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Rohenkohl AC, Sowada P, Lambert M, Gallinat J, Karow A, Lüdecke D, Rühl F, Schöttle D. Service users' perceptions of relevant and helpful components of an integrated care concept (ACCESS) for psychosis. Front Psychol 2023; 14:1285575. [PMID: 38192398 PMCID: PMC10773616 DOI: 10.3389/fpsyg.2023.1285575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/23/2023] [Indexed: 01/10/2024] Open
Abstract
Introduction Psychotic disorders have a significant impact on patients' lives and their families, and long-term treatment with individually tailored multimodal combinations of therapies is often required. Integrated care (IC) concepts such as the "Hamburg Model (ACCESS)" with a focus on psychotic disorders, includes different (therapeutic) components with pharmaco- and psychotherapy, family involvement, home treatment and the option of using a 24/7 crisis hotline. All components are offered by a therapeutically-oriented assertive community treatment (TACT) team in a need-adapted manner. So far, however, little is known about which specific components are regarded as especially relevant and helpful by the users of IC. Methods Patients currently participating in IC completed a questionnaire as part of the continuous quality assurance study (ACCESS II) in which they were asked to rate the different components of treatment according to their relevance and helpfulness, considering the individual's unique experiences with IC and needs in mental health care. Furthermore, they were asked to make suggestions regarding additional helpful components of treatment. Results Fifty patients participated in this survey (23% of the patients currently participating in the IC concept). For participants, the most helpful and important factors were having the same therapist in the long-term and the 24/7 crisis telephone. Additional components suggested by patients included more addiction-specific therapies and increased focus on vocational rehabilitation and integration. Conclusion From the perspective of the users of IC, long-term care from a trusted therapist with whom there is a therapeutic relationship and the possibility to reach someone they already know from the TACT team 24/7 serves as the best basis for effective care, fostering trust, understanding, and open communication. In contrast, home treatment remains a relevant aspect of evidence-based care for people with severe mental illness, but perhaps surprisingly, is not viewed as the most important issue.
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Gur S, Weizman S, Hermesh H, Matalon A, Meyerovitch J, Krivoy A. Comparison of medical treatment of patients with schizophrenia in general practitioners' clinics versus mental health clinics: A cohort study. J Psychosom Res 2023; 171:111383. [PMID: 37269644 DOI: 10.1016/j.jpsychores.2023.111383] [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: 08/24/2022] [Revised: 04/30/2023] [Accepted: 05/17/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Individuals with schizophrenia have more cardiometabolic comorbidities than the general population, live about twenty years less and consume more medical services. They are treated at general practitioners' clinics (GPCs) or at mental health clinics (MHCs). In this cohort study we investigated the association between patients' main treatment setting, cardiometabolic comorbidities and medical services utilization. METHODS Demographics, healthcare services utilization, cardiometabolic comorbidities and medication prescriptions of patients with schizophrenia were retrieved from an electronic database for the period 1.1.2011 to 31.12.2012 and compared between patients treated mostly in MHCs (N = 260) and those treated mostly in GPCs (N = 115). RESULTS GPC patients tended to be older (mean age 39.8 ± 13.7 vs. 34.6 ± 12.3 yrs., p < 0.0001), of lower socioeconomic status (42.6% vs 24.6%, p = 0.001) and have more cardiometabolic diagnoses (hypertension: 19.1% vs 10.8%, diabetes mellitus: 25.2% vs 17.0%, p < 0.05) than MHC patients. The former received more cardiometabolic disorder medications and utilized more secondary and tertiary medical services. Charlson Comorbidity Index (CCI) was higher in the GPC group than in the MHC group (1.8 ± 1.9 vs.1.2 ± 1. 6, p < 0.0001). A multivariate binary logistic regression analysis, adjusted for age, sex, SES and CCI found lower adjusted odds ratio for the MHC group versus the GPC group, of visiting an EMD, a specialist or to be hospitalized. CONCLUSIONS The current study highlights the critical importance of integrating GPCs and MHCs, thus offering patients combined physical and mental care at a single location. More studies on the potential benefits of such integration to patients' health are warranted.
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Affiliation(s)
- Shay Gur
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah Tikva, Israel.
| | - Shira Weizman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Abarbanel Mental Health Center, Bat Yam, Israel
| | - Haggai Hermesh
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah Tikva, Israel
| | - Andre Matalon
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Dan-Petah Tikva District, Clalit Health Services, Petah Tikva, Israel
| | - Joseph Meyerovitch
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; The Jesse Z. and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel and Chief Pediatrician's Office, Community Division, Clalit Health Services, Tel Aviv, Israel
| | - Amir Krivoy
- Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel; Geha Mental Health Center, Petah Tikva, Israel
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Glasdam S, Hybholt L, Stjernswärd S. Experiences of Everyday Life among Individuals with Co-Existence of Serious Mental Illness and Cancer-A Qualitative Systematic Literature Review. Healthcare (Basel) 2023; 11:1897. [PMID: 37444731 DOI: 10.3390/healthcare11131897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Daily life with severe mental health (SMI) and cancer comorbidity entails multiple challenges. The study aims to explore everyday life experiences among individuals with SMI and cancer comorbidity from the perspectives of patients, significant others, and involved healthcare professionals. The study is registered in PROSPERO (CRD42021259604). A qualitative systematic review was conducted through searches in the databases MEDLINE, CINAHL, PsychInfo, and Web of Sciences (last search 14 February 2023). Inclusion criteria were empirical qualitative research studies investigating experiences of healthcare and everyday life among persons living with SMI and who were subsequently diagnosed with cancer from the perspective of the individuals themselves, their significant others, and healthcare professionals involved in their care. Exclusion criteria: Literature reviews, quantitative studies, intervention studies, quantitative parts of mix-methods studies, non-English languages, persons <18 years, dementia/learning disabilities, diagnosed with anxiety/depression as a consequence of cancer. Seven articles, published between January 2011 and February 2023, were included and analysed through a thematic analysis. The PRISMA 2020 checklist guided the study. The results were presented in four themes: 'Navigating between different worlds and logics', 'Decision-making capacity depending on the assessor', 'Cancer must give way to severe mental illness or vice versa', and 'Significant others as a safety net'. Research about the everyday lives of persons with SMI and cancer comorbidities from patients' and relatives' perspectives is lacking and thus called for.
