. Evidence indicates that differential liability for PDWG exists for antipsychotics, antidepressants, and anticonvulsants. During the past two decades, agents within these classes have become available with significantly lower or no liability for PDWG and as such should be prioritized. Although lithium is associated with weight gain, the overall extent of weight gain is significantly lower than previously estimated. The benefit of lifestyle and behavioral modification for obesity and/or PDWG in psychiatric populations is established, with effectiveness similar to that in the general population. Metformin is the most studied pharmacological treatment in the prevention and treatment of PDWG, and promising data are emerging for glucagon-like peptide-1 (GLP-1) receptor agonists (e.g., liraglutide, exenatide, semaglutide). Most pharmacologic antidotes for PDWG are supported with low-confidence data (e.g., topiramate, histamine-2 receptor antagonists). Future vistas for pharmacologic treatment for PDWG include large, adequately controlled studies with GLP-1 receptor agonists and possibly GLP-1/glucose-dependent insulinotropic polypeptide co-agonists (e.g., tirzepatide) as well as specific dietary modifications.
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Affiliation(s)
- Roger S McIntyre
- Department of Psychiatry (McIntyre, Rosenblat, Mansur) and Department of Pharmacology and Toxicology (McIntyre, Rosenblat, Mansur), University of Toronto, Toronto; Brain and Cognition Discovery Foundation, Toronto (McIntyre, Kwan, Teopiz); Faculty of Medicine, University of Ottawa, Ottawa (Kwan)
| | - Angela T H Kwan
- Department of Psychiatry (McIntyre, Rosenblat, Mansur) and Department of Pharmacology and Toxicology (McIntyre, Rosenblat, Mansur), University of Toronto, Toronto; Brain and Cognition Discovery Foundation, Toronto (McIntyre, Kwan, Teopiz); Faculty of Medicine, University of Ottawa, Ottawa (Kwan)
| | - Joshua D Rosenblat
- Department of Psychiatry (McIntyre, Rosenblat, Mansur) and Department of Pharmacology and Toxicology (McIntyre, Rosenblat, Mansur), University of Toronto, Toronto; Brain and Cognition Discovery Foundation, Toronto (McIntyre, Kwan, Teopiz); Faculty of Medicine, University of Ottawa, Ottawa (Kwan)
| | - Kayla M Teopiz
- Department of Psychiatry (McIntyre, Rosenblat, Mansur) and Department of Pharmacology and Toxicology (McIntyre, Rosenblat, Mansur), University of Toronto, Toronto; Brain and Cognition Discovery Foundation, Toronto (McIntyre, Kwan, Teopiz); Faculty of Medicine, University of Ottawa, Ottawa (Kwan)
| | - Rodrigo B Mansur
- Department of Psychiatry (McIntyre, Rosenblat, Mansur) and Department of Pharmacology and Toxicology (McIntyre, Rosenblat, Mansur), University of Toronto, Toronto; Brain and Cognition Discovery Foundation, Toronto (McIntyre, Kwan, Teopiz); Faculty of Medicine, University of Ottawa, Ottawa (Kwan)
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Castaldelli-Maia JM, Camargos de Oliveira V, Irber FM, Blaas IK, Angerville B, Sousa Martins-da-Silva A, Koch Gimenes G, Waisman Campos M, Torales J, Ventriglio A, Guillois C, El Ouazzani H, Gazaix L, Favré P, Dervaux A, Apter G. Psychopharmacology of smoking cessation medications: focus on patients with mental health disorders. Int Rev Psychiatry 2023; 35:397-417. [PMID: 38299651 DOI: 10.1080/09540261.2023.2249084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 08/14/2023] [Indexed: 02/02/2024]
Abstract
The adverse effects of smoking cessation in individuals with mental health disorders have been a point of concern, and progress in the development of treatment has been slow. The primary first-line treatments for smoking cessation are Nicotine Replacement Therapy, Bupropion, Varenicline, and behavioural support. Nortriptyline and Clonidine are second-line treatments used when the first-line treatments are not effective or are contraindicated. Smoking cessation medications have been shown to be effective in reducing nicotine cravings and withdrawal symptoms and promoting smoking cessation among patients living with mental disorders. However, these medications may have implications for patients' mental health and need to be monitored closely. The efficacy and side effects of these medications may vary depending on the patient's psychiatric condition, medication regimen, substance use, or medical comorbidities. The purpose of this review is to synthesise the pharmacokinetics, pharmacodynamics, therapeutic effects, adverse effects, and pharmacological interactions of first- and second-line smoking cessation drugs, with an emphasis on patients suffering from mental illnesses. Careful consideration of the risks and benefits of using smoking cessation medications is necessary, and treatment plans must be tailored to individual patients' needs. Monitoring symptoms and medication regimens is essential to ensure optimal treatment outcomes.
