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Daumit GL, Evins AE, Cather C, Dalcin AT, Dickerson FB, Miller ER, Appel LJ, Jerome GJ, McCann U, Ford DE, Charleston JB, Young DR, Gennusa JV, Goldsholl S, Cook C, Fink T, Wang NY. Effect of a Tobacco Cessation Intervention Incorporating Weight Management for Adults With Serious Mental Illness: A Randomized Clinical Trial. JAMA Psychiatry 2023; 80:895-904. [PMID: 37378972 PMCID: PMC10308301 DOI: 10.1001/jamapsychiatry.2023.1691] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/05/2023] [Indexed: 06/29/2023]
Abstract
Importance Tobacco smoking drives markedly elevated cardiovascular disease risk and preventable death in persons with serious mental illness, and these risks are compounded by the high prevalence of overweight/obesity that smoking cessation can exacerbate. Guideline-concordant combined pharmacotherapy and behavioral smoking cessation treatment improves abstinence but is not routinely offered in community settings, particularly to those not seeking to quit smoking immediately. Objective To determine the effectiveness of an 18-month pharmacotherapy and behavioral smoking cessation intervention incorporating weight management and support for physical activity in adults with serious mental illness interested in quitting smoking within 1 or 6 months. Design, Setting, and Participants This was a randomized clinical trial conducted from July 25, 2016, to March 20, 2020, at 4 community health programs. Adults with serious mental illness who smoked tobacco daily were included in the study. Participants were randomly assigned to intervention or control, stratified by willingness to try to quit immediately (within 1 month) or within 6 months. Assessors were masked to group assignment. Interventions Pharmacotherapy, primarily varenicline, dual-form nicotine replacement, or their combination; tailored individual and group counseling for motivational enhancement; smoking cessation and relapse prevention; weight management counseling; and support for physical activity. Controls received quitline referrals. Main Outcome and Measures The primary outcome was biochemically validated, 7-day point-prevalence tobacco abstinence at 18 months. Results Of the 298 individuals screened for study inclusion, 192 enrolled (mean [SD] age, 49.6 [11.7] years; 97 women [50.5%]) and were randomly assigned to intervention (97 [50.5%]) or control (95 [49.5%]) groups. Participants self-identified with the following race and ethnicity categories: 93 Black or African American (48.4%), 6 Hispanic or Latino (3.1%), 90 White (46.9%), and 9 other (4.7%). A total of 82 participants (42.7%) had a schizophrenia spectrum disorder, 62 (32.3%) had bipolar disorder, and 48 (25.0%) had major depressive disorder; 119 participants (62%) reported interest in quitting immediately (within 1 month). Primary outcome data were collected in 183 participants (95.3%). At 18 months, 26.4% of participants (observed count, 27 of 97 [27.8%]) in the intervention group and 5.7% of participants (observed count, 6 of 95 [6.3%]) in the control group achieved abstinence (adjusted odds ratio [OR], 5.9; 95% CI, 2.3-15.4; P < .001). Readiness to quit within 1 month did not statistically significantly modify the intervention's effect on abstinence. The intervention group did not have significantly greater weight gain than the control group (mean weight change difference, 1.6 kg; 95% CI, -1.5 to 4.7 kg). Conclusions and Relevance Findings of this randomized clinical trial showed that in persons with serious mental illness who are interested in quitting smoking within 6 months, an 18-month intervention with first-line pharmacotherapy and tailored behavioral support for smoking cessation and weight management increased tobacco abstinence without significant weight gain. Trial Registration ClinicalTrials.gov Identifier: NCT02424188.
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Affiliation(s)
- Gail L. Daumit
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - A. Eden Evins
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Corinne Cather
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Arlene T. Dalcin
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | | | - Edgar R. Miller
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lawrence J. Appel
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gerald J. Jerome
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- College of Health Professions, Towson University, Towson, Maryland
| | - Una McCann
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel E. Ford
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jeanne B. Charleston
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Deborah R. Young
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Joseph V. Gennusa
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stacy Goldsholl
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Courtney Cook
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tyler Fink
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nae-Yuh Wang
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Hany M, Aboudeeb MF, Shapiro-Koss C, Agayby ASS, Torensma B. Safety and Effect of Bariatric Metabolic Surgeries for Psychiatric Patients with Obesity: A Retrospective Matched Case-control Trial. Obes Surg 2023; 33:2115-2124. [PMID: 37178224 PMCID: PMC10289947 DOI: 10.1007/s11695-023-06627-x] [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: 11/01/2022] [Revised: 04/25/2023] [Accepted: 05/04/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Patients living with psychiatric illnesses (PIs) have a high prevalence of obesity. In a 2006 survey, 91.2% of professionals in the bariatric field identified "psychiatric issues" as clear contraindications to weight-loss surgery. METHODS This retrospective matched case-control study investigated the impact, safety, and possible relapse after bariatric metabolic surgery (BMS) in patients with PIs. Also, we tested the incidence of patients who developed PI after BMS and compared the post-procedural weight loss with that in a matched control group without PIs. The cases were matched in a ratio of 1:4 to the control patients standardized for age, sex, preoperative BMI, and type of BMS. RESULTS Of 5987 patients, 2.82% had a preoperative PI; postoperative de novo PI was present in 0.45%. Postoperative BMI was significantly different between the groups when compared to preoperative BMI (p < 0.001). Percentage of total weight loss (%TWL) after six months was not significantly different between the case (24.6% ± 8.9) and control groups (24.0% ± 8.4, p = 1.000). Early and late complications were not significantly different between the groups. The psychiatric drug use and dosage changes did not differ significantly pre- and postoperatively. Of the psychiatric patients, 5.1% were postoperatively admitted to a psychiatric hospital (p = 0.06) unrelated to BMS, and 3.4% had a prolonged absence from work after surgery. CONCLUSION BMS is an effective weight loss treatment and a safe procedure for patients with psychiatric disorders. We found no change in the patients' psychiatric status outside the usual disease course. Postoperative de novo PI was rare in the present study. Furthermore, patients with severe psychiatric illness were excluded from undergoing surgery and, therefore, from the study. Careful follow-up is necessary to guide and protect patients with PI.
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Affiliation(s)
- Mohamed Hany
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, 21561, Alexandria, Egypt.
- Consultant of Bariatric Surgery at Madina Women's Hospital, Alexandria, Egypt.
| | | | | | - Ann Samy Shafiq Agayby
- Department of Surgery, Medical Research Institute, Alexandria University, 165 Horreya Avenue, Hadara, 21561, Alexandria, Egypt
| | - Bart Torensma
- Clinical Epidemiologist, Leiden University Medical Center (LUMC), Leiden, The Netherlands
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3
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Williams K, Maise AA, Brar JS, Malito A, Washington L, Loveland D, Carney T, Bruce D, Schake P, Schuster J. Scaling a Behavioral Health Home Delivery Model to Special Populations. Community Ment Health J 2023; 59:552-563. [PMID: 36271976 DOI: 10.1007/s10597-022-01040-7] [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: 12/10/2021] [Accepted: 10/06/2022] [Indexed: 11/24/2022]
Abstract
The present project utilized a Learning Collaborative (LC) to disseminate the Behavioral Health Home Plus (BHHP) physical-behavioral health integration model to providers serving two behavioral health populations at risk for adverse health conditions: youth psychiatric residential treatment facilities (five sites) and adult opioid treatment providers (seven sites). Following the positive results of a randomized controlled trial utilizing an LC to implement two behavioral health home models in community mental health provider organizations serving adults with serious mental illness, Community Care Behavioral Health Organization facilitated integration of the models to scale health and wellness supports to additional behavioral health care delivery settings. This paper presents provider results focused on BHHP implementation training, LC implementation, physical health and wellness promotion within sites, and BHHP model sustainment plans. Provider self-reported data indicate that the LC approach is a successful tool for integrating and sustaining BHHP model components in routine care.
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Affiliation(s)
- Kelly Williams
- UPMC Center for High-Value Health Care, U.S. Steel Tower, 40Th Floor, 600 Grant St., Pittsburgh, PA, 15219, USA
| | - Amanda A Maise
- UPMC Insurance Services Division, Community Care Behavioral Health, 339 Sixth Ave., Suite 1300, Pittsburgh, PA, 15222, USA
| | - Jaspreet S Brar
- UPMC Insurance Services Division, Community Care Behavioral Health, 339 Sixth Ave., Suite 1300, Pittsburgh, PA, 15222, USA.,UPMC Western Psychiatric Hospital, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Adelina Malito
- UPMC Center for High-Value Health Care, U.S. Steel Tower, 40Th Floor, 600 Grant St., Pittsburgh, PA, 15219, USA
| | - Leslie Washington
- UPMC Insurance Services Division, Community Care Behavioral Health, 339 Sixth Ave., Suite 1300, Pittsburgh, PA, 15222, USA
| | - David Loveland
- UPMC Insurance Services Division, Community Care Behavioral Health, 339 Sixth Ave., Suite 1300, Pittsburgh, PA, 15222, USA
| | - Tracy Carney
- UPMC Insurance Services Division, Community Care Behavioral Health, 339 Sixth Ave., Suite 1300, Pittsburgh, PA, 15222, USA
| | - Duncan Bruce
- UPMC Insurance Services Division, Community Care Behavioral Health, 339 Sixth Ave., Suite 1300, Pittsburgh, PA, 15222, USA
| | - Patricia Schake
- UPMC Insurance Services Division, Community Care Behavioral Health, 339 Sixth Ave., Suite 1300, Pittsburgh, PA, 15222, USA.
| | - James Schuster
- UPMC Center for High-Value Health Care, U.S. Steel Tower, 40Th Floor, 600 Grant St., Pittsburgh, PA, 15219, USA
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4
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Strunz M, Jiménez NP, Gregorius L, Hewer W, Pollmanns J, Viehmann K, Jacobi F. Interventions to Promote the Utilization of Physical Health Care for People with Severe Mental Illness: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:126. [PMID: 36612457 PMCID: PMC9819522 DOI: 10.3390/ijerph20010126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The main contributor to excess mortality in severe mental illness (SMI) is poor physical health. Causes include unfavorable health behaviors among people with SMI, stigmatization phenomena, as well as limited access to and utilization of physical health care. Patient centered interventions to promote the utilization of and access to existing physical health care facilities may be a pragmatic and cost-effective approach to improve health equity in this vulnerable and often neglected patient population. OBJECTIVE/METHODS In this study, we systematically reviewed the international literature on such studies (sources: literature databases, trial-registries, grey literature). Empirical studies (quantitative, qualitative, and mixed methods) of interventions to improve the utilization of and access to medical health care for people with a SMI, were included. RESULTS We identified 38 studies, described in 51 study publications, and summarized them in terms of type, theoretical rationale, outcome measures, and study author's interpretation of the intervention success. CONCLUSIONS Useful interventions to promote the utilization of physical health care for people with a SMI exist, but still appear to be rare, or at least not supplemented by evaluation studies. The present review provides a map of the evidence and may serve as a starting point for further quantitative effectiveness evaluations of this promising type of behavioral intervention.
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Affiliation(s)
| | | | - Lisa Gregorius
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany
| | - Walter Hewer
- Klinikum Christophsbad, 73035 Göppingen, Germany
| | | | - Kerstin Viehmann
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany
| | - Frank Jacobi
- Psychologische Hochschule Berlin, 10179 Berlin, Germany
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5
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Korchia T, Tastevin M, Sunhary de Verville PL, Joober R, Andrieu-Haller C, Faugere M, Godin O, Etchecopar-Etchart D, Berna F, Aouizerate B, Capdevielle D, Chereau I, Clauss-Kobayashi J, Coulon N, Dorey JM, Dubertret C, Dubreucq J, Mallet J, Misdrahi D, Passerieux C, Rey R, Schürhoff F, Szoke A, Urbach M, Leboyer M, Llorca PM, Lançon C, Richieri R, Boyer L, Fond G. Precision-medicine findings from the FACE-SZ cohort to develop motivation-enhancing programs in real-world schizophrenia. World J Biol Psychiatry 2022; 23:703-714. [PMID: 35057713 DOI: 10.1080/15622975.2022.2031286] [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: 01/25/2023]
Abstract
BACKGROUND In people with schizophrenia, major areas of everyday life are impaired, including independent living, productive activities, social relationships and overall quality of life. Enhanced understanding of factors that hinder real-life functioning is vital for treatments to translate into more positive outcomes. AIM The goal of the present study was to identify factors associated with motivation deficits in real-life schizophrenia, and to assess its contribution to impaired functioning and quality of life. METHODS Based on previous literature and clinical experience, several factors were selected and grouped into factors potentially explaining motivation deficits. Some of these variables were never investigated before in relationship with motivation deficits. RESULTS In 561 patients with schizophrenia of the national FACE-SZ cohort living in the community, 235 (41.9%) reported severe motivation deficits. These deficits were found to be significantly associated with impaired socially useful activities, psychological and physical quality of life (in almost all domains), alcohol use disorder (aOR = 2.141, p = 0.021), severe nicotine dependence (aOR = 2.906, p < 0.001) independently of age and sex. No significant association was found for body mass index, metabolic syndrome or physical activity level. In the second model, we identified the following modifiable factors associated with motivation deficits: history of suicide attempt (aOR = 2.297, p = 0.001), positive symptoms (aOR = 1.052, p = 0.006), current major depressive episode (aOR = 2.627, p < 0.001), sleep disorders (aOR = 1.474, p = 0.024) and lower medication adherence (aOR = 0.836, p = 0.001) independently of gender, current alcohol use disorder, second-generation antipsychotics and akathisia. No significant association was found for negative symptoms, childhood trauma and inflammation. These results were maintained after removing patients with schizoaffective disorders or those with major depressive disorder. INTERPRETATION Motivation deficits are frequent and remain persistent unmet need in real-world schizophrenia that should be addressed in future guidelines. Based on our results, literature and clinical experience, we recommend to address in priority major depression, sleep, suicide, positive symptoms (when present and as early as possible) and medication adherence to improve motivation deficits of schizophrenia.