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Affiliation(s)
- Stinne Glasdam
- Department of Health Sciences, Faculty of Medicine, Lund University, 222 41 Lund, Sweden
| | - Lisbeth Hybholt
- Research Unit, Mental Health Services East, Psychiatry Region Zealand, Smedegade 16, 4000 Roskilde, Denmark
- Psychiatric Research Unit, Psychiatry Region Zealand, Fælledvej 6, 4200 Slagelse, Denmark
| | - Sigrid Stjernswärd
- Department of Health Sciences, Faculty of Medicine, Lund University, 222 41 Lund, Sweden
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Schröter R, Lambert M, Rohenkohl A, Kraft V, Rühl F, Luedecke D, Gallinat J, Karow A, Schmidt SJ. Mediators of quality of life change in people with severe psychotic disorders treated in integrated care: ACCESS II study. Eur Psychiatry 2022; 66:e1. [PMID: 36329654 PMCID: PMC9879911 DOI: 10.1192/j.eurpsy.2022.2332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Patients with severe psychotic disorders exhibit a severely reduced quality of life (QoL) at all stages of the disease. Integrated care often led to an improvement in QoL. However, the specific mediators of QoL change are not yet well understood. METHODS The ACCESS II study is a prospective, long-term study investigating the effectiveness of an integrated care program for people with severe psychotic disorders (IC-TACT) that includes Therapeutic Assertive Community Treatment within a care network of in- and outpatient services at the University Medical Center Hamburg-Eppendorf, Germany. We examined longitudinal associations between QoL and the hypothesized mediators of change (i.e., negative symptoms, depression, and anxiety), using cross-lagged panel models. RESULTS The sample includes 418 severely ill patients treated in IC-TACT for at least 1 year. QoL increased, whereas symptom severity decreased significantly from baseline to 6-month follow-up (p-values ≤ 0.001), and remained stable until 12-month follow-up. QoL and symptom severity demonstrated significant auto-correlated effects and significant cross-lagged effects from QoL at baseline to negative symptoms (6 months, β = -0.20, p < 0.001) to QoL (12 months, β = -0.19, p < 0.01) resulting in a significant indirect, mediated effect. Additionally, negative symptoms after 6 months had a significant effect on the severity of depression after 12 months (β = 0.13, p < 0.05). CONCLUSIONS Negative symptoms appear to represent an important mechanism of change in IC-TACT indicating that improvement of QoL could potentially be achieved through optimized intervention on negative symptoms. Moreover, this may lead to a reduction in the severity of depression after 12 months.
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Affiliation(s)
- Romy Schröter
- Centre for Psychosis and Bipolar Disorders, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Lambert
- Centre for Psychosis and Bipolar Disorders, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Rohenkohl
- Centre for Psychosis and Bipolar Disorders, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vivien Kraft
- Centre for Psychosis and Bipolar Disorders, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Friederike Rühl
- Centre for Psychosis and Bipolar Disorders, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Luedecke
- Centre for Psychosis and Bipolar Disorders, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Centre for Psychosis and Bipolar Disorders, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Karow
- Centre for Psychosis and Bipolar Disorders, Department of Psychiatry and Psychotherapy, Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefanie J Schmidt
- Department of Clinical Psychology and Psychotherapy, University of Bern, 3012Bern, Switzerland
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Launders N, Kirsh L, Osborn DPJ, Hayes JF. The temporal relationship between severe mental illness diagnosis and chronic physical comorbidity: a UK primary care cohort study of disease burden over 10 years. Lancet Psychiatry 2022; 9:725-735. [PMID: 35871794 PMCID: PMC9630158 DOI: 10.1016/s2215-0366(22)00225-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Despite increased rates of physical health problems in people with schizophrenia, bipolar disorder, and other psychotic illnesses, the temporal relationship between physical disease acquisition and diagnosis of a severe mental illness remains unclear. We aimed to determine the cumulative prevalence of 24 chronic physical conditions in people with severe mental illness from 5 years before to 5 years after their diagnosis. METHODS In this cohort study, we used the UK Clinical Practice Research Datalink (CPRD) to identify patients aged 18-100 years who were diagnosed with severe mental illness between Jan 1, 2000, and Dec 31, 2018. Each patient with severe mental illness was matched with up to four individuals in the CPRD without severe mental illness by sex, 5-year age band, primary care practice, and year of primary care practice registration. Individuals in the matched cohort were assigned an index date equal to the date of severe mental illness diagnosis in the patient with severe mental illness to whom they were matched. Our primary outcome was the cumulative prevalence of 24 physical health conditions, based on the Charlson and Elixhauser comorbidity indices, at 5 years, 3 years, and 1 year before and after severe mental illness diagnosis and at the time of diagnosis. We used logistic regression to compare people with severe mental illness with the matched cohort, adjusting for key variables such as age, sex, and ethnicity. FINDINGS We identified 68 789 patients diagnosed with a severe mental illness between Jan 1, 2000, and Dec 31, 2018, and we matched them to 274 827 patients without a severe mental illness diagnosis. In both cohorts taken together, the median age was 40·90 years (IQR 29·46-56·00), 175 138 (50·97%) people were male, and 168 478 (49·03%) were female. The majority of patients were of White ethnicity (59 867 [87·03%] patients with a severe mental illness and 244 566 [88·99%] people in the matched cohort). The most prevalent conditions at the time of diagnosis in people with severe mental illness were asthma (10 581 [15·38%] of 68 789 patients), hypertension (8696 [12·64%]), diabetes (4897 [7·12%]), neurological disease (3484 [5·06%]), and hypothyroidism (2871 [4·17%]). At diagnosis, people with schizophrenia had increased odds of five of 24 chronic physical conditions compared with matched controls, and nine of 24 conditions were diagnosed less frequently than in matched controls. Individuals with bipolar disorder and other psychoses had increased odds of 15 conditions at diagnosis. At 5 years after severe mental illness diagnosis, these numbers had increased to 13 conditions for schizophrenia, 19 for bipolar disorder, and 16 for other psychoses. INTERPRETATION Elevated odds of multiple conditions at the point of severe mental illness diagnosis suggest that early intervention on physical health parameters is necessary to reduce morbidity and premature mortality. Some physical conditions might be under-recorded in patients with schizophrenia relative to patients with other severe mental illness subtypes. FUNDING UK Office For Health Improvement and Disparities.