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Affiliation(s)
- João Mauricio Castaldelli-Maia
- Cellule de Recherche Clinique, Groupe Hospitalier du Havre, Le Havre, France
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo, Brazil
| | | | | | - Israel K Blaas
- Perdizes Institute (IPer), Clinics Hospital (HCFMUSP), Medical School, University of São Paulo, São Paulo, Brazil
| | | | | | - Gislaine Koch Gimenes
- Perdizes Institute (IPer), Clinics Hospital (HCFMUSP), Medical School, University of São Paulo, São Paulo, Brazil
| | - Marcela Waisman Campos
- Department of Cognitive Neurology, Neuropsychiatry, and Neuropsychology, FLENI, Buenos Aires, Argentina
| | - Julio Torales
- Department of Psychiatry, National University of Asuncion, San Lorenzo, Paraguay
- Regional Institute of Health Research, Universidad Nacional de Caaguazú, Coronel Oviedo, Paraguay
- School of Health Sciences, Universidad Sudamericana, Pedro Juan Caballero, Paraguay
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Carine Guillois
- Cellule de Recherche Clinique, Groupe Hospitalier du Havre, Le Havre, France
| | - Houria El Ouazzani
- Cellule de Recherche Clinique, Groupe Hospitalier du Havre, Le Havre, France
| | - Léna Gazaix
- Cellule de Recherche Clinique, Groupe Hospitalier du Havre, Le Havre, France
| | - Pascal Favré
- Établissement Public de Santé Mentale, Neuilly sur Marne, France
| | - Alain Dervaux
- Établissement Public de Santé Barthélémy Durand, Étampes, France
- Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Gisèle Apter
- Cellule de Recherche Clinique, Groupe Hospitalier du Havre, Le Havre, France
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
- Établissement Public de Santé Mentale, Neuilly sur Marne, France
- Societé de l'Information Psychiatrique, Bron, France
- University of Rouen Normandy, Rouen, France
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4
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Essay topic - What is the role of psychiatry in recovery from severe trauma? Australas Psychiatry 2023; 31:567-569. [PMID: 37583106 DOI: 10.1177/10398562231190829f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
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Campforts B, Drukker M, Crins J, van Amelsvoort T, Bak M. Association between antipsychotic medication and clinically relevant weight change: meta-analysis. BJPsych Open 2023; 9:e18. [PMID: 36651070 PMCID: PMC9885350 DOI: 10.1192/bjo.2022.619] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Previous meta-analyses have shown that almost all antipsychotics are associated with weight gain. However, mean weight gain is not informative about clinically relevant weight gain or weight loss. AIMS To provide further insight into the more severe body weight changes associated with antipsychotic use, we assessed the proportion of patients with clinically relevant weight gain (CRWG) and clinically relevant weight loss (CRWL), defined as ≥7% weight gain and ≥7% weight loss. METHOD We searched PubMed, Embase and PsycInfo for randomised controlled trials of antipsychotics that reported CRWG and CRWL in study populations aged 15 years or older. We conducted meta-analyses stratified by antipsychotic and study duration using a random-effects model. We performed meta-regression analyses to assess antipsychotic-naive status and psychiatric diagnosis as modifiers for CRWG. PROSPERO: CRD42020204734. RESULTS We included 202 articles (201 studies). Almost all included antipsychotics were associated with CRWG. For CRWL, available data were too limited to draw firm conclusions. For some antipsychotics, CRWG was more pronounced in individuals who were antipsychotic-naive than in individuals switching to another antipsychotic. Moreover, a longer duration of antipsychotic use was associated with more CRWG, but not CRWL. For some antipsychotics, CRWG was higher in people diagnosed with schizophrenia, but this was inconsistent. CONCLUSIONS Switching antipsychotic medication is associated with both weight gain and weight loss, but the level of CRWG is higher than CRWL in antipsychotic-switch studies. CRWG was more pronounced in antipsychotic-naive patients, highlighting their vulnerability to weight gain. The impact of diagnosis on CRWG remains inconclusive.
