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Gofton C, Bondezi K, Kotze B, McKee K, Yesudoss A, McCaughan G, George J. Micro-elimination of chronic hepatitis C virus in mental health settings: A prospective multicentre pragmatic trial. Drug Alcohol Rev 2024; 43:1247-1255. [PMID: 38773898 DOI: 10.1111/dar.13854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 03/24/2024] [Accepted: 03/27/2024] [Indexed: 05/24/2024]
Abstract
INTRODUCTION Hepatitis C virus (HCV) prevalence is high in the mental health population. We sought to evaluate testing and treatment uptake for HCV following the implementation of a universal nurse led study in inpatient and outpatient mental health populations. METHODS From January 2018 to December 2020, we screened mental health inpatients (n = 322) and community mental health patients (n = 615) for HCV with either specialist hepatology nurses or mental health nurses (mental health nurse). RESULTS 75.5% (464/615) of community patients and 100% (322/322) of inpatients consented to screening, with an HCV antibody-positive prevalence of 12.7% (59/464) in community patients and 19.6% (63/322) in inpatients. RNA detectable prevalence was 4.0% (22/464) and 7.5% (24/322), respectively. Community patients who were screened by specialist hepatology nurses were more likely to consent to screening (94.4% vs. 45.7%, p < 0.001) but had lower proportion of HCV antibody (10.5% vs. 20.3%, p < 0.001) and RNA detectable (4.0% vs. 7.5%, p = 0.018) when compared to mental health nurse screening. Engagement with treatment was 27.0% of community mental health patients and 45.8% of mental health inpatients undergoing treatment. All patients undergoing treatment and underwent sustained viral response (SVR) testing achieved SVR. DISCUSSION AND CONCLUSIONS Universal screening of HCV using a nurse-led model has high rates of success in mental health patients with high proportions undergoing screening, with no reduction in the rates of SVR achieved with DAA therapy compared to the general population. Further work is needed to bridge the gap between identification of HCV and treatment among mental health patients.
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Affiliation(s)
- Cameron Gofton
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and The University of Sydney, Sydney, New South Wales, Australia
- Department of Gastroenterology and Hepatology, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Department of Gastroenterology and Hepatology, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia
| | - Kindness Bondezi
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and The University of Sydney, Sydney, New South Wales, Australia
| | - Beth Kotze
- Sydney Local Health District, Sydney, New South Wales, Australia
| | - Kristen McKee
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and The University of Sydney, Sydney, New South Wales, Australia
| | - Antoni Yesudoss
- Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Geoff McCaughan
- AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, Sydney Local Health District, Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Jacob George
- Storr Liver Centre, Westmead Institute for Medical Research, Westmead Hospital and The University of Sydney, Sydney, New South Wales, Australia
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Rami FZ, Li L, Le TH, Kang C, Han MA, Chung YC. Risk and protective factors for severe mental disorders in Asia. Neurosci Biobehav Rev 2024; 161:105652. [PMID: 38608827 DOI: 10.1016/j.neubiorev.2024.105652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 03/22/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024]
Abstract
Among 369 diseases and injuries, the years lived with disability (YLDs) and disability-adjusted life-years (DALYs) rates for severe mental illnesses (SMIs) are within the top 20 %. Research on risk and protective factors for SMIs is critically important, as acting on modifiable factors may reduce their incidence or postpone their onset, while early detection of new cases enables prompt treatment and improves prognosis. However, as most of the studies on these factors are from Western countries, the findings are not generalizable across ethnic groups. This led us to conduct a systematic review of the risk and protective factors for SMIs identified in Asian studies. There were common factors in Asian and Western studies and unique factors in Asian studies. In-depth knowledge of these factors could help reduce disability, and the economic and emotional burden of SMIs. We hope that this review will inform future research and policy-making on mental health in Asian countries.
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Affiliation(s)
- Fatima Zahra Rami
- Department of Psychiatry, Jeonbuk National University Medical School, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University and Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Ling Li
- Department of Psychiatry, Jeonbuk National University Medical School, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University and Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Thi Hung Le
- Department of Psychiatry, Jeonbuk National University Medical School, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University and Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Chaeyeong Kang
- Research Institute of Clinical Medicine of Jeonbuk National University and Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Mi Ah Han
- Department of Preventive Medicine, College of Medicine, Chosun University, Republic of Korea
| | - Young-Chul Chung
- Department of Psychiatry, Jeonbuk National University Medical School, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University and Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea.
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Fountoulakis KN, Karakatsoulis GN, Abraham S, Adorjan K, Ahmed HU, Alarcón RD, Arai K, Auwal SS, Berk M, Bjedov S, Bobes J, Bobes-Bascaran T, Bourgin-Duchesnay J, Bredicean CA, Bukelskis L, Burkadze A, Cabrera Abud II, Castilla-Puentes R, Cetkovich M, Colon-Rivera H, Corral R, Cortez-Vergara C, Crepin P, De Berardis D, Zamora Delgado S, Lucena DD, Sousa AD, Stefano RD, Dodd S, Priyanka Elek L, Elissa A, Erdelyi-Hamza B, Erzin G, Etchevers MJ, Falkai P, Farcas A, Fedotov I, Filatova V, Fountoulakis NK, Frankova I, Franza F, Frias P, Galako T, Garay CJ, Garcia-Álvarez L, García-Portilla MP, Gonda X, Gondek TM, Morera González D, Gould H, Grandinetti P, Grau A, Groudeva V, Hagin M, Harada T, Hasan TM, Azreen Hashim N, Hilbig J, Hossain S, Iakimova R, Ibrahim M, Iftene F, Ignatenko Y, Irarrazaval M, Ismail Z, Ismayilova J, Jakobs A, Jakovljević M, Jakšić N, Javed A, Kafali HY, Karia S, Kazakova O, Khalifa D, Khaustova O, Koh S, Kopishinskaia S, Kosenko K, Koupidis SA, Kovacs I, Kulig B, Lalljee A, Liewig J, Majid A, Malashonkova E, Malik K, Malik NI, Mammadzada G, Mandalia B, Marazziti D, Marčinko D, Martinez S, Matiekus E, Mejia G, Memon RS, Meza Martínez XE, Mickevičiūtė D, Milev R, Mohammed M, Molina-López A, Morozov P, Muhammad NS, Mustač F, Naor MS, Nassieb A, Navickas A, Okasha T, Pandova M, Panfil AL, Panteleeva L, Papava I, Patsali ME, Pavlichenko A, Pejuskovic B, Pinto Da Costa M, Popkov M, Popovic D, Raduan NJN, Vargas Ramírez F, Rancans E, Razali S, Rebok F, Rewekant A, Ninoska Reyes Flores E, Rivera-Encinas MT, Saiz P, Sánchez de Carmona M, Saucedo Martínez D, Saw JA, Saygili G, Schneidereit P, Shah B, Shirasaka T, Silagadze K, Sitanggang S, Skugarevsky O, Spikina A, Mahalingappa SS, Stoyanova M, Szczegielniak A, Tamasan SC, Tavormina G, Tavormina MGM, Theodorakis PN, Tohen M, Tsapakis EM, Tukhvatullina D, Ullah I, Vaidya R, Vega-Dienstmaier JM, Vrublevska J, Vukovic O, Vysotska O, Widiasih N, Yashikhina A, Prezerakos PE, Smirnova D. Somatic multicomorbidity and disability in patients with psychiatric disorders in comparison to the general population: a quasi-epidemiological investigation in 54,826 subjects from 40 countries (COMET-G study). CNS Spectr 2024; 29:126-149. [PMID: 38269574 DOI: 10.1017/s1092852924000026] [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: 01/26/2024]
Abstract
BACKGROUND The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders. METHODS The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions. RESULTS About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15-20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome. CONCLUSIONS The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.
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Affiliation(s)
- Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki Greece, Thessaloniki, Greece
| | - Grigorios N Karakatsoulis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki Greece, Thessaloniki, Greece
| | - Seri Abraham
- Pennine Care NHS Foundation Trust, Heywood, UK
- Manchester Metropolitan University, Manchester, UK
- Core Psychiatry Training, Health Education England North West, Manchester, UK
| | - Kristina Adorjan
- Department of Psychiatry, Ludiwig-Maximilians-University, Munich, Germany
| | - Helal Uddin Ahmed
- Child Adolescent and Family Psychiatry, National Institute of Mental Health, Dhaka, Bangladesh
| | - Renato D Alarcón
- Section of Psychiatry and Mental Health, Universidad Peruana Cayetano Heredia, Facultad de Medicina Alberto Hurtado, Lima, Peru
- Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, Rochester, MN, USA
| | - Kiyomi Arai
- School of Medicine and Health Science, Institute of Health Science Shinshu University, Matsumoto, Japan
| | - Sani Salihu Auwal
- Department of Psychiatry, Bayero University, Kano, Nigeria
- Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Michael Berk
- IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Deakin University, School of Medicine, Barwon Health, Geelong, Australia
- Orygen The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Sarah Bjedov
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Julio Bobes
- Psychiatry Area, Department of Medicine, University of Oviedo, Oviedo, Spain
- Department of Psychiatry, Hospital Universitario Central de Asturias, Oviedo, Spain
- ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
| | - Teresa Bobes-Bascaran
- ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
- Mental Health Center of La Corredoria, Oviedo, Spain
- Department of Psychology, University of Oviedo, Oviedo, Spain
| | - Julie Bourgin-Duchesnay
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Groupe Hospitalier Nord Essonne, Orsay, France
| | - Cristina Ana Bredicean
- Department of Neuroscience, Discipline of Psychiatry, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Laurynas Bukelskis
- Clinic of Psychiatry, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - Akaki Burkadze
- Mental Hub, Tbilisi, Georgia
- NGO Healthcare Research and Quality Agency, Tbilisi, Georgia
| | | | - Ruby Castilla-Puentes
- Janssen Research and Development, Johnson & Johnson, American Society of Hispanic Psychiatry and WARMI Women Mental Health, Cincinnati, OH, USA
| | - Marcelo Cetkovich
- Institute of Translational and Cognitive Neuroscience (INCyT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Hector Colon-Rivera
- APM Board Certified in General Psychiatry and Neurology, Addiction Psychiatry, & Addiction Medicine, UPMC, DDAP, Philadelphia, PA, USA
| | - Ricardo Corral
- Department of Teaching and Research, Hospital Borda, Buenos Aires, Argentina
- University of Buenos Aires, Buenos Aires, Argentina
| | | | - Piirika Crepin
- Sanitaire and Social Union for Accompaniment and Prevention, Center of Ambulatory Psychiatry of Narbonne and Lezigan, Narbonne, France
| | - Domenico De Berardis
- Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", ASL Teramo, Teramo, Italy
- School of Nursing, University of L'Aquila, Italy
- Department of Neuroscience and Imaging, School of Psychiatry, University of Chieti, Chieti, Italy
| | - Sergio Zamora Delgado
- Child and Adolescent Psychiatry Department, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - David De Lucena
- Departamento de Fisiología e Farmacología, Universidade Federal do Ceará, Fortaleza, Ceará, Brazil
| | - Avinash De Sousa
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
- Desousa Foundation, Mumbai, Maharashtra, India
| | - Ramona Di Stefano
- Department of Biotechnological and Applied Clinical Sciences, Section of Psychiatry, University of L'Aquila, L'Aquila, Italy
| | - Seetal Dodd
- IMPACT - The Institute for Mental and Physical Health and Clinical Translation, Deakin University, School of Medicine, Barwon Health, Geelong, Australia
- Orygen The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health and the Department of Psychiatry, The University of Melbourne, Melbourne, Australia
- University Hospital Geelong, Barwon Health, Geelong, Victoria, Australia
| | - Livia Priyanka Elek
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Anna Elissa
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Berta Erdelyi-Hamza
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Gamze Erzin
- Department of Psychiatry, Ankara Dışkapı Training and Research Hospital, Ankara, Turkey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Martin J Etchevers
- Faculty of Psychology, University of Buenos Aires (UBA), Buenos Aires, Argentina
| | - Peter Falkai
- Department of Psychiatry, Ludiwig-Maximilians-University, Munich, Germany
| | - Adriana Farcas
- Centre of Neuroscience, Queen's University, Kingston, Ontario, Canada
| | - Ilya Fedotov
- Department of Psychiatry and Narcology, Ryazan State Medical University n.a. Academician I.P. Pavlov, Ryazan, Russia
| | - Viktoriia Filatova
- State Budgetary Institution of the Rostov Region "Psychoneurological Dispensary", Rostov-on-Don, Russia
| | | | - Iryna Frankova
- Medical Psychology, Psychosomatic Medicine and Psychotherapy Department, Bogomolets National Medical University, Kyiv, Ukraine
| | - Francesco Franza
- "Villa dei Pini" Psychiatric Rehabilitation Center, Avellino, Italy
- Psychiatric Studies Centre, Provaglio d'Iseo, Italy
| | | | - Tatiana Galako
- Department of Psychiatry, Medical Psychology and Drug Abuse, Kyrgyz State Medical Academy, Bishkek, Kyrgyz Republic
| | - Cristian J Garay
- Faculty of Psychology, University of Buenos Aires (UBA), Buenos Aires, Argentina
| | - Leticia Garcia-Álvarez
- ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
- Department of Psychology, University of Oviedo, Oviedo, Spain
| | - Maria Paz García-Portilla
- Psychiatry Area, Department of Medicine, University of Oviedo, Oviedo, Spain
- ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
- Mental Health Center of La Ería, Oviedo, Spain
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Tomasz M Gondek
- Specialty Training Section, Polish Psychiatric Association, Wroclaw, Poland
| | | | - Hilary Gould
- Department of Psychiatry, University of California San Diego, San Diego, USA
| | - Paolo Grandinetti
- Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", ASL Teramo, Teramo, Italy
| | - Arturo Grau
- Child and Adolescent Psychiatry Department, Hospital Luis Calvo Mackenna, Santiago, Chile
- Universidad Diego Portales, Santiago, Chile
| | - Violeta Groudeva
- Department of Diagnostic Imaging, University Hospital Saint Ekaterina, Sofia, Bulgaria
| | - Michal Hagin
- Forensic Psychiatry Unit, Abarbanel Mental Health Center, Bat Yam, Israel
| | - Takayuki Harada
- Faculty of Human Sciences, Education Bureau of the Laboratory Schools, University of Tsukuba, Tokyo, Japan
| | - Tasdik M Hasan
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
- Public Health Foundation, Dhaka, Bangladesh
| | - Nurul Azreen Hashim
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Jan Hilbig
- Clinic of Psychiatry, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - Sahadat Hossain
- Department of Public Health and Informatics, Jahangirnagar University, Dhaka, Bangladesh
| | - Rossitza Iakimova
- Second Psychiatric Clinic, University Hospital for Active Treatment in Neurology and Psychiatry "Saint Naum", Sofia, Bulgaria
| | - Mona Ibrahim
- Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Felicia Iftene
- Department of Psychiatry, Queens University, Kingston, ON, Canada
| | - Yulia Ignatenko
- Education Center, Mental Health Clinic No. 1 named after N.A. Alexeev of Moscow Healthcare Department, Moscow, Russia
| | - Matias Irarrazaval
- Ministry of Health, Millenium Institute for Research in Depression and Personality, Santiago, Chile
| | - Zaliha Ismail
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Jamila Ismayilova
- National Mental Health Center of the Ministry of Health of the Republic of Azerbaijan, Baku, Azerbaijan
| | - Asaf Jakobs
- Department of Psychiatry, Westchester Medical Center Health System, Valhalla, NY, USA
- New York Medical College, Valhalla, NY, USA
| | | | - Nenad Jakšić
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Afzal Javed
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
- Warwick Medical School, University of Warwick, Coventry, UK
- Pakistan Psychiatric Research Centre, Fountain House, Lahore, Pakistan
| | | | - Sagar Karia
- Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
| | | | - Doaa Khalifa
- Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Olena Khaustova
- Medical Psychology, Psychosomatic Medicine and Psychotherapy Department, Bogomolets National Medical University, Kyiv, Ukraine
| | - Steve Koh
- Department of Psychiatry, University of California San Diego, San Diego, USA
| | - Svetlana Kopishinskaia
- International Centre for Education and Research in Neuropsychiatry (ICERN), Samara State Medical University, Samara, Russia
- Kirov State Medical University, Kirov, Russia
| | - Korneliia Kosenko
- Department of Psychiatry, Drug Abuse and Psychology, Odessa National Medical University, Odessa, Ukraine
| | - Sotirios A Koupidis
- Occupational and Environmental Health Sector, Public Health Policy Department, School of Public Health, University of West Attica, Athens, Greece
| | - Illes Kovacs
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Barbara Kulig
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | | | - Justine Liewig
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Groupe Hospitalier Nord Essonne, Orsay, France
| | - Abdul Majid
- Department of Psychiatry, SKIMS Medical College, Srinagar, India
| | - Evgeniia Malashonkova
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Groupe Hospitalier Nord Essonne, Orsay, France
| | - Khamelia Malik
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Najma Iqbal Malik
- Department of Psychology, University of Sargodha, Sargodha, Pakistan
| | - Gulay Mammadzada
- Department of Psychiatry, Azerbaijan Medical University, Baku, Azerbaijan
| | | | - Donatella Marazziti
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy