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Affiliation(s)
- Naomi Launders
- Division of Psychiatry, University College London, London, UK
| | - Leiah Kirsh
- Division of Psychiatry, University College London, London, UK
| | - David P J Osborn
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Joseph F Hayes
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK.
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6
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Wootten JC, Wiener JC, Blanchette PS, Anderson KK. Cancer incidence and stage at diagnosis among people with psychotic disorders: Systematic review and meta-analysis. Cancer Epidemiol 2022; 80:102233. [PMID: 35952461 DOI: 10.1016/j.canep.2022.102233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 12/16/2022]
Abstract
Research regarding the incidence of cancer among people with psychotic disorders relative to the general population is equivocal, although the evidence suggests that they have more advanced stage cancer at diagnosis. We conducted a systematic review and meta-analysis to examine the incidence and stage at diagnosis of cancer among people with, relative to those without, psychotic disorders. We searched the MEDLINE, EMBASE, PsycINFO, and CINAHL databases. Articles were included if they reported the incidence and/or stage at diagnosis of cancer in people with psychotic disorders. Random effects meta-analyses were used to determine risk of cancer and odds of advanced stage cancer at diagnosis in people with psychosis, relative to those without psychotic disorders. A total of 40 articles were included in the review, of which, 31 were included in the meta-analyses. The pooled age-adjusted risk ratio for all cancers in people with psychotic disorders was 1.08 (95% CI: 1.01-1.15), relative to those without psychotic disorders, with significant heterogeneity by cancer site. People with psychotic disorders had a higher incidence of breast, oesophageal, colorectal, testicular, uterine, and cervical cancer, and a lower incidence of skin, prostate, and thyroid cancer. People with psychotic disorders also had 22% higher (95% CI: 2-46%) odds of metastases at diagnosis, compared to those without psychotic disorders. Our systematic review found a significant difference in overall cancer incidence among people diagnosed with psychotic disorders and people with psychotic disorders were more likely to present with advanced stage cancer at diagnosis. This finding may reflect a need for improved access to and uptake of cancer screening for patients diagnosed with psychotic disorders.
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Affiliation(s)
- Jared C Wootten
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Joshua C Wiener
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Phillip S Blanchette
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; ICES Western, London, Ontario, Canada; Division of Medical Oncology, London Regional Cancer Program, London Health Sciences Centre, London, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; ICES Western, London, Ontario, Canada; Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Nunes EJ, Kebede N, Bagdas D, Addy NA. Cholinergic and dopaminergic-mediated motivated behavior in healthy states and in substance use and mood disorders. J Exp Anal Behav 2022; 117:404-419. [PMID: 35286712 PMCID: PMC9743782 DOI: 10.1002/jeab.747] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 01/16/2022] [Accepted: 01/20/2022] [Indexed: 02/06/2023]
Abstract
Acetylcholine is an important neuromodulator of the mesolimbic dopamine (DA) system, which itself is a mediator of motivated behavior. Motivated behavior can be described by two primary components, termed directional and activational motivation, both of which can be examined and dissociated using effort-choice tasks. The directional component refers to motivated behavior directed towards reinforcing stimuli and away from aversive stimuli. Behaviors characterized by increased vigor, persistence, and work output are considered to reflect activational components of motivation. Disruption of DA signaling has been shown to decrease activational components of motivation, while leaving directional features intact. Facilitation of DA release promotes the activational aspects of motivated behavior. In this review, we discuss cholinergic and DA regulation of motivated behaviors. We place emphasis on effort-choice processes and the ability of effort-choice tasks to examine and dissociate changes of motivated behavior in the context of substance use and mood disorders. Furthermore, we consider how altered cholinergic transmission impacts motivated behavior across disease states, and the possible role of cholinergic dysregulation in the etiology of these illnesses. Finally, we suggest that treatments targeting cholinergic activity may be useful in ameliorating motivational disruptions associated with substance use and comorbid substance use and mood disorders.