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Affiliation(s)
- Théo Korchia
- Fondation FondaMental, Créteil, France.,Secteur Timone, EA 327, Faculté de Médecine, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, AP-HM, Aix-Marseille Université, Marseille, France
| | - Maud Tastevin
- Fondation FondaMental, Créteil, France.,Secteur Timone, EA 327, Faculté de Médecine, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, AP-HM, Aix-Marseille Université, Marseille, France
| | - Pierre-Louis Sunhary de Verville
- Secteur Timone, EA 327, Faculté de Médecine, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, AP-HM, Aix-Marseille Université, Marseille, France
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis (PEPP-Montréal), Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montréal, Canada
| | - Christelle Andrieu-Haller
- Fondation FondaMental, Créteil, France.,Secteur Timone, EA 327, Faculté de Médecine, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, AP-HM, Aix-Marseille Université, Marseille, France
| | - Mélanie Faugere
- Fondation FondaMental, Créteil, France.,Secteur Timone, EA 327, Faculté de Médecine, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, AP-HM, Aix-Marseille Université, Marseille, France
| | | | - Damien Etchecopar-Etchart
- Fondation FondaMental, Créteil, France.,Secteur Timone, EA 327, Faculté de Médecine, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, AP-HM, Aix-Marseille Université, Marseille, France
| | - Fabrice Berna
- Fondation FondaMental, Créteil, France.,INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Bruno Aouizerate
- Fondation FondaMental, Créteil, France.,Centre Hospitalier Charles Perrens, F-33076 Université de Bordeaux, CNRS UMR 5287-INCIA, Pôle de psychiatrie Générale et Universitaire, Bordeaux, France.,INRA, NutriNeuro, University of Bordeaux, Bordeaux, France
| | - Delphine Capdevielle
- Fondation FondaMental, Créteil, France.,Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHRU Montpellier, IGF, CNRS, INSERM, Université Montpellier, Montpellier, France
| | - Isabelle Chereau
- Fondation FondaMental, Créteil, France.,CMP-B, CHU, CNRS, Clermont Auvergne INP, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Julie Clauss-Kobayashi
- Fondation FondaMental, Créteil, France.,INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Nathalie Coulon
- Fondation FondaMental, Créteil, France.,Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - Jean-Michel Dorey
- Fondation FondaMental, Créteil, France.,INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Bron Cedex, France
| | - Caroline Dubertret
- Fondation FondaMental, Créteil, France.,Department of Psychiatry, Louis Mourier Hospital, Université de Paris, AP-HP, Colombes, Paris, France
| | - Julien Dubreucq
- Fondation FondaMental, Créteil, France.,Centre Référent de Réhabilitation Psychosociale, CH Alpes Isère, Grenoble, France
| | - Jasmina Mallet
- Fondation FondaMental, Créteil, France.,Department of Psychiatry, Louis Mourier Hospital, Université de Paris, AP-HP, Colombes, Paris, France
| | - David Misdrahi
- Fondation FondaMental, Créteil, France.,Centre Hospitalier Charles Perrens, F-33076 Université de Bordeaux, CNRS UMR 5287-INCIA, Pôle de psychiatrie Générale et Universitaire, Bordeaux, France.,CNRS UMR 5287-INCIA, Université de Bordeaux, Bordeaux, France
| | - Christine Passerieux
- Fondation FondaMental, Créteil, France.,Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie d'Adultes et d'Addictologie, Le Chesnay, France.,DisAP-DevPsy-CESP, INSERM UMR1018, Université Paris-Saclay, Villejuif, France
| | - Romain Rey
- Fondation FondaMental, Créteil, France.,INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Université Claude Bernard Lyon 1, Bron Cedex, France
| | - Frank Schürhoff
- Fondation FondaMental, Créteil, France.,Hôpitaux Universitaires « H. Mondor », DMU IMPACT, INSERM, IMRB, translational Neuropsychiatry, Fondation FondaMental, Université Paris Est Creteil (UPEC), AP-HP, Creteil, France
| | - Andrei Szoke
- Fondation FondaMental, Créteil, France.,Hôpitaux Universitaires « H. Mondor », DMU IMPACT, INSERM, IMRB, translational Neuropsychiatry, Fondation FondaMental, Université Paris Est Creteil (UPEC), AP-HP, Creteil, France
| | - Mathieu Urbach
- Fondation FondaMental, Créteil, France.,Centre Hospitalier de Versailles, Service Universitaire de Psychiatrie d'Adultes et d'Addictologie, Le Chesnay, France.,DisAP-DevPsy-CESP, INSERM UMR1018, Université Paris-Saclay, Villejuif, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France.,Hôpitaux Universitaires « H. Mondor », DMU IMPACT, INSERM, IMRB, translational Neuropsychiatry, Fondation FondaMental, Université Paris Est Creteil (UPEC), AP-HP, Creteil, France
| | - Pierre-Michel Llorca
- Fondation FondaMental, Créteil, France.,CMP-B, CHU, CNRS, Clermont Auvergne INP, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Christophe Lançon
- Fondation FondaMental, Créteil, France.,Secteur Timone, EA 327, Faculté de Médecine, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, AP-HM, Aix-Marseille Université, Marseille, France
| | - Raphaelle Richieri
- Fondation FondaMental, Créteil, France.,Secteur Timone, EA 327, Faculté de Médecine, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, AP-HM, Aix-Marseille Université, Marseille, France
| | - Laurent Boyer
- Fondation FondaMental, Créteil, France.,Secteur Timone, EA 327, Faculté de Médecine, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, AP-HM, Aix-Marseille Université, Marseille, France
| | - Guillaume Fond
- Fondation FondaMental, Créteil, France.,Secteur Timone, EA 327, Faculté de Médecine, CEReSS-Centre d'Etude et de Recherche sur les Services de Santé et la Qualité de vie, AP-HM, Aix-Marseille Université, Marseille, France
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Cabassa LJ, Stefancic A, Chen JH, Park M, Tuda D, Hawes MR, Guo S. Impact of Moderating Demographic Variables on a Health Intervention for People with Serious Mental Illness. RESEARCH ON SOCIAL WORK PRACTICE 2022; 32:952-962. [PMID: 38741792 PMCID: PMC11090479 DOI: 10.1177/10497315221102403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Purpose Healthy lifestyle interventions can improve the health of people with serious mental illness (SMI). Little is known whether demographic variables moderate the effectiveness of these interventions on health outcomes. Method Data from an effectiveness trial of a peer-led healthy lifestyle intervention (PGLB) for people with SMI examine whether age, racial/ethnic minoritized status, and gender moderated the effectiveness of PGLB compared to usual care (UC) in achieving clinically significant improvements in weight, cardiorespiratory fitness, and cardiovascular disease (CVD) risk reduction. Results Compared to UC, PGLB was most beneficial for participants age 49 and younger for achieving clinically significant weight loss and from racial/ethnic minoritized communities for achieving clinically significant weight loss and reductions in CVD risk. Conclusions These findings suggest the impact of healthy lifestyle interventions for people with SMI may not be uniform and adaptations may be needed to make these interventions responsive to the needs of diverse populations.
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Affiliation(s)
| | | | - Jun-Hong Chen
- Brown School of Social Work at Washington University in St. Louis
| | - Michael Park
- Brown School of Social Work at Washington University in St. Louis
| | - Daniela Tuda
- Brown School of Social Work at Washington University in St. Louis
| | - Mark R. Hawes
- Brown School of Social Work at Washington University in St. Louis
| | - Shenyang Guo
- Brown School of Social Work at Washington University in St. Louis
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7
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Sommerfeld DH, Brunner AM, Glorioso D, Lee EE, Ibarra C, Zunshine E, Daly RE, Zoumas C, Jeste DV. Improving Healthy Living in Residential Care Facilities: Feasibility, Acceptability, and Appropriateness of Implementing a Multicomponent Intervention for Diabetes Risk Reduction in Adults with Serious Mental Illnesses. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:646-657. [PMID: 35113264 PMCID: PMC8820366 DOI: 10.1007/s10488-022-01189-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/28/2022]
Abstract
Persons with serious mental illnesses experience high rates of medical comorbidity, especially diabetes. This study examined initial implementation feasibility, acceptability, and appropriateness of a new 6-month Multicomponent Intervention for Diabetes risk reduction in Adults with Serious mental illnesses (MIDAS) among persons in residential care facilities (RCFs). We conducted a mixed-methods study using four types of quantitative and qualitative data sources (administrative data; structured facility-level observations; resident assessments including blood-based biomarkers, 24-h dietary recalls, and self-report physical activity; and focus groups/interviews with staff and participants), to assess evidence of and factors affecting intervention feasibility, acceptability, and appropriateness. It was feasible to provide a high percentage of MIDAS class sessions (mean 50 of 52 intended sessions delivered) and make nutrition-related RCF changes (substitutions for healthier food items and reduced portion sizes). Class attendance rates and positive feedback from residents and staff provided evidence of MIDAS acceptability and appropriateness for addressing identified health needs. The residents who attended ≥ 85% of the sessions had greater improvement in several desired outcomes compared to others. Implementing a fully integrated MIDAS model with more extensive changes to facilities and more fundamental health changes among residents was more challenging. While the study found evidence to support feasibility, acceptability, and appropriateness of individual MIDAS components, some challenges for full implementation and success in obtaining immediate health benefits were also apparent. The study results highlight the need for improving health among RCF populations and will inform MIDAS adaptations designed to improve intervention fit and effectiveness outcomes.
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Affiliation(s)
- David H Sommerfeld
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Amy M Brunner
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Danielle Glorioso
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, 92093, USA
| | - Ellen E Lee
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, 92093, USA
- VA San Diego Healthcare System, San Diego, CA, 92161, USA
| | - Cynthia Ibarra
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, 92093, USA
| | - Elizabeth Zunshine
- Moores Cancer Center, University of California San Diego, La Jolla, CA, 92037, USA
| | - Rebecca E Daly
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, 92093, USA
| | - Christine Zoumas
- Moores Cancer Center, University of California San Diego, La Jolla, CA, 92037, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, 92093, USA.
- Department of Neurosciences, University of California San Diego, La Jolla, CA, 92093, USA.
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8
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Schöttl SE, Niedermeier M, Kopp-Wilfling P, Frühauf A, Bichler CS, Edlinger M, Holzner B, Kopp M. Add-on exercise interventions for smoking cessation in people with mental illness: a systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2022; 14:115. [PMID: 35729669 PMCID: PMC9210718 DOI: 10.1186/s13102-022-00498-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 06/07/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Smoking is the most common substance use disorder among people with mental illness. In contrast to people without mental illness, among whom the proportion of smokers has declined in recent decades, the proportion of smokers among people with mental illness remains high. There is a growing body of literature suggesting the use of exercise interventions in combination with smoking cessation in people without mental illness, but to our knowledge the available studies on this treatment option in people with mental illness have not been systematically reviewed. Therefore, this systematic review and meta-analysis aims to assess the effectiveness of exercise interventions as an adjunctive treatment for smoking cessation in people with mental illness. METHODS Electronic databases (PubMed, Web of Science, PsycInfo, Sport Discus and Base) were searched for randomised controlled trials and prospective single-group studies that investigated exercise interventions in combination with smoking cessation programmes alone or in comparison with a control group in people with mental illness. A meta-analysis using the Mantel-Haenszel fixed-effect model was conducted to estimate the overall effect of treatment on smoking cessation (abstinence rate at the end of the intervention and at 6-month follow-up). RESULTS Six studies, five randomised controlled trials and one study with a prospective single-group design, were included in the systematic review and four randomised controlled trials were included in the meta-analysis. The meta-analysis found a significantly higher abstinence rate after additional exercise at the end of the intervention [risk ratio (RR) 1.48, 95% confidence interval (CI) 1.13-1.94], but not at the 6-month follow-up (RR 1.34, 95% CI 0.89-2.04). CONCLUSIONS Exercise appears to be an effective adjunctive therapy to temporarily increase abstinence rates in individuals with mental illness at the end of the intervention. However, due to the small number of included studies and some risk of bias in the included studies, the results should be treated with caution. Therefore, future studies with larger samples are needed to provide a more accurate estimate of the effect in people with mental illness. Registration The systematic review and meta-analysis were registered in the International Prospective Register of Systematic Reviews (PROSPERO) (registration number: CRD42020178630).
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Affiliation(s)
- Stefanie E. Schöttl
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020 Innsbruck, Austria
| | - Martin Niedermeier
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020 Innsbruck, Austria
| | - Prisca Kopp-Wilfling
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry I, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Anika Frühauf
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020 Innsbruck, Austria
| | - Carina S. Bichler
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020 Innsbruck, Austria
| | - Monika Edlinger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry I, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry I, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Martin Kopp
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020 Innsbruck, Austria
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9
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Chene M, Sánchez-Rico M, Blanco C, De Raykeer RP, Hanon C, Vandel P, Limosin F, Hoertel N. Psychiatric symptoms and mortality in older adults with major psychiatric disorders: results from a multicenter study. Eur Arch Psychiatry Clin Neurosci 2022; 273:627-638. [PMID: 35723739 DOI: 10.1007/s00406-022-01426-4] [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] [Received: 10/04/2021] [Accepted: 05/02/2022] [Indexed: 12/01/2022]
Abstract
Prior research suggests that certain psychiatric symptoms could be associated with increased risk of death. However, it remains unclear whether this association could rely on all or specific symptoms. In this report, we used data from a multicenter 5-year prospective study (N = 641) of older adults with an ICD-10 diagnosis of schizophrenia, bipolar disorder or major depressive disorder, recruited from French community psychiatric departments. We used a latent variable approach to disentangle the effects shared by all psychiatric symptoms (i.e., general psychopathology factor) and those specific to individual psychiatric symptoms, while adjusting for sociodemographic and clinical factors. Psychiatric symptoms were assessed face-to-face by psychiatrists trained to semi-structured interviews using the Brief Psychiatric Rating Scale (BPRS). Among older adults with major psychiatric disorders, we found that all psychiatric symptoms were associated with increased mortality, and that their effect on the 5-year mortality were exerted mostly through a general psychopathology dimension (β = 0.13, SE = 0.05, p < 0.05). No BPRS item or lower order factor had a significant effect on mortality beyond and above the effect of the general psychopathology factor. Greater number of medical conditions, older age, male sex, and being hospitalized or institutionalized at baseline were significantly associated with this risk beyond the effect of the general psychopathology factor. Since psychiatric symptoms may affect mortality mainly through a general psychopathology dimension, biological and psychological mechanisms underlying this dimension should be considered as promising targets for interventions to decrease excess mortality of older individuals with psychiatric disorders.
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Affiliation(s)
- Margaux Chene
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France. .,Department of Psychiatry, Corentin Celton Hospital, Paris Descartes University, 4 parvis Corentin Celton, 92130, Issy-les-Moulineaux, France.
| | - Marina Sánchez-Rico
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France.,Department of Psychobiology and Behavioural Sciences Methods, Faculty of Psychology, Universidad Complutense de Madrid, Campus de Somosaguas, Madrid, Spain
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute On Drug Abuse, Bethesda, MD, USA
| | - Rachel Pascal De Raykeer
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France
| | - Cécile Hanon
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France.,Department of Psychiatry, Corentin Celton Hospital, Paris Descartes University, 4 parvis Corentin Celton, 92130, Issy-les-Moulineaux, France
| | - Pierre Vandel
- Department of Adult Psychiatry, Laboratory of Neurosciences, University Hospital of Besançon, UBFC, EA-481, Besançon, France
| | - Frédéric Limosin
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France.,INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France.,Department of Psychiatry, Corentin Celton Hospital, Paris Descartes University, 4 parvis Corentin Celton, 92130, Issy-les-Moulineaux, France
| | - Nicolas Hoertel
- Department of Psychiatry, AP-HP, Western Paris University Hospitals, 92130, Issy-les-Moulineaux, France.,INSERM UMR 894, Psychiatry and Neurosciences Center, Paris, France.,Paris Descartes University, Sorbonne Paris Cité, Paris, France
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10
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Momen NC, Plana-Ripoll O, Agerbo E, Christensen MK, Iburg KM, Laursen TM, Mortensen PB, Pedersen CB, Prior A, Weye N, McGrath JJ. Mortality Associated With Mental Disorders and Comorbid General Medical Conditions. JAMA Psychiatry 2022; 79:444-453. [PMID: 35353141 PMCID: PMC8968685 DOI: 10.1001/jamapsychiatry.2022.0347] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE Premature mortality has been observed among people with mental disorders. Comorbid general medical conditions contribute substantially to this reduction in life expectancy. OBJECTIVE To provide an analysis of mortality associated with comorbidity between a broad range of mental disorders and general medical conditions. DESIGN, SETTING, AND PARTICIPANTS Population-based cohort study of 5 946 800 individuals born in Denmark from 1900 to 2015 and residing in the country at the start of follow-up (January 1, 2000, or their date of birth, whichever occurred later). EXPOSURES Danish health registers were used to identify people with mental disorders and general medical conditions. MAIN OUTCOMES AND MEASURES Considering pairs of mental disorders and general medical conditions, we calculated mortality rate ratios (MRRs) and differences in life expectancy (ie, life-years lost) to assess the association of mortality with both disorders of interest compared with the mental disorder of interest, the general medical condition of interest, and neither disorder of interest. RESULTS The study population comprised 2 961 397 males and 2 985 403 females, with a median (IQR) age of 32.0 years (7.3-52.9) at start of follow-up and 48.9 years (42.5-68.8) at the end. Based on all pairs of comorbid mental disorders and general medical conditions, the mean MRR compared with people without these conditions was 5.90 (median, 4.94; IQR, 3.80-7.30), and the mean reduction of life expectancy compared with the general population was 11.35 years (median, 11.08; range, 5.27-23.53; IQR, 8.22-13.72). The association with general medical condition comorbidity in those with mental disorders varied by general medical condition; for example, the addition of a neurological condition for each of the mental disorders was associated with a mean MRR of 1.22, whereas for cancer, the mean MRR for all mental disorders was 4.07. CONCLUSIONS AND RELEVANCE In this study, shorter life expectancy was associated with comorbid mental disorders and general medical conditions compared with the entire population and also when compared with patients who had either mental disorders only or general medical conditions only. Prevention and early detection of comorbidities could reduce premature mortality in patients with mental disorders.
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Affiliation(s)
- Natalie C. Momen
- National Centre for Register-based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Oleguer Plana-Ripoll
- National Centre for Register-based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark,Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Esben Agerbo
- National Centre for Register-based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark,CIRRAU – Centre for Integrated Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
| | - Maria K. Christensen
- National Centre for Register-based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark,Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Thomas Munk Laursen
- National Centre for Register-based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - Preben B. Mortensen
- National Centre for Register-based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark,CIRRAU – Centre for Integrated Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
| | - Carsten B. Pedersen
- National Centre for Register-based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark,CIRRAU – Centre for Integrated Register-based Research, Aarhus BSS, Aarhus University, Aarhus, Denmark
| | - Anders Prior
- Department of Public Health, Aarhus University, Aarhus, Denmark,Research Unit for General Practice, Aarhus, Denmark
| | - Nanna Weye
- National Centre for Register-based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
| | - John J. McGrath
- National Centre for Register-based Research, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark,Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Queensland, Australia
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11
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Zern A, Seserman M, Dacus H, Wallace B, Friedlander S, Manseau MW, Smalling MM, Smith TE, Williams JM, Compton MT. Screening and Treatment of Tobacco Use Disorder in Mental Health Clinics in New York State: Current Status and Potential Next Steps. Community Ment Health J 2021; 57:1023-1031. [PMID: 33083939 DOI: 10.1007/s10597-020-00726-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 10/05/2020] [Indexed: 11/28/2022]
Abstract
The prevalence of smoking is higher among individuals with serious mental illnesses than the general population. Evidence-based practices exist for tobacco cessation, but little is known about mental health clinics' tobacco cessation treatment practices/protocols. Mental health clinics in New York State were surveyed about their tobacco use treatment protocols and outdoor-smoking policies. One-third of clinics were not providing individual counseling for tobacco use disorder, 39% were not prescribing nicotine replacement therapy, and nearly half reported not prescribing bupropion or varenicline. Even smaller proportions reported implementing other clinical practice guidelines, with only 25.2% providing staff training and 20.3% having a dedicated staff member for coordinating tobacco use disorder treatment. Regarding outdoor smoke-free policies, 38% of clinics reported not allowing any tobacco use anywhere on grounds. Despite some successes, many clinics do not provide evidence-based tobacco use treatments, meaning important opportunities exist for mental health clinics and oversight agencies to standardize practices.
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Affiliation(s)
- Adria Zern
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | - Heather Dacus
- New York State Department of Health, Albany, NY, USA
| | | | | | | | | | - Thomas E Smith
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.,New York State Office of Mental Health, Albany, NY, USA.,New York State Psychiatric Institute, New York, NY, USA
| | - Jill M Williams
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA. .,New York State Psychiatric Institute, New York, NY, USA.
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12
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Zhou Y, Huang J, Zhang P, Tong J, Fan F, Gou M, Cui Y, Luo X, Tan S, Wang Z, Feng W, Yang F, Tian B, Tian L, Savransky A, Hare S, Ryan MC, Goldwaser E, Chiappelli J, Chen S, Kochunov P, Kvarta M, Tan Y, Hong LE. Allostatic Load Effects on Cortical and Cognitive Deficits in Essentially Normotensive, Normoweight Patients with Schizophrenia. Schizophr Bull 2021; 47:1048-1057. [PMID: 33501486 PMCID: PMC8266595 DOI: 10.1093/schbul/sbaa196] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Reduced cortical gray matter integrity and cognitive abilities are among core deficits in schizophrenia. We hypothesized that higher allostatic load (AL) that accounts for exposure to chronic stress is a contributor to structural and cognitive deficits in schizophrenia. One hundred and sixty-seven schizophrenia patients who were on average with normal weight, normal systolic, and diastolic blood pressure and 72 healthy controls were enrolled in the study. Group differences in subclinical cardiovascular, metabolic, immune, and neuroendocrine biological markers as indexed by AL and contribution of AL components to the structural and cognitive deficits in schizophrenia were explored. Compared with controls, schizophrenia patients who were normotensive, normoweight, and had low total cholesterol levels still had significantly higher AL mainly due to lower high-density lipoprotein cholesterol and higher heart rate, waist-hip ratio, hemoglobinA1c, hypersensitive C-reactive protein, and overnight-urine cortisol levels. Patients also had decreased whole-brain mean cortical thickness, and lower cognition assessed by the MATRICS consensus cognitive battery. AL was inversely correlated with mean cortical thickness and cognition in schizophrenia, while none of these relationships existed in controls. Mediation analyses showed the effect of AL on cognitive deficits in schizophrenia was significantly mediated by cortical thinning, and the most significant mediating cortical area was the left superior frontal gyrus. Cortical thickness may act as a mediator between AL and cognitive deficits in schizophrenia. Early intervention strategies to reduce cortical thinning and cognitive dysfunction in schizophrenia should target specific aspects of their high AL in addition to weight gain, hypertension and high cholesterol levels.
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Affiliation(s)
- Yanfang Zhou
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Junchao Huang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Ping Zhang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Jinghui Tong
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Fengmei Fan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Mengzhuang Gou
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Yimin Cui
- Department of Pharmacy, Peking University First Hospital, Beijing, P.R. China
| | - Xingguang Luo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
| | - Shuping Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Zhiren Wang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Wei Feng
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Fude Yang
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Baopeng Tian
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - Li Tian
- Institute of Biomedicine and Translational Medicine, Department of Physiology, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Anya Savransky
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Stephanie Hare
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Meghann C Ryan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Eric Goldwaser
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Joshua Chiappelli
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Shuo Chen
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Peter Kochunov
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Mark Kvarta
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Yunlong Tan
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing, P.R. China
| | - L Elliot Hong
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
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13
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Matshoba T, Mashaphu S, Tomita A, Paruk S. HIV knowledge, attitudes and practices amongst patients with severe mental illnesses and chronic medical illnesses in Durban, South Africa. S Afr J Psychiatr 2021; 27:1586. [PMID: 34230865 PMCID: PMC8252175 DOI: 10.4102/sajpsychiatry.v27i0.1586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 04/16/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Studies exploring HIV knowledge, attitudes and practices (KAP) of individuals with severe mental illness (SMI) have suggested their poorer knowledge about HIV. In KwaZulu-Natal (KZN) province, South Africa (SA), the epicentre of the country's HIV epidemic, improving KAP is essential for reduce its incidence amongst individuals with SMI. Comparing the KAP related to HIV between those with SMI and chronic medical illnesses (CMI) such as hypertension and diabetes may expose gaps in KAP related to HIV in the mentally ill who are more vulnerable to HIV. AIM This study aimed to compare the KAP related to HIV between people living with SMI and CMI. SETTING Outpatient clinics in Durban, SA. METHODS A cross-sectional structured questionnaire survey was conducted amongst 214 adult outpatients with SMI and CMI attending two general public sector hospitals in Durban, KZN. The KAP questionnaire consisted of three sections: general information, prevention and transmission of HIV. RESULTS Interviews were conducted with 124 patients with SMI and 90 with CMI. Most were female (69.5%), single (57.5%) and unemployed (59.4%). The diagnosis of SMI was associated with poorer general information of HIV (p = 0.02), but not with its prevention and transmission compared with those with CMI. Educational level was associated with poorer performance in all three domains: general information of HIV (p = 0.01), prevention (p = 0.01) and transmission (p = 0.02) amongst all the participants. CONCLUSION Gaps in the KAP of HIV amongst individuals with SMI compared with those with CMI suggested a need to provide focused health promotion regarding sexual health and HIV to the mentally ill at psychiatric facilities.
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Affiliation(s)
- Thembeka Matshoba
- Department of Psychiatry, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Sibongile Mashaphu
- Department of Psychiatry, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Tomita
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa,KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Saeeda Paruk
- Department of Psychiatry, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa
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14
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Lister J, Han L, Bellass S, Taylor J, Alderson SL, Doran T, Gilbody S, Hewitt C, Holt RIG, Jacobs R, Kitchen CEW, Prady SL, Radford J, Ride JR, Shiers D, Wang HI, Siddiqi N. Identifying determinants of diabetes risk and outcomes for people with severe mental illness: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background
People with severe mental illness experience poorer health outcomes than the general population. Diabetes contributes significantly to this health gap.
Objectives
The objectives were to identify the determinants of diabetes and to explore variation in diabetes outcomes for people with severe mental illness.
Design
Under a social inequalities framework, a concurrent mixed-methods design combined analysis of linked primary care records with qualitative interviews.
Setting
The quantitative study was carried out in general practices in England (2000–16). The qualitative study was a community study (undertaken in the North West and in Yorkshire and the Humber).
Participants
The quantitative study used the longitudinal health records of 32,781 people with severe mental illness (a subset of 3448 people had diabetes) and 9551 ‘controls’ (with diabetes but no severe mental illness), matched on age, sex and practice, from the Clinical Practice Research Datalink (GOLD version). The qualitative study participants comprised 39 adults with diabetes and severe mental illness, nine family members and 30 health-care staff.
Data sources
The Clinical Practice Research Datalink (GOLD) individual patient data were linked to Hospital Episode Statistics, Office for National Statistics mortality data and the Index of Multiple Deprivation.
Results
People with severe mental illness were more likely to have diabetes if they were taking atypical antipsychotics, were living in areas of social deprivation, or were of Asian or black ethnicity. A substantial minority developed diabetes prior to severe mental illness. Compared with people with diabetes alone, people with both severe mental illness and diabetes received more frequent physical checks, maintained tighter glycaemic and blood pressure control, and had fewer recorded physical comorbidities and elective admissions, on average. However, they had more emergency admissions (incidence rate ratio 1.14, 95% confidence interval 0.96 to 1.36) and a significantly higher risk of all-cause mortality than people with diabetes but no severe mental illness (hazard ratio 1.89, 95% confidence interval 1.59 to 2.26). These paradoxical results may be explained by other findings. For example, people with severe mental illness and diabetes were more likely to live in socially deprived areas, which is associated with reduced frequency of health checks, poorer health outcomes and higher mortality risk. In interviews, participants frequently described prioritising their mental illness over their diabetes (e.g. tolerating antipsychotic side effects, despite awareness of harmful impacts on diabetes control) and feeling overwhelmed by competing treatment demands from multiple morbidities. Both service users and practitioners acknowledged misattributing physical symptoms to poor mental health (‘diagnostic overshadowing’).
Limitations
Data may not be nationally representative for all relevant covariates, and the completeness of recording varied across practices.
Conclusions
People with severe mental illness and diabetes experience poorer health outcomes than, and deficiencies in some aspects of health care compared with, people with diabetes alone.
Future work
These findings can inform the development of targeted interventions aimed at addressing inequalities in this population.
Study registration
National Institute for Health Research (NIHR) Central Portfolio Management System (37024); and ClinicalTrials.gov NCT03534921.
Funding
This project was funded by the NIHR Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 10. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Jennie Lister
- Department of Health Sciences, University of York, York, UK
| | - Lu Han
- Department of Health Sciences, University of York, York, UK
| | - Sue Bellass
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Jo Taylor
- Department of Health Sciences, University of York, York, UK
| | - Sarah L Alderson
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Tim Doran
- Department of Health Sciences, University of York, York, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | | | - Richard IG Holt
- Faculty of Medicine, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rowena Jacobs
- Centre for Health Economics, University of York, York, UK
| | | | | | - John Radford
- Patient and public involvement representative, Keighley, UK
| | - Jemimah R Ride
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - David Shiers
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Primary Care and Health Sciences, Keele University, Keele, UK
| | - Han-I Wang
- Department of Health Sciences, University of York, York, UK
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, UK
- Hull York Medical School, University of York, York, UK
- Bradford District Care NHS Foundation Trust, Bradford, UK
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15
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Serious Mental Illness in Primary Care: a National Physician Survey. J Gen Intern Med 2021; 36:833-835. [PMID: 32524252 PMCID: PMC7947081 DOI: 10.1007/s11606-020-05950-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 05/29/2020] [Indexed: 10/24/2022]
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16
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Mishu MP, Uphoff E, Aslam F, Philip S, Wright J, Tirbhowan N, Ajjan RA, Al Azdi Z, Stubbs B, Churchill R, Siddiqi N. Interventions for preventing type 2 diabetes in adults with mental disorders in low- and middle-income countries. Cochrane Database Syst Rev 2021; 2:CD013281. [PMID: 33591592 PMCID: PMC8092639 DOI: 10.1002/14651858.cd013281.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The prevalence of type 2 diabetes is increased in individuals with mental disorders. Much of the burden of disease falls on the populations of low- and middle-income countries (LMICs). OBJECTIVES To assess the effects of pharmacological, behaviour change, and organisational interventions versus active and non-active comparators in the prevention or delay of type 2 diabetes among people with mental illness in LMICs. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register, CENTRAL, MEDLINE, Embase and six other databases, as well as three international trials registries. We also searched conference proceedings and checked the reference lists of relevant systematic reviews. Searches are current up to 20 February 2020. SELECTION CRITERIA Randomized controlled trials (RCTs) of pharmacological, behavioural or organisational interventions targeting the prevention or delay of type 2 diabetes in adults with mental disorders in LMICs. DATA COLLECTION AND ANALYSIS Pairs of review authors working independently performed data extraction and risk of bias assessments. We conducted meta-analyses using random-effects models. MAIN RESULTS One hospital-based RCT with 150 participants (99 participants with schizophrenia) addressed our review's primary outcome of prevention or delay of type 2 diabetes onset. Low-certainty evidence from this study did not show a difference between atypical and typical antipsychotics in the development of diabetes at six weeks (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.03 to 7.05) (among a total 99 participants with schizophrenia, 68 were in atypical and 31 were in typical antipsychotic groups; 55 participants without mental illness were not considered in the analysis). An additional 29 RCTs with 2481 participants assessed one or more of the review's secondary outcomes. All studies were conducted in hospital settings and reported on pharmacological interventions. One study, which we could not include in our meta-analysis, included an intervention with pharmacological and behaviour change components. We identified no studies of organisational interventions. Low- to moderate-certainty evidence suggests there may be no difference between the use of atypical and typical antipsychotics for the outcomes of drop-outs from care (RR 1.31, 95% CI 0.63 to 2.69; two studies with 144 participants), and fasting blood glucose levels (mean difference (MD) 0.05 lower, 95% CI 0.10 to 0.00; two studies with 211 participants). Participants who receive typical antipsychotics may have a lower body mass index (BMI) at follow-up than participants who receive atypical antipsychotics (MD 0.57, 95% CI 0.33 to 0.81; two studies with 141 participants; moderate certainty of evidence), and may have lower total cholesterol levels eight weeks after starting treatment (MD 0.35, 95% CI 0.27 to 0.43; one study with 112 participants). There was moderate certainty evidence suggesting no difference between the use of metformin and placebo for the outcomes of drop-outs from care (RR 1.22, 95% CI 0.09 to 16.35; three studies with 158 participants). There was moderate-to-high certainty evidence of no difference between metformin and placebo for fasting blood glucose levels (endpoint data: MD -0.35, 95% CI -0.60 to -0.11; change from baseline data: MD 0.01, 95% CI -0.21 to 0.22; five studies with 264 participants). There was high certainty evidence that BMI was lower for participants receiving metformin compared with those receiving a placebo (MD -1.37, 95% CI -2.04 to -0.70; five studies with 264 participants; high certainty of evidence). There was no difference between metformin and placebo for the outcomes of waist circumference, blood pressure and cholesterol levels. Low-certainty evidence from one study (48 participants) suggests there may be no difference between the use of melatonin and placebo for the outcome of drop-outs from care (RR 1.00, 95% CI 0.38 to 2.66). Fasting blood glucose is probably reduced more in participants treated with melatonin compared with placebo (endpoint data: MD -0.17, 95% CI -0.35 to 0.01; change from baseline data: MD -0.24, 95% CI -0.39 to -0.09; three studies with 202 participants, moderate-certainty evidence). There was no difference between melatonin and placebo for the outcomes of waist circumference, blood pressure and cholesterol levels. Very low-certainty evidence from one study (25 participants) suggests that drop-outs may be higher in participants treated with a tricyclic antidepressant (TCA) compared with those receiving a selective serotonin reuptake inhibitor (SSRI) (RR 0.34, 95% CI 0.11 to 1.01). It is uncertain if there is no difference in fasting blood glucose levels between these groups (MD -0.39, 95% CI -0.88 to 0.10; three studies with 141 participants, moderate-certainty evidence). It is uncertain if there is no difference in BMI and depression between the TCA and SSRI antidepressant groups. AUTHORS' CONCLUSIONS Only one study reported data on our primary outcome of interest, providing low-certainty evidence that there may be no difference in risk between atypical and typical antipsychotics for the outcome of developing type 2 diabetes. We are therefore not able to draw conclusions on the prevention of type 2 diabetes in people with mental disorders in LMICs. For studies reporting on secondary outcomes, there was evidence of risk of bias in the results. There is a need for further studies with participants from LMICs with mental disorders, particularly on behaviour change and on organisational interventions targeting prevention of type 2 diabetes in these populations.
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Affiliation(s)
| | - Eleonora Uphoff
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Faiza Aslam
- WHO Collaborating Centre for Mental Health & Research, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Sharad Philip
- Psychiatric Rehabilitation Services Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), An Institute of National Importance, Bangalore, India
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Nilesh Tirbhowan
- Department of Health Sciences, Hull York Medical School, University of York, York, UK
| | - Ramzi A Ajjan
- Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Zunayed Al Azdi
- Research and Research Uptake Division, ARK Foundation, Dhaka, Bangladesh
| | - Brendon Stubbs
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Rachel Churchill
- Cochrane Common Mental Disorders, University of York, York, UK
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, UK
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17
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Maj M, van Os J, De Hert M, Gaebel W, Galderisi S, Green MF, Guloksuz S, Harvey PD, Jones PB, Malaspina D, McGorry P, Miettunen J, Murray RM, Nuechterlein KH, Peralta V, Thornicroft G, van Winkel R, Ventura J. The clinical characterization of the patient with primary psychosis aimed at personalization of management. World Psychiatry 2021; 20:4-33. [PMID: 33432763 PMCID: PMC7801854 DOI: 10.1002/wps.20809] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The current management of patients with primary psychosis worldwide is often remarkably stereotyped. In almost all cases an antipsychotic medica-tion is prescribed, with second-generation antipsychotics usually preferred to first-generation ones. Cognitive behavioral therapy is rarely used in the vast majority of countries, although there is evidence to support its efficacy. Psychosocial interventions are often provided, especially in chronic cases, but those applied are frequently not validated by research. Evidence-based family interventions and supported employment programs are seldom implemented in ordinary practice. Although the notion that patients with primary psychosis are at increased risk for cardiovascular diseases and diabetes mellitus is widely shared, it is not frequent that appropriate measures be implemented to address this problem. The view that the management of the patient with primary psychosis should be personalized is endorsed by the vast majority of clinicians, but this personalization is lacking or inadequate in most clinical contexts. Although many mental health services would declare themselves "recovery-oriented", it is not common that a focus on empowerment, identity, meaning and resilience is ensured in ordinary practice. The present paper aims to address this situation. It describes systematically the salient domains that should be considered in the characterization of the individual patient with primary psychosis aimed at personalization of management. These include positive and negative symptom dimensions, other psychopathological components, onset and course, neurocognition and social cognition, neurodevelopmental indicators; social functioning, quality of life and unmet needs; clinical staging, antecedent and concomitant psychiatric conditions, physical comorbidities, family history, history of obstetric complications, early and recent environmental exposures, protective factors and resilience, and internalized stigma. For each domain, simple assessment instruments are identified that could be considered for use in clinical practice and included in standardized decision tools. A management of primary psychosis is encouraged which takes into account all the available treatment modalities whose efficacy is supported by research evidence, selects and modulates them in the individual patient on the basis of the clinical characterization, addresses the patient's needs in terms of employment, housing, self-care, social relationships and education, and offers a focus on identity, meaning and resilience.
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Affiliation(s)
- Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Jim van Os
- Department of Psychiatry, Brain Centre Rudolf Magnus, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Marc De Hert
- University Psychiatric Centre KU Leuven, Kortenberg, Belgium
- Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University Düsseldorf, LVR-Klinikum Düsseldorf, and WHO Collaborating Center on Quality Assurance and Empowerment in Mental Health, Düsseldorf, Germany
| | - Silvana Galderisi
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Michael F Green
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- Department of Veterans Affairs, Desert Pacific Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA
| | - Sinan Guloksuz
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Philip D Harvey
- Division of Psychology, Department of Psychiatry, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge and Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, UK
| | - Dolores Malaspina
- Department of Psychiatry and Neuroscience, Ichan Medical School at Mount Sinai, New York, NY, USA
| | - Patrick McGorry
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Jouko Miettunen
- Centre for Life Course Health Research, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Robin M Murray
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Keith H Nuechterlein
- Semel Institute for Neuroscience and Human Behavior, Geffen School of Medicine, and Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Victor Peralta
- Mental Health Department, Servicio Navarro de Salud, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Ruud van Winkel
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
- Antwerp Health Law and Ethics Chair, University of Antwerp, Antwerp, Belgium
- University Psychiatric Center KU Leuven, Leuven, Belgium
| | - Joseph Ventura
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
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18
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McGinty EE, Murphy KA, Dalcin AT, Stuart EA, Wang NY, Dickerson F, Gudzune K, Jerome G, Thompson D, Cullen BA, Gennusa J, Kilbourne AM, Daumit GL. A Model for Advancing Scale-Up of Complex Interventions for Vulnerable Populations: the ALACRITY Center for Health and Longevity in Mental Illness. J Gen Intern Med 2021; 36:500-505. [PMID: 32869192 PMCID: PMC7878664 DOI: 10.1007/s11606-020-06137-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 08/11/2020] [Indexed: 12/17/2022]
Abstract
Many of the most pressing health issues in the USA and worldwide require complex, multi-faceted solutions. Delivery of such solutions is often complicated by the need to reach and engage vulnerable populations facing multiple barriers to care. While the fields of quality improvement and implementation science have made valuable gains in the development and spread of individual strategies to improve evidence-based practice delivery, models for coordinated deployment of numerous strategies to simultaneously implement multiple evidence-based interventions in vulnerable populations are lacking. In this Perspective, we describe a model for this type of comprehensive research-practice translation effort: the Johns Hopkins ALACRITY Center for Health and Longevity in Mental Illness, which is focused on reducing premature mortality in the population with serious mental illness. We describe the Center's conceptual framework, which is built upon an integrated set of quality improvement and implementation science frameworks, provide an overview of the Center's organizational structure and core research-practice translation activities, and discuss our vision for how the Center may evolve over time. Lessons learned from this Center's efforts could inform models to address other critical health issues in vulnerable populations that require multi-component solutions at the policy, system, provider, and patient levels.
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Affiliation(s)
- Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Karly A Murphy
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Arlene T Dalcin
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nae-Yuh Wang
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Kim Gudzune
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gerald Jerome
- Department of Kinesiology, Towson University, Towson, MD, USA
| | - David Thompson
- Department of Anesthesiology and Critical Care and Armstrong Institute for Patient Safety and Quality, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Bernadette A Cullen
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Joseph Gennusa
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Amy M Kilbourne
- Health Services Research and Development Service, Veterans Health Administration, US Department of Veterans Affairs and Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MD, USA
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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19
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Ward M. Increasing Psychiatrists' Role in Addressing the Cardiovascular Health of Patients With Severe Mental Illness. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:24-30. [PMID: 34483763 DOI: 10.1176/appi.focus.20200036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The early mortality of individuals with serious mental illness has long been documented yet persists despite calls for change. Individuals with serious mental illness have a higher rate of medical morbidity than those in the general population across all categories of disease. Cardiovascular disease is particularly prevalent in this population, and it is the leading cause of death for persons with serious mental illness. Addressing cardiovascular risk factors is essential to closing the mortality gap, yet patients with serious mental illness often receive poor continuity of medical care, and psychiatrists are often their only physicians. Thus, to have an impact on the mortality gap, psychiatrists must address the cardiovascular health of their patients with serious mental illness. Here, the author presents a framework of intervention at varying levels of intensity for psychiatrists to increase their role in addressing the cardiovascular health of patients with serious mental illness.
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Affiliation(s)
- Martha Ward
- Department of Psychiatry and Behavioral Sciences and Department of Medicine, Emory University School of Medicine, Atlanta
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20
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Lupton-Smith C, Stuart EA, McGinty EE, Dalcin AT, Jerome GJ, Wang NY, Daumit GL. Determining Predictors of Weight Loss in a Behavioral Intervention: A Case Study in the Use of Lasso Regression. Front Psychiatry 2021; 12:707707. [PMID: 35185628 PMCID: PMC8850776 DOI: 10.3389/fpsyt.2021.707707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 12/29/2021] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE This study investigates predictors of weight loss among individuals with serious mental illness participating in an 18-month behavioral weight loss intervention, using Lasso regression to select the most powerful predictors. METHODS Data were analyzed from the intervention group of the ACHIEVE trial, an 18-month behavioral weight loss intervention in adults with serious mental illness. Lasso regression was employed to identify predictors of at least five-pound weight loss across the intervention time span. Once predictors were identified, classification trees were created to show examples of how to classify participants into having likely outcomes based on characteristics at baseline and during the intervention. RESULTS The analyzed sample contained 137 participants. Seventy-one (51.8%) individuals had a net weight loss of at least five pounds from baseline to 18 months. The Lasso regression selected weight loss from baseline to 6 months as a primary predictor of at least five pound 18-month weight loss, with a standardized coefficient of 0.51 (95% CI: -0.37, 1.40). Three other variables were also selected in the regression but added minimal predictive ability. CONCLUSIONS The analyses in this paper demonstrate the importance of tracking weight loss incrementally during an intervention as an indicator for overall weight loss, as well as the challenges in predicting long-term weight loss with other variables commonly available in clinical trials. The methods used in this paper also exemplify how to effectively analyze a clinical trial dataset containing many variables and identify factors related to desired outcomes.
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Affiliation(s)
- Carly Lupton-Smith
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elizabeth A Stuart
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Emma E McGinty
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Arlene T Dalcin
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Gerald J Jerome
- Department of Kinesiology, Towson University, Towson, MD, United States
| | - Nae-Yuh Wang
- Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Gail L Daumit
- Johns Hopkins School of Medicine, Baltimore, MD, United States
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21
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Chen S, Jones PB, Underwood BR, Moore A, Bullmore ET, Banerjee S, Osimo EF, Deakin JB, Hatfield CF, Thompson FJ, Artingstall JD, Slann MP, Lewis JR, Cardinal RN. The early impact of COVID-19 on mental health and community physical health services and their patients' mortality in Cambridgeshire and Peterborough, UK. J Psychiatr Res 2020; 131:244-254. [PMID: 33035957 PMCID: PMC7508053 DOI: 10.1016/j.jpsychires.2020.09.020] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 09/17/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND COVID-19 has affected social interaction and healthcare worldwide. METHODS We examined changes in presentations and referrals to the primary provider of mental health and community health services in Cambridgeshire and Peterborough, UK (population ~0·86 million), plus service activity and deaths. We conducted interrupted time series analyses with respect to the time of UK "lockdown", which was shortly before the peak of COVID-19 infections in this area. We examined changes in standardized mortality ratio for those with and without severe mental illness (SMI). RESULTS Referrals and presentations to nearly all mental and physical health services dropped at lockdown, with evidence for changes in both supply (service provision) and demand (help-seeking). This was followed by an increase in demand for some services. This pattern was seen for all major forms of presentation to liaison psychiatry services, except for eating disorders, for which there was no evidence of change. Inpatient numbers fell, but new detentions under the Mental Health Act were unchanged. Many services shifted from face-to-face to remote contacts. Excess mortality was primarily in the over-70s. There was a much greater increase in mortality for patients with SMI, which was not explained by ethnicity. CONCLUSIONS COVID-19 has been associated with a system-wide drop in the use of mental health services, with some subsequent return in activity. "Supply" changes may have reduced access to mental health services for some. "Demand" changes may reflect a genuine reduction of need or a lack of help-seeking with pent-up demand. There has been a disproportionate increase in death among those with SMI during the pandemic.
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Affiliation(s)
- Shanquan Chen
- Department of Psychiatry, University of Cambridge, Sir William Hardy Building, Downing Site, Cambridge, CB2 3EB, UK.
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Sir William Hardy Building, Downing Site, Cambridge, CB2 3EB, UK,Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, CB21 5EF, UK
| | - Benjamin R. Underwood
- Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, CB21 5EF, UK
| | - Anna Moore
- Department of Psychiatry, University of Cambridge, Sir William Hardy Building, Downing Site, Cambridge, CB2 3EB, UK; Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, CB21 5EF, UK.
| | - Edward T. Bullmore
- Department of Psychiatry, University of Cambridge, Sir William Hardy Building, Downing Site, Cambridge, CB2 3EB, UK,Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, CB21 5EF, UK
| | - Soumya Banerjee
- Department of Psychiatry, University of Cambridge, Sir William Hardy Building, Downing Site, Cambridge, CB2 3EB, UK.
| | - Emanuele F. Osimo
- Department of Psychiatry, University of Cambridge, Sir William Hardy Building, Downing Site, Cambridge, CB2 3EB, UK,Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, CB21 5EF, UK
| | - Julia B. Deakin
- Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, CB21 5EF, UK
| | - Catherine F. Hatfield
- Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, CB21 5EF, UK
| | - Fiona J. Thompson
- Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, CB21 5EF, UK
| | - Jonathon D. Artingstall
- Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, CB21 5EF, UK
| | - Matthew P. Slann
- Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, CB21 5EF, UK
| | - Jonathan R. Lewis
- Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, CB21 5EF, UK
| | - Rudolf N. Cardinal
- Department of Psychiatry, University of Cambridge, Sir William Hardy Building, Downing Site, Cambridge, CB2 3EB, UK,Cambridgeshire & Peterborough NHS Foundation Trust, Fulbourn Hospital, Cambridge, CB21 5EF, UK,Corresponding author. Department of Psychiatry, University of Cambridge, Sir William Hardy Building, Downing Site, Cambridge, CB2 3EB, UK
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22
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Nemec PB, Swarbrick M, Spagnolo A, Brandow CL. Nudges to Support Health and Wellness for Individuals Served by Behavioral Health Programs. J Psychosoc Nurs Ment Health Serv 2020; 59:21-28. [PMID: 33095264 DOI: 10.3928/02793695-20201015-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/28/2020] [Indexed: 11/20/2022]
Abstract
Individuals served by behavioral health programs experience risk factors that threaten health and longevity. Health behavior changes may be supported through environmental modifications known as nudges. The current review (a) examines the potential value of nudges for helping individuals receiving services from behavioral health programs, and (b) offers physical and social environment strategies to support positive health behaviors. The authors discuss literature related to nudges and environmental influences on health behaviors. The research related to nudges supports the potential value of this framework for nurses in behavioral health settings, who are in a strong position to help address health and wellness concerns disproportionately experienced by individuals in behavioral health programs. [Journal of Psychosocial Nursing and Mental Health Services, 59(1), 21-28.].
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Fochtmann LJ, Medicus J, Hong SH. Performance in Practice: Practice Assessment Tool for the Care of Patients With Schizophrenia. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:402-423. [PMID: 33343252 PMCID: PMC7725154 DOI: 10.1176/appi.focus.20200034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Schizophrenia is associated with significant health, social, occupational, and economic burdens, including increased mortality. Despite extensive and robust research on the treatment of individuals with schizophrenia, many individuals with the illness do not currently receive evidence-based pharmacological and nonpharmacological treatments. The American Psychiatric Association Practice Guideline for the Treatment of Patients With Schizophrenia, Third Edition, aims to enhance knowledge and increase the appropriate use of interventions for schizophrenia, thereby improving the quality of care and treatment outcomes. To this end, this evidence-based Performance in Practice tool can facilitate the implementation of a systematic approach to practice improvement for the care of individuals with schizophrenia. This practice assessment activity can also be used in partial fulfillment of Continuing Medical Education and Maintenance of Certification, part IV, requirements, which can also satisfy requirements for the Centers for Medicare & Medicaid Services Merit-based Incentive Payment System program.
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Affiliation(s)
- Laura J Fochtmann
- Department of Psychiatry, Stony Brook University, Stony Brook, New York (Fochtmann); Division of Policy, Programs, and Partnerships, Department of Practice Management and Delivery Systems Policy, American Psychiatric Association, Washington, D.C. (Medicus, Hong)
| | - Jennifer Medicus
- Department of Psychiatry, Stony Brook University, Stony Brook, New York (Fochtmann); Division of Policy, Programs, and Partnerships, Department of Practice Management and Delivery Systems Policy, American Psychiatric Association, Washington, D.C. (Medicus, Hong)
| | - Seung-Hee Hong
- Department of Psychiatry, Stony Brook University, Stony Brook, New York (Fochtmann); Division of Policy, Programs, and Partnerships, Department of Practice Management and Delivery Systems Policy, American Psychiatric Association, Washington, D.C. (Medicus, Hong)
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Lewis M, Chondros P, Mihalopoulos C, Lee YY, Gunn JM, Harvey C, Furler J, Osborn D, Castle D, Davidson S, Jayaram M, Kenny A, Nelson MR, Morgan VA, Harrap S, McKenzie K, Potiriadis M, Densley K, Palmer VJ. The assertive cardiac care trial: A randomised controlled trial of a coproduced assertive cardiac care intervention to reduce absolute cardiovascular disease risk in people with severe mental illness in the primary care setting. Contemp Clin Trials 2020; 97:106143. [PMID: 32931919 DOI: 10.1016/j.cct.2020.106143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) accounts for 40% of the excess mortality identified in people with severe mental illness (SMI). Modifiable CVD risk factors are higher and can be exacerbated by the cardiometabolic impact of psychotropic medications. People with SMI frequently attend primary care presenting a valuable opportunity for early identification, prevention and management of cardiovascular health. The ACCT Healthy Hearts Study will test a coproduced, nurse-led intervention delivered with general practitioners to reduce absolute CVD risk (ACVDR) at 12 months compared with an active control group. METHODS/DESIGN ACCT is a two group (intervention/active control) individually randomised (1:1) controlled trial (RCT). Assessments will be completed baseline (pre-randomisation), 6 months, and 12 months. The primary outcome is 5-year ACVDR measured at 12 months. Secondary outcomes include 6-month ACVDR; and blood pressure, lipids, HbA1c, BMI, quality of life, physical activity, motivation to change health behaviour, medication adherence, alcohol use and hospitalisation at 6 and 12 months. Linear mixed-effects regression will estimate mean difference between groups for primary and secondary continuous outcomes. Economic cost-consequences analysis will be conducted using quality of life and health resource use information and routinely collected government health service use and medication data. A parallel process evaluation will investigate implementation of the intervention, uptake and outcomes. DISCUSSION ACCT will deliver a coproduced and person-centred, guideline level cardiovascular primary care intervention to a high need population with SMI. If successful, the intervention could lead to the reduction of the mortality gap and increase opportunities for meaningful social and economic participation. Trial registration ANZCTR Trial number: ACTRN12619001112156.
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Affiliation(s)
- Matthew Lewis
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Patty Chondros
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Cathrine Mihalopoulos
- Deakin University, Geelong, Deakin Health Economics Unit, Faculty of Health, Australia
| | - Yong Yi Lee
- Deakin University, Geelong, Deakin Health Economics Unit, Faculty of Health, Australia; School of Public Health, The University of Queensland, Australia; Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Australia
| | - Jane M Gunn
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Carol Harvey
- The Department of Psychiatry, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia; NorthWestern Mental Health, Melbourne, Australia
| | - John Furler
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - David Osborn
- Division of Psychiatry, Faculty of Brain Sciences, University College London, Australia; Camden and Islington NHS Foundation Trust, NW1OPE, United Kingdom
| | - David Castle
- The Department of Psychiatry, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Sandra Davidson
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Mahesh Jayaram
- The Department of Psychiatry, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia; NorthWestern Mental Health, Melbourne, Australia
| | - Amanda Kenny
- College of Science, Health and Engineering, La Trobe Rural Health School, Violet Vines Marshman Centre for Rural Health Research, La Trobe University, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, University of Western Australia, Australia; Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, University of Western Australia, Australia
| | - Stephen Harrap
- Department of Physiology, University of Melbourne, Australia
| | - Kylie McKenzie
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Maria Potiriadis
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Konstancja Densley
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Victoria J Palmer
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia.
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Sachinvala ND, Teramoto N, Stergiou A. Proposed Neuroimmune Roles of Dimethyl Fumarate, Bupropion, S-Adenosylmethionine, and Vitamin D 3 in Affording a Chronically Ill Patient Sustained Relief from Inflammation and Major Depression. Brain Sci 2020; 10:E600. [PMID: 32878267 PMCID: PMC7563300 DOI: 10.3390/brainsci10090600] [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: 06/30/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 12/14/2022] Open
Abstract
We had discussed earlier that, after most of the primary author's multiple sclerosis (MS) symptoms were lessened by prior neuroimmune therapies, use of dimethyl fumarate (DMF) gradually subdued his asthma and urticaria symptoms, as well as his MS-related intercostal cramping; and bupropion supplemented with S-adenosylmethionine (SAMe) and vitamin D3 (vit-D3) helped remit major depression (MD). Furthermore, the same cocktail (bupropion plus supplements), along with previously discussed routines (yoga, meditation, physical exercises, and timely use of medications for other illnesses), continued to subdue MD during new difficulties with craniopharyngioma, which caused bitemporal vision loss; sphenoid sinus infections, which caused cranial nerve-VI (CN6) palsy and diplopia; and through their treatments. Impressed by the benefit the four compounds provided, in this manuscript, we focus on explaining current neuroimmune literature proposals on how: (1) DMF impedes inflammation, oxidative stress, and cell death in CNS and peripheral tissues; (2) Bupropion curbs anxiety, MD, and enhances alertness, libido, and moods; (3) SAMe silences oxidative stress and depression by multiple mechanisms; and (4) Vit-D3 helps brain development and functioning and subdues inflammation. we realize that herein we have reviewed proposed mechanisms of remedies we discovered by literature searches and physician assisted auto-experimentation; and our methods might not work with other patients. We present our experiences so readers are heartened to reflect upon their own observations in peer-reviewed forums and make available a wide body of information for the chronically ill and their physicians to benefit from.
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Affiliation(s)
| | - Naozumi Teramoto
- Department of Applied Chemistry, Faculty of Engineering, Chiba Institute of Technology, 2-17-1, Tsudanuma, Narashino, Chiba 275-0016, Japan;
| | - Angeline Stergiou
- Department of Medicine, Fairfield Medical Center, 401 North Ewing, Lancaster, OH 43130, USA;
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Agaba DC, Migisha R, Lugobe HM, Katamba G, Ashaba S. A 10-Year Risk of Cardiovascular Disease among Patients with Severe Mental Illness at Mbarara Regional Referral Hospital, Southwestern Uganda. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2508751. [PMID: 32775412 PMCID: PMC7396089 DOI: 10.1155/2020/2508751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/05/2020] [Accepted: 07/14/2020] [Indexed: 01/28/2023]
Abstract
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. Patients with severe mental illness (SMI) are at a higher risk for developing CVD and have a higher risk for harboring factors related to CVD. In addition to the effects of antipsychotic medications, unhealthy lifestyle factors, such as poor diet, inadequate physical activity, cigarette smoking, and sedentary behaviors, are known to be risk factors that may contribute to poor cardiovascular health in patients with SMI. Early identification of individuals at elevated risk of CVD is essential so that dietary and lifestyle modifications or pharmacological interventions can be prescribed to alleviate the risk of cardiovascular disease. The objective of the study was to determine the 10-year risk of cardiovascular disease among patients with severe mental illness at Mbarara Regional Referral Hospital, southwestern Uganda. We conducted a cross-sectional study at the outpatient mental health clinic of Mbarara Regional Referral Hospital, between October 2018 and March 2019. We used the Globorisk CVD risk score to estimate the 10-year risk of CVD among patients with SMI, using the online Globorisk calculator. Participants were then assigned to one of three categories depending on their 10-year CVD risk score: <3% (low), 3-10% (intermediate), and >10% (high). We calculated the risk scores of 125 participants aged 40-74 years. Most of the participants were female 75 (60%), had a diagnosis of bipolar disorder 75 (60%), and had mental illness for ≥10 years 57 (46%). Eighty five percent (85%) of the participants had intermediate to high 10-year risk of CVD (64% with intermediate and 21% with high risk). The average risk score was significantly higher in males compared to females, 8.82% versus 6.43%, p = 0.016. We detected a high 10-year risk of CVD in a significant proportion of patients with SMI in southwestern Uganda. We recommend lifestyle modifications and pharmacological interventions to reverse risk or delay progression to CVD in this patient population.
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Affiliation(s)
- David Collins Agaba
- Department of Physiology, Mbarara University of Science & Technology, Mbarara, Uganda
| | - Richard Migisha
- Department of Physiology, Mbarara University of Science & Technology, Mbarara, Uganda
| | - Henry Mark Lugobe
- Department of Obstetrics and Gynaecology, Mbarara University of Science & Technology, Uganda
| | - Godfrey Katamba
- Department of Physiology, King Ceasor University, Kampala, Uganda
| | - Scholastic Ashaba
- Department of Psychiatry, Mbarara University of Science & Technology, Mbarara, Uganda
- Department of Psychiatry, Kampala International University, Uganda
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Every-Palmer S, Romans SE, Stubbs R, Tomlinson A, Gandhi S, Huthwaite M. Experiences of Weight-Loss Surgery in People With Serious Mental Illness: A Qualitative Study. Front Psychiatry 2020; 11:419. [PMID: 32477191 PMCID: PMC7236816 DOI: 10.3389/fpsyt.2020.00419] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 04/23/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Bariatric surgery is seldom accessed by people with serious mental illness, despite high rates of obesity in this population. It is sometimes assumed that patients with complex psychiatric histories will have poor post-surgical weight loss or exacerbation of psychiatric symptoms, although this is unsubstantiated. OBJECTIVES A qualitative descriptive study to explore personal experiences and the impact of bariatric surgery on physical and mental well-being and life-quality in individuals with serious mental illness. METHODS Nine adults with a history of bariatric surgery and concurrent severe depressive disorder, bipolar disorder, or schizoaffective disorder were interviewed about their experiences of bariatric surgery and its outcomes using semi-structured interview schedules. Data were transcribed and inductive thematic analysis undertaken. RESULTS Five broad themes emerged: (1) surgery was highly effective for weight loss, and resulted in subjective improvements in physical health, quality of life, and mental health described as being able to live a life; (2) recovering from surgery was a tough road, notably in the post-operative period where negative sequelae often anteceded benefits; (3) post-operative support was important, but sometimes insufficient, including from families, mental health services, and surgical teams; (4) most considered surgery life-changing, recommending it to others with mental illness and obesity, two had different experiences; (5) participants considered it discriminatory that people with mental illness were not referred or declined weight loss surgery. CONCLUSIONS Participants benefited from bariatric surgery and felt it should be offered to others with mental illness, but with additional care and support.
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Affiliation(s)
- Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
- *Correspondence: Susanna Every-Palmer,
| | - Sarah E. Romans
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Richard Stubbs
- Wakefield Obesity Surgery, Wakefield Hospital, Wellington, New Zealand
| | - Anneka Tomlinson
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Sophie Gandhi
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Mark Huthwaite
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
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Wadowski PP, Giurgea GA, Schlager O, Luf A, Gremmel T, Hobl EL, Unterhumer S, Löffler-Stastka H, Koppensteiner R. Acute Limb Ischemia after Intake of the Phenylethylamine Derivate NBOMe. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16245071. [PMID: 31842318 PMCID: PMC6950699 DOI: 10.3390/ijerph16245071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/08/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023]
Abstract
Objective: N-(2-methoxy) benzyl-phenethylamine (NBOMe) derivatives have a high affinity to the serotonin receptor 2A and emerged as new psychedelic agents. We report the case of a 30-year-old man admitted to the hospital because of acute ischemia of the left arm with clinical symptoms of pallor, pulselessness, paresthesia, and a motoric deficit. The patient had a history of schizophrenia and drug abuse and disclosed during the hospital stay the sublingual intake of a substance bought as 25I-NBOMe the night before the ischemic event. Methods: Routine clinical diagnostics including among others color-coded duplex sonography and computed tomography angiography (CTA) were performed. The remainder of the drugs was analyzed using high performance liquid chromatography. Results: Initial color-coded duplex sonography of the upper left limb showed pathological flow profiles of the axillary, brachial, ulnar, and radial artery with a reduced diameter of the ulnar (0.9 mm) and radial (1.1 mm) artery. In consequence, peripheral vasospasm, distal arterial thrombosis, or arterial embolization was anticipated. As therapeutic measures, the patient immediately received intravenous systemic vasodilators (alprostadil) and therapeutic anticoagulation with low molecular weight heparin. Instant symptom improvement was observed within the first day after therapy initiation. The subsequently performed CTA of the heart and left arm showed no signs of thrombotic material. Treatment was continued for five days and the patient was released thereafter having completely normalized perfusion in his left arm. Outpatient treatment was continued with calcium-channel blockers, as the patient had also displayed arterial hypertension. Drug analysis retrieved a composition of the isomers 25I-NBOMe, 25C-NBOMe, and 25H-NBOMe as well as traces of pentylon. Conclusion: NBOMe ingestion implicates the risk of peripheral vasospasms with severe, limb-threatening ischemia.
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Affiliation(s)
- Patricia P. Wadowski
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, A-1090 Vienna, Austria; (P.P.W.); (G.-A.G.); (O.S.); (T.G.)
| | - Georgiana-Aura Giurgea
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, A-1090 Vienna, Austria; (P.P.W.); (G.-A.G.); (O.S.); (T.G.)
| | - Oliver Schlager
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, A-1090 Vienna, Austria; (P.P.W.); (G.-A.G.); (O.S.); (T.G.)
| | - Anton Luf
- Department of Laboratory Medicine, Medical University of Vienna, A-1090 Vienna, Austria;
| | - Thomas Gremmel
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, A-1090 Vienna, Austria; (P.P.W.); (G.-A.G.); (O.S.); (T.G.)
| | - Eva-Luise Hobl
- Department of Clinical Pharmacology, Medical University of Vienna, A-1090 Vienna, Austria;
| | - Sylvia Unterhumer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, A-1090 Vienna, Austria;
| | - Henriette Löffler-Stastka
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, A-1090 Vienna, Austria;
| | - Renate Koppensteiner
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, A-1090 Vienna, Austria; (P.P.W.); (G.-A.G.); (O.S.); (T.G.)
- Correspondence: ; Tel.: +43-1-40400-46710
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Looijmans A, Jörg F, Bruggeman R, Schoevers RA, Corpeleijn E. Multimodal lifestyle intervention using a web-based tool to improve cardiometabolic health in patients with serious mental illness: results of a cluster randomized controlled trial (LION). BMC Psychiatry 2019; 19:339. [PMID: 31690281 PMCID: PMC6833253 DOI: 10.1186/s12888-019-2310-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/09/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Unhealthy lifestyle behaviours contribute to alarming cardiometabolic risk in patients with serious mental illness (SMI). Evidence-based practical lifestyle tools supporting patients and staff in improving patient lifestyle are lacking. METHODS This multi-site randomized controlled pragmatic trial determined the effectiveness of a twelve-month multimodal lifestyle approach, including a web-based tool to improve patients' cardiometabolic health, versus care-as-usual. Using the web tool, nurses (trained in motivational interviewing) assisted patients in assessing their lifestyle behaviours, creating a risk profile and constructing lifestyle goals, which were discussed during fortnightly regular care visits. Twenty-seven community-care and sheltered-living teams were randomized into intervention (N = 17) or control (N = 10) groups, including 244 patients (140 intervention/104 control, 49.2% male, 46.1 ± 10.8 years) with increased waist circumference (WC), BMI or fasting glucose. The primary outcomes concerned differences in WC after six and twelve months intervention, while BMI and metabolic syndrome Z-score were secondary outcome measures. RESULTS General multilevel linear mixed models adjusted for antipsychotic medication showed that differences in WC change between intervention and control were - 0.15 cm (95%CI: - 2.49; 2.19) after six and - 1.03 cm (95%CI: - 3.42; 1.35) after twelve months intervention; however, the differences were not statistically significant. No intervention effects were found for secondary outcome measures. The intervention increased patients' readiness to change dietary behaviour. CONCLUSION A multimodal web-based intervention facilitating nurses to address lifestyle changes in SMI patients did not improve patient cardiometabolic health. Web-tool use was lower than expected and nurses need more lifestyle coaching knowledge and skills. The type of intervention and delivery mode need optimization to realize effective lifestyle care for SMI patients. TRIAL REGISTRATION Dutch Trial Registry, www.trialregister.nl , NTR3765, 21 December 2012.
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Affiliation(s)
- Anne Looijmans
- Department of Health Psychology, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700, RB, Groningen, The Netherlands.
| | - Frederike Jörg
- Rob Giel Research Centre, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands ,Research Department, Friesland Mental Health Services, Leeuwarden, The Netherlands
| | - Richard Bruggeman
- Rob Giel Research Centre, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands ,0000 0000 9558 4598grid.4494.dDepartment of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert A. Schoevers
- 0000 0000 9558 4598grid.4494.dDepartment of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eva Corpeleijn
- 0000 0000 9558 4598grid.4494.dDepartment of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Schneider* F, Erhart* M, Hewer W, AK Loeffler L, Jacobi F. Mortality and Medical Comorbidity in the Severely Mentally Ill. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:405-411. [PMID: 31366432 PMCID: PMC6683445 DOI: 10.3238/arztebl.2019.0405] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 09/04/2018] [Accepted: 03/27/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mentally ill patients die on average 10 years earlier than the general population, largely due to general medical disorders. This study is the first to explore in a large German sample the prevalence, mortality, and medical comorbidity in pa- tients with severe mental illness (SMI). The patients were affected by borderline personality disorder (BPD), psychotic disorders, bipolar disorder, or severe unipolar depression. METHODS Our database consists of billing data from all adults with statutory health insurance in Germany. Twelve-month administrative SMI prevalence and medical comorbidity were estimated using cross-sectional data from 2016 (age ≥ 18; N = 59 561 310). Two-year mortality was established longitudinally in a randomly selected subset of the billing data (most recent mortality information available for 2012 to 2014; 2012: n = 15 590 107). RESULTS Severe unipolar depression had the highest prevalence (2.01%), followed by psychotic disorders (1.25%), BPD (0.34%), and bipolar disorder (0.29%). While the prevalence of malignant neoplasms showed moderate deviations from reference values [severe unipolar depression: OR = 1.30 (95% CI = 1.29; 1.31), BPD: OR = 1.11 (1.09; 1.14), psychotic dis- orders: OR = 0.90 (0.89; 0.90), bipolar disorder: OR = 1.07 (1.06; 1.09)], other disease groups (infectious, endocrine/nutritional/ metabolic, circulatory, respiratory) were substantially elevated in all categories of SMI. Mortality rates for psychotic disorders, BPD, bipolar disorder, and severe unipolar depression were increased (OR = 2.38 [95% CI=2.32; 2.44], 2.30 [2.08; 2.54], 1.52 [1.42; 1.62], and 1.40 [1.37; 1.44], respectively), with a loss of 2.6 to 12.3 years, depending on age, sex, and SMI. CONCLUSION Mortality is substantially elevated in all SMI patients. The results underline the need to remove barriers to adequate general medical care, both on the patient and the provider side, to reduce excess mortality.
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Affiliation(s)
- Frank Schneider*
- * Joint first authors
- University Hospital Düsseldorf
- Department of Psychiatry, Psychotherapy and Psychosomatics, School of Medicine, RWTH Aachen University, Aachen, Germany
| | - Michael Erhart*
- * Joint first authors
- Central Institute for Ambulatory Care in Germany, Berlin, Germany
- Alice Salomon University Berlin, Germany
| | - Walter Hewer
- Department of Geriatric Psychiatry, Christophsbad Hospital, Göppingen, Germany
| | - Leonie AK Loeffler
- Department of Psychiatry, Psychotherapy and Psychosomatics, School of Medicine, RWTH Aachen University, Aachen, Germany
| | - Frank Jacobi
- Psychologische Hochschule Berlin, Berlin, Germany
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31
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Nielsen RE, Kugathasan P, Straszek S, Jensen SE, Licht RW. Why are somatic diseases in bipolar disorder insufficiently treated? Int J Bipolar Disord 2019; 7:12. [PMID: 31055668 PMCID: PMC6500513 DOI: 10.1186/s40345-019-0147-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/23/2019] [Indexed: 12/27/2022] Open
Abstract
Background Somatic diseases, including cardiovascular, respiratory, and cancer diseases, are the main contributors to a shortened life expectancy of 10–20 years in patients with bipolar disorder as compared to the general population. In the general population an increase in survival has been observed over the last decades, primarily due to the advances in primary prophylaxis, medical treatment and progress in early detection and monitoring of somatic diseases. In this narrative review, we discuss the existing literature on treatment and outcomes of cardiovascular, respiratory, and cancer diseases in patients with bipolar disorder, and put this in the context of findings in studies on patients diagnosed with other severe mental disorders. Main body The existing literature suggests that patients with bipolar disorder receive fewer or delayed medical interventions, when admitted with severe somatic diseases, compared to those not diagnosed with bipolar disorder. Cardiovascular disease is the most investigated disease regarding outcomes in patients with severe mental illness, and novel findings indicate that the increased mortality following cardiac events in these patients can be reduced if they are intensively treated with secondary prophylactic cardiac intervention. Elderly patients diagnosed with mental disorders and cancer experience a delay in receiving specific cancer treatment. No studies have investigated treatment outcomes in patients with severe mental disease and respiratory diseases. Conclusion It is surprising and of major concern that patients with bipolar disorder have not benefitted from the significant improvement that has taken place over time over time of somatic treatments in general, especially in countries with equal and free access to healthcare services. Therefore, no matter whether this situation is a result of a negative attitude from health care providers to patients with mental illness, the result of the patient’s lack of awareness of their physical illness or the results of other factors, further attention including research on developing strategies for improving the management of somatic diseases in patients with bipolar disorder is needed.
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Affiliation(s)
- René Ernst Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. .,Department of Psychiatry, Aalborg University Hospital, Mølleparkvej 10, 9000, Aalborg, Denmark.
| | - Pirathiv Kugathasan
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Psychiatry, Aalborg University Hospital, Mølleparkvej 10, 9000, Aalborg, Denmark
| | - Sune Straszek
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Psychiatry, Aalborg University Hospital, Mølleparkvej 10, 9000, Aalborg, Denmark
| | - Svend Eggert Jensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Rasmus W Licht
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Psychiatry, Aalborg University Hospital, Mølleparkvej 10, 9000, Aalborg, Denmark
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Alexander E, McGinty EE, Wang NY, Dalcin A, Jerome GJ, Miller ER, Dickerson F, Charleston J, Young DR, Gennusa JV, Goldsholl S, Cook C, Appel LJ, Daumit GL. Effects of a behavioural weight loss intervention in people with serious mental illness: Subgroup analyses from the ACHIEVE trial. Obes Res Clin Pract 2019; 13:205-210. [PMID: 30852244 PMCID: PMC7255457 DOI: 10.1016/j.orcp.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/01/2019] [Accepted: 02/08/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Persons with serious mental illnesses (SMI) such as schizophrenia and bipolar disorder have an increased risk of obesity and related chronic diseases and die 10-20years earlier than the overall population, primarily due to cardiovascular disease. In the ACHIEVE trial, a behavioural weight loss intervention led to clinically significant weight loss in persons with SMI. As the field turns its attention to intervention scale-up, it is important to understand whether the effectiveness of behavioural weight loss interventions for people with SMI, like ACHIEVE, differ for specific subgroups. METHODS This study examined whether the effectiveness of the ACHIEVE intervention differed by participant characteristics (e.g. age, sex, race, psychiatric diagnosis, body mass index) and/or their weight-related attitudes and behaviours (e.g. eating, food preparation, and shopping habits). We used likelihood-based mixed effects models to examine whether the baseline to 18 month effects of the ACHIEVE intervention differed across subgroups. RESULTS No statistically significant differences were found in the effectiveness of the ACHIEVE intervention across any of the subgroups examined. CONCLUSIONS These findings suggest that the ACHIEVE behavioural weight loss intervention is broadly applicable to the diverse population of individuals with SMI.
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Affiliation(s)
- Eleanore Alexander
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, United States.
| | - Emma E McGinty
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, United States
| | - Nae-Yuh Wang
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, United States; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
| | - Arlene Dalcin
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
| | - Gerald J Jerome
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Department of Kinesiology, Towson University, Baltimore, MD, 21252, United States
| | - Edgar R Miller
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
| | - Faith Dickerson
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD 21204, United States
| | - Jeanne Charleston
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
| | - Deborah R Young
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91024, United States
| | - Joseph V Gennusa
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States
| | - Stacy Goldsholl
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States
| | - Courtney Cook
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
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Waters HC, Furukawa MF, Jorissen SL. Evaluating the Impact of Integrated Care on Service Utilization in Serious Mental Illness. Community Ment Health J 2018; 54:1101-1108. [PMID: 29948631 DOI: 10.1007/s10597-018-0297-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 06/07/2018] [Indexed: 11/26/2022]
Abstract
Serious mental illness (SMI) affects 5% of the United States population and is associated with increased morbidity and mortality, and use of high-cost healthcare services including hospitalizations and emergency department visits. Integrating behavioral and physical healthcare may improve care for consumers with SMI, but prior research findings have been mixed. This quantitative retrospective cohort study assessed whether there was a predictive relationship between integrated healthcare clinic enrollment and inpatient and emergency department utilization for consumers with SMI when controlling for demographic characteristics and disease severity. While findings indicated no statistically significant impact of integrated care clinic enrollment on utilization, the sample had lower levels of utilization than would have been expected. Since policy and payment structures continue to support integrated care models, further research on different programs are encouraged, as each setting and practice pattern is unique.
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Affiliation(s)
- Heidi C Waters
- College of Health Sciences, Walden University, Minneapolis, MN, USA.
- , 1375 Bayport Ave, Marco Island, FL, 34145, USA.
| | | | - Shari L Jorissen
- College of Health Sciences, Walden University, Minneapolis, MN, USA
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Stumbo SP, Yarborough BJH, Yarborough MT, Green CA. Perspectives on Providing And Receiving Preventive Health Care From Primary Care Providers and Their Patients With Mental Illnesses. Am J Health Promot 2018; 32:1730-1739. [PMID: 29658287 PMCID: PMC7220499 DOI: 10.1177/0890117118763233] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Individuals with mental illnesses have higher morbidity rates and reduced life expectancy compared to the general population. Understanding how patients and providers perceive the need for prevention, as well as the barriers and beliefs that may contribute to insufficient care, are important for improving service delivery tailored to this population. DESIGN Cross-sectional; mixed methods. SETTING An integrated health system and a network of federally qualified health centers and safety net clinics. PARTICIPANTS Interviews (n = 30) and surveys (n = 249) with primary care providers. Interviews (n = 158) and surveys (n = 160) with patients diagnosed with schizophrenia, bipolar, anxiety, or major depressive disorders. MEASURES Semi-structured interviews and surveys. ANALYSIS Thematic analysis for qualitative data; frequencies for quantitative data. RESULTS More than half (n = 131, 53%) of clinicians believed patients with mental illnesses care less about preventive care than the general population, yet 88% (n = 139) of patients reported interest in improving health. Most providers (n = 216, 88%) lacked confidence that patients with mental illnesses would follow preventive recommendations; 82% (n = 129) of patients reported they would try to change lifestyles if their doctor recommended. Clinicians explained that their perception of patients' chaotic lives and lack of interest in preventive care contributed to their fatalistic attitudes on care delivery to this population. Clinicians and patients agreed on substantial need for additional support for behavior changes. Clinicians reported providing informational support by keeping messages simple; patients reported a desire for more detailed information on reasons to complete preventive care. Patients also detailed the need for assistive and tangible support to manage behavioral health changes. CONCLUSIONS Our results suggest a few clinical changes could help patients complete preventive care recommendations and improve health behaviors: improving clinician-patient collaboration on realistic goal setting, increasing visit time or utilizing behavioral health consultants that bridge primary and specialty mental health care, and increasing educational and tangible patient support services.
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Affiliation(s)
- Scott P. Stumbo
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | | | | | - Carla A. Green
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
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Sajatovic M, Howland M, Gunzler D, Kanuch SW, Cassidy KA, McCormick R, Bauer MS, Scheidemantel T, Thomas C, Blixen C, Dawson NV. Race analysis in an African American sample with serious mental illness and comorbid diabetes. Psychiatr Rehabil J 2018; 41:246-252. [PMID: 30160510 PMCID: PMC6442459 DOI: 10.1037/prj0000314] [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: 11/08/2022]
Abstract
OBJECTIVES Targeted Training in Illness Management (TTIM) focuses on enhancing care engagement for people living with serious mental illness and diabetes. This secondary analysis from a 60-week, randomized controlled trial of TTIM versus treatment as usual evaluated racial subgroup outcomes. METHOD Demographics, clinical characteristics, and diabetes status were evaluated for those self-identifying as non-Hispanic White, African American, and Hispanic. Longitudinal response to TTIM was evaluated using a multiple domain risk index. Due to their small sample size; those identifying as Hispanic were excluded from this analysis. RESULTS Non-Hispanic White participants had greater baseline socioeconomic advantages. Baseline risk scores, glycosylated hemoglobin (HbA1c) values, and HbA1c differences over time were similar for African American and non-Hispanic White participants. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE African American participants living with serious mental illness and diabetes receiving TTIM did as well as non-Hispanic White participants. Inclusive approaches that feature peer support and are situated in safety-net health care settings need to be further investigated with respect to potentially impacting health disparities. (PsycINFO Database Record
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Affiliation(s)
- Martha Sajatovic
- Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine
| | - Molly Howland
- Neurological and Behavioral Outcomes Center, Case Western Reserve University School of Medicine
| | - Douglas Gunzler
- Center for Health Care Research and Policy, Case Western Reserve University School of Medicine
| | | | - Kristin A Cassidy
- University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine
| | - Richard McCormick
- Center for Health Care Research and Policy, Case Western Reserve University
| | - Mark S Bauer
- Department of Psychiatry, Harvard Medical School
| | - Thomas Scheidemantel
- Scheidemantel, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine
| | | | - Carol Blixen
- Neurological and Behavioral Outcomes Center, Case Western Reserve University
| | - Neal V Dawson
- Center for Health Care Research and Policy, Case Western Reserve University School of Medicine
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Young AS, Cohen AN, Chang ET, Flynn AWP, Hamilton AB, Oberman R, Vinzon M. A clustered controlled trial of the implementation and effectiveness of a medical home to improve health care of people with serious mental illness: study protocol. BMC Health Serv Res 2018; 18:428. [PMID: 29880047 PMCID: PMC5992687 DOI: 10.1186/s12913-018-3237-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 05/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with serious mental illness (SMI) die many years prematurely, with rates of premature mortality two to three times greater than the general population. Most premature deaths are due to "natural causes," especially cardiovascular disease and cancer. Often, people with SMI are not well engaged in primary care treatment and do not receive high-value preventative and medical services. There have been numerous efforts to improve this care, and few controlled trials, with inconsistent results. While people with SMI often do poorly with usual primary care arrangements, research suggests that integrated care and medical care management may improve treatment and outcomes, and reduce treatment costs. METHODS This hybrid implementation-effectiveness study is a prospective, cluster controlled trial of a medical home, the SMI Patient-Aligned Care Team (SMI PACT), to improve the healthcare of patients with SMI enrolled with the Veterans Health Administration. The SMI PACT team includes proactive medical nurse care management, and integrated mental health treatment through regular psychiatry consultation and a collaborative care model. Patients are recruited to receive primary care through SMI PACT based on having a serious mental illness that is manageable with treatment, and elevated risk for hospitalization or death. In a site-level prospective controlled trial, this project studies the effect, relative to usual care, of SMI PACT on provision of appropriate preventive and medical treatments, health-related quality of life, satisfaction with care, and medical and mental health treatment utilization and costs. Research includes mixed-methods formative evaluation of usual care and SMI PACT implementation to strengthen the intervention and assess barriers and facilitators. Investigators examine relationships among organizational context, intervention factors, and patient and clinician outcomes, and identify patient factors related to successful patient outcomes. DISCUSSION This will be one of the first controlled trials of the implementation and effectiveness of a patient centered medical home for people with serious mental illness. It will provide information regarding the value of this strategy, and processes and tools for implementing this model in community healthcare settings. TRIAL REGISTRATION ClinicalTrials.gov, NCT01668355 . Registered August 20, 2012.
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Affiliation(s)
- Alexander S. Young
- VA Greater Los Angeles Healthcare System, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA 90073 USA
- Department of Psychiatry, Geffen School of Medicine, UCLA, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA 90024 USA
| | - Amy N. Cohen
- VA Greater Los Angeles Healthcare System, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA 90073 USA
- Department of Psychiatry, Geffen School of Medicine, UCLA, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA 90024 USA
| | - Evelyn T. Chang
- VA Greater Los Angeles Healthcare System, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA 90073 USA
- Department of Medicine, Geffen School of Medicine, UCLA, Los Angeles, CA 90095 USA
| | - Anthony W. P. Flynn
- VA Greater Los Angeles Healthcare System, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA 90073 USA
- Department of Psychiatry, Geffen School of Medicine, UCLA, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA 90024 USA
| | - Alison B. Hamilton
- VA Greater Los Angeles Healthcare System, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA 90073 USA
| | - Rebecca Oberman
- VA Greater Los Angeles Healthcare System, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA 90073 USA
| | - Merlyn Vinzon
- VA Greater Los Angeles Healthcare System, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA 90073 USA
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Druss BG, Singh M, von Esenwein SA, Glick GE, Tapscott S, Tucker SJ, Lally CA, Sterling EW. Peer-Led Self-Management of General Medical Conditions for Patients With Serious Mental Illnesses: A Randomized Trial. Psychiatr Serv 2018; 69:529-535. [PMID: 29385952 PMCID: PMC5930018 DOI: 10.1176/appi.ps.201700352] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Individuals with serious mental illnesses have high rates of general medical comorbidity and challenges in managing these conditions. A growing workforce of certified peer specialists is available to help these individuals more effectively manage their health and health care. However, few studies have examined the effectiveness of peer-led programs for self-management of general medical conditions for this population. METHODS This randomized study enrolled 400 participants with a serious mental illness and one or more chronic general medical conditions across three community mental health clinics. Participants were randomly assigned to the Health and Recovery Peer (HARP) program, a self-management program for general medical conditions led by certified peer specialists (N=198), or to usual care (N=202). Assessments were conducted at baseline and three and six months. RESULTS At six months, participants in the intervention group demonstrated a significant differential improvement in the primary study outcome, health-related quality of life. Specifically, compared with the usual care group, intervention participants had greater improvement in the Short-Form Health Survey physical component summary (an increase of 2.7 versus 1.4 points, p=.046) and mental component summary (4.6 versus 2.5 points, p=.039). Significantly greater six-month improvements in mental health recovery were seen for the intervention group (p=.02), but no other between-group differences in secondary outcome measures were significant. CONCLUSIONS The HARP program was associated with improved physical health- and mental health-related quality of life among individuals with serious mental illness and comorbid general medical conditions, suggesting the potential benefits of more widespread dissemination of peer-led disease self-management in this population.
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Affiliation(s)
- Benjamin G Druss
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Manasvini Singh
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Silke A von Esenwein
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Gretl E Glick
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Stephanie Tapscott
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Sherry Jenkins Tucker
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Cathy A Lally
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
| | - Evelina W Sterling
- Dr. Druss, Ms. Singh, Dr. von Esenwein, Ms. Tapscott, and Ms. Lally are with the Department of Health Policy and Management, Emory University, Atlanta. Ms. Glick is with J. Michael Consulting, Atlanta. Ms. Tucker is with the Georgia Mental Health Consumer Network, Atlanta. Dr. Sterling is with the Department of Sociology, Kennesaw State University, Kennesaw, Georgia
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O'Hara K, Stefancic A, Cabassa LJ. Developing a peer-based healthy lifestyle program for people with serious mental illness in supportive housing. Transl Behav Med 2018; 7:793-803. [PMID: 28155109 DOI: 10.1007/s13142-016-0457-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Overweight and obesity disproportionally impact people with serious mental illness (SMI). Healthy lifestyle interventions can improve the health of people with SMI but may need to be adapted for this population. The aims of this study were: to (1) examine the feasibility and acceptability of delivering the Peer-based Group Lifestyle Balance (PGLB) intervention and (2) describe intervention adaptations for people with SMI in supportive housing. Peer specialists and social workers co-facilitated 12 weekly PGLB sessions for 14 supportive housing clients. We conducted structured interviews and collected qualitative data through field notes and two focus groups. Frequencies and measures of central tendencies were used to describe participant characteristics and PGLB feasibility and acceptability measures. Qualitative data was analyzed using directed content analysis. Participants on average attended 8 of 12 sessions, and reported that services were satisfactory and helpful. Intervention adaptations, ongoing throughout the study, focused on adding peer-specialists as co-facilitators, increasing individualized support and developing strategies to address socioeconomic barriers impacting participants' ability to engage in healthy lifestyle changes. Study findings suggest that participants with SMI in supportive housing perceived PGLB as feasible and acceptable. Expanding the relevance and reach of peer-based healthy lifestyle interventions in community settings serving people with SMI requires careful adaptations to the socioeconomic realities of this population and the complexities of living with co-morbid health and mental health conditions.
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Affiliation(s)
- Kathleen O'Hara
- Columbia University School of Social Work, 1255 Amsterdam Ave, New York, NY, 10027, USA
| | - Ana Stefancic
- Columbia University School of Social Work, 1255 Amsterdam Ave, New York, NY, 10027, USA
| | - Leopoldo J Cabassa
- Columbia University School of Social Work, 1255 Amsterdam Ave, New York, NY, 10027, USA.
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McGinty EE, Gudzune KA, Dalcin A, Jerome GJ, Dickerson F, Gennusa J, Goldsholl S, Young D, Daumit GL. Bringing an Effective Behavioral Weight Loss Intervention for People With Serious Mental Illness to Scale. Front Psychiatry 2018; 9:604. [PMID: 30515109 PMCID: PMC6256009 DOI: 10.3389/fpsyt.2018.00604] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/29/2018] [Indexed: 11/23/2022] Open
Abstract
People with serious mental illnesses (SMIs) die 10-20 years earlier than the general population, mainly due to cardiovascular disease. Obesity is a key driver of cardiovascular risk in this group. Because behavioral weight loss interventions tailored to the needs of people with SMI have been shown to lead to clinically significant weight loss, achieving widespread implementation of these interventions is a public health priority. In this Perspective, we consider strategies for scaling the ACHIEVE behavioral weight loss intervention for people with SMI, shown to be effective in a randomized clinical trial (RCT), to mental health programs in the U.S. and internationally. Given the barriers to high-fidelity implementation of the complex, multi-component ACHIEVE intervention in often under-resourced mental health programs, we posit that substantial additional work is needed to realize the full public health potential of this intervention for people with SMI. We discuss considerations for successful "scale-up," or efforts to expand ACHIEVE to similar settings and populations as those included in the RCT, and "scale-out," or efforts to expand the intervention to different mental health program settings/sub-populations with SMI. For both, we focus on considerations related (1) intervention adaptation and (2) implementation strategy development, highlighting four key domains of implementation strategies that we believe need to be developed and tested: staff capacity building, leadership engagement, organizational change, and policy strategies. We conclude with discussion of the types of future research needed to support ACHIEVE scale-up/out, including hybrid trial designs testing the effectiveness of intervention adaptations and/or implementations strategies.
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Affiliation(s)
- Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kimberly A Gudzune
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Arlene Dalcin
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Gerald J Jerome
- Department of Kinesiology, Towson University, Towson, MD, United States
| | | | - Joseph Gennusa
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Stacy Goldsholl
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Deborah Young
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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40
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Lally J, Watkins R, Nash S, Shetty H, Gardner-Sood P, Smith S, Murray RM, Gaughran F. The Representativeness of Participants With Severe Mental Illness in a Psychosocial Clinical Trial. Front Psychiatry 2018; 9:654. [PMID: 30564154 PMCID: PMC6288469 DOI: 10.3389/fpsyt.2018.00654] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/16/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction: Cardiovascular morbidity and mortality are increased in severe mental illnesses (SMI). Trials of psychosocial health interventions to improve physical health in SMI, including in treatment-resistant schizophrenia, have shown some benefit. However, the representativeness of participants in such trials has not been determined. Method: We utilized an anonymised case register to determine if participants in a randomized controlled trial (RCT) of a novel psychosocial health intervention aiming to improve physical health in SMI had similar severity of illness to eligible non-participants. A retrospective database analysis was performed, using Health of the Nation Outcome Scale (HoNOS) data from the sample of patients participating in the IMPaCT (Improving Physical health and reducing substance use in Psychosis) RCT (n = 293) compared to all eligible participants with a psychotic illness (n = 774). Results: The mean total HoNOS score in the eligible comparator population (Mean = 9.09, SD = 5.8, range = 0-30) was significantly greater than that of the IMPaCT RCT participants (Mean = 7.16, SD = 4.7, range = 0-26), (t = 3.810, p = 0.006), as was the degree of overall illness severity and functional impairment, as measured by HoNOS. Conclusion: This study shows for the first time that the patient population participating in an RCT of a lifestyle intervention for those with SMI had a better mental health status at entry to the trial, than the total eligible population, although there was no difference in physical health needs. This has relevance to the applicability of RCTs of lifestyle interventions in service planning and suggests that when people are more unwell, greater effort may be needed to include them in psychosocial interventions. A more careful and focused recruitment approach should be followed to improve the participation of the more severely ill patients in psychosocial interventions in order to enhance the external validity of such studies.
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Affiliation(s)
- John Lally
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.,Department of Psychiatry, School of Medicine and Medical Sciences, University College Dublin, Dublin, Ireland.,St Vincent's Hospital Fairview, Dublin, Ireland
| | - Rochelle Watkins
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Sarah Nash
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Hitesh Shetty
- Biomedical Research Centre (BRC) Case Register, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Poonam Gardner-Sood
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Shubulade Smith
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom.,Forensic Intensive Care Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Department of Psychiatry, Experimental Biomedicine and Clinical Neuroscience (BIONEC), University of Palermo, Palermo, Italy
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Department of Psychiatry, Experimental Biomedicine and Clinical Neuroscience (BIONEC), University of Palermo, Palermo, Italy
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41
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Dalcin AT, Jerome GJ, Appel LJ, Dickerson FB, Wang NY, Miller ER, Young DR, Charleston JB, Gennusa JV, Goldsholl S, Heller A, Evins AE, Cather C, McGinty EE, Crum RM, Daumit GL. Need for Cardiovascular Risk Reduction in Persons With Serious Mental Illness: Design of a Comprehensive Intervention. Front Psychiatry 2018; 9:786. [PMID: 30800079 PMCID: PMC6375886 DOI: 10.3389/fpsyt.2018.00786] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 12/31/2018] [Indexed: 01/30/2023] Open
Abstract
Persons with serious mental illness (SMI) comprise a high-risk group for cardiovascular disease (CVD)-related mortality with rates at least twice those of the overall US. Potentially modifiable CVD risk behaviors (tobacco smoking, obesity, physical inactivity, unhealthy diet) and risk factors (hypertension, diabetes, dyslipidemia) are all markedly elevated in persons with SMI. Evaluations of programs implementing integrated medical care into specialty mental health settings have not shown meaningful effects on CVD risk factor reduction. Rigorously tested, innovative interventions are needed to address the large burden of CVD risk in populations with SMI. In this article, we describe the design of a comprehensive 18-month intervention to decrease CVD risk that we are studying in a randomized clinical trial in a community mental health organization with psychiatric rehabilitation programs. The individual-level intervention incorporated health behavior coaching and care coordination/care management to address all seven CVD risk behaviors and risk factors, and is delivered by a health coach and nurse. If successful, the intervention could be adopted within current integrated care models and significantly improve the physical health of persons with SMI.
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Affiliation(s)
- Arlene T Dalcin
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Gerald J Jerome
- Department of Kinesiology, Towson University, Baltimore, MD, United States
| | - Lawrence J Appel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Nae-Yuh Wang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Edgar R Miller
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Deborah R Young
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jeanne B Charleston
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Joseph V Gennusa
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Stacy Goldsholl
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ann Heller
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - A Eden Evins
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Corinne Cather
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Emma E McGinty
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Rosa M Crum
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Gail L Daumit
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Druss BG. Improving access to exercise training programs for patients with serious mental illness. Transl Behav Med 2017; 7:62-63. [PMID: 27550183 DOI: 10.1007/s13142-016-0435-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
In a recent issue of this journal, Pratt et al report on an important new position statement by the Society of Behavioral Medicine and the American College of Sports Medicine to improve access to exercise programming as a treatment for patients treated in community mental health settings. If implemented, these recommendations could greatly expand access to these services and improve outcomes for patients treated in community mental health settings.
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Affiliation(s)
- Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Naslund JA, Aschbrenner KA, Kim SJ, McHugo GJ, Unützer J, Bartels SJ, Marsch LA. Health behavior models for informing digital technology interventions for individuals with mental illness. Psychiatr Rehabil J 2017; 40:325-335. [PMID: 28182469 PMCID: PMC5550360 DOI: 10.1037/prj0000246] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Theoretical models offer valuable insights for designing effective and sustainable behavioral health interventions, yet the application of theory for informing digital technology interventions for people with mental illness has received limited attention. We offer a perspective on the importance of applying behavior theories and models to developing digital technology interventions for addressing mental and physical health concerns among people with mental illness. METHOD In this commentary, we summarize prominent theories of human behavior, highlight key theoretical constructs, and identify opportunities to inform digital health interventions for people with mental illness. We consider limitations with existing theories and models, and examine recent theoretical advances that can specifically guide development of digital technology interventions. RESULTS Established behavioral frameworks including health belief model, theory of planned behavior, transtheoretical model, and social cognitive theory consist of important and overlapping constructs that can inform digital health interventions for people with mental illness. As digital technologies continue to evolve and enable longitudinal data collection, real-time behavior monitoring, and adaptive features tailored to users' changing needs over time, there are new opportunities to broaden our understanding of health behaviors and mechanisms of behavior change. Recent advances include dynamic models of behavior, persuasive system design, the behavioral intervention technology model, and behavioral models for just-in-time adaptive interventions. CONCLUSION AND IMPLICATIONS FOR PRACTICE Behavior theories offer advantages for guiding use of digital technologies. Future researchers must explore how theoretical models can effectively advance efforts to develop, evaluate, and disseminate digital health interventions targeting individuals with mental illness. (PsycINFO Database Record
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Affiliation(s)
- John A. Naslund
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States
- The Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
| | - Kelly A. Aschbrenner
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Sunny Jung Kim
- The Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
| | - Gregory J. McHugo
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Stephen J. Bartels
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Lisa A. Marsch
- The Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
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Sajatovic M, Gunzler DD, Kanuch SW, Cassidy KA, Tatsuoka C, McCormick R, Blixen CE, Perzynski AT, Einstadter D, Thomas CL, Lawless ME, Martin S, Falck-Ytter C, Seeholzer EL, McKibben CL, Bauer MS, Dawson NV. A 60-Week Prospective RCT of a Self-Management Intervention for Individuals With Serious Mental Illness and Diabetes Mellitus. Psychiatr Serv 2017; 68:883-890. [PMID: 28502243 PMCID: PMC5675044 DOI: 10.1176/appi.ps.201600377] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES A 60-week randomized controlled trial assessed the effects of targeted training in illness management (TTIM) versus treatment as usual among 200 individuals with serious mental illness and diabetes mellitus. METHODS The study used the Clinical Global Impression (CGI), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Brief Psychiatric Rating Scale (BPRS) to assess psychiatric symptoms; the Global Assessment of Functioning (GAF) and the Sheehan Disability Scale (SDS) to assess functioning; the 36-Item Short-Form Health Survey (SF-36) to assess general health, and serum glycosylated hemoglobin (HbA1c) to assess diabetes control. RESULTS Participants' mean±SD age was 52.7±9.5 years, and 54% were African American. They were diagnosed as having depression (48%), schizophrenia (25%), and bipolar disorder (28%). At baseline, depression severity was substantial but psychosis severity was modest. At 60 weeks, there was greater improvement among TTIM participants versus treatment-as-usual recipients on the CGI (p<.001), the MADRS (p=.016), and the GAF (p=.003). Diabetes knowledge was significantly improved among TTIM participants but not in the treatment-as-usual group. In post hoc analyses among participants whose HbA1c levels at baseline met recommendations set by the American Diabetes Association for persons with high comorbidity (53%), TTIM participants had minimal change in HbA1c over the 60-week follow-up, whereas HbA1c levels worsened in the treatment-as-usual group. CONCLUSIONS TTIM was associated with improved psychiatric symptoms, functioning, and diabetes knowledge compared with treatment as usual. Among participants with better diabetes control at baseline, TTIM participants had better diabetes control at 60 weeks compared with recipients of treatment as usual.
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Affiliation(s)
- Martha Sajatovic
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Douglas D Gunzler
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Stephanie W Kanuch
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Kristin A Cassidy
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Curtis Tatsuoka
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Richard McCormick
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Carol E Blixen
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Adam T Perzynski
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Douglas Einstadter
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Charles L Thomas
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Mary E Lawless
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Siobhan Martin
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Corinna Falck-Ytter
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Eileen L Seeholzer
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Christine L McKibben
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Mark S Bauer
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
| | - Neal V Dawson
- Dr. Sajatovic, Ms. Cassidy, and Dr. Blixen are with the Department of Psychiatry, Dr. Tatsuoka is with the Department of Neurology, and Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, Dr. Seeholzer, and Dr. Dawson are with the Center for Health Care Research and Policy, all at Case Western Reserve University School of Medicine, Cleveland. Dr. Gunzler, Dr. McCormick, Dr. Perzynski, Dr. Einstadter, Dr. Thomas, and Dr. Dawson are also with MetroHealth Medical Center, Cleveland, where Ms. Kanuch, Ms. Lawless, and Ms. Martin are affiliated. Dr. Falck-Ytter is with the Louis Stokes Cleveland Veterans Affairs (VA) Medical Center, Cleveland. Dr. McKibben is with the Department of Psychology, University of Wyoming, Laramie. Dr. Bauer is with the Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Massachusetts, and with the Department of Psychiatry, Harvard Medical School, Boston
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Docherty AR. Leveraging psychiatric and medical genetics to understand comorbid depression and obesity. Br J Psychiatry 2017; 211:61-62. [PMID: 28765304 PMCID: PMC5770192 DOI: 10.1192/bjp.bp.116.194662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 03/30/2017] [Accepted: 05/08/2017] [Indexed: 11/23/2022]
Abstract
Precision medicine in psychiatry is on the rise, and depression and obesity - two highly prevalent, comorbid and well-characterised phenotypes - are optimal targets for the approach. Add the bedrock susceptibility gene, FTO, and Riviera et al have identified a constellation of factors that could enhance clinical treatment of both disorders.
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Affiliation(s)
- Anna R. Docherty
- Department of Psychiatry, University of Utah School of Medicine, 383 Colorow Way #338, SLC, Utah 84110, USA
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46
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Strassnig M, Kotov R, Cornaccio D, Fochtmann L, Harvey PD, Bromet EJ. Twenty-year progression of body mass index in a county-wide cohort of people with schizophrenia and bipolar disorder identified at their first episode of psychosis. Bipolar Disord 2017; 19:336-343. [PMID: 28574189 PMCID: PMC5568920 DOI: 10.1111/bdi.12505] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/25/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE There is an increased prevalence of obesity in schizophrenia and bipolar disorder, leading to a disproportionate risk of adverse health conditions. Prospective, long-term weight gain data, however, are scarce. METHODS We analyzed data from the Suffolk County Mental Health Project cohort of consecutive first admissions with psychosis recruited from September 1989 to December 1995 and subsequently followed for 20 years, focusing on people with schizophrenia (n=146) and bipolar disorder (n=87). The time course of weight gain was examined using a 2 (group)×5 (time) mixed-model repeated measures ANOVA, and body mass index (BMI) scores at the first (6 months) and second (2 years) assessments were compared to examine whether early overweight predicted later obesity. RESULTS There was a statistically significant effect of time (F(1,210)=68.06, P<.001) and diagnosis (F(1,210)=29.18, P<.001) on BMI, but not the interaction of time×diagnosis (F(1,210)=0.88, P=.48). Most participants had normal BMIs at the first two assessments. Early overweight was a predictor of eventual obesity for both groups. At the 20-year follow-ups, approximately 50% of the bipolar and 62% of the schizophrenia sample were obese, with a greater prevalence of obesity in schizophrenia at each assessment (all P<.02), except for years 4 (P=.12) and 20 (P=.27). CONCLUSIONS Nearly two-thirds of the participants with schizophrenia and over half of those with bipolar disorder were obese 20 years after first hospitalization for psychosis, considerably higher than the rate for adults in New York State (27%). Early intervention may be required to prevent long-term consequences of obesity-related morbidity and mortality.
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Affiliation(s)
- M Strassnig
- Department of Integrated Medical Science, Charles Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, Boca Raton, FL 