- Unicamillus, Saint Camillus International University of Health Sciences, Rome, Italy
- Brain Research Foundation onus, Lucca, Italy
| | - Darko Marčinko
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Stephanie Martinez
- Department of Psychiatry, University of California San Diego, San Diego, USA
| | - Eimantas Matiekus
- Clinic of Psychiatry, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - Gabriela Mejia
- Department of Psychiatry, University of California San Diego, San Diego, USA
| | - Roha Saeed Memon
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | | | - Roumen Milev
- Department of Psychiatry, Queens University, Kingston, ON, Canada
| | - Muftau Mohammed
- Department of Clinical Services, Federal Neuropsychiatric Hospital, Kaduna, Nigeria
| | - Alejandro Molina-López
- General Office for the Psychiatric Services of the Ministry of Health, Mexico City, Mexico
| | - Petr Morozov
- Department of Postgraduate Education, Russian National Research Medical University n.a. N.I. Pirogov, Moscow, Russia
| | - Nuru Suleiman Muhammad
- Department of Community Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Filip Mustač
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Mika S Naor
- Sackler School of Medicine New York State American Program, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Amira Nassieb
- Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Alvydas Navickas
- Clinic of Psychiatry, Institute of Clinical Medicine, Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - Tarek Okasha
- Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Milena Pandova
- Second Psychiatric Clinic, University Hospital for Active Treatment in Neurology and Psychiatry "Saint Naum", Sofia, Bulgaria
| | - Anca-Livia Panfil
- Compartment of Liaison Psychiatry, "Pius Brinzeu" County Emergency Clinical Hospital, Timisoara, Romania
| | - Liliya Panteleeva
- Department of Medical Psychology, Psychiatry and Psychotherapy, Kyrgyz-Russian Slavic University, Bishkek, Kyrgyz Republic
| | - Ion Papava
- Department of Neuroscience, Discipline of Psychiatry, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Mikaella E Patsali
- School of Social Sciences, Hellenic Open University, Patras, Greece
- Department of Internal Medicine, Nicosia General Hospital, Nicosia, Cyprus
| | - Alexey Pavlichenko
- Education Center, Mental Health Clinic No. 1 named after N.A. Alexeev of Moscow Healthcare Department, Moscow, Russia
| | - Bojana Pejuskovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinical Department for Crisis and Affective Disorders, Institute of Mental Health, Belgrade, Serbia
| | - Mariana Pinto Da Costa
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Mikhail Popkov
- Department of the Introduction to Internal Medicine and Family Medicine, International Higher School of Medicine, Bishkek, Kyrgyz Republic
| | | | - Nor Jannah Nasution Raduan
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Francisca Vargas Ramírez
- Child and Adolescent Psychiatry Department, Hospital Luis Calvo Mackenna, Santiago, Chile
- Universidad Diego Portales, Santiago, Chile
| | - Elmars Rancans
- Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia
- Riga Centre of Psychiatry and Narcology, Riga, Latvia
| | - Salmi Razali
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Federico Rebok
- Servicio de Emergencia, Acute inpatient Unit, Hospital Moyano, Buenos Aires, Argentina
- Argentine Institute of Clinical Psychiatry (IAPC), Buenos Aires, Argentina
| | - Anna Rewekant
- General Psychiatry Unit I, Greater Poland Neuropsychiatric Center, Kościan, Poland
| | | | - María Teresa Rivera-Encinas
- Centro de Investigación en Salud Pública, Facultad de Medicina, Universidad de San Martín de Porres, Instituto Nacional de Salud Mental "Honorio Delgado - Hideyo Noguchi", Lima, Perú
| | - Pilar Saiz
- Psychiatry Area, Department of Medicine, University of Oviedo, Oviedo, Spain
- ISPA, INEUROPA, CIBERSAM, Oviedo, Spain
- Mental Health Center of La Corredoria, Oviedo, Spain
| | | | - David Saucedo Martínez
- Department of Psychiatry, Escuela Nacional de Medicina, TEC de Monterrey, Servicio de geriatría. Hospital Universitario "José Eleuterio González" UANL, Monterrey, Nuevo León, Mexico
| | - Jo Anne Saw
- Department of Psychiatry, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Görkem Saygili
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, Tilburg, The Netherlands
| | - Patricia Schneidereit
- Klinik für Allgemeine Psychiatrie und Psychotherapie Ost, Psychiatrische Institutsambulanz, Klinikum am Weissenhof, Weissenhof, Germany
| | - Bhumika Shah
- DY Patil Medical College, Navi Mumbai, Maharashtra, India
| | - Tomohiro Shirasaka
- Department of Psychiatry, Teine Keijinkai Medical Center, Sapporo, Japan
| | | | - Satti Sitanggang
- Psychiatric Unit, Pambalah Batung General Hospital, South Kalimantan, Amuntai, Indonesia
| | - Oleg Skugarevsky
- Department of Psychiatry and Medical Psychology, Belarusian State Medical University, Minsk, Belarus
| | - Anna Spikina
- Saint Petersburg Psychoneurological Dispensary No. 2, Saint Petersburg, Russia
| | - Sridevi Sira Mahalingappa
- Derbyshire Healthcare NHS Foundation Trust, The Liasion Team, Royal Derby Hospital, Derby, Derbyshire, UK
| | - Maria Stoyanova
- Second Psychiatric Clinic, University Hospital for Active Treatment in Neurology and Psychiatry "Saint Naum", Sofia, Bulgaria
| | - Anna Szczegielniak
- Department of Psychiatric Rehabilitation, Department of Psychiatry and Psychotherapy, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Poland
| | - Simona Claudia Tamasan
- Compartment of Liaison Psychiatry, "Pius Brinzeu" County Emergency Clinical Hospital, Timisoara, Romania
| | - Giuseppe Tavormina
- Psychiatric Studies Centre, Provaglio d'Iseo, Italy
- European Depression Association and Italian Association on Depression, Brussels, Belgium
- Bedforshire Center for Mental Health Research, University of Cambridge, Cambridge, UK
| | | | | | - Mauricio Tohen
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of New Mexico, Albuquerque, Nm, USA
| | - Eva Maria Tsapakis
- "Agios Charalambos" Mental Health Clinic, Heraklion, Crete, Greece
- 1st Department of Academic Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Greece
| | - Dina Tukhvatullina
- Centre for Global Public Health, Institute of Population Health Sciences, Queen Mary University of London, London, UK
| | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
| | - Ratnaraj Vaidya
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Jelena Vrublevska
- Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia
- Riga Centre of Psychiatry and Narcology, Riga, Latvia
- Institute of Public Health, Riga Stradins University, Riga, Latvia
| | - Olivera Vukovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Research and Education, Institute of Mental Health, Belgrade, Serbia
| | - Olga Vysotska
- Educational and Research Center - Ukrainian Family Medicine Training Center, Bogomolets National Medical University, Kyiv, Ukraine
| | - Natalia Widiasih
- Department of Psychiatry, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia
| | - Anna Yashikhina
- International Centre for Education and Research in Neuropsychiatry (ICERN), Samara State Medical University, Samara, Russia
- Department of Psychiatry, Narcology, Psychotherapy and Clinical Psychology, Samara State Medical University, Samara, Russia
| | - Panagiotis E Prezerakos
- Department of Nursing, University of Peloponnese, Laboratory of Integrated Health Care, Tripoli, Greece
| | - Daria Smirnova
- International Centre for Education and Research in Neuropsychiatry (ICERN), Samara State Medical University, Samara, Russia
- Department of Psychiatry, Narcology, Psychotherapy and Clinical Psychology, Samara State Medical University, Samara, Russia
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Wootten JC, Richard L, Lam M, Blanchette PS, Solmi M, Anderson KK. Treatment and Mortality Following Cancer Diagnosis Among People With Non-affective Psychotic Disorders in Ontario, Canada: A Retrospective Cohort Study. Schizophr Bull 2024:sbae013. [PMID: 38431887 DOI: 10.1093/schbul/sbae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
BACKGROUND AND HYPOTHESIS People with psychotic disorders have a higher risk of mortality following cancer diagnosis, compared to people without psychosis. The extent to which this disparity is influenced by differences in cancer-related treatment is currently unknown. We hypothesized that, following a cancer diagnosis, people with psychotic disorders were less likely to receive treatment and were at higher risk of death than those without psychosis. STUDY DESIGN We constructed a retrospective cohort of cases of non-affective psychotic disorder (NAPD) and a general population comparison group, using Ontario Health (OH) administrative data. We identified cases of all cancers diagnosed between 1995 and 2019 and obtained information on cancer-related treatment and mortality. Cox proportional hazards models were used to compare the probability of having a consultation with an oncologist and receiving cancer-related treatment, adjusting for tumor site and stage. We also compared the rate of all-cause and cancer-related mortality between the two groups, adjusting for tumor site. STUDY RESULTS Our analytic sample included 24 944 people diagnosed with any cancer. People with NAPD were less likely to receive treatment than people without psychosis (HR = 0.87, 95% CI = 0.82, 0.91). In addition, people with NAPD had a greater risk of death from any cause (HR = 1.68, 95% CI = 1.60, 1.76), compared to people without NAPD. CONCLUSIONS The lower likelihood of receiving cancer treatment reflects disparities in accessing cancer care for people with psychotic disorders, which may partially explain the higher mortality risk following cancer diagnosis. Future research should explore mediating factors in this relationship to identify targets for reducing health disparities.
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Affiliation(s)
- Jared C Wootten
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | | | | | - Phillip S Blanchette
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- ICES Western, London, ON, Canada
- Division of Medical Oncology, Department of Oncology, London Regional Cancer Program, London Health Sciences Centre, Western University, London, ON, Canada
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, Regional Centre for the Treatment of Eating Disorders and On Track: The Champlain First Episode Psychosis Program, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Department of Psychiatry, Western University, London, ON, Canada
- ICES Western, London, ON, Canada
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Beridze G, Abbadi A, Ars J, Remelli F, Vetrano DL, Trevisan C, Pérez LM, López-Rodríguez JA, Calderón-Larrañaga A. Patterns of multimorbidity in primary care electronic health records: A systematic review. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2024; 14:26335565231223350. [PMID: 38298757 PMCID: PMC10829499 DOI: 10.1177/26335565231223350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/12/2023] [Indexed: 02/02/2024]
Abstract
Background Multimorbidity, the coexistence of multiple chronic conditions in an individual, is a complex phenomenon that is highly prevalent in primary care settings, particularly in older individuals. This systematic review summarises the current evidence on multimorbidity patterns identified in primary care electronic health record (EHR) data. Methods Three databases were searched from inception to April 2022 to identify studies that derived original multimorbidity patterns from primary care EHR data. The quality of the included studies was assessed using a modified version of the Newcastle-Ottawa Quality Assessment Scale. Results Sixteen studies were included in this systematic review, none of which was of low quality. Most studies were conducted in Spain, and only one study was conducted outside of Europe. The prevalence of multimorbidity (i.e. two or more conditions) ranged from 14.0% to 93.9%. The most common stratification variable in disease clustering models was sex, followed by age and calendar year. Despite significant heterogeneity in clustering methods and disease classification tools, consistent patterns of multimorbidity emerged. Mental health and cardiovascular patterns were identified in all studies, often in combination with diseases of other organ systems (e.g. neurological, endocrine). Discussion These findings emphasise the frequent coexistence of physical and mental health conditions in primary care, and provide useful information for the development of targeted preventive and management strategies. Future research should explore mechanisms underlying multimorbidity patterns, prioritise methodological harmonisation to facilitate the comparability of findings, and promote the use of EHR data globally to enhance our understanding of multimorbidity in more diverse populations.
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Affiliation(s)
- Giorgi Beridze
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Aging Research Center, Stockholm, Sweden
| | - Ahmad Abbadi
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Aging Research Center, Stockholm, Sweden
| | - Joan Ars
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Aging Research Center, Stockholm, Sweden
- RE-FiT Barcelona Research group, Vall d'Hebron Institute of Research (VHIR) and Parc Sanitari Pere Virgili, Barcelona, Spain
- Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesca Remelli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Davide L Vetrano
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Aging Research Center, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Caterina Trevisan
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Aging Research Center, Stockholm, Sweden
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Laura-Mónica Pérez
- RE-FiT Barcelona Research group, Vall d'Hebron Institute of Research (VHIR) and Parc Sanitari Pere Virgili, Barcelona, Spain
| | - Juan A López-Rodríguez
- Research Unit, Primary Health Care Management, Madrid, Spain
- Department of Medical Specialties and Public Health, Faculty of Health Sciences Rey Juan Carlos University, Madrid, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Carlos III Health Institute, Madrid, Spain
| | - Amaia Calderón-Larrañaga
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Aging Research Center, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Carlos III Health Institute, Madrid, Spain
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Grassi L, McFarland D, Riba M. The Risk and The Course of Cancer Among People with Severe Mental Illness. Clin Pract Epidemiol Ment Health 2023; 19:e174501792301032. [PMID: 38659632 PMCID: PMC11037550 DOI: 10.2174/17450179-v17-e211208-2021-ht2-1910-8] [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: 02/27/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 04/26/2024]
Abstract
The paucity of data regarding patients with Serious Mental Illness (SMI) and cancer is alarming given the fact that people with SMI, especially schizophrenia, bipolar disorders and severe depressive disorders, have in general poorer access to physical health care and higher morbidity and mortality because of physical illnesses. The aims of this review were to examine the current evidence from existing literature on the risk of developing cancer and its course among people with SMI. Equivocal results emerge regarding the risk of developing some kind of cancer among people with SMI, with contrasting data on a possible higher, similar or lower risk in comparison with the general population. In contrast, a series of studies have pointed out that patients with SMI who develop cancer are less likely to receive standard levels of cancer care, both in terms of screening, diagnosis and treatment. Also, the mortality for cancer has been confirmed to be higher than the general population. A global sensitization about these problems is mandatory in an era in which community psychiatry has been developed in all countries and that policies of prevention, treatment, follow up, and palliative care should regard all the segments of the population, including people with SMI, through an interdisciplinary approach.
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Affiliation(s)
- Luigi Grassi
- Department of Neuroscience and Rehabilitation, DInstitute of Psychiatry, University of Ferrara and University Hospital Psychiatric Unit, Ferrara, Italy
| | - Daniel McFarland
- Department of Medicine, Hofstra University, Northwell Health, Lenox Hill Hospital, New York, NY, US
| | - Michelle Riba
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
- Psycho-oncology Program, University of Michigan Depression Center and Rogel Cancer Center, Ann Arbor, MI, USA
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7
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Lyngdoh LAM, Antony S, Basavarajappa C, Kalyanasundaram JR, Ammapattian T. Marriage in persons with severe mental illness: A narrative review-based framework for a supported relationship. J Family Med Prim Care 2023; 12:3033-3041. [PMID: 38361907 PMCID: PMC10866282 DOI: 10.4103/jfmpc.jfmpc_797_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/12/2023] [Accepted: 07/26/2023] [Indexed: 02/17/2024] Open
Abstract
Background Studies in the past have shown the effect of mental illness on marriage in persons with severe mental illnesses (SMIs). Primary care and family physicians have a major role in addressing marriage-associated dilemmas in their life. Methods The literature search was conducted from databases such as PubMed, ProQuest, EBSCO, Scopus, and Google Scholar for understanding the context and the problem in-depth for bringing out the narrative-review based framework for addressing the dilemmas. Results Marriage rates in persons with SMI are high in Eastern countries. Marriage in persons with SMI enhances social support and prevents the stigma of being unmarried. Disability, unemployment, stigma, and disclosure-related issues are barriers to getting desirable alliances. Evidence based interventions are available to reduce the associated distress to an extent. Conclusion Published peer-reviewed literature has pointed out that marriage plays a significant role in the life of persons with SMI and their families, especially in Asian countries where marriage is an important social institution. It can have a positive impact or can lead to relapse, marital conflicts, and divorce based on contextual and clinical factors. Hence, there is a need to come up with tailor-made interventions to address marriage-related expectations in persons with SMI.