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Affiliation(s)
- Eric J. Nunes
- Department of Psychiatry, Yale School of Medicine,Yale Tobacco Center of Regulatory Science, Yale School of Medicine
| | - Nardos Kebede
- Department of Psychiatry, Yale School of Medicine,Yale Tobacco Center of Regulatory Science, Yale School of Medicine
| | - Deniz Bagdas
- Department of Psychiatry, Yale School of Medicine,Yale Tobacco Center of Regulatory Science, Yale School of Medicine
| | - Nii A. Addy
- Department of Psychiatry, Yale School of Medicine,Yale Tobacco Center of Regulatory Science, Yale School of Medicine,Department of Cellular and Molecular Physiology, Yale School of Medicine,Interdepartmental Neuroscience Program, Yale University,Wu Tsai Institute, Yale University
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Wei DN, Wang YZ, Deng SY, Cohen A, Luo W, Liu B, Ran MS. Physical illness comorbidity and its influencing factors among persons with severe mental illness in Rural China. Asian J Psychiatr 2022; 71:103075. [PMID: 35305451 DOI: 10.1016/j.ajp.2022.103075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/28/2022] [Accepted: 03/09/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Comorbid physical illness is a common cause of death in people with severe mental illness (SMI) worldwide. In rural China, the prevalence of physical illness comorbidity among persons with SMI remains unclear. This study aimed to examine non-communicable physical illness comorbidity and its risk factors among people with SMI in a rural area of China. METHODS A mental health survey, using the International Classification of Disease (ICD-10), was conducted in six townships of Xinjin District, Chengdu, China in 2015. RESULTS A total of 724 persons with SMI were included in this study, and 37.8% of them had at least one physical illness. The most common physical illnesses were hypertension (10.5%) and diabetes (5.8%). More physical comorbidity was reported among persons with affective disorders than persons with schizophrenia. Many participants (37.4%) had never received antipsychotic treatment, and of those, 51.6% reported having a physical illness comorbidity. Significant associations were found between physical illness comorbidity and participants' family economic status, family size, age at onset of mental disorder, treatment status, and symptom severity. CONCLUSIONS Our findings indicate the need of an integration of medical and psychiatric care in primary care. It also suggests that poverty and having never received treatment for mental health problems negatively affect the health of persons with SMI, which deserve more attention. Researchers and policymakers can take these findings into account to develop health policies and improve the mental and physical health care in rural China.
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Affiliation(s)
- Dan-Nuo Wei
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR
| | - Yi-Zhou Wang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR
| | - Shu-Yu Deng
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR
| | - Alex Cohen
- London School of Hygiene & Tropical Medicine, UK
| | - Wei Luo
- Chengdu Xinjin Second People's Hospital, Chengdu, Xinjin 611432, China
| | - Bo Liu
- Jingzhou Mental Health Center, Jingzhou, Hubei 434000, China
| | - Mao-Sheng Ran
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR; Mental Health Center, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China.
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A population-based follow-up study shows high psychosis risk in women with PCOS. Arch Womens Ment Health 2022; 25:301-311. [PMID: 34841466 PMCID: PMC8921102 DOI: 10.1007/s00737-021-01195-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022]
Abstract
Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting up to 18% of women. Besides metabolic and fertility aspects, attention has lately been directed towards the detrimental effect of PCOS on psychological health. The objective of the study was to investigate whether women with PCOS are at higher risk for psychotic disorders. The study population derives from the Northern Finland Birth Cohort 1966 (N = 5889 women). The women with PCOS were identified by two simple questions on oligo-amenorrhea and hirsutism at age 31. Women reporting both symptoms were considered PCOS (N = 124) and asymptomatic women as controls (N = 2145). The diagnosis of psychosis was traced using multiple national registers up to the year 2016. Symptoms of psychopathology were identified using validated questionnaires at age 31. Women with PCOS showed an increased risk for any psychosis by age 50 (HR [95% CI] 2.99, [1.52-5.82]). Also, the risk for psychosis after age 31 was increased (HR 2.68 [1.21-5.92]). The results did not change after adjusting for parental history of psychosis, nor were they explained by body mass index or hyperandrogenism at adulthood. The scales of psychopathology differed between women with PCOS and non-PCOS controls showing more psychopathologies among the affected women. PCOS cases were found to be at a three-fold risk for psychosis, and they had increased psychopathological symptoms. PCOS should be taken into consideration when treating women in psychiatric care. More studies are required to further assess the relationship between PCOS and psychotic diseases.
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Martens N, Destoop M, Dom G. Organization of Community Mental Health Services for Persons with a Severe Mental Illness and Comorbid Somatic Conditions: A Systematic Review on Somatic Outcomes and Health Related Quality of Life. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E462. [PMID: 33435525 PMCID: PMC7826863 DOI: 10.3390/ijerph18020462] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/11/2020] [Accepted: 12/30/2020] [Indexed: 12/20/2022]
Abstract
It is well established that persons with a severe mental illness (SMI) have a greater risk of physical comorbid conditions and premature mortality. Most studies in the field of community mental health care (CMHC) have only focused on improving cardiovascular health in people with a SMI using lifestyle approaches. Studies using organizational modifications are rather scarce. This systematic review aimed to synthesize and describe possible organizational strategies to improve physical health for persons with a SMI in CMHC. The primary outcome was Health-related Quality of Life (HR-QOL). Results suggested modest effects on quality of life and were inconsistent throughout all the included studies. Despite these findings, it appears that a more integrated approach had a positive effect on health outcomes, patient satisfaction and HR-QOL. The complexity of the processes involved in community care delivery makes it difficult to compare different models and organizational approaches. Mental health nurses were identified as possible key professionals in care organization, but no clear description of their role was found. This review could provide new insights into contributing factors for integrated care. Future research targeting the identification of the nurses' role and facilitating factors in integrated care, in order to improve treatment and follow-up of somatic comorbidities, is recommended.