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Affiliation(s)
- Bea Campforts
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Marjan Drukker
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Joost Crins
- Faculty of Health Medicine and Life Science, Maastricht University, Maastricht, The Netherlands
| | - Therese van Amelsvoort
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Maarten Bak
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Johnson PJ, Mentzer KM, Jou J, Upchurch DM. Unmet healthcare needs among midlife adults with mental distress and multiple chronic conditions. Aging Ment Health 2022; 26:775-783. [PMID: 33792432 PMCID: PMC10843861 DOI: 10.1080/13607863.2021.1904830] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Limited attention has focused on midlife health. Yet, this is a time of great change, including onset of chronic conditions and changes in mental health. OBJECTIVE To examine unmet healthcare needs among midlife adults (50-64 years) in the US with severe psychological distress (SPD) and/or multiple chronic conditions (MCC). METHODS Nationally representative data for midlife adults (50-64 years) from NHIS 2014-2018 were examined (n = 39,329). Multimorbidity status: no MCC/SPD, MCC alone, SPD alone, or both. We used logistic regression to estimate adjusted odds ratios (AOR) of delayed or foregone care by multimorbidity status. RESULTS Nearly 40% of midlife adults had MCC, SPD, or SPD/MCC. SPD with or without MCC had higher prevalence of social disadvantage, fair/poor health, activity limitations, and delayed/foregone healthcare. Compared to those with neither, adults with SPD/MCC were more likely to delay care due to limited office hours (AOR = 4.2, 95% CI 3.1-5.5) and had nearly three to four times higher odds of delays for all other reasons. Those with SPD/MCC had higher odds of needing but not getting mental healthcare (AOR = 6.4, 95% CI 4.5-9.1), prescriptions (AOR = 4.8, 95% CI 3.9-5.9), or follow-up care (AOR = 5.0, 95% CI 3.7-6.6), and three to four times higher odds of all other types of foregone care. CONCLUSIONS Midlife adults with SPD/MCC have substantial unmet healthcare needs. Midlife is a critical time to manage both chronic conditions and mental illness. Coordinated efforts by policymakers and healthcare systems are crucial to address complex healthcare needs of this population at a critical stage of the life-course.
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Affiliation(s)
- Pamela Jo Johnson
- Department of Public Health, North Dakota State University, Fargo, ND, USA
| | | | - Judy Jou
- Health Science Department, California State University-Long Beach, Long Beach, CA, USA
| | - Dawn M Upchurch
- Department of Community Health Sciences, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
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Gogia S, Grieb A, Jang A, Gordon MR, Coverdale J. Medical considerations in delusion of pregnancy: a systematic review. J Psychosom Obstet Gynaecol 2022; 43:51-57. [PMID: 32597281 DOI: 10.1080/0167482x.2020.1779696] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Delusions of pregnancy are associated with functional impairment and psychological distress. Previous works have focused on characterizing their etiology and identifying contributory social and cultural factors. The purpose of this review is to give an overview of the literature on medical or surgical comorbidities associated with delusions of pregnancy. METHODS We searched Google Scholar, PubMed, and PsycInfo using the terms "pregnancy delusion," "delusional pregnancy," "pseudocyesis", and "false/pseudo/phantom/spurious pregnancy" to identify all published cases of delusional pregnancies. We included cases in which medical or surgical factors might have contributed to the delusion. We extracted the following information from selected case reports: patient age, psychiatric diagnoses, medications, medical comorbidities, somatic complaints, treatment, and outcome. RESULTS We found that 23 of 140 cases (16.4%) were potentially influenced by concomitant medical or surgical conditions including gallstones, abdominal tumors, hyperprolactinemia, constipation, a tubal cyst, and esophageal achalasia. Medical or surgical treatment was pursued in 15 of these 23 cases, followed by mitigation of the delusion in ten cases. CONCLUSIONS We emphasize the importance of a thorough workup including physical and gynecological examinations in patients presenting with a delusion of pregnancy. Clinicians should recognize and overcome potential barriers to undertaking comprehensive assessments in order to prevent delays in management and treatment of underlying medical or surgical conditions.