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Affiliation(s)
- Lavinia A. M. Lyngdoh
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro-Sciences, Bengaluru, Karnataka, India
| | - Sojan Antony
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro-Sciences, Bengaluru, Karnataka, India
| | - Chethan Basavarajappa
- Department of Psychiatry, National Institute of Mental Health and Neuro-Sciences, Bengaluru, Karnataka, India
| | - Janaki Raman Kalyanasundaram
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro-Sciences, Bengaluru, Karnataka, India
| | - Thirumoorthy Ammapattian
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro-Sciences, Bengaluru, Karnataka, India
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Funer F. Admitting the heterogeneity of social inequalities: intersectionality as a (self-)critical framework and tool within mental health care. Philos Ethics Humanit Med 2023; 18:21. [PMID: 38001488 PMCID: PMC10668443 DOI: 10.1186/s13010-023-00144-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023] Open
Abstract
Inequities shape the everyday experiences and life chances of individuals at the margins of societies and are often associated with lower health and particular challenges in accessing quality treatment and support. This fact is even more dramatic for those individuals who live at the nexus of different marginalized groups and thus may face multiple discrimination, stigma, and oppression. To address these multiple social and structural disadvantages, intersectional approaches have recently gained a foothold, especially in the public health field. This study makes an empirically informed argument for the merits of increasing the use of intersectional frameworks in the mental health field. In the mental health field, the potential for greater attention to multiple unjustified disadvantages appears to be of particular importance, as many mental health service users already face stigma and discrimination because of their mental health issues and thus may benefit particularly frequently and far-reachingly from effective problem awareness about multiple disadvantages. Intersectional approaches may help address the complexity, interdependence, and mutual constitution of social inequalities better than previous approaches that examined only one category of sociostructural stratification. By helping to identify the needs of those at the greatest risk of poor health, intersectional frameworks and tools can contribute not only to better address the needs of multiple disadvantaged individuals with mental health issues but also to the promotion of equity in the field of mental health, contributing to the reduction of health disparities.
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Affiliation(s)
- Florian Funer
- Institute of Ethics and History of Medicine, Eberhard Karls University Tübingen, Tübingen, Germany.
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9
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Michel M, Hariz AJ, Chevreul K. Association of mental disorders with costs of somatic admissions in France. L'ENCEPHALE 2023; 49:453-459. [PMID: 35973851 DOI: 10.1016/j.encep.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/12/2022] [Accepted: 04/22/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Mentally ill patients have worse health outcomes when they suffer from somatic conditions compared to other patients. The objective of this study was to assess the association of mental illness with hospital inpatient costs for somatic reasons. METHODS All adult inpatient stays for somatic reasons in acute care hospitals between 2009 and 2013 were included using French exhaustive hospital discharge databases. Total inpatient costs were calculated from the all-payer perspective and compared in patients with and without a mental disorder. Only patients who had been admitted at least once for a mental disorder (either full-time or part-time) were considered to be mentally ill in this study. Generalized linear models with and without interaction terms studied the factors associated with hospital inpatient costs. RESULTS 17,728,424 patients corresponding to 37,458,810 admissions were included. 1,163,972 patients (6.57%) were identified as having a mental illness. A previous full-time or part-time admission for a mental disorder significantly increased hospital inpatient costs (+32.64%, 95%CI=1.3243-1.3284). Interaction terms found an increased impact of mental disorders on costs in patients with low socio-economic status, as well as in men, patients aged between 45 and 60, and patients with a cardiovascular disease or diabetes. CONCLUSION Mentally ill patients have higher hospital costs than non-mentally ill patients. Improving curative and preventive treatments in those patients could improve their health and decrease the burden on healthcare systems.
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Affiliation(s)
- M Michel
- Faculté de médecine de l'Université de Paris-site Villemin, ECEVE UMR 1123 Université Paris Cité, 10, avenue de Verdun, 75010 Paris, France; Inserm, UMR 1123, 75010 Paris, France; Assistance Publique-Hôpitaux de Paris, DRCI, URC Eco, 75004 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, 75019 Paris, France.
| | - A J Hariz
- Faculté de médecine de l'Université de Paris-site Villemin, ECEVE UMR 1123 Université Paris Cité, 10, avenue de Verdun, 75010 Paris, France; Inserm, UMR 1123, 75010 Paris, France; Assistance Publique-Hôpitaux de Paris, DRCI, URC Eco, 75004 Paris, France
| | - K Chevreul
- Faculté de médecine de l'Université de Paris-site Villemin, ECEVE UMR 1123 Université Paris Cité, 10, avenue de Verdun, 75010 Paris, France; Inserm, UMR 1123, 75010 Paris, France; Assistance Publique-Hôpitaux de Paris, DRCI, URC Eco, 75004 Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Unité d'Epidémiologie Clinique, 75019 Paris, France
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10
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Lamadé EK, Özer N, Schaupp B, Krumm B, Deuschle M, Häfner S. Association of hypertension, type 2 diabetes mellitus and dyslipidemia with the duration of inpatient treatments and recurrence of schizophrenia. J Psychosom Res 2023; 172:111436. [PMID: 37454415 DOI: 10.1016/j.jpsychores.2023.111436] [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: 07/17/2022] [Revised: 06/26/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE People with schizophrenia have an increased cardiovascular risk with higher mortality than the general population. Only a few studies have investigated the impact of cardiovascular risk on the later course of schizophrenia. This study aims to explore the association of cardiovascular risk factors, as detected during an index inpatient treatment for schizophrenia, with the duration of psychiatric inpatient treatments and number of inpatient admissions in the subsequent 10 years, in patients with schizophrenia. METHODS Cardiovascular risk factors of 736 patients with schizophrenia, identified through retrospective chart review, were assessed by hypertension, type 2 diabetes mellitus and dyslipidemia during an index inpatient stay. The duration of inpatient treatments, assessed by the total duration of psychiatric inpatient treatments in days, and the number of inpatient admissions, over the next 10 years were assessed and analyzed for an association with cardiovascular risk factors. RESULTS Hypertension associated with longer duration of inpatient treatments and higher number of inpatient admissions. Type 2 diabetes mellitus and dyslipidemia associated with a higher number of psychiatric inpatient treatments. Hypertension remained significantly associated with the duration of inpatient treatments (β = 0.174; p < 0.001) and the number of inpatient treatments (β = 0.144; p < 0.001), when adjusting for age, sex and BMI. CONCLUSION Out of the investigated cardiovascular risk factors documented during an index inpatient stay for schizophrenia, only hypertension associated with an increased duration of in-hospital stay and an increased number of re-hospitalizations during the subsequent ten years when adjusting for confounders. Screening for hypertension should be considered in all patients with schizophrenia.
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Affiliation(s)
- Eva Kathrin Lamadé
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
| | - Nicole Özer
- Department of Psychiatry and Psychotherapy, University of Göttingen, Germany
| | - Bernhard Schaupp
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Bertram Krumm
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Deuschle
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sibylle Häfner
- Department of Psychiatry and Psychotherapy, University of Göttingen, Germany; Department of Psychiatry and Psychotherapy, University of Heidelberg, Germany
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Brown DE, Finn CB, Roberts SE, Rosen CB, Kaufman EJ, Wirtalla C, Kelz R. Effect of Serious Mental Illness on Surgical Consultation and Operative Management of Older Adults with Acute Biliary Disease: A Nationwide Study. J Am Coll Surg 2023; 237:301-308. [PMID: 37052311 PMCID: PMC10525026 DOI: 10.1097/xcs.0000000000000710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
BACKGROUND Mental illness is associated with worse outcomes after emergency general surgery. To understand how preoperative processes of care may influence disparate outcomes, we examined rates of surgical consultation, treatment, and operative approach between older adults with and without serious mental illness (SMI). STUDY DESIGN We performed a nationwide, retrospective cohort study of Medicare beneficiaries aged 65.5 years or more hospitalized via the emergency department for acute cholecystitis or biliary colic. SMI was defined as schizophrenia spectrum, mood, and/or anxiety disorders. The primary outcome was surgical consultation. Secondary outcomes included operative treatment and surgical approach (laparoscopic vs open). Multivariable logistic regression was used to examine outcomes with adjustment for potential confounders related to patient demographics, comorbidities, and rates of imaging. RESULTS Of 85,943 included older adults, 19,549 (22.7%) had SMI. Before adjustment, patients with SMI had lower rates of surgical consultation (78.6% vs 80.2%, p < 0.001) and operative treatment (68.2% vs 71.7%, p < 0.001), but no significant difference regarding laparoscopic approach (92.0% vs 92.1%, p = 0.805). In multivariable regression models with adjustment for confounders, there was no difference in odds of receiving a surgical consultation (odds ratio 0.98 [95% CI 0.93 to 1.03]) or undergoing operative treatment (odds ratio 0.98 [95% CI 0.93 to 1.03]) for patients with SMI compared with those without SMI. CONCLUSIONS Older adults with SMI had similar odds of receiving surgical consultation and operative treatment as those without SMI. As such, differences in processes of care that result in SMI-related disparities likely occur before or after the point of surgical consultation in this universally insured patient population.
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Affiliation(s)
- Danielle E Brown
- From the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Brown, Kaufman, Kelz)
| | - Caitlin B Finn
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA (Finn, Roberts, Rosen, Kaufman, Wirtalla, Kelz)
- Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia, PA (Finn, Kelz)
| | - Sanford E Roberts
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA (Finn, Roberts, Rosen, Kaufman, Wirtalla, Kelz)
| | - Claire B Rosen
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA (Finn, Roberts, Rosen, Kaufman, Wirtalla, Kelz)
| | - Elinore J Kaufman
- From the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Brown, Kaufman, Kelz)
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA (Finn, Roberts, Rosen, Kaufman, Wirtalla, Kelz)
| | - Chris Wirtalla
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA (Finn, Roberts, Rosen, Kaufman, Wirtalla, Kelz)
| | - Rachel Kelz
- From the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA (Brown, Kaufman, Kelz)
- Center for Surgery and Health Economics, Department of Surgery, University of Pennsylvania, Philadelphia, PA (Finn, Roberts, Rosen, Kaufman, Wirtalla, Kelz)
- Leonard David Institute of Health Economics, University of Pennsylvania, Philadelphia, PA (Finn, Kelz)
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Tian YE, Di Biase MA, Mosley PE, Lupton MK, Xia Y, Fripp J, Breakspear M, Cropley V, Zalesky A. Evaluation of Brain-Body Health in Individuals With Common Neuropsychiatric Disorders. JAMA Psychiatry 2023; 80:567-576. [PMID: 37099313 PMCID: PMC10134046 DOI: 10.1001/jamapsychiatry.2023.0791] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 02/15/2023] [Indexed: 04/27/2023]
Abstract
Importance Physical health and chronic medical comorbidities are underestimated, inadequately treated, and often overlooked in psychiatry. A multiorgan, systemwide characterization of brain and body health in neuropsychiatric disorders may enable systematic evaluation of brain-body health status in patients and potentially identify new therapeutic targets. Objective To evaluate the health status of the brain and 7 body systems across common neuropsychiatric disorders. Design, Setting, and Participants Brain imaging phenotypes, physiological measures, and blood- and urine-based markers were harmonized across multiple population-based neuroimaging biobanks in the US, UK, and Australia, including UK Biobank; Australian Schizophrenia Research Bank; Australian Imaging, Biomarkers, and Lifestyle Flagship Study of Ageing; Alzheimer's Disease Neuroimaging Initiative; Prospective Imaging Study of Ageing; Human Connectome Project-Young Adult; and Human Connectome Project-Aging. Cross-sectional data acquired between March 2006 and December 2020 were used to study organ health. Data were analyzed from October 18, 2021, to July 21, 2022. Adults aged 18 to 95 years with a lifetime diagnosis of 1 or more common neuropsychiatric disorders, including schizophrenia, bipolar disorder, depression, generalized anxiety disorder, and a healthy comparison group were included. Main Outcomes and Measures Deviations from normative reference ranges for composite health scores indexing the health and function of the brain and 7 body systems. Secondary outcomes included accuracy of classifying diagnoses (disease vs control) and differentiating between diagnoses (disease vs disease), measured using the area under the receiver operating characteristic curve (AUC). Results There were 85 748 participants with preselected neuropsychiatric disorders (36 324 male) and 87 420 healthy control individuals (40 560 male) included in this study. Body health, especially scores indexing metabolic, hepatic, and immune health, deviated from normative reference ranges for all 4 neuropsychiatric disorders studied. Poor body health was a more pronounced illness manifestation compared to brain changes in schizophrenia (AUC for body = 0.81 [95% CI, 0.79-0.82]; AUC for brain = 0.79 [95% CI, 0.79-0.79]), bipolar disorder (AUC for body = 0.67 [95% CI, 0.67-0.68]; AUC for brain = 0.58 [95% CI, 0.57-0.58]), depression (AUC for body = 0.67 [95% CI, 0.67-0.68]; AUC for brain = 0.58 [95% CI, 0.58-0.58]), and anxiety (AUC for body = 0.63 [95% CI, 0.63-0.63]; AUC for brain = 0.57 [95% CI, 0.57-0.58]). However, brain health enabled more accurate differentiation between distinct neuropsychiatric diagnoses than body health (schizophrenia-other: mean AUC for body = 0.70 [95% CI, 0.70-0.71] and mean AUC for brain = 0.79 [95% CI, 0.79-0.80]; bipolar disorder-other: mean AUC for body = 0.60 [95% CI, 0.59-0.60] and mean AUC for brain = 0.65 [95% CI, 0.65-0.65]; depression-other: mean AUC for body = 0.61 [95% CI, 0.60-0.63] and mean AUC for brain = 0.65 [95% CI, 0.65-0.66]; anxiety-other: mean AUC for body = 0.63 [95% CI, 0.62-0.63] and mean AUC for brain = 0.66 [95% CI, 0.65-0.66). Conclusions and Relevance In this cross-sectional study, neuropsychiatric disorders shared a substantial and largely overlapping imprint of poor body health. Routinely monitoring body health and integrated physical and mental health care may help reduce the adverse effect of physical comorbidity in people with mental illness.
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Affiliation(s)
- Ye Ella Tian
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, Melbourne Medical School, the University of Melbourne, Melbourne, Victoria, Australia
| | - Maria A. Di Biase
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, Melbourne Medical School, the University of Melbourne, Melbourne, Victoria, Australia
| | - Philip E. Mosley
- Clinical Brain Networks Group, Queensland Institute of Medical Research Berghofer Medical Institute, Brisbane, Queensland, Australia
- Queensland Brain Institute, Brisbane, Queensland, Australia
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation Health and Biosecurity, Brisbane, Queensland, Australia
| | - Michelle K. Lupton
- Queensland Institute of Medical Research Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Ying Xia
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation Health and Biosecurity, Brisbane, Queensland, Australia
| | - Jurgen Fripp
- Australian e-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation Health and Biosecurity, Brisbane, Queensland, Australia
| | - Michael Breakspear
- Discipline of Psychiatry, College of Health, Medicine and Wellbeing, the University of Newcastle, Newcastle, New South Wales, Australia
- School of Psychological Sciences, College of Engineering, Science and Environment, the University of Newcastle, Newcastle, New South Wales, Australia
| | - Vanessa Cropley
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, Melbourne Medical School, the University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Zalesky
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, Melbourne Medical School, the University of Melbourne, Melbourne, Victoria, Australia
- Department of Biomedical Engineering, Faculty of Engineering and Information Technology, the University of Melbourne, Melbourne, Victoria, Australia
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Owusu AFS, Abdullah A, Pinto GH, Bentum H, Moo JTN, Ayim M, Mbamba CR, Cudjoe E. Where Do We Go After Surviving the Virus? Cross-Country Documentary Analysis of the Social Consequences Faced by COVID-19 Survivors. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2023; 43:329-338. [PMID: 34102924 PMCID: PMC9996079 DOI: 10.1177/0272684x211022176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In this study, we attempted to move beyond the skewed discussions on stigma to unravel other social consequences that are experienced by persons who have recovered from COVID-19. We conducted a documentary review of published news reports from 14 highly ranked news portals in Ghana and Malaysia (published between 1st January 2020 and 30th August 2020) that contained personal accounts from the recovered patients about their lived experiences with the virus and social consequences encountered after recovery. Narratives from the recovered patients were extracted and analyzed following the narrative thematic analysis procedure. Common themes identified from the narratives included: 1) Stigma impacting mental health, 2) Assault and abuse 3) Experiences of treatment. The findings show the need for interprofessional collaboration between social and health care professionals such as social workers, community health workers, medical practitioners and psychologists to prevent and address issues of abuse and other social consequences experienced by COVID-19 survivors.