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Affiliation(s)
- Nicolaas Martens
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, B-2000 Antwerp, Belgium; (M.D.); (G.D.)
- Multiversum Mental Health Services, B-2530 Boechout, Belgium
- Department of Health and Welfare, Karel De Grote University College, B-2018 Antwerp, Belgium
| | - Marianne Destoop
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, B-2000 Antwerp, Belgium; (M.D.); (G.D.)
- Multiversum Mental Health Services, B-2530 Boechout, Belgium
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, B-2000 Antwerp, Belgium; (M.D.); (G.D.)
- Multiversum Mental Health Services, B-2530 Boechout, Belgium
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Abstract
PURPOSE OF REVIEW Despite of the heightened risks and burdens of physical comorbidities across the entire spectrum of mental disorders, relatively little is known about physical multimorbidity in this population. The aim of this narrative review is to present recent data regarding the onset and accumulation of physical multimorbidity and to assess its impact on the onset, course, treatment, and outcomes of mental disorders. RECENT FINDINGS A substantial body of literature shows increased risk of physical multimorbidity among people with mental disorders. The disparity in physical multimorbidity occurs even before the diagnosis of mental disorder, and the younger age group appears to be at particular risk. Numerous patterns of association between mental disorders and medical disorders involving multiple organ systems have been identified. Physical multimorbidity affects people with mental disorders across their life spans, is associated with a wide range of unfavorable outcomes and presents significant clinical and public health concerns. SUMMARY To address physical health inequalities among people with mental disorders compared with the general population, we must focus on the physical health from the very first point of contact with a mental health service. Treatment of mental disorders must be customized to meet the needs of patients with different physical multimorbidity patterns. Future work is needed to clarify how physical multimorbidity influences mental disorder treatment outcomes.
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Ruppelt F, Rohenkohl A, Kraft V, Schöttle D, Schröter R, Gaianigo J, Werkle N, Daubmann A, Karow A, Lambert M. Course, remission and recovery in patients with severe psychotic disorders with or without comorbid substance use disorders: Long-term outcome in evidence-based integrated care (ACCESS II study). Schizophr Res 2020; 222:437-443. [PMID: 32507378 DOI: 10.1016/j.schres.2020.03.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/27/2020] [Accepted: 03/27/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES People with psychotic disorders have a high prevalence of comorbid mental disorders, especially if severe mental illness (SMI) criteria are fulfilled. Substance Use Disorders (SUD) are the most common comorbidity. The aim of the study is to investigate whether SMI patients with and without comorbid SUD have a comparable course, remission and recovery rates within evidence-based care. METHODS ACCESS is an integrated care model for patients with severe nonaffective and affective psychotic disorders. Treatment trajectories of patients, who have been in ACCESS care for at least 4 years, with and without SUD were compared with regard to the course of illness using Mixed Model Repeated Measures (MMRM) as well as recovery rates and its predictors. RESULTS 187 of 312 patients (60%) were at least 4 years in ACCESS. Of these, 126 (67.4%) had a comorbid SUD at admission. Patients had on average 2.96 SUD, 87 (69%) had a dependence. Both groups improved significantly over 4 years in all outcome parameters. However, patients with substance dependence showed significantly worse outcomes in psychopathology (p < 0.001), functioning (p = 0.006) and quality of life (p = 0.026). Using LOCF, 44 patients (23.5%) fulfilled recovery criteria at endpoint. Comorbid substance use dependence was the only significant predictor for non-recovery (OR = 0.462, p = 0.048). CONCLUSION SUD and especially substance dependence are common in psychotic disorders with SMI. Evidence-based integrated care also leads to long-term improvement in these patients, but to a lesser extent than in patients without SUD. In particular, the "optimal" outcome recovery is made more difficult by SUD dependence.
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Affiliation(s)
- Friederike Ruppelt
- Center for Psychosis and Integrated Care, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246 Hamburg, Germany.
| | - Anja Rohenkohl
- Center for Psychosis and Integrated Care, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246 Hamburg, Germany.
| | - Vivien Kraft
- Center for Psychosis and Integrated Care, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246 Hamburg, Germany.
| | - Daniel Schöttle
- Center for Psychosis and Integrated Care, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246 Hamburg, Germany.
| | - Romy Schröter
- Center for Psychosis and Integrated Care, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246 Hamburg, Germany.
| | - Julia Gaianigo
- Center for Psychosis and Integrated Care, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246 Hamburg, Germany.
| | - Nathalie Werkle
- Center for Psychosis and Integrated Care, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246 Hamburg, Germany.
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, UKE, Hamburg, Germany.
| | - Anne Karow
- Center for Psychosis and Integrated Care, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246 Hamburg, Germany.
| | - Martin Lambert
- Center for Psychosis and Integrated Care, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Martinistr. 52, 20246 Hamburg, Germany.