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Affiliation(s)
- Soumya Gogia
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Anastasia Grieb
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Albert Jang
- Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mollie R Gordon
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | - John Coverdale
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
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8
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Long-term observation of mortality among inpatients evacuated from psychiatric hospitals in Fukushima prefecture following the Fukushima nuclear disaster. Sci Rep 2021; 11:14651. [PMID: 34282221 PMCID: PMC8289941 DOI: 10.1038/s41598-021-94152-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022] Open
Abstract
The debate regarding the need for hospital evacuation and the evacuation distance remains rather chaotic. Furthermore, the relationship between hospital evacuation and the prognoses of psychiatric inpatients has not yet been investigated. We aimed to reveal the association between the long-term prognosis of psychiatric inpatients evacuated immediately following the Fukushima Daiichi Nuclear Power Plant accident and their backgrounds. In this retrospective cohort study, 777 psychiatric inpatients who were immediately evacuated from their hospitals following the accident were included for analysis. Survival time was the primary outcome. We conducted univariable and multivariable analyses to examine the associations between mortality and linear distance of evacuation and different backgrounds, including psychiatric/physical traits. Univariable analysis showed that the estimated survival time among patients was significantly associated with their evacuation distance. A multivariable analysis showed that a longer evacuation distance had a significantly lower hazard ratio (HR) and resulted in lower mortality. In contrast, older patients with physical complications of respiratory disease (International Statistical Classification of Diseases and Related Health Problems 10th revision, J00–99) and genitourinary disease (N00–99) showed a significantly higher HR and had a higher mortality than patients without these complications. To prevent death among elderly psychiatric inpatients with physical comorbidities during disasters, the evacuation destination should be determined taking into consideration the evacuees’ tolerance for long-distance transportation and the availability of post-evacuation care in the destination hospitals.
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Wilson C, Nichles A, Zmicerevska N, Carpenter JS, Song YJC, McHugh C, Hamilton B, Hockey S, Scott EM, Hickie IB. Effect of an online healthy lifestyle psychoeducation programme to improve cardiometabolic outcomes and affective symptoms in youth receiving mental health care: study protocol for a pilot clinical trial. BMJ Open 2021; 11:e044977. [PMID: 34187819 PMCID: PMC8245471 DOI: 10.1136/bmjopen-2020-044977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Worsened cardiometabolic profiles in youth with mental ill health have been associated with a number of modifiable lifestyle risk factors. It is becoming increasingly evident that clinical interventions need to be multimodal in focus to improve mental health symptoms and the physical health symptoms in this already at-risk cohort. METHODS AND ANALYSIS This 12-week pilot clinical trial examines the efficacy, feasibility and acceptability of an adjunctive online psychoeducation programme for improving cardiometabolic risk parameters and affective symptoms in a transdiagnostic sample of at least 44 young people aged 16-25 years presenting for mental healthcare for mood and/or psychotic syndromes (including anxiety, depression, bipolar disorder and psychosis). Individuals will be invited to participate in a pilot clinical trial for a structured online psychoeducation programme incorporating nutritional, physical activity, sleep-wake and healthy lifestyle information, delivered fortnightly over six online modules. Participants will undergo a series of assessments including: (1) self-report and clinician administered assessments determining mental health symptomatology; (2) fasting blood tests to assess cardiometabolic markers (fasting insulin, fasting glucose and blood lipids); (3) anthropometric assessments (height, weight, waist circumference and blood pressure); and (4) sleep-wake behaviours and circadian rhythm assessments. Changes in scores for all cardiometabolic and affective measures will be assessed via paired samples t-tests, and correlations between change scores will be assessed via Pearson's or Spearman's correlations. Feasibility will be assessed via completion rates, and the acceptability of the programme will be assessed via programme satisfaction measures. ETHICS AND DISSEMINATION This pilot clinical trial has been approved by the Sydney Local Health District Research Ethics and Governance Office (X20-0228 & 2020/ETH01201). The results of this pilot clinical trial will be disseminated into the scientific and broader community through peer-reviewed journals, conference presentations, social media and university websites. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ANZCTR) Number: ACTRN12620000772943, Date 28 August 2020.