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Affiliation(s)
- Alfred F S Owusu
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Alhassan Abdullah
- Department of Social Work and Social Administration, the University of Hong Kong, HKU Centennial Campus, Hong Kong
| | - Godfred H Pinto
- Department of Geography and Rural Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Hajara Bentum
- Department of Sociology and Social Work, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Janet Tein Ni Moo
- Department of Social Work and Social Administration, the University of Hong Kong, HKU Centennial Campus, Hong Kong
| | - Mary Ayim
- Department of Social Work and Social Care, University of Birmingham, UK
| | - Crispin R Mbamba
- School of Governance and International Affairs, Durham Global Security Institute, UK
| | - Ebenezer Cudjoe
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong
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Bačar Bole C, Nagode K, Pišlar M, Mrhar A, Grabnar I, Vovk T. Potential Drug-Drug Interactions among Patients with Schizophrenia Spectrum Disorders: Prevalence, Association with Risk Factors, and Replicate Analysis in 2021. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020284. [PMID: 36837485 PMCID: PMC9962414 DOI: 10.3390/medicina59020284] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/29/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
Background and Objectives: Patients with schizophrenia are often exposed to polypharmacotherapy, which may lead to drug-drug interactions. The aim of the study was to investigate the prevalence of potential drug-drug interactions (pDDIs) in hospitalized patients with schizophrenia spectrum disorders and to identify factors associated with pDDIs and manifested symptoms and signs. Materials and Methods: This cross-sectional observational study included 311 inpatients admitted to a psychiatric hospital. The LexiComp drug interaction program was used to identify pDDIs in 2014. Factors associated with the prevalence of pDDIs and factors related to clinically observed symptoms and signs were assessed using multivariable regression. In addition, replicate analysis of pDDI was performed using 2021 program updates. Results: The prevalence of pDDIs was 88.7%. Our study showed that more than half of the patients received at least one drug combination that should be avoided. The most common pDDIs involved combinations of two antipsychotics or combinations of antipsychotics and benzodiazepines, which can lead to cardio-respiratory depression, sedation, arrhythmias, anticholinergic effects, and neuroleptic malignant syndrome. The number of prescribed drugs was a risk factor for pDDIs (OR 2.85; 95% CI 1.84-5.73). All groups of clinically observed symptoms and signs were associated with the number of drugs. In addition, symptoms and signs characteristic of the nervous system and psychiatric disorders were associated with antipsychotic dosage (IRR 1.33; 95% CI 1.12-1.58), which could contribute to the development of extrapyramidal syndrome, insomnia, anxiety, agitation, and bipolar mania. The 2021 version of the drug interaction program showed a shift in drug interactions toward a lower risk rating, implying less severe patient management and possibly less alert fatigue. Conclusions: Patients with schizophrenia spectrum disorders are at high risk of developing drug-drug interactions. Optimization of drug therapy, patient monitoring, and use of drug interaction programs could help to prevent pDDIs and subsequent adverse drug events.
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Affiliation(s)
| | - Katja Nagode
- Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Mitja Pišlar
- Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Aleš Mrhar
- Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Iztok Grabnar
- Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Tomaž Vovk
- Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia
- Correspondence: ; Tel.: +386-1-4769-500
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15
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Stafford J, Dykxhoorn J, Sommerlad A, Dalman C, Kirkbride JB, Howard R. Association between risk of dementia and very late-onset schizophrenia-like psychosis: a Swedish population-based cohort study. Psychol Med 2023; 53:750-758. [PMID: 34030750 PMCID: PMC9975996 DOI: 10.1017/s0033291721002099] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/21/2021] [Accepted: 05/04/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although the incidence of psychotic disorders among older people is substantial, little is known about the association with subsequent dementia. We aimed to examine the rate of dementia diagnosis in individuals with very late-onset schizophrenia-like psychosis (VLOSLP) compared to those without VLOSLP. METHODS Using Swedish population register data, we established a cohort of 15 409 participants with VLOSLP matched by age and calendar period to 154 090 individuals without VLOSLP. Participants were born between 1920 and 1949 and followed from their date of first International Classification of Diseases [ICD], Revisions 8-10 (ICD-8/9/10) non-affective psychotic disorder diagnosis after age 60 years old (or the same date for matched participants) until the end of follow-up (30th December 2011), emigration, death, or first recorded ICD-8/9/10 dementia diagnosis. RESULTS We found a substantially higher rate of dementia in individuals with VLOSLP [hazard ratio (HR): 4.22, 95% confidence interval (95% CI) 4.05-4.41]. Median time-to-dementia-diagnosis was 75% shorter in those with VLOSLP (time ratio: 0.25, 95% CI 0.24-0.26). This association was strongest in the first year following VLOSLP diagnosis, and attenuated over time, although dementia rates remained higher in participants with VLOSLP for up to 20 years of follow-up. This association remained after accounting for potential misdiagnosis (2-year washout HR: 2.22, 95% CI 2.10-2.36), ascertainment bias (HR: 2.89, 95% CI 2.75-3.04), and differing mortality patterns between groups (subdistribution HR: 2.89, 95% CI 2.77-3.03). CONCLUSIONS Our findings demonstrate that individuals with VLOSLP represent a high-risk group for subsequent dementia. This may be due to early prodromal changes for some individuals, highlighting the importance of ongoing symptom monitoring in people with VLOSLP.
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Affiliation(s)
- J. Stafford
- Division of Psychiatry, University College London, London, UK
| | - J. Dykxhoorn
- Division of Psychiatry, University College London, London, UK
| | - A. Sommerlad
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - C. Dalman
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- The Center for Epidemiology and Social Medicine (CES), Region Stockholm
| | - J. B. Kirkbride
- Division of Psychiatry, University College London, London, UK
| | - R. Howard
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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16
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Lin YH, Lan YT, Ho YC, Chang YH, Hsiung CA, Chiou HY. The methodology to estimate the demand and supply of national psychiatric services in Taiwan from 2005 to 2030. Asian J Psychiatr 2023; 79:103393. [PMID: 36521405 DOI: 10.1016/j.ajp.2022.103393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/07/2022] [Accepted: 10/20/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The transformation from institutionalization to community-based mental healthcare may increase the difficulty of psychiatric workforce estimation and change the role of psychiatrists in hospitals and private clinics. METHODS This study aimed to estimate the growth and forecast psychiatric services in hospitals and private clinics in Taiwan from 2005 to 2030. We first examined the correlation between the number of psychiatrists and several indicators of psychiatric services. The forecast of the national demand for psychiatrists was based on projected outpatient psychiatrist visits from historical data. We also estimated the supply of psychiatrists by the number of psychiatrists practicing in hospitals or private clinics from Taiwan's Medical Affairs System and examined the supply and demand of the psychiatrist workforce through 2030. RESULTS Outpatient visit was the most relevant indicator of psychiatric services to psychiatrist workforce. Growth rates in private clinics were higher than the hospital counterparts within the following decade (172.3 % vs. 37.7 %) and in the following decade (42.3 % vs. 13.3 %). The hospital-clinic disparity in the growth of psychiatric services also reflects the shortage of psychiatrists in private clinics but not in hospitals through 2030. The supply of 1158 psychiatrists in hospitals would nearly equal the clinical-based demand of 1156 psychiatrists in 2030. By contrast, the supply of 514 psychiatrists in private clinics would be lower than the clinical-based demand of 636 psychiatrists in 2030. CONCLUSION The hospital-clinic disparity in the growth of psychiatric services reflects the transformation from hospital-based to community-based mental healthcare in Taiwan.
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Affiliation(s)
- Yu-Hsuan Lin
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan; Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan; Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu-Tung Lan
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Yen-Cheng Ho
- Serene Clinic, Linkou District, New Taipei City, Taiwan
| | - Yu-Hung Chang
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Chao A Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan
| | - Hung-Yi Chiou
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan; School of Public Health, College of Public Health, Taipei Medical University, Taiwan.
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Impact of a pre-existing diagnosis of mental illness on stage of breast cancer diagnosis among older women. Breast Cancer Res Treat 2023; 197:201-210. [PMID: 36350471 DOI: 10.1007/s10549-022-06793-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/30/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE Having a mental illness increases risk of mortality for women with breast cancer, partly due to barriers to accessing recommended care (e.g., cancer screening). Early detection is one important factor in breast cancer survival. To further understand this disparity in survival, we examined whether older women with mental illness are more likely to be diagnosed with later-staged breast cancers compared to women without mental illnesses. METHODS We used 2005-2015 SEER-Medicare data to identify AJCC stage I-IV breast cancer patients with and without a history of mental illness prior to cancer diagnosis. We used generalized ordinal regression to examine associations between mental illness diagnoses and stage at diagnosis, controlling for age, race/ethnicity, income, comorbidities, primary care use, rurality, and marital status. RESULTS Among 96,034 women with breast cancer, 1.7% have a serious mental illness (SMI), 19.9% depression or anxiety, and 7.0% other mental illness. Those with SMI have 40% higher odds of being diagnosed with AJCC Stages II, III than Stage I; women with depression/anxiety have 25% lower odds of being diagnosed with Stage IV cancer than Stage I; and women with other mental illnesses have similar odds of being diagnosed in later stages. CONCLUSION Women with SMI have higher odds of being diagnosed at later stages, which likely contributes to higher mortality after breast cancer. Surprisingly, women with depression and anxiety have a lower risk of being diagnosed with Stage IV cancer. Earlier breast cancer diagnosis in women with SMI is an important goal for reducing disparities breast cancer survival.
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Colorectal cancer treatment in people with severe mental illness: a systematic review and meta-analysis. Epidemiol Psychiatr Sci 2022; 31:e82. [PMID: 36384819 PMCID: PMC9706308 DOI: 10.1017/s2045796022000634] [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: 11/19/2022] Open
Abstract
AIMS People with severe mental illness (SMI) have a greater risk of dying from colorectal cancer (CRC), even though the incidence is lower or similar to that of the general population This pattern is unlikely to be solely explained by lifestyle factors, while the role of differences in cancer healthcare access or treatment is uncertain. METHODS We undertook a systematic review and meta-analysis on access to guideline-appropriate care following CRC diagnosis in people with SMI including the receipt of surgery, chemo- or radiotherapy. We searched for full-text articles indexed by PubMed, EMBASE, PsychInfo and CINAHL that compared CRC treatment in those with and without pre-existing SMI (schizophrenia, schizoaffective, bipolar and major affective disorders). Designs included cohort or population-based case-control designs. RESULTS There were ten studies (sample size = 3501-591 561). People with SMI had a reduced likelihood of surgery (RR = 0.90, 95% CI 0.92-0.97; p = 0.005; k = 4). Meta-analyses were not possible for the other outcomes but in results from individual studies, people with SMI were less likely to receive radiotherapy, chemotherapy or sphincter-sparing procedures. The disparity in care was greatest for those who had been psychiatric inpatients. CONCLUSIONS People with SMI, including both psychotic and affective disorders, receive less CRC care than the general population. This might contribute to higher case-fatality rates for an illness where the incidence is no higher than that of the general population. The reasons for this require further investigation, as does the extent to which differences in treatment access or quality contribute to excess CRC mortality in people with SMI.
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Cerebral blood flow and cardiovascular risk effects on resting brain regional homogeneity. Neuroimage 2022; 262:119555. [PMID: 35963506 PMCID: PMC10044499 DOI: 10.1016/j.neuroimage.2022.119555] [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: 06/09/2022] [Revised: 08/01/2022] [Accepted: 08/09/2022] [Indexed: 11/22/2022] Open
Abstract
Regional homogeneity (ReHo) is a measure of local functional brain connectivity that has been reported to be altered in a wide range of neuropsychiatric disorders. Computed from brain resting-state functional MRI time series, ReHo is also sensitive to fluctuations in cerebral blood flow (CBF) that in turn may be influenced by cerebrovascular health. We accessed cerebrovascular health with Framingham cardiovascular risk score (FCVRS). We hypothesize that ReHo signal may be influenced by regional CBF; and that these associations can be summarized as FCVRS→CBF→ReHo. We used three independent samples to test this hypothesis. A test-retest sample of N = 30 healthy volunteers was used for test-retest evaluation of CBF effects on ReHo. Amish Connectome Project (ACP) sample (N = 204, healthy individuals) was used to evaluate association between FCVRS and ReHo and testing if the association diminishes given CBF. The UKBB sample (N = 6,285, healthy participants) was used to replicate the effects of FCVRS on ReHo. We observed strong CBF→ReHo links (p<2.5 × 10-3) using a three-point longitudinal sample. In ACP sample, marginal and partial correlations analyses demonstrated that both CBF and FCVRS were significantly correlated with the whole-brain average (p<10-6) and regional ReHo values, with the strongest correlations observed in frontal, parietal, and temporal areas. Yet, the association between ReHo and FCVRS became insignificant once the effect of CBF was accounted for. In contrast, CBF→ReHo remained significantly linked after adjusting for FCVRS and demographic covariates (p<10-6). Analysis in N = 6,285 replicated the FCVRS→ReHo effect (p = 2.7 × 10-27). In summary, ReHo alterations in health and neuropsychiatric illnesses may be partially driven by region-specific variability in CBF, which is, in turn, influenced by cardiovascular factors.
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20
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Comparing cardiovascular disease incidence and prevalence between depressed and non-depressed older persons over time: Cohort differences in the Longitudinal Aging Study Amsterdam. J Psychosom Res 2022; 162:111015. [PMID: 36162162 DOI: 10.1016/j.jpsychores.2022.111015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 08/01/2022] [Accepted: 08/17/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Previous studies suggest that prevention of cardiovascular disease (CVD) is more difficult in depressed persons. Although the prevalence and incidence of CVD decreased over the past decades, it is uncertain whether this is also true for depressed persons. This study examined whether changes in the prevalence and incidence of CVD differ between depressed and non-depressed older persons. METHODS Longitudinal data from three community-based representative birth cohorts aged 55-65 years of the Longitudinal Aging Study Amsterdam were used; N = 1070 born in 1926-1937, N = 995 born in 1938-1947, N = 1019 born in 1948-1957. The outcome included fatal and non-fatal CVD. Depression was defined as ≥16 points on the Center for Epidemiological Studies Depression Scale or a general practitioner's diagnosis of depression. Data were analysed with for age and sex adjusted logistic regression and cox regression models. RESULTS Comparing cohort 2 and 3 with cohort 1 in the complete sample, the prevalence of CVD decreased by 2% (OR = 0.98, 95%CI = 0.76-1.26) and 32% (OR = 0.68, 95%CI = 0.52-0.89), respectively, and the three-year incidence of CVD decreased by 6% (OR = 0.94, 95%CI = 0.63-1.41) and 26% (OR = 0.74, 95%CI = 0.48-1.15), respectively. The 13-year incidence of CVD decreased by 19% (HR = 0.81, 95%CI = 0.67-0.99) in cohort 2 compared to cohort 1. These decreases did not differ statistically significantly between depressed and non-depressed respondents (p-values of interaction terms: 0.35-0.98). CONCLUSION Substantial decreases in the prevalence and incidence of CVD were observed in depressed and non-depressed older persons. Although this is encouraging, cardiovascular risk remained higher in depressed persons over time, warranting tailored prevention programs for depressed older persons.