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Lambert M, Karow A, Gallinat J, Lüdecke D, Kraft V, Rohenkohl A, Schröter R, Finter C, Siem AK, Tlach L, Werkle N, Bargel S, Ohm G, Hoff M, Peter H, Scherer M, Mews C, Pruskil S, Lüke J, Härter M, Dirmaier J, Schulte-Markwort M, Löwe B, Briken P, Peper H, Schweiger M, Mösko M, Bock T, Wittzack M, Meyer HJ, Deister A, Michels R, Herr S, Konnopka A, König H, Wegscheider K, Daubmann A, Zapf A, Peth J, König HH, Schulz H. Study protocol for a randomised controlled trial evaluating an evidence-based, stepped and coordinated care service model for mental disorders (RECOVER). BMJ Open 2020; 10:e036021. [PMID: 32371520 PMCID: PMC7223141 DOI: 10.1136/bmjopen-2019-036021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/23/2020] [Accepted: 04/03/2020] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Healthcare systems around the world are looking for solutions to the growing problem of mental disorders. RECOVER is the synonym for an evidence-based, stepped and cross-sectoral coordinated care service model for mental disorders. RECOVER implements a cross-sectoral network with managed care, comprehensive psychological, somatic and social diagnostics, crisis resolution and a general structure of four severity levels, each with assigned evidence-based therapy models (eg, assertive community treatment) and therapies (eg, psychotherapy). The study rationale is the investigation of the effectiveness and efficiency of stepped and integrated care in comparison to standard care. METHODS AND ANALYSIS The trial is conducted in accordance to the Standard Protocol Items: Recommendations for Interventional Trials Statement. The study aims to compare the RECOVER model with treatment as usual (TAU). The following questions are examined: Does RECOVER reduce healthcare costs compared with TAU? Does RECOVER improve patient-relevant outcomes? Is RECOVER cost-effective compared with TAU? A total sample of 890 patients with mental disorders will be assessed at baseline and individually randomised into RECOVER or TAU. Follow-up assessments are conducted after 6 and 12 months. As primary outcomes, cost reduction, improvement in symptoms, daily functioning and quality of life as well as cost-effectiveness ratios will be measured. In addition, several secondary outcomes will be assessed. Primary and secondary outcomes are evaluated according to the intention-to-treat principle. Mixed linear or logistic regression models are used with the direct maximum likelihood estimation procedure which results in unbiassed estimators under the missing-at-random assumption. Costs due to healthcare utilisation and productivity losses are evaluated using difference-in-difference regressions. ETHICS AND DISSEMINATION Ethical approval from the ethics committee of the Hamburg Medical Association has been obtained (PV5672). The results will be disseminated to service users and their families via the media, to healthcare professionals via professional training and meetings and to researchers via conferences and publications. TRIAL REGISTRATION NUMBER AND REGISTRY NAME ClinicalTrials.gov (NCT03459664), RECOVER PROTOCOL VERSION: 19 March 2020 (V.3.0).
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Affiliation(s)
- Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Karow
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Lüdecke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vivien Kraft
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Rohenkohl
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Romy Schröter
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Constanze Finter
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna-Katharina Siem
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lisa Tlach
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nathalie Werkle
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susann Bargel
- Department of Strategic Business Development, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gunda Ohm
- Department of Strategic Business Development, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Hoff
- Department of Strategic Business Development, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Helmut Peter
- Ambulatory Healthcare Center for Psychotherapy, Psychiatry and Psychosomatic, Cognitive-Behavioral Therapy Falkenried MVZ GmbH, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claudia Mews
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Pruskil
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Lüke
- Department of General Practice/Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Schulte-Markwort
- Department of Child- and Youth Psychiatry, Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heike Peper
- Chamber for Psychotherapists Hamburg, Hamburg, Germany
| | - Michael Schweiger
- Service Provider for vocational rehabilitation, ARINET GmbH, Hamburg, Hamburg, Germany
| | - Mike Mösko
- Department of Medical Psychology, Research Group on Migration and Psychosocial Health, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Bock
- Irre Menschlich Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
| | - Martin Wittzack
- Regional Psychiatric Patient Association Hamburg e.V, Hamburg, Germany
| | - Hans-Jochim Meyer
- Regional Psychiatric Relative Association Hamburg e.V, Hamburg, Germany
| | - Arno Deister
- Center for Psychosocial Medicine, Klinikum Itzehoe, Itzehoe, Schleswig-Holstein, Germany
| | - Rolf Michels
- Center for Psychosocial Medicine, Klinikum Itzehoe, Itzehoe, Schleswig-Holstein, Germany
| | - Stephanie Herr
- Center for Psychosocial Medicine, Klinikum Itzehoe, Itzehoe, Schleswig-Holstein, Germany
| | - Alexander Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hannah König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Wegscheider
- Institute of Medical Biometry and Epidemiology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Daubmann
- Institute of Medical Biometry and Epidemiology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Judith Peth
- Department of Medical Psychology, Professorship Clinical Healthcare Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Holger Schulz
- Department of Medical Psychology, Professorship Clinical Healthcare Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Karow A, Brettschneider C, Helmut König H, Correll CU, Schöttle D, Lüdecke D, Rohenkohl A, Ruppelt F, Kraft V, Gallinat J, Lambert M. Better care for less money: cost-effectiveness of integrated care in multi-episode patients with severe psychosis. Acta Psychiatr Scand 2020; 141:221-230. [PMID: 31814102 DOI: 10.1111/acps.13139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/04/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare cost-effectiveness of integrated care with therapeutic assertive community treatment (IC-TACT) versus standard care (SC) in multiple-episode psychosis. METHOD Twelve-month IC-TACT in patients with schizophrenia-spectrum and bipolar I disorders were compared with a historical control group. Primary outcomes were entropy-balanced cost-effectiveness based on mental healthcare costs from a payers' perspective and quality-adjusted life years (QALYs) as a measure of health effects during 12-month follow-up. RESULTS At baseline, patients in IC-TACT (n = 214) had significantly higher illness severity and lower functioning than SC (n = 56). Over 12 months, IC-TACT had significantly lower days in inpatient (10.3 ± 20.5 vs. 28.2 ± 44.9; P = 0.005) and day-clinic care (2.6 ± 16.7 vs. 16.4 ± 33.7; P = 0.004) and correspondingly lower costs (€-55 084). Within outpatient care, IC-TACT displayed a higher number of treatment contacts (116.3 ± 45.3 vs. 15.6 ± 6.3) and higher related costs (€+1417). Both resulted in lower total costs in IC-TACT (mean difference = €-13 248 ± 2975, P < 0.001). Adjusted incremental QALYs were significantly higher for IC-TACT versus SC (+0.10 ± 0.37, P = 0.05). The probability of cost-effectiveness of IC-TACT was constantly higher than 99%. CONCLUSION IC-TACT was cost-effective compared with SC. The use of prima facies 'costly' TACT teams is highly recommended to improve outcomes and save total cost for patients with severe psychotic disorders.