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Affiliation(s)
- Chloe Wilson
- Youth Mental Health and Technology Team, The University of Sydney Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Alissa Nichles
- Youth Mental Health and Technology Team, The University of Sydney Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Natalia Zmicerevska
- Youth Mental Health and Technology Team, The University of Sydney Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Joanne Sarah Carpenter
- Youth Mental Health and Technology Team, The University of Sydney Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Yun Ju Christine Song
- Youth Mental Health and Technology Team, The University of Sydney Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Catherine McHugh
- Youth Mental Health and Technology Team, The University of Sydney Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Blake Hamilton
- Youth Mental Health and Technology Team, The University of Sydney Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Samuel Hockey
- Youth Mental Health and Technology Team, The University of Sydney Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Elizabeth M Scott
- Youth Mental Health and Technology Team, The University of Sydney Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Ian B Hickie
- Youth Mental Health and Technology Team, The University of Sydney Brain and Mind Centre, Sydney, New South Wales, Australia
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Filiatreau LM, Ebasone PV, Dzudie A, Ajeh R, Pence B, Wainberg M, Nash D, Yotebieng M, Anastos K, Pefura-Yone E, Nsame D, Parcesepe AM. Correlates of self-reported history of mental health help-seeking: a cross-sectional study among individuals with symptoms of a mental or substance use disorder initiating care for HIV in Cameroon. BMC Psychiatry 2021; 21:293. [PMID: 34090367 PMCID: PMC8180128 DOI: 10.1186/s12888-021-03306-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/25/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mental health and substance use disorders (MSDs) increase the risk of poor human immunodeficiency virus (HIV) care outcomes among people living with HIV (PLWH). Receipt of mental health care may improve these adverse outcomes. We aimed to identify correlates of prior mental health help-seeking among PLWH with symptoms of an MSD in Cameroon. METHODS We characterize prior mental health help-seeking from formal (mental health specialist/general medical provider) and informal (traditional healer/religious leader) sources among 161 people with symptoms of depression (Patient Health Questionnaire-9 scores> 9), anxiety (General Anxiety Disorder-7 scores> 9), probable post-traumatic stress disorder (PTSD Checklist for DSM-5 scores> 30), or possible alcohol use disorder (Alcohol Use Disorders Identification Test scores≥16) who were newly entering HIV care at three healthcare facilities in Cameroon between June 2019 and March 2020. Help-seeking was defined as ever speaking to a formal or informal source about emotional problems, sadness, or the way they were feeling or behaving. We estimated the association between sociodemographic and psychosocial measures and lifetime mental health help-seeking from each type of source using log-binomial regression. RESULTS Overall, 55.3% of 161 PLWH with MSD symptoms reported prior mental health help-seeking, with 24.2% and 46.0% seeking help from formal and informal sources, respectively. Religious leaders were the most common source of help (40.4%), followed by general medical professionals (22.4%), traditional healers (16.8%), and mental health specialists (7.4%). Individuals with higher depressive, anxiety, and trauma symptom severity scores were more likely to have sought help than those with lower scores. Individuals with possible alcohol use disorder were the least likely to have sought help. Prior help-seeking was more common among those reporting a higher number of lifetime traumatic events (prevalence ratio [PR]: 1.06; 95% confidence interval [CI]: 1.01, 1.11) and those with a history of emotional intimate partner violence (PR: 1.34; 95% CI: 1.01, 1.80). CONCLUSIONS Prior mental health help-seeking was associated with psychosocial stressors. Help-seeking from informal networks was more common than formal help-seeking. Training in the provision of evidence-based mental health support for informal networks could improve access to mental health care for PLWH with MSDs in Cameroon.