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21
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Tickell AM, Rohleder C, Ho N, McHugh C, Jones G, Song YJC, Hickie IB, Scott EM. Identifying pathways to early-onset metabolic dysfunction, insulin resistance and inflammation in young adult inpatients with emerging affective and major mood disorders. Early Interv Psychiatry 2022; 16:1121-1129. [PMID: 34852406 DOI: 10.1111/eip.13260] [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: 11/06/2020] [Revised: 09/09/2021] [Accepted: 11/07/2021] [Indexed: 12/17/2022]
Abstract
AIM Young people with common mood disorders face the prospect of shortened life expectancy largely due to premature cardiovascular disease. Metabolic dysfunction is a risk factor for premature cardiovascular disease. There is an ongoing debate whether metabolic dysfunction can be simply explained by weight gain secondary to psychotropic medications or whether shared genetic vulnerability, intrinsic immune-metabolic disturbances or other system perturbations (e.g. dysregulated sympathetic nervous system, circadian dysfunction) are more relevant determinants of premature cardiovascular disease. Thus, we aimed to investigate underlying drivers of metabolic dysfunction and premature cardiovascular disease in young people in the early phases of common mood disorders. METHODS We evaluated the relationships between insulin resistance (assessed by HOMA2-IR) and body mass index (BMI), sex, diagnosis, medication, inflammatory markers and hormonal factors in 327 inpatients with emerging affective and major mood disorders admitted to the Young Adult Mental Health Unit, St Vincent's Private Hospital, Sydney. RESULTS While HOMA2-IR scores were positively associated with BMI (rs = 0.465, p < .001), they were also higher in those prescribed mood stabilizers (p = .044) but were not associated with specific diagnoses, other medication types or the number of prescribed medications. Further, high-sensitivity C-reactive protein levels (but not thyroid-stimulating hormone and ferritin levels) were positively associated with HOMA2-IR (rs = 0. 272, p < .001) and BMI (rs = . 409, p < .001). CONCLUSIONS In addition to BMI, other non-specific markers of inflammation are associated with early metabolic dysfunction in young people with emerging affective and major mood disorders.
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Affiliation(s)
| | - Cathrin Rohleder
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Nicholas Ho
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Catherine McHugh
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Graham Jones
- SydPath, St Vincent's Hospital, Sydney, Australia.,St Vincent's Clinical School, University of NSW, Australia
| | | | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Camperdown, Australia
| | - Elizabeth M Scott
- Brain and Mind Centre, University of Sydney, Camperdown, Australia.,Young Adult Mental Health Unit, St Vincent's Private Hospital, Sydney, Australia
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22
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Healthcare Professionals' Perspectives on Integrating Reproductive and Acute Mental Healthcare. SEXUALITY AND DISABILITY 2022. [DOI: 10.1007/s11195-022-09757-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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23
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Karambelas GJ, Filia K, Byrne LK, Allott KA, Jayasinghe A, Cotton SM. A systematic review comparing caregiver burden and psychological functioning in caregivers of individuals with schizophrenia spectrum disorders and bipolar disorders. BMC Psychiatry 2022; 22:422. [PMID: 35733174 PMCID: PMC9219207 DOI: 10.1186/s12888-022-04069-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/08/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Informal primary caregivers provide crucial supports to loved ones experiencing serious mental illnesses with profound outcomes for the caregivers themselves. A comprehensive understanding of how different serious mental illnesses change the caregiving experience may provide important insight into the ways in which caregivers can be better supported in their role. The aim of this review was to synthesize the comparative literature examining caregiver burden and psychological functioning (anxiety, depression, distress, and psychological wellbeing) between caregivers of people with schizophrenia spectrum disorders and bipolar disorder. METHODS Studies were included if they compared caregivers across both diagnostic groups and used measures assessing either caregiver burden or psychological functioning of caregivers. Databases searched up until 11th of January 2022 included: Medline COMPLETE, Embase, PsycINFO and CINAHL. Reference list scans and grey literature searches across government, organisational and dissertation databases were also conducted. RESULTS Twenty-eight studies comprising 6166 caregivers were included. Fourteen studies suggested that caregiving burden was comparable across both groups. The effects of caring on caregiver mental health and stress were comparable across both groups. However, methodological limitations were noted, including a reliance on cross-sectional studies, multiple and sometimes competing definitions of caregiving burden, variable sample sizes, and variation in measures used. CONCLUSION AND IMPLICATIONS The experience of providing care is multidimensional and complex. Symptoms and functional difficulties experienced by people being cared for may affect caregivers more so than diagnosis. Caregivers play a vital role in helping people with serious mental illness. Supporting caregivers by reducing their burden and improving their psychological functioning may help them to continue to provide support, and cope with, the challenges of providing care.
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Affiliation(s)
- George J. Karambelas
- grid.488501.00000 0004 8032 6923Orygen, 35 Poplar Road, Melbourne, Victoria 3052 Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, University of Melbourne, Melbourne, Australia ,grid.1021.20000 0001 0526 7079School of Psychology, Deakin University, Melbourne, Victoria Australia
| | - Kate Filia
- grid.488501.00000 0004 8032 6923Orygen, 35 Poplar Road, Melbourne, Victoria 3052 Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Linda K. Byrne
- grid.1021.20000 0001 0526 7079School of Psychology, Deakin University, Melbourne, Victoria Australia
| | - Kelly A. Allott
- grid.488501.00000 0004 8032 6923Orygen, 35 Poplar Road, Melbourne, Victoria 3052 Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Anuradhi Jayasinghe
- grid.1021.20000 0001 0526 7079School of Psychology, Deakin University, Melbourne, Victoria Australia
| | - Sue M. Cotton
- grid.488501.00000 0004 8032 6923Orygen, 35 Poplar Road, Melbourne, Victoria 3052 Australia ,grid.1008.90000 0001 2179 088XCentre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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Orme WH, Fowler JC, Bradshaw MR, Carlson M, Hadden J, Daniel J, Flack JN, Freeland D, Head J, Marder K, Weinstein BL, Madan A. Functional Rehabilitation: An Integrated Treatment Model for Patients With Complex Physical and Psychiatric Conditions. J Psychiatr Pract 2022; 28:193-202. [PMID: 35511095 DOI: 10.1097/pra.0000000000000623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The health care delivery system in the United States, structured to provide single-disease care, presents unique challenges for patients with complex physical and psychiatric comorbidities. Patients in these populations are often referred to multiple specialty clinics, encounter little continuity of care or collaboration among their providers, incur high health care costs, and experience poor treatment outcomes. Given these barriers, questions remain about the extent to which siloed and fragmented care, as opposed to the complex nature of the illnesses themselves, contribute to poor outcomes. If given the opportunity to receive well-integrated, consistent, and personalized care, can patients with historically difficult-to-treat comorbid medical and mental illnesses make progress? This article describes an innovative model of care called functional rehabilitation that is designed to address existing barriers in treatment. The functional rehabilitation program seeks to disrupt the escalating effects of interacting comorbidities by offering highly collaborative treatment from a small team of clinicians, personalized interventions using a shared decision-making framework, multipronged treatment options, colocation in a large hospital system, and significant 1:1 time with patients. The article includes a case example with longitudinal outcome data that illustrates how progress can be made with appropriate programmatic supports. Future research should examine the cost-effectiveness of this model of care.
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Shiamptanis A, Osesky J, de Graaf-Dunlop J. A collaborative strategy with community pharmacists and physicians to improve patient experience and implement quality standards for patients with depression. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 5:100125. [PMID: 35478507 PMCID: PMC9031082 DOI: 10.1016/j.rcsop.2022.100125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 02/25/2022] [Accepted: 03/07/2022] [Indexed: 11/12/2022] Open
Abstract
Background The experience for patients with mental health disorders may be negatively impacted by the barriers to care, such as low health care provider-to-population ratios, travel time to reach service providers, higher hospital readmission rates, and local demand for services, especially in suburban and rural areas. Objectives The project aimed to design a model in which physicians and pharmacists collaborate to provide comprehensive care to patients with depression in two northern communities and improve the patient and provider experience. Methods Pharmacists and primary care physicians developed a model in which patients starting on new antidepressant medications received regular follow-up care and education on adjunct therapies from the community pharmacists instead of the physician. The patient and provider experiences were measured through surveys. Results Out of the 14 patients who completed the patient survey, 13 reported feeling more supported by receiving follow-up care from pharmacists. Out of the 5 providers who completed the provider survey, 4 reported that the physician-pharmacist collaboration and additional support were helpful to patients. Conclusion Overall, the project positively impacted patient experience and providers perceived value in the shared-care model.
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Rodrigues M, Stranges S, Ryan BL, Anderson KK. The prevalence of physical multimorbidity among people with non-affective psychotic disorders 10 years after first diagnosis: a matched retrospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:495-503. [PMID: 34357406 DOI: 10.1007/s00127-021-02157-y] [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: 02/05/2021] [Accepted: 07/30/2021] [Indexed: 12/31/2022]
Abstract
AIMS The higher prevalence of chronic physical health conditions among people with psychotic disorders may result in a reduced life expectancy as compared to the general population. More research is needed on the risk of multiple co-occurring chronic health conditions, known as multimorbidity, for people with psychotic disorders. METHODS We conducted a matched retrospective cohort study to quantify the prevalence of multimorbidity and associated factors among people with psychotic disorders over the 10-year period following first diagnosis, relative to those without psychosis. Data from an early psychosis intervention program in London, Canada were linked to population-based health administrative data to identify patients with first-episode psychosis (n = 439), and a comparison group from the general population (n = 1759) matched on age, sex, and postal code. We followed the cohort for 10 years to ascertain the prevalence of multimorbidity. We compared people with and without psychosis using modified Poisson regression models, and explored risk factors for multimorbidity among those with psychotic disorders. RESULTS People with psychotic disorders may have a 26% higher prevalence of multimorbidity 10 years following first diagnosis, although our findings include the possibility of a null effect (PR = 1.26, 95% CI 0.96-1.66). People with psychosis living in areas with the highest levels of material deprivation had a threefold higher prevalence of multimorbidity as compared to those in the lowest areas of material deprivation (PR = 3.09, 95% CI 1.21-7.90). CONCLUSION Multimorbidity is prevalent among those with psychosis, and assessment for chronic health conditions should be integrated into clinical care for younger populations with psychotic illness.
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Affiliation(s)
- Myanca Rodrigues
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada.,Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada.,Department of Population Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Bridget L Ryan
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada.,Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada. .,Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Canada.
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Onyeaka H, Acquah I, Firth J, Khan B, Baiden P, Muoghalu C, Anugwom G, Torous J. Trends and factors associated with use of digital health technology among adults with serious psychological distress in the United States: A secondary data analysis of the National Health Interview Survey. POPULATION MEDICINE 2022. [DOI: 10.18332/popmed/145913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Aguglia A, Salvi V, Amerio A, Gari M, Dragogna F, Mencacci C, Volpe U, Serafini G, Amore M. Number of episodes and duration of illness associated with hypertension and 10-year cardiovascular risk in patients with bipolar disorder type I. Psychiatry Res 2022; 308:114344. [PMID: 35065469 DOI: 10.1016/j.psychres.2021.114344] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/20/2021] [Accepted: 12/11/2021] [Indexed: 12/24/2022]
Abstract
Severe Mental Illnesses, including bipolar disorder (BD) and schizophrenia (SCZ), are burdened with an increased mortality and a significantly reduced life expectancy than general population, and cardiovascular diseases (CVD) are considered the most contributing conditions. The aim of the present study is to evaluate 10-year CV risk and the associated clinical characteristics in patients with SCZ, BD type I and II. Patients were consecutively recruited from two Italian psychiatric acute units. Single CV risk factors were assessed, and 10-year CV risk calculated by means of the CUORE Project 10-year CV risk algorithm, based on the combination of the following risk factors: age, systolic blood pressure, total and high-density lipoprotein cholesterol, diabetes, smoking habit, and hypertensive treatment. Three hundred patients were included. Patients with BD type I showed a higher prevalence of hypertension and 10-year CV risk score compared to the other groups. In subjects with BD type I, we found a significant correlation between duration of illness and number of mood episodes and both hypertension and 10-year CV risk score. Several preventive strategies should be provided to these vulnerable populations, such as correcting unhealthy lifestyles, prescribing medications at lower CV and metabolic risk, enhancing access to care.
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Affiliation(s)
- Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy.
| | - Virginio Salvi
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Matteo Gari
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Filippo Dragogna
- Department of Neuroscience, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Claudio Mencacci
- Department of Neuroscience, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Umberto Volpe
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, School of Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
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Gajwani R, Wilson N, Nelson R, Gumley A, Smith M, Minnis H. Recruiting and exploring vulnerabilities among young people at risk, or in the early stages of serious mental illness (borderline personality disorder and first episode psychosis). Front Psychiatry 2022; 13:943509. [PMID: 35990053 PMCID: PMC9386049 DOI: 10.3389/fpsyt.2022.943509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Many gaps exist in our understanding of the developmental pathways to severe mental illness (SMI), including borderline personality disorder (BPD) and psychosis. However, those who have experienced adverse childhood experiences (ACEs) are at an increased risk and there is evidence to suggest that one of the earliest markers is emotional dysregulation. An area which has received relatively less research attention is the role neurodevelopmental disorders (NDDs) play. The aim of this feasibility study was therefore to explore the clinical profiles of young people early in the course of SMI, including their profiles of ACEs, emotional regulation difficulties, borderline personality traits and NDDs. METHODS A cross-sectional study of young people (aged 15-25) at risk of SMI, currently being seen within NHS mental health services, was conducted. This included those with early symptoms of psychosis and/or BPD as assessed by diagnostic interview. Eligible participants self-completed a battery of sociodemographic, clinical, and psychological measures in the company of a researcher. This included assessments of: symptoms of NDDs; borderline pathology traits; ACEs; and difficulties in emotional regulation. Statistical analyses included Mann-Whitney U tests and multiple regression. RESULTS Of the 118 potentially eligible participants who were referred, 48 were ultimately included in the study. Young people early in the course of SMI reported a high prevalence of ACEs and deficits in emotional regulation. In total, 79% met criteria for attention deficit hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD). Emotional dysregulation was found to significantly mediate the association between both ACEs and the frequency of NDDs and borderline personality traits, however given the small sample size these results are preliminary in nature. CONCLUSION Young people early in the course of SMI are at an increased risk of experiencing multiple childhood adversities and our results indicate a high prevalence of NDDs amongst them. Emotional dysregulation emerged as a potentially significant early marker of future clinical severity. We suggest that the clinical implications of our findings include routine screening for NDDs and ACEs and an increased recognition of the significance of emotional dysregulation. However, larger scale longitudinal studies are needed to investigate these preliminary findings further.
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Affiliation(s)
- Ruchika Gajwani
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom.,NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Naomi Wilson
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Rebecca Nelson
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Andrew Gumley
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom.,NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Michael Smith
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom.,NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - Helen Minnis
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom.,NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
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Herschkopf MD. Ethical Issues in Consultation-Liaison Psychiatry. Psychiatr Clin North Am 2021; 44:591-601. [PMID: 34763792 DOI: 10.1016/j.psc.2021.08.008] [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: 11/20/2022]
Abstract
This article contextualizes several key ethical issues in consultation-liaison (C-L) psychiatry within historical and principlist frameworks. After summarizing the history of the field, it focuses on 3 main areas of ethical import in C-L psychiatry: decisional capacity assessment, psychosocial evaluations for transplant, and treating mental illness in pregnant patients.
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Affiliation(s)
- Marta D Herschkopf
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard Medical School Center for Bioethics, 375 Longwood Avenue, Masco Suite 370, Boston, MA 02215, USA.