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Affiliation(s)
- A Karow
- Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Brettschneider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C U Correll
- Recognition and Prevention Program, Zucker Hillside Hospital, New York, NY, USA.,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, New York, NY, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - D Schöttle
- Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D Lüdecke
- Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Rohenkohl
- Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F Ruppelt
- Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - V Kraft
- Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J Gallinat
- Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Lambert
- Competence Centre for Integrated Care in Mental Disorders, Centre for Psychosocial Medicine, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Ralat SI, Barrios RI. THE MANAGEMENT OF CARDIOVASCULAR DISEASE RISK FACTORS IN BIPOLAR DISORDER PATIENTS IN PRIMARY HEALTHCARE SETTINGS. REVISTA PUERTORRIQUENA DE PSICOLOGIA 2020; 31:62-78. [PMID: 34221244 PMCID: PMC8249201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Accumulating evidence supports the association between cardiovascular disease (CVD) risk factors and bipolar disorder (BD). CVD is the leading cause of morbidity and mortality in patients with bipolar disorder. However, there is a need to study the management of the risk factors in the primary healthcare context. This narrative review aims to appraise the different approaches of care that have been used in the management of these patients to address CVD risk factors in primary care. We reviewed articles from PubMed, Science Direct and other studies cited in the articles found. The keywords used for this review included "bipolar," "bipolar disorder," "cardiovascular" or "metabolic syndrome," "screening," "primary care," and "integrative" or "integrated care model" or "collaborative care model." This review includes studies published over a period of 48 months (January 2016 through December 2019). We identified 128 articles, removing two duplicates. From them, 115 articles are excluded based on the inclusion/exclusion criteria leaving eleven relevant articles. Upon full-text review, six studies were excluded. The final studies included are five. We used the study-quality assessment tools from the National Heart, Lung, and Blood Institute to assess the quality of the articles found. CVD risk factors in patients with BD and forms of other severe mental illness (SMI) are often underdetected. Primary healthcare providers need to identify these risk factors in the management of these patients to determine and recommend appropriate strategies.
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Affiliation(s)
- Sandra I. Ralat
- Department of Psychiatry, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Rossana I. Barrios
- Conrado F. Asenjo Library, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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16
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[Healthcare research in the living environment]. DER NERVENARZT 2019; 90:1093-1102. [PMID: 31482184 DOI: 10.1007/s00115-019-00793-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Healthcare research in the living environment is focused on the scientific investigation of care, which is delivered in the personal environment of those affected by diseases. OBJECTIVE Presentation of the healthcare policy starting position, content and evidence of forms of care by which treatment focuses on the living environment of affected persons. Presentation of the RECOVER model, by which these forms of care are integrated and coordinated in a care model. MATERIAL AND METHODS Literature search on "care or treatment models" and "psychiatric disease" over the last 10 years. RESULTS Many experts are calling for the introduction of integrated and coordinated care as well as the digitalization of the healthcare system as essential future solutions. Evidence-based forms of care, which have a main focus on the living environment of those concerned, play an important role here. These include, for example early diagnosis and treatment of psychoses (early psychosis services, EPS), crisis resolution team (CRT), assertive community treatment (ACT), supported employment (SE) and e‑mental health. With the exception of CRT, which can be financed as a hospital ward equivalent treatment according to §§ 39 and 115d (German Social Code V, SGB V), many of these treatment models are not yet part of standard care in Germany. In an integrated and coordinated care system these components work together in a meaningful and coordinated manner in defined care processes. This approach is currently being tested using the so-called RECOVER model, a severity level, evidence-based and cross-sectoral coordinated care model, where implementation, testing and transfer from 2017-2020 will be promoted by the Innovation Fund of the Joint Federal Committee (G-BA).
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Abstract
PURPOSE OF REVIEW Previous research has demonstrated the high prevalence of medical comorbidity and multimorbidity among patients with schizophrenia. However, little is known regarding the potential effects of chronic physical illness (CPI) on schizophrenia treatment outcomes. In the present report, we aim to provide an updated review of the relevant literature. RECENT FINDINGS We searched MEDLINE for studies published between 2017 and 2018. After screening 683 articles, we included six studies of adequate quality. Five of these studies reported significant associations between several CPIs and different schizophrenia treatment outcomes, whereas the remaining study did not. Significant effects were low to moderate in size. CPIs with significant effects on treatment outcomes included metabolic syndrome, cardiovascular disease, and asthma. No significant effects were observed for diabetes, chronic obstructive pulmonary disease, hepatitis, hypertension, hyperlipidemia, or lung conditions. One study reported a significant association between the total number of CPIs and the overall number of psychiatric rehospitalizations. SUMMARY In addition to increasing the risk of premature mortality, accumulating evidence indicates that various CPIs affect schizophrenia treatment outcomes. Thus, researchers and healthcare practitioners should increase efforts to raise awareness regarding the importance of physical health among patients with schizophrenia. Further high-quality studies are required, particularly those targeting the potential effects of individual CPIs.
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18
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Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C, Allan S, Caneo C, Carney R, Carvalho AF, Chatterton ML, Correll CU, Curtis J, Gaughran F, Heald A, Hoare E, Jackson SE, Kisely S, Lovell K, Maj M, McGorry PD, Mihalopoulos C, Myles H, O'Donoghue B, Pillinger T, Sarris J, Schuch FB, Shiers D, Smith L, Solmi M, Suetani S, Taylor J, Teasdale SB, Thornicroft G, Torous J, Usherwood T, Vancampfort D, Veronese N, Ward PB, Yung AR, Killackey E, Stubbs B. The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry 2019; 6:675-712. [PMID: 31324560 DOI: 10.1016/s2215-0366(19)30132-4] [Citation(s) in RCA: 741] [Impact Index Per Article: 148.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Joseph Firth
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Najma Siddiqi
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK; Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain; Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Simon Rosenbaum
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Cherrie Galletly
- Ramsay Health Care Mental Health, Adelaide, SA, Australia; Northern Adelaide Local Health Network, Adelaide, SA, Australia; Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Constanza Caneo
- Departamento de Psiquiatría, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rebekah Carney
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Andre F Carvalho
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Mary Lou Chatterton
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Christoph U Correll
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Jackie Curtis
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Fiona Gaughran
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adrian Heald
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
| | - Erin Hoare
- Food and Mood Centre, Deakin University, Melbourne, VIC, Australia
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Steve Kisely
- School of Medicine, University of Queensland, Brisbane, QLD, Australia; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Patrick D McGorry
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Hannah Myles
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Brian O'Donoghue
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Toby Pillinger
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Medical Research Council London Institute of Medical Sciences, London, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia; The Melbourne Clinic, Melbourne, VIC, Australia
| | - Felipe B Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - David Shiers
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Marco Solmi
- Neurosciences Department and Padua Neuroscience Centre, University of Padua, Padua, Italy
| | - Shuichi Suetani
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Johanna Taylor
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK
| | - Scott B Teasdale
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of General Practice, Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium; University Psychiatric Centre, Katholieke Universiteit Leuven, Kortenberg, Belgium
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Philip B Ward
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Alison R Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Innovative Versorgungsmodelle für Menschen mit schizophrenen Erkrankungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:163-172. [DOI: 10.1007/s00103-018-2868-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Schöttle D, Ruppelt F, Schimmelmann BG, Karow A, Bussopulos A, Gallinat J, Wiedemann K, Luedecke D, Rohenkohl AC, Huber CG, Bock T, Lambert M. Reduction of Involuntary Admissions in Patients With Severe Psychotic Disorders Treated in the ACCESS Integrated Care Model Including Therapeutic Assertive Community Treatment. Front Psychiatry 2019; 10:736. [PMID: 31708810 PMCID: PMC6822062 DOI: 10.3389/fpsyt.2019.00736] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/13/2019] [Indexed: 01/12/2023] Open
Abstract
Objective: The ACCESS treatment model offers assertive community treatment (ACT) embedded in an integrated care program to patients with severe psychotic disorders. Compared to standard care, it proved to be more effective in terms of service disengagement and other outcomes in patients with psychotic disorders over 12, 24, and 48 months. Many patients with severe mental disorders experience involuntary admissions which can be potentially traumatic. In this study, we assessed the effect of ACT on reducing involuntary admissions over an observation period of 4 years. Method: One hundred seventy-one patients treated in ACCESS were included in this study. The primary outcome was rate of involuntary admissions during 48 months. Secondary outcomes were differences between those with and without involuntary admissions in the 2 years prior to ACCESS regarding change of psychopathology, severity of illness, psychosocial functioning, quality of life, satisfaction with care, medication non-adherence, and service-disengagement. Results: Of 171 patients, 58 patients (33.9%) were involuntarily admitted to hospital in the past 2 years before entry. During the 4 years of treatment, 16 patients (9.4%) were involuntarily admitted to hospital which was a significantly lower rate compared to the 2 years before inclusion in ACCESS (p < .001). Comparing the two groups, larger improvements in severity of illness (p = .004) and functional status (p = .043) were detected in the group with no history of involuntary admissions. At 4-year follow-up, of the remaining patients, 69.2% (n = 81) were full adherent (p < .001), compared to 18.9% (n = 31) at baseline with no differences between the two groups over the study period (p = .25). Over 4 years, only 13 patients (13.2%) were service-disengaged due to non-practical reasons. Conclusions: In this long-term study, we were able to demonstrate a reduction in involuntary admissions in four treatment years compared to the 2 years prior to admission to the ACCESS model in patients with severe and mostly multiphase schizophrenia spectrum disorders and affective disorders with psychotic features. This may help prevent patients from suffering from a potentially traumatic experience during treatment in the psychiatric system. Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT01888627.
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Affiliation(s)
- Daniel Schöttle
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Friederike Ruppelt
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Benno G Schimmelmann
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland.,University Hospital of Child and Adolescent Psychiatry, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Karow
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandra Bussopulos
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jürgen Gallinat
- Department of Adult Psychiatry, Universitäre Psychiatrische Kliniken Basel (UPK), University of Basel, Basel, Switzerland
| | - Klaus Wiedemann
- Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel Luedecke
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Christine Rohenkohl
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian G Huber
- Department of Adult Psychiatry, Universitäre Psychiatrische Kliniken Basel (UPK), University of Basel, Basel, Switzerland
| | - Thomas Bock
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Lambert
- Psychosis Centre, Department of Psychiatry and Psychotherapy, University Centre of Psychosocial Medicine, Medical Center Hamburg-Eppendorf, Hamburg, Germany
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