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Affiliation(s)
- Lindsey M. Filiatreau
- grid.10698.360000000122483208Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | | | - Anastase Dzudie
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Rogers Ajeh
- Clinical Research Education Networking and Consultancy, Yaounde, Cameroon
| | - Brian Pence
- grid.10698.360000000122483208Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Milton Wainberg
- grid.413734.60000 0000 8499 1112Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY USA
| | - Denis Nash
- grid.212340.60000000122985718Institute of Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY USA
| | - Marcel Yotebieng
- grid.251993.50000000121791997Department of Medicine, Albert Einstein College of Medicine, Bronx, NY USA
| | - Kathryn Anastos
- grid.251993.50000000121791997Departments of Medicine and Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY USA
| | | | - Denis Nsame
- Bamenda Regional Hospital, Bamenda, Cameroon
| | - Angela M. Parcesepe
- grid.10698.360000000122483208Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA ,grid.10698.360000000122483208Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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11
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Wilson CE, Carpenter JS, Song Y, Ho N, Hickie IB. Associations between 24-h sleep–wake patterns and cardiometabolic risk factors in youth seeking mental health care. Sleep Biol Rhythms 2021. [DOI: 10.1007/s41105-021-00314-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Brett J, Pearson SA, Daniels B, Wylie CE, Buckley NA. A cross sectional study of psychotropic medicine use in Australia in 2018: A focus on polypharmacy. Br J Clin Pharmacol 2020; 87:1369-1377. [PMID: 32881057 DOI: 10.1111/bcp.14527] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 12/29/2022] Open
Abstract
AIMS To examine prescribed psychotropic medicine use on a given day in Australia (25 September 2018; World Pharmacists Day), with a focus on psychotropic polypharmacy. METHODS We used a 10% sample of individual-level nationwide dispensing claims to examine psychotropic medicine use on a given day. We estimated the prevalence of psychotropic medicine use in all ages stratified by age and sex. We also calculated the observed vs expected (had medicines been randomly combined) prevalence of psychotropic combinations used. We focused on combinations of clinical significance as well combinations of psychotropics with medicines prescribed to manage cardiovascular risk and disease. RESULTS Serotonin reuptake inhibitors, serotonin-noradrenalin reuptake inhibitors/noradrenaline reuptake inhibitors, tricyclic antidepressants and gabapentinoids dominated psychotropic use. The use of any psychotropic as a proportion of people in the Australian population increased with age, peaking at the 85-89 year age group and declining thereafter. Combinations of medicines from the same subclass generally occurred at lower than expected frequencies. However, combinations including atypical antipsychotics occurred more frequently than expected; e.g. 7.4× with anticonvulsants and 2.2× with other atypical antipsychotics. This was also the case for combinations of sedatives, e.g. anxiolytic with hypnotic benzodiazepines (3.8×). Lipid-lowering drugs and antidiabetic medicines were combined with psychotropics at frequencies close to those expected had they been randomly combined. CONCLUSION Psychotropic use in older adults and certain psychotropic combinations that are not well supported with evidence remain prevalent and greater consideration of the drivers of this potentially inappropriate prescribing is required.
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Affiliation(s)
- Jonathan Brett
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia.,Clinical Pharmacology and Toxicology Research Group, Discipline of Pharmacology, The University of Sydney, Sydney, NSW, Australia
| | - Sallie-Anne Pearson
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Benjamin Daniels
- Medicines Policy Research Unit, Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Claire E Wylie
- Clinical Pharmacology and Toxicology Research Group, Discipline of Pharmacology, The University of Sydney, Sydney, NSW, Australia
| | - Nicholas A Buckley
- Clinical Pharmacology and Toxicology Research Group, Discipline of Pharmacology, The University of Sydney, Sydney, NSW, Australia
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Rio JHM, Fuller J, Taylor K, Muir-Cochrane E. A lack of therapeutic engagement and consumer input in acute inpatient care planning limits fully accountable mental health nursing practice. Int J Ment Health Nurs 2020; 29:290-298. [PMID: 31859453 DOI: 10.1111/inm.12684] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2019] [Indexed: 02/03/2023]
Abstract
It is mental health consumer's human right to lead a fulfilling life as they are empowered to actively manage their recovery. This can be facilitated through care planning, yet research suggests that the care plan is not routinely created, discussed, or updated in acute mental health settings. Research on care planning and the role of the mental health nurse highlights the importance of therapeutic communication in care plan development. This paper argues that the lack of meaningful care plan discussions between consumers and mental health nurses in an acute setting is a limitation to the practice of fully accountable mental health nursing care. We explore this limitation in quality care provision by examining literature on accountability and conclude that in mental health nursing, accountability is frequently enacted through an overarching focus on the organizational need to manage risks, rather than on therapeutic engagement.