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31
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Aborode AT, Corriero AC, Mehmood Q, Nawaz A, Aayush, Upadhyay P, Badri R, Hasan MM. People living with mental disorder in Nigeria amidst COVID-19: Challenges, implications, and recommendations. Int J Health Plann Manage 2021; 37:1191-1198. [PMID: 34825400 PMCID: PMC9015638 DOI: 10.1002/hpm.3394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/15/2021] [Indexed: 01/06/2023] Open
Abstract
COVID‐19 has become a global public health obstacle. This disease has caused negligence on mental health institutions, decreased trust in the healthcare system and traditional and religious beliefs, and has created a widespread stigma on people living with mental health illness, specifically in Nigeria. The increase of COVID‐19 cases that have exhausted the healthcare system in Nigeria have brought further negligence to people living with mental disorder, thus increasing the burden of the disease on these patients. Overall, this article considerably highlighted the need for equal accessibility to healthcare resources, as well as the requirement of proper attention and care for mental health patients in Nigeria. This article discusses the challenges that surfaced because of the COVID‐19 pandemic on people living with mental illness and their implications, as well as suggesting necessary actions and recommendations. In Nigeria, only about 15% of patients with severe mental illnesses have access to mental health care. In Nigeria, the COVID‐19 pandemic has caused negligence on mental health institutions and created a widespread stigma on people living with mental health illnesses. People in Nigeria lack basic understanding about mental health illnesses and have various misconceptions for its underlying causes. It is critical to strengthen Nigeria's health‐care system, particularly during COVID‐19, by devising measures to improve mental health literacy and change stigmatizing attitudes at both the institutional and community levels.
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Affiliation(s)
- Abdullahi Tunde Aborode
- Healthy Africans Platform, Research and Development, Ibadan, Nigeria.,West African Academy of Public Health, Abuja, Nigeria
| | | | | | - Arisha Nawaz
- Dow International Medical College, Karachi, Pakistan
| | - Aayush
- Government Medical College, Jalaun, Uttar Pradesh, India
| | | | - Rawa Badri
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | - Mohammad Mehedi Hasan
- Department of Biochemistry and Molecular Biology, Faculty of Life Science, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
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Harris JI, Hanson D, Leskela J, Billig J, Padilla-Martinez V, Boyd J, Nienow T. Reconsidering research exclusion for serious mental illness: Ethical principles, current status, and recommendations. J Psychiatr Res 2021; 143:138-143. [PMID: 34487990 DOI: 10.1016/j.jpsychires.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/19/2021] [Accepted: 09/01/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Historically, individuals managing serious mental illness (SMI) have often been excluded from research, typically because of concern that these individuals may not be able to understand and provide truly informed consent. As treatment has improved, the assumption that individuals managing SMI may not be capable of consent needs to be re-examined. Systematic exclusion from research may limit empirically tested treatments available for people managing SMI, and may contribute to the health care disparities seen in this population. OBJECTIVES This article examines this issue by documenting current rates of research exclusion for high disease burden conditions, based on empirical review of studies in ClinicalTrials.gov. RESEARCH DESIGN Current rates of exclusion from studies for psychiatric conditions were assessed through systematic review of relevant clinical trials on ClinicalTrials.gov. SUBJECTS Subjects in this inquiry are either articles accessed in the literature reviews, or descriptions of studies in public data on ClinicalTrials.gov. MEASURES The primary measure was a previously published coding system to document the extent and types of research exclusion related to psychiatric status. RESULTS Among studies of interventions for substance use disorders and chronic pain, individuals managing SMI were more likely to be excluded than those with other psychiatric disorders at statistically significant levels. This was not the case among studies of interventions for ischemic heart disease. In studies of substance use disorders, 9% explicitly excluded SMI and 83% could exclude people with SMI based on broader exclusion criteria. In studies of chronic pain these two categories of exclusion were 16% and 55%, and in studies of ischemic heart disease, these two categories of exclusion were 1% and 20%. CONCLUSIONS Evidence indicates that it is ethically and scientifically more appropriate to exclude based on capacity to consent than membership in the group of individuals managing SMI. The discussion outlines techniques researchers can use for more equitable and generalizable sampling.
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Affiliation(s)
- J Irene Harris
- VA Bedford Healthcare System, Bedford, MA, USA; University of Minnesota, Minneapolis, MN, USA.
| | | | - Jennie Leskela
- University of Minnesota, Minneapolis, MN, USA; ABPP Minneapolis VA Health Care System, Minneapolis, MN, USA
| | - John Billig
- ABPP, National Center for Ethics in Health Care, Veterans Health Administration, Washington, DC, USA
| | | | - Jennifer Boyd
- San Francisco VA Health Care System, San Francisco, CA, USA; University of California San Francisco, San Francisco, CA, USA
| | - Tasha Nienow
- Minneapolis VA Health Care System, Minneapolis, MN, USA
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Grassi L, Stivanello E, Belvederi Murri M, Perlangeli V, Pandolfi P, Carnevali F, Caruso R, Saponaro A, Ferri M, Sanza M, Fioritti A, Meggiolaro E, Ruffilli F, Nanni MG, Ferrara M, Carozza P, Zerbinati L, Toffanin T, Menchetti M, Berardi D. Mortality from cancer in people with severe mental disorders in Emilia Romagna Region, Italy. Psychooncology 2021; 30:2039-2051. [PMID: 34499790 PMCID: PMC9290959 DOI: 10.1002/pon.5805] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 11/11/2022]
Abstract
Objective To examine cancer‐related mortality in patients with severe mental disorders (SMI) in the Emilia Romagna (ER) Region, Northern Italy, during the period 2008–2017 and compare it with the regional population. Methods We used the ER Regional Mental Health Registry identifying all patients aged ≥18 years who had received an ICD‐9CM system diagnosis of SMI (i.e., schizophrenia or other functional psychosis, mania, or bipolar affective disorders) during a 10‐year period (2008–2017). Information on deaths (date and causes of death) were retrieved through the Regional Cause of Death Registry. Comparisons were made with the deaths and cause of deaths of the regional population over the same period. Results Amongst 12,385 patients suffering from SMI (64.1% schizophrenia spectrum and 36.9% bipolar spectrum disorders), 24% (range 21%–29%) died of cancer. In comparison with the general regional population, the mortality for cancer was about 50% higher among patients with SMI, irrespective if affected by schizophrenia or bipolar disorders. As for the site‐specific cancers, significant excesses were reported for stomach, central nervous system, respiratory, and pancreas cancer with a variability according to psychiatric diagnosis and gender. Conclusions Patients suffering from SMI had higher mortality risk than the regional population with some differences according to cancer type, gender, and psychiatric diagnosis. Proper cancer preventive and treatment interventions, including more effective risk modification strategies (e.g., smoking cessation, dietary habits) and screening for cancer, should be part of the agenda of all mental health departments in conjunction with other health care organizations, including psycho‐oncology.
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Affiliation(s)
- Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Elisa Stivanello
- Department of Public Health, Local Health Trust of Bologna, Bologna, Italy
| | - Martino Belvederi Murri
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | | | - Paolo Pandolfi
- Department of Public Health, Local Health Trust of Bologna, Bologna, Italy
| | - Fabio Carnevali
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Rosangela Caruso
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Alessio Saponaro
- General Directorate of Health and Social Policies, Bologna, Italy
| | - Mila Ferri
- General Directorate of Health and Social Policies, Bologna, Italy
| | - Michele Sanza
- Department of Mental Health and Substance Abuse, Local Health Trust of Romagna, Cesena, Italy
| | - Angelo Fioritti
- Department of Mental Health and Substance Abuse, Local Health Trust of Bologna, Bologna, Italy
| | - Elena Meggiolaro
- Psycho-Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Federica Ruffilli
- Psycho-Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Maria Giulia Nanni
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Maria Ferrara
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Paola Carozza
- Integrated Department of Mental Health and Pathological Addictions, Local Health Trust of Ferrara, Ferrara, Italy
| | - Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Tommaso Toffanin
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Domenico Berardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Rising co-payments and continuity of healthcare for Dutch patients with bipolar disorder: retrospective longitudinal cohort study. BJPsych Open 2021. [PMCID: PMC8444049 DOI: 10.1192/bjo.2021.994] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background The Netherlands has few financial barriers to access mental healthcare. However, in 2012, a sharp rise in co-payments was introduced. Aims We tested whether these increased co-payments coincided with less guideline-recommended continuous out-patient psychiatric care and more crisis interventions for patients with bipolar disorder. Method A retrospective longitudinal cohort study on a health insurance registry was performed to examine trends, and deviations from these trends, in the healthcare received by patients with bipolar disorder. Deviations of trends were tested by time-series analyses (autoregressive integrated moving average). Subsequently, the relationship between significant deviations of trends and rise in co-payments was examined. Outcome measures were the level of standard out-patient care (out-patient psychiatric care and/or medication), crisis psychiatric care and somatic care. Results The cohort comprised 3210 patients. During follow-up, the use of psychiatric care decreased and somatic care increased. The high rise in co-payments from 2012 onward coincided with decreases in standard out-patient care and increases in medication-only treatment, crisis psychiatric care and somatic care. Crisis intervention was highest when patients received only bipolar disorder medication. Patients receiving continuous standard out-patient care (62%) had less crisis intervention compared with the other patients. Conclusions Our data suggest that the rise of co-payments decreased guideline-recommended continuous out-patient psychiatric care among patients with bipolar disorder, and increased crisis psychiatric care.
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Nguyen TT, Hathaway H, Kosciolek T, Knight R, Jeste DV. Gut microbiome in serious mental illnesses: A systematic review and critical evaluation. Schizophr Res 2021; 234:24-40. [PMID: 31495702 PMCID: PMC7056547 DOI: 10.1016/j.schres.2019.08.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/19/2019] [Accepted: 08/22/2019] [Indexed: 02/08/2023]
Abstract
Schizophrenia and bipolar disorder (BD) are associated with debilitating psychiatric and cognitive dysfunction, worse health outcomes, and shorter life expectancies. The pathophysiological understanding of and therapeutic resources for these neuropsychiatric disorders are still limited. Humans harbor over 1000 unique bacterial species in our gut, which have been linked to both physical and mental/cognitive health. The gut microbiome is a novel and promising avenue to understand the attributes of psychiatric diseases and, potentially, to modify them. Building upon our previous work, this systematic review evaluates the most recent evidence of the gut microbiome in clinical populations with serious mental illness (SMI). Sixteen articles that met our selection criteria were reviewed, including cross-sectional cohort studies and longitudinal treatment trials. All studies reported alterations in the gut microbiome of patients with SMI compared to non-psychiatric comparison subjects (NCs), and beta-diversity was consistently reported to be different between schizophrenia and NCs. Ruminococcaceae and Faecalibacterium were relatively decreased in BD, and abundance of Ruminococcaceae was reported across several investigations of SMI to be associated with better clinical characteristics. Lactic acid bacteria were relatively more abundant in SMI and associated with worse clinical outcomes. There was very limited evidence for the efficacy of probiotic or prebiotic interventions in SMI. As microbiome research in psychiatry is still nascent, the extant literature has several limitations. We critically evaluate the current data, including experimental approaches. There is a need for more unified methodological standards in order to arrive at robust biological understanding of microbial contributions to SMI.
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Affiliation(s)
- Tanya T Nguyen
- Department of Psychiatry, University of California San Diego, CA, United States of America; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, CA, United States of America.
| | - Hugh Hathaway
- Medical Sciences Division, University of Oxford, Oxford, United Kingdom; Department of Pediatrics, University of California San Diego, CA, United States of America
| | - Tomasz Kosciolek
- Department of Pediatrics, University of California San Diego, CA, United States of America; Małopolska Centre of Biotechnology, Jagiellonian University, Kraków, Poland
| | - Rob Knight
- Department of Pediatrics, University of California San Diego, CA, United States of America; Department of Computer Science and Engineering, University of California San Diego, CA, United States of America; Department of Bioengineering, University of California San Diego, CA, United States of America; Center for Microbiome Innovation, University of California San Diego, CA, United States of America
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, CA, United States of America; Center for Microbiome Innovation, University of California San Diego, CA, United States of America; Department of Neurosciences, University of California San Diego, CA, United States of America; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, CA, United States of America
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Shafie S, Subramaniam M, Abdin E, Vaingankar JA, Sambasivam R, Zhang Y, Shahwan S, Chang S, Jeyagurunathan A, Chong SA. Help-Seeking Patterns Among the General Population in Singapore: Results from the Singapore Mental Health Study 2016. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:586-596. [PMID: 33057931 PMCID: PMC8192323 DOI: 10.1007/s10488-020-01092-5] [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] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 11/05/2022]
Abstract
This study aimed to establish lifetime mental health service utilisation among the general population of Singapore. The sociodemographic correlates of those seeking help from different service provider groups and changes in lifetime mental health service utilisation between 2010 and 2016 among those with mental disorders were also explored. A population-based cross-sectional epidemiological household survey of the Singapore resident population aged 18 years and above was conducted from 2016 to 2018, using the World Mental Health Composite International Diagnostic Interview (CIDI) version 3.0. Data from two cross-sectional population-based studies were used for comparison of lifetime mental health service utilisation in 2010 (n = 6616) and 2016 (n = 6126). Chi square test and multiple logistic regression were used to analyse the data. A total of 6126 respondents completed the study in 2016. Overall 9.3% of the total sample, 32.0% of those with mental disorders, and 5.7% of those not meeting criteria for mental disorders, ever sought help for their mental health issues in their lifetime, from any treatment service sectors. Several sociodemographic characteristics were found to be correlated with different service provider groups. There was no change in mental health service utilisation between 2010 and 2016 for all mental disorders included in this study, with the exception of a significant increase in help sought from professionals in social services, among those with alcohol abuse. Even though the overall help-seeking rates are low, it is encouraging that those seeking help did so from mental health professionals and professionals working in the social services.
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Affiliation(s)
- Saleha Shafie
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Janhavi Ajit Vaingankar
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Rajeswari Sambasivam
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Yunjue Zhang
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Shazana Shahwan
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Sherilyn Chang
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Anitha Jeyagurunathan
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore, 539747 Singapore
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Syed S, Couse M, Ojha R. Management challenges in patients with comorbid COVID-19 associated delirium and serious mental illness - A case series. Int J Psychiatry Med 2021; 56:255-265. [PMID: 33517809 DOI: 10.1177/0091217420985979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND There is still a lot unknown about the novel Coronavirus Disease 19 (COVID-19) and its effects in humans. This pandemic has posed several challenging clinical situations to healthcare providers. OBJECTIVE We hope to highlight the distinctive challenges that COVID-19 presents in patients with serious mental illness and what steps primary medical teams can take to co-manage these patients with the psychiatry consultants. METHODS We present a retrospective chart review of four patients who were on psychotropic polypharmacy and admitted to our hospital from the same long-term psychiatric facility with COVID-19 delirium and other associated medical complications. RESULTS We illustrate how the primary medical teams and psychiatrists collaborated in clinical diagnosis, treatment, and management. CONCLUSIONS Patients with serious mental illness and COVID-19 infection require active collaboration between primary medical teams and psychiatrists for diagnostic clarification, reduction of psychotropic polypharmacy to avoid adverse effects and drug-drug interactions, prevention of psychiatric decompensation, and active management of agitation while balancing staff and patient safety concerns.
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Affiliation(s)
- Saba Syed
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Department of Psychiatry, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - Michael Couse
- Psychiatry Residency Program, Olive-View UCLA Medical Center, Sylmar, CA, USA
| | - Rashi Ojha
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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van der Lee APM, Hoogendoorn A, de Haan L, Beekman ATF. Discontinuity of psychiatric care for patients with schizophrenia, relation to previous psychiatric care and practice variation between providers: a retrospective longitudinal cohort study. BMC Psychiatry 2021; 21:319. [PMID: 34187433 PMCID: PMC8244203 DOI: 10.1186/s12888-021-03319-7] [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: 01/14/2021] [Accepted: 06/09/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Patients with schizophrenia need continuous integrated healthcare, but many discontinue their treatment, often experiencing adverse outcomes. The first objective of this study is to assess whether patient characteristics or treatment history are associated with discontinuity of psychiatric elective care. The second objective is to assess whether practice variation between providers of psychiatric care contributes to discontinuity of elective care. METHODS A large registry-based retrospective cohort of 9194 schizophrenia patients, who were included if they received elective psychiatric care in December 2014-January 2015. Logistic regression models were used to identify predictive factors of discontinuity of care. The dependent variable was the binary variable discontinuity of care in 2016. Potential independent predictive variables were: age, sex, urbanization, and treatment history in 2013-2014. Practice variation between providers was assessed, adjusting for the case mix of patients regarding their demographic and care utilization characteristics. RESULTS 12.9% of the patients showed discontinuity of elective psychiatric care in the follow-up year 2016. The risk of discontinuity of care in 2016 was higher in younger patients (between age 18 and 26), patients with a history of receiving less elective psychiatric care, more acute psychiatric care, more quarters with elective psychiatric care without antipsychotic medication, or receiving no elective treatment at all. No evidence for practice variation between providers was found. CONCLUSIONS Our findings show that the pattern of previous care consumption is an important prognostic factor of future discontinuity of elective care. We propose that previous care consumption can be used to design strategies to improve treatment retention and focus resources on those most at risk of dropping out.
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Affiliation(s)
- Arnold P. M. van der Lee
- grid.7177.60000000084992262Department Psychiatry Amsterdam University Medical Centre – location VUmc, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
| | - Adriaan Hoogendoorn
- grid.7177.60000000084992262Department Psychiatry Amsterdam University Medical Centre – location VUmc, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
| | - Lieuwe de Haan
- grid.5650.60000000404654431Department Psychiatry Amsterdam University Medical Centre – location AMC, Amsterdam, The Netherlands
| | - Aartjan T. F. Beekman
- grid.7177.60000000084992262Department Psychiatry Amsterdam University Medical Centre – location VUmc, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
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Chang CH, Liu CY, Chen SJ, Tsai HC. Hepatitis C virus and hepatitis B virus in patients with schizophrenia. Medicine (Baltimore) 2021; 100:e26218. [PMID: 34087899 PMCID: PMC8183751 DOI: 10.1097/md.0000000000026218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 05/17/2021] [Indexed: 01/04/2023] Open
Abstract
This study evaluated the severe hepatic outcome (SHO) in patients with schizophrenia and viral hepatitis who received antipsychotics.Using the nationwide Taiwan National Health Insurance Research Database, patients first diagnosed with schizophrenia between 2002 and 2013 were identified. Patients diagnosed with schizophrenia who had viral hepatitis, including hepatitis B virus (HBV) or hepatitis C virus (HCV), were designated as the viral hepatitis group. A control group without viral hepatitis was matched for age, sex, and index year in a 2:1 ratio. Patients with severe hepatic outcomes before enrollment were excluded. The 2 cohorts were observed until December 31, 2013. The primary endpoint was occurrence of a SHO, including liver cancer, liver failure, liver decompensation, or transplantation.Among the 16,365 patients newly diagnosed with schizophrenia between January 2002 and December 2013, we identified 614 patients with viral hepatitis and 1228 matched patients without viral hepatitis. Of these 1842 patients, 41 (2.22%) developed SHOs, including 26 (4.23%) in the viral hepatitis group and 15 (1.22%) in the control group, during the mean follow-up period of 3.71 ± 2.49 years. Cox proportional hazard analysis indicated that the SHO risk increased by 3.58 (95% confidence interval [CI]: 1.859-6.754; P < .001) in patients with schizophrenia and viral hepatitis. Moreover, patients with schizophrenia having HCV had a higher SHO risk than those without viral hepatitis (hazard ratio: 5.07, 95% CI: 1.612-15.956; P < .0001). Patients having both schizophrenia and viral hepatitis, especially HCV, had a higher risk of SHOs.
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Affiliation(s)
- Chun-Hung Chang
- Institute of Clinical Medical Science, China Medical University
- Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung
- An Nan Hospital, China Medical University, Tainan
| | - Chieh-Yu Liu
- Biostatistical Consulting Lab, Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei
| | - Shaw-Ji Chen
- Department of Psychiatry, Taitung MacKay Memorial Hospital, Taitung
- Department of Medicine, Mackay Medical College, New Taipei
| | - Hsin-Chi Tsai
- Department of Psychiatry, Tzu-Chi General Hospital, Hualien City
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan, R.O.C
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Wilson R, Gaughran F, Whitburn T, Higginson IJ, Gao W. Acute care utilisation towards the end of life and the place of death for patients with serious mental disorders: a register-based cohort study in South London. Public Health 2021; 194:79-85. [PMID: 33866148 DOI: 10.1016/j.puhe.2021.02.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 01/26/2021] [Accepted: 02/05/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of the study was to explore acute care utilisation towards end of life by and the place of death for patients with serious mental disorders and to demonstrate any inequalities in end-of-life care faced by this patient group. STUDY DESIGN This is a retrospective cohort study using linked, routinely collected data. METHODS This study used linked data extracted from mental health records, Hospital Episode Statistics and mortality data. Adult cases (≥18 years old) were included if they had a serious mental disorder and died between 2007 and 2015. Multiple imputation was used to manage missing data, and generalised linear models were used to assess multiple adjusted associations between sociodemographic and clinical explanatory variables and acute service use at the end of life and in-hospital deaths. RESULTS A cohort of 1350 adults was analysed. More than half visited the accident and emergency (A&E) department in the last 90 days of life, and a third had a burdensome transition (multiple hospital admissions in the last 90 days of life or at least one in the last three days); the median number of days spent in the hospital was 4 (range: 0-86). Having more comorbidities was a strong correlate of more A&E visits (adjusted odds ratio [OR] = 1.03 [95% confidence interval = 1.02-1.04]), burdensome transitions (adjusted OR = 1.06 [1.04-1.08]) and days spent in the hospital (adjusted OR = 1.04 [1.03-1.05]). Having a diagnosis of schizophrenia spectrum disorder, compared with other serious mental disorder diagnoses, was associated with fewer A&E visits (adjusted OR = 0.78 [0.71-0.88]) and fewer days in the hospital (adjusted OR = 0.77 [0.66-0.89]). Younger age was associated with more A&E visits (adjusted OR = 1.28 [1.07-1.53]) and fewer days spent in the hospital (adjusted OR = 0.70 [0.52-0.95]). Hospital deaths were high (51%), and in a fully adjusted model, they were associated with having more comorbidities (adjusted OR = 1.02 [1.01-1.03]) and accessing acute care at the end of life (including more A&E visits; adjusted OR = 1.07 [1.05-1.10]), burdensome transitions (adjusted OR = 1.53 [1.37-1.71]) and days spent in the hospital (adjusted OR = 2.05 [1.70-247]). CONCLUSION People with comorbidities are more likely to use more burdensome acute health care at the end of life and are more likely to die in the hospital. Hospital deaths could be reduced, and end-of-life care could be improved by targeting patients with comorbidities and who are accessing more acute healthcare services.
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Affiliation(s)
- R Wilson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, Bessemer Road, London, SE5 9PJ, United Kingdom
| | - F Gaughran
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom; National Psychosis Unit, South London and Maudsley NHS Foundation Trust 7th Floor, Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, SE5 8AF, United Kingdom
| | - T Whitburn
- Barts Health NHS Trust, Macmillan Palliative Care Team, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, United Kingdom
| | - I J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, Bessemer Road, London, SE5 9PJ, United Kingdom
| | - W Gao
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, Bessemer Road, London, SE5 9PJ, United Kingdom.
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Ford J, Bushnell G, Griffith AM, Joodi G, Ashoka A, Patel N, Husain M, Pursell IW, Sears SF, Mounsey JP, Simpson RJ. Mental Disorders, Substance Use Disorders, and Psychotropic Medication Use Among Sudden-Death Victims. Psychiatr Serv 2021; 72:378-383. [PMID: 33593102 DOI: 10.1176/appi.ps.201900389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The authors sought to estimate the prevalence of mental and substance use disorders and psychotropic medication prescriptions among working-age sudden-death victims. METHODS Using a written protocol, the authors screened for sudden deaths attended by emergency medical services (EMS) in a large metropolitan county in North Carolina from March 1, 2013, to February 28, 2015. Sudden-death cases were adjudicated by three cardiologists. Mental health and chronic disease diagnoses and treatments were abstracted from EMS, medical examiner, toxicology, and autopsy reports and from clinical records for the past 5 years before death. RESULTS Sudden death was identified for 399 adults ages 18-64 years, 270 of whom had available medical records. Most sudden-death victims were White (63%) and male (65%), had a comorbid condition such as hypertension or respiratory disease, and had a mean±SD age of death of 53.6±8.8 years. Most victims (59%) had at least one mental health or substance use disorder documented in a recent medical record; 76%-78% of victims with a mental disorder had a documented psychotropic medication prescription. However, fewer than one-half (41%) had a documented referral to a mental health professional. The most common diagnostic categories were depressive, anxiety, and alcohol-related disorders. Almost one-half (46%) of the victims had a recent psychotropic prescription, most commonly antidepressants (29%) and benzodiazepines (19%). CONCLUSIONS Mental illness, substance use disorders, and psychotropic medication prescriptions were prevalent among sudden-death victims. The health care needs of these individuals may be better addressed by collaborative care for general medical and mental disorders.
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Affiliation(s)
- Jessica Ford
- Department of Psychology, East Carolina University, Greenville, North Carolina (Ford, Griffith, Sears); Mental and Behavioral Health Service Line, Greenville Health Care Center, Durham U.S. Department of Veterans Affairs Medical Center, Greenville, North Carolina (Ford); Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey (Bushnell); School of Medicine, Yale University, New Haven, Connecticut (Joodi); School of Medicine, University of Arizona, Tucson (Ashoka); Department of Cardiology and Cardiac Electrophysiology, University of North Carolina, Chapel Hill (Patel, Husain, Simpson); Department of Medical Specialties, University of Arkansas for Medical Sciences, Little Rock (Pursell, Mounsey)
| | - Greta Bushnell
- Department of Psychology, East Carolina University, Greenville, North Carolina (Ford, Griffith, Sears); Mental and Behavioral Health Service Line, Greenville Health Care Center, Durham U.S. Department of Veterans Affairs Medical Center, Greenville, North Carolina (Ford); Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey (Bushnell); School of Medicine, Yale University, New Haven, Connecticut (Joodi); School of Medicine, University of Arizona, Tucson (Ashoka); Department of Cardiology and Cardiac Electrophysiology, University of North Carolina, Chapel Hill (Patel, Husain, Simpson); Department of Medical Specialties, University of Arkansas for Medical Sciences, Little Rock (Pursell, Mounsey)
| | - Ashley M Griffith
- Department of Psychology, East Carolina University, Greenville, North Carolina (Ford, Griffith, Sears); Mental and Behavioral Health Service Line, Greenville Health Care Center, Durham U.S. Department of Veterans Affairs Medical Center, Greenville, North Carolina (Ford); Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey (Bushnell); School of Medicine, Yale University, New Haven, Connecticut (Joodi); School of Medicine, University of Arizona, Tucson (Ashoka); Department of Cardiology and Cardiac Electrophysiology, University of North Carolina, Chapel Hill (Patel, Husain, Simpson); Department of Medical Specialties, University of Arkansas for Medical Sciences, Little Rock (Pursell, Mounsey)
| | - Golsa Joodi
- Department of Psychology, East Carolina University, Greenville, North Carolina (Ford, Griffith, Sears); Mental and Behavioral Health Service Line, Greenville Health Care Center, Durham U.S. Department of Veterans Affairs Medical Center, Greenville, North Carolina (Ford); Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey (Bushnell); School of Medicine, Yale University, New Haven, Connecticut (Joodi); School of Medicine, University of Arizona, Tucson (Ashoka); Department of Cardiology and Cardiac Electrophysiology, University of North Carolina, Chapel Hill (Patel, Husain, Simpson); Department of Medical Specialties, University of Arkansas for Medical Sciences, Little Rock (Pursell, Mounsey)
| | - Ankita Ashoka
- Department of Psychology, East Carolina University, Greenville, North Carolina (Ford, Griffith, Sears); Mental and Behavioral Health Service Line, Greenville Health Care Center, Durham U.S. Department of Veterans Affairs Medical Center, Greenville, North Carolina (Ford); Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey (Bushnell); School of Medicine, Yale University, New Haven, Connecticut (Joodi); School of Medicine, University of Arizona, Tucson (Ashoka); Department of Cardiology and Cardiac Electrophysiology, University of North Carolina, Chapel Hill (Patel, Husain, Simpson); Department of Medical Specialties, University of Arkansas for Medical Sciences, Little Rock (Pursell, Mounsey)
| | - Neil Patel
- Department of Psychology, East Carolina University, Greenville, North Carolina (Ford, Griffith, Sears); Mental and Behavioral Health Service Line, Greenville Health Care Center, Durham U.S. Department of Veterans Affairs Medical Center, Greenville, North Carolina (Ford); Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey (Bushnell); School of Medicine, Yale University, New Haven, Connecticut (Joodi); School of Medicine, University of Arizona, Tucson (Ashoka); Department of Cardiology and Cardiac Electrophysiology, University of North Carolina, Chapel Hill (Patel, Husain, Simpson); Department of Medical Specialties, University of Arkansas for Medical Sciences, Little Rock (Pursell, Mounsey)
| | - Mariya Husain
- Department of Psychology, East Carolina University, Greenville, North Carolina (Ford, Griffith, Sears); Mental and Behavioral Health Service Line, Greenville Health Care Center, Durham U.S. Department of Veterans Affairs Medical Center, Greenville, North Carolina (Ford); Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey (Bushnell); School of Medicine, Yale University, New Haven, Connecticut (Joodi); School of Medicine, University of Arizona, Tucson (Ashoka); Department of Cardiology and Cardiac Electrophysiology, University of North Carolina, Chapel Hill (Patel, Husain, Simpson); Department of Medical Specialties, University of Arkansas for Medical Sciences, Little Rock (Pursell, Mounsey)
| | - Irion W Pursell
- Department of Psychology, East Carolina University, Greenville, North Carolina (Ford, Griffith, Sears); Mental and Behavioral Health Service Line, Greenville Health Care Center, Durham U.S. Department of Veterans Affairs Medical Center, Greenville, North Carolina (Ford); Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey (Bushnell); School of Medicine, Yale University, New Haven, Connecticut (Joodi); School of Medicine, University of Arizona, Tucson (Ashoka); Department of Cardiology and Cardiac Electrophysiology, University of North Carolina, Chapel Hill (Patel, Husain, Simpson); Department of Medical Specialties, University of Arkansas for Medical Sciences, Little Rock (Pursell, Mounsey)
| | - Samuel F Sears
- Department of Psychology, East Carolina University, Greenville, North Carolina (Ford, Griffith, Sears); Mental and Behavioral Health Service Line, Greenville Health Care Center, Durham U.S. Department of Veterans Affairs Medical Center, Greenville, North Carolina (Ford); Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey (Bushnell); School of Medicine, Yale University, New Haven, Connecticut (Joodi); School of Medicine, University of Arizona, Tucson (Ashoka); Department of Cardiology and Cardiac Electrophysiology, University of North Carolina, Chapel Hill (Patel, Husain, Simpson); Department of Medical Specialties, University of Arkansas for Medical Sciences, Little Rock (Pursell, Mounsey)
| | - John Paul Mounsey
- Department of Psychology, East Carolina University, Greenville, North Carolina (Ford, Griffith, Sears); Mental and Behavioral Health Service Line, Greenville Health Care Center, Durham U.S. Department of Veterans Affairs Medical Center, Greenville, North Carolina (Ford); Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey (Bushnell); School of Medicine, Yale University, New Haven, Connecticut (Joodi); School of Medicine, University of Arizona, Tucson (Ashoka); Department of Cardiology and Cardiac Electrophysiology, University of North Carolina, Chapel Hill (Patel, Husain, Simpson); Department of Medical Specialties, University of Arkansas for Medical Sciences, Little Rock (Pursell, Mounsey)
| | - Ross J Simpson
- Department of Psychology, East Carolina University, Greenville, North Carolina (Ford, Griffith, Sears); Mental and Behavioral Health Service Line, Greenville Health Care Center, Durham U.S. Department of Veterans Affairs Medical Center, Greenville, North Carolina (Ford); Department of Biostatistics and Epidemiology, Rutgers University, New Brunswick, New Jersey (Bushnell); School of Medicine, Yale University, New Haven, Connecticut (Joodi); School of Medicine, University of Arizona, Tucson (Ashoka); Department of Cardiology and Cardiac Electrophysiology, University of North Carolina, Chapel Hill (Patel, Husain, Simpson); Department of Medical Specialties, University of Arkansas for Medical Sciences, Little Rock (Pursell, Mounsey)
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Mariano A, Di Lorenzo G, Jannini TB, Santini R, Bertinelli E, Siracusano A, Niolu C. Medical Comorbidities in 181 Patients With Bipolar Disorder vs. Schizophrenia and Related Psychotic Disorders: Findings From a Single-Center, Retrospective Study From an Acute Inpatients Psychiatric Unit. Front Psychiatry 2021; 12:702789. [PMID: 34658948 PMCID: PMC8517081 DOI: 10.3389/fpsyt.2021.702789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/02/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Medical comorbidities (MCs) represent a significant burden in terms of more frequent hospitalizations and overall lower life expectancy among people with severe mental disorders, such as schizophrenia and related psychotic disorders (SZ) and bipolar disorder (BD). The present article aims to compare the prevalence of MCs and to examine the associated characteristics as marital status, job occupation, level of education, and living arrangements, between BD and SZ patients. Methods: One-hundred-eight-one patients with MCs (85/47% had BD and 96/53% had SZ) were recruited retrospectively from the Acute Inpatients Psychiatry Unit of Policlinico Tor Vergata, Rome, between January-2017 and December-2020. MCs were: cardiovascular diseases (CVD), bacterial infections, mycoses, viral diseases, neoplasms, musculoskeletal, respiratory tract, urological and male genital, gynecological, neurological, gastrointestinal, metabolic syndrome, nutritional, and metabolic diseases. Results: BD had more MC than SZ (36.2 vs. 28.2%, respectively, p = 0.04). CVD and metabolic MC were more common among BD (51.8 vs.34.4%; 51.8 vs.35.3%; p = 0.018; p = 0.039; respectively), while viral diseases were more frequent in SZ (13.5 vs.3.5%, p = 0.035). Hypertension was common in both psychiatric illnesses (81.8% BD vs. 65.6% SZ, p = 0.18). Obesity was the most frequent metabolic disease in both BD and SZ (75% BD vs. 73.5% SZ, p = 0.91), followed by diabetes mellitus (52.3% BD vs. 55.9% SZ, p = 0.93), metabolic syndrome (54.5% BD vs. 47.1% SZ, p = 0.67) and dysthyroidism (47.7% BD vs. 25.7% SZ, p = 0.093). After performing a binary logistic regression analysis, only two MCs showed a statistically significant association: patients with SZ had an OR of 2.01 [CI 95% (1.00-4.01)] for CVD compared to BD; on the other hand, patients with BD had an OR of 16.57 [CI 95% (3.58-76.77)] for gynecological diseases compared to SZ patients. Conclusions: MCs are common among people with severe mental illness, especially CVD and metabolic diseases, highlighting the need for a more collaborative relationship between general medical providers and psychiatrists.
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Affiliation(s)
- Antonella Mariano
- Department of Systems Medicine, Chair of Psychiatry, University of Rome Tor Vergata, Rome, Italy
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, Chair of Psychiatry, University of Rome Tor Vergata, Rome, Italy.,IRCCS - Fondazione Santa Lucia, Rome, Italy
| | - Tommaso B Jannini
- Department of Systems Medicine, Chair of Psychiatry, University of Rome Tor Vergata, Rome, Italy
| | - Riccardo Santini
- Department of Systems Medicine, Chair of Psychiatry, University of Rome Tor Vergata, Rome, Italy
| | - Emanuela Bertinelli
- Department of Systems Medicine, Chair of Psychiatry, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, Chair of Psychiatry, University of Rome Tor Vergata, Rome, Italy
| | - Cinzia Niolu
- Department of Systems Medicine, Chair of Psychiatry, University of Rome Tor Vergata, Rome, Italy
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Fernandes S, Fond G, Zendjidjian XY, Baumstarck K, Lançon C, Berna F, Schurhoff F, Aouizerate B, Henry C, Etain B, Samalin L, Leboyer M, Llorca PM, Coldefy M, Auquier P, Boyer L. Measuring the Patient Experience of Mental Health Care: A Systematic and Critical Review of Patient-Reported Experience Measures. Patient Prefer Adherence 2020; 14:2147-2161. [PMID: 33192054 PMCID: PMC7653683 DOI: 10.2147/ppa.s255264] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 06/23/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There is growing concern about measuring patient experience with mental health care. There are currently numerous patient-reported experience measures (PREMs) available for mental health care, but there is little guidance for selecting the most suitable instruments. The objective of this systematic review was to provide an overview of the psychometric properties and the content of available PREMs. METHODS A comprehensive review following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines was conducted using the MEDLINE database with no date restrictions. The content of PREMs was analyzed using an inductive qualitative approach, and the methodological quality was assessed according to Pesudovs quality criteria. RESULTS A total of 86 articles examining 75 PREMs and totaling 1932 items were included. Only four PREMs used statistical methods from item response theory (IRT). The 1932 items covered seven key mental health care domains: interpersonal relationships (22.6%), followed by respect and dignity (19.3%), access and care coordination (14.9%), drug therapy (14.1%), information (9.6%), psychological care (6.8%) and care environment (6.1%). Additionally, a few items focused on patient satisfaction (6.7%) rather than patient experience. No instrument covered the latent trait continuum of patient experience, as defined by the inductive qualitative approach, and the psychometric properties of the instruments were heterogeneous. CONCLUSION This work is a critical step in the creation of an item library to measure mental health care patient-reported experience that will be used in France to develop, validate, and standardize item banks and computerized adaptive testing (CAT) based on IRT. It will also provide internationally replicable measures that will allow direct comparisons of mental health care systems. TRIAL REGISTRATION NCT02491866.
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Affiliation(s)
- Sara Fernandes
- Aix-Marseille University, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Guillaume Fond
- Aix-Marseille University, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Xavier Yves Zendjidjian
- Aix-Marseille University, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Karine Baumstarck
- Aix-Marseille University, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Christophe Lançon
- Aix-Marseille University, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | | | | | | | | | | | | | | | | | - Magali Coldefy
- Institute for Research and Information in Health Economics (IRDES), Paris, France
| | - Pascal Auquier
- Aix-Marseille University, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Laurent Boyer
- Aix-Marseille University, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - On behalf of the French PREMIUM Group
- Aix-Marseille University, School of Medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of Life Center, Marseille, France
- FondaMental Foundation, Créteil, France
- Institute for Research and Information in Health Economics (IRDES), Paris, France
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Danek PJ, Wójcikowski J, Daniel WA. Asenapine and iloperidone decrease the expression of major cytochrome P450 enzymes CYP1A2 and CYP3A4 in human hepatocytes. A significance for drug-drug interactions during combined therapy. Toxicol Appl Pharmacol 2020; 406:115239. [PMID: 32941854 DOI: 10.1016/j.taap.2020.115239] [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: 07/20/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 02/06/2023]
Abstract
Antipsychotics are often used in combination with other psychotropic drugs to treat a variety of psychiatric disorders, as well as in combination with other drugs taken by patients with co-morbidities. When these drugs are combined, the potential for drug-drug interaction increases, leading to side-effects, in addition to the predicted increase in effectiveness. The present study aimed at examining the effects of the three atypical neuroleptics asenapine, lurasidone and iloperidone on cytochrome P450 (CYP) expression in the human liver. The study was carried out on cryopreserved human hepatocytes. The hepatotoxicity of the tested drugs was assessed after exposure to the neuroleptics (LDH cytotoxicity assay). CYP activities were measured in the incubation medium using the CYP-specific reactions: caffeine 3-N-demethylation (CYP1A1/2), diclofenac 4'-hydroxylation (CYP2C9), perazine N-demethylation (CYP2C19) and testosterone 6β-hydroxylation (CYP3A4). Parallel, CYP mRNA levels were measured in neuroleptic-treated hepatocytes. Asenapine significantly decreased the mRNA level and activity of CYP1A2, while iloperidone potently diminished the mRNA level and activity of CYP3A4 in the cultures of human hepatocytes. Lurasidone did not affect the expression and activity of any of the investigated human CYP enzymes. The presented findings may have clinical implications for the prediction of potential drug-drug interactions involving the asenapine-induced inhibition of metabolism of CYP1A2 substrates (e.g. caffeine, theophylline, melatonin, tricyclic antidepressants, phenacetin, propranolol) and iloperidone-induced inhibition of CYP3A4 substrates (e.g. antidepressants, benzodiazepines, atorvastatin, macrolide antibiotics, calcium channel antagonists).
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Affiliation(s)
- Przemysław J Danek
- Department of Pharmacokinetics and Drug Metabolism, Maj Institute of Pharmacology, Polish Academy of Sciences, Smętna 12, 31-343 Kraków, Poland
| | - Jacek Wójcikowski
- Department of Pharmacokinetics and Drug Metabolism, Maj Institute of Pharmacology, Polish Academy of Sciences, Smętna 12, 31-343 Kraków, Poland
| | - Władysława A Daniel
- Department of Pharmacokinetics and Drug Metabolism, Maj Institute of Pharmacology, Polish Academy of Sciences, Smętna 12, 31-343 Kraków, Poland.
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Asonye U, Apping N, Lopez LV, Popeo DM. Health Disparities in Black Patients with Severe Mental Illness and the Role of Structural Racism. Psychiatr Ann 2020. [DOI: 10.3928/00485713-20201007-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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47
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Beach SR, Shalev D, Fischel SV, Boland RJ, Ernst CL. Optimizing Fit: Targeting a Residency Psychiatry Consultation-Liaison Rotation to Various Levels of Training. PSYCHOSOMATICS 2020; 61:645-654. [PMID: 32778423 PMCID: PMC7366985 DOI: 10.1016/j.psym.2020.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Determining the optimal timing and structure for a core residency rotation in consultation-liaison psychiatry (CLP) remains a key challenge for program directors and rotation leaders. Previous surveys have been conducted regarding these questions, and guidelines from national organizations have been issued, but practices remain varied among institutions. METHODS We conducted a narrative review of the literature related to the timing of CLP rotations and generated consensus recommendations based on our experience as program directors, rotation leaders, and residents. RESULTS Explicit goals of CLP training in residency include identifying and treating psychiatric manifestation of medical illness and communicating effectively with primary teams. Implicit goals of training may includeconflict management, limit setting, and "thinking dirty." DISCUSSION Although CLP rotations earlier in residency often create a better fit within the overarching curriculum and allow for generating early interest in the field, significant amounts of supervision are required, and consultees may look to attendings as the primary consultant. Conversely, while later rotations are sometimes challenging to structure with other outpatient responsibilities, they allow for greater autonomy and may map better onto the informal curriculum. A hybrid model, with training spread across multiple years, is another approach that may mitigate some of the disadvantages of confining consultation-liaison training to a single year. Compelling arguments can be made for placing the core CLP rotation in postgraduate year 2 or 3 or using a hybrid model. Regardless of placement, program directors and rotation leaders should be mindful of tailoring the rotation to the trainees' developmental stage.
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Affiliation(s)
- Scott R Beach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - Daniel Shalev
- Department of Psychiatry, Columbia University, New York, NY
| | - Steven V Fischel
- Department of Psychiatry, Baystate Medical Center, Springfield, MA; Department of Psychiatry, University of Massachusetts Medical School - Baystate, Springfield, MA
| | - Robert J Boland
- Harvard Medical School, Boston, MA; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA
| | - Carrie L Ernst
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY
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48
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Hautekiet P, Nawrot TS, Demarest S, Van der Heyden J, Van Overmeire I, De Clercq EM, Saenen ND. Environmental exposures and health behavior in association with mental health: a study design. Arch Public Health 2020; 78:105. [PMID: 33093954 PMCID: PMC7576706 DOI: 10.1186/s13690-020-00477-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/22/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Air pollution, green space and smoking are known to affect human health. However, less is known about their underlying biological mechanisms. One of these mechanisms could be biological aging. In this study, we explore the mediation of biomarkers of exposure and biological aging to explain the associations between environmental exposures, health behavior and mental health. METHODS The study population of this cross-sectional study (n = 1168) is a subsample of the Belgian 2018 Health Interview Survey (BHIS). Mental health indicators including psychological and severe psychological distress, life satisfaction, vitality, eating disorders, suicidal ideation, subjective health and depressive and anxiety disorders, demographics and health behavior such as smoking are derived from the BHIS. Urine and blood samples are collected to measure respectively the biomarkers of exposure (urinary black carbon (BC) and (hydroxy)cotinine) and the biomarkers of biological aging (mitochondrial DNA content (mtDNAc) and telomere length (TL)). Recent and chronic exposure (μg/m3) to nitrogen dioxide (NO2), particulate matter ≤2.5 μm (PM2.5) and ≤ 10 μm (PM10) and BC at the participants' residence are modelled using a high resolution spatial temporal interpolation model. Residential green space is defined in buffers of different size (50 m - 5000 m) using land cover data in ArcGIS 10 software. For the statistical analysis multivariate linear and logistic regressions as well as mediation analyses are used taking into account a priori selected covariates and confounders. RESULTS As this study combined data of BHIS and laboratory analyses, not all data is available for all participants. Therefore, data analyses will be conducted on different subsets. Data on air pollution and green space exposure is available for all BHIS participants. Questions on smoking and mental health were answered by respectively 7829 and 7213 BHIS participants. For biomarker assessment, (hydroxy) cotinine, urinary BC and the biomarkers of biological aging are measured for respectively 1130, 1120 and 985 participants. CONCLUSION By use of personal markers of air pollution and smoking, as well as biological aging, we will gain knowledge about the association between environmental exposures, health behavior, and the mental health status. The results of the study can provide insights on the health of the Belgian population, making it a nationwide interesting study.
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Affiliation(s)
- Pauline Hautekiet
- Sciensano, Brussels, Belgium
- Centre for Environmental Sciences, Hasselt University, Agoralaan gebouw D, BE-3590 Hasselt, Belgium
| | - Tim S. Nawrot
- Centre for Environmental Sciences, Hasselt University, Agoralaan gebouw D, BE-3590 Hasselt, Belgium
- Centre for Environment and Health, Leuven University, Leuven, Belgium
| | | | | | | | | | - Nelly D. Saenen
- Sciensano, Brussels, Belgium
- Centre for Environmental Sciences, Hasselt University, Agoralaan gebouw D, BE-3590 Hasselt, Belgium
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Madden DR, Lam CN, Redline B, Dzubur E, Rhoades H, Intille SS, Dunton GF, Henwood B. Real-Time Data Collection to Examine Relations Between Physical Activity and Affect in Adults With Mental Illness. JOURNAL OF SPORT & EXERCISE PSYCHOLOGY 2020; 42:386-393. [PMID: 33022657 PMCID: PMC8761482 DOI: 10.1123/jsep.2019-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 06/11/2023]
Abstract
Adults with serious mental illness engage in limited physical activity, which contributes to significant health disparities. This study explored the use of both ecological momentary assessments (EMAs) and activity trackers in adults with serious mental illness to examine the bidirectional relationship between activity and affect with multilevel modeling. Affective states were assessed up to seven times per day using EMA across 4 days. The participants (n = 20) were equipped with a waist-worn accelerometer to measure moderate to vigorous physical activity. The participants had a mean EMA compliance rate of 88.3%, and over 90% of completed EMAs were matched with 30-min windows of accelerometer wear. The participants who reported more positive affect than others had a higher probability of engaging in moderate to vigorous physical activity. Engaging in more moderate to vigorous physical activity than one's usual was associated with more negative affect. This study begins to address the effect of momentary mood on physical activity in a population of adults that is typically difficult to reach.
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Affiliation(s)
- Danielle R. Madden
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Chun Nok Lam
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California
| | - Brian Redline
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Eldin Dzubur
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Harmony Rhoades
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California
| | - Stephen S. Intille
- College of Computer and Information Science and Bouvé College of Health Sciences, Northeastern University
| | - Genevieve F. Dunton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California
| | - Benjamin Henwood
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California
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50
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Grassi L, Riba M. Cancer and severe mental illness:
Bi‐directional
problems and potential solutions. Psychooncology 2020; 29:1445-1451. [DOI: 10.1002/pon.5534] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 08/03/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences University of Ferrara Ferrara Italy
| | - Michelle Riba
- Department of Psychiatry University of Michigan Ann Arbor Michigan USA
- University of Michigan Depression Center Ann Arbor Michigan USA
- Psycho‐oncology Program University of Michigan Rogel Cancer Center Ann Arbor Michigan USA
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