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Affiliation(s)
- Josephien H M Rio
- College of Nursing & Health Sciences Flinders University, Adelaide, Australia.,Mental Health - Central Australian Health Service, Alice Springs, Australia
| | - Jeffrey Fuller
- College of Nursing & Health Sciences Flinders University, Adelaide, Australia
| | - Kerry Taylor
- College of Medicine & Public Health, Flinders University, Adelaide, Australia
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Kar SK, Tewari A. Relevance of mortality related to mental disorders in policy development for low- and middle-income countries. Asian J Psychiatr 2020; 49:101988. [PMID: 32120295 DOI: 10.1016/j.ajp.2020.101988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 02/24/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Sujita Kumar Kar
- King George's Medical University, Lucknow, Lucknow, Uttar Pradesh India.
| | - Abhinav Tewari
- King George's Medical University, Lucknow, Lucknow, Uttar Pradesh India
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Abstract
INTRODUCTION: Prolonged QT interval (PQTI) is a cardiac condition widely documented in the mental health literature and linked to psychotropic medication use. Medications notable for contributing to the condition are antipsychotics, antidepressants, and some mood stabilizers. Although additional medication classes and other contributing risk factors are often present, the prudent mental health provider benefits from having a basic understanding of this condition and how to prevent and manage it with safe prescribing practices. AIMS: This guide seeks to provide mental health prescribers with a basic understanding of the risk factors, pathophysiology, identification, and management of PQTI. METHOD: Relevant literature and practice guidelines were reviewed and summarized with a focus on practical interventions for the psychiatric mental health nurse practitioner (PMHNP). RESULTS: One of the primary contributing factors to PQTI development and complications is polypharmacy. Patients with co-occurring medical, mental health, and/or substance use disorders may receive medications from multiple providers. Anticancer drugs, antiarrhythmic medications, and even a number of common antibiotics can increase the QT interval, making it a challenge for even the most experienced mental health provider to monitor medication interactions and side effects that contribute to PQTI. Having a sound knowledge base of these factors can guide safe PMHNP practice. CONCLUSIONS: Decision-making trees grounded in evidence-based research were developed in order to direct thorough assessment and safe treatment of patients requiring psychotropic medications.
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Affiliation(s)
- Rebecca S Swenson
- Rebecca S. Swenson, FNP-BC, APNP, University of Wisconsin-Madison, WI, USA
| | - Kathleen Murphy-Ende
- Kathleen Murphy-Ende, PhD, PsyD, PMHNP-BC, University of Wisconsin-Madison, WI, USA
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Abstract
Psychiatric disorders are highly prevalent and remains a huge burden on the society. In spite of that persons with mental illness are marginalized and mental health is largely being neglected. There is an acute shortage of mental health professionals in India, and also there is inadequate exposure to psychiatry during the medical undergraduate training in India. Moreover, the perception towards psychiatry and psychiatrists is not favorable among medical fraternity and policy makers. This is reflected in the fact that in spite of clearly deficient undergraduate psychiatry curriculum, no steps have been taken towards improving it and recommendations are not being implemented in true spirit. This review tries to identify the gaps in undergraduate curriculum, present a SWOT analysis of current situation and recommend the possible ways to address the deficiencies particularly in India.
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Affiliation(s)
- Pawan Kumar
- Department of Psychiatry, Pt. B. D. Sharma PGIMS, Rohtak, India.
| | | | - Sujata Sethi
- Department of Psychiatry, Pt. B. D. Sharma PGIMS, Rohtak, India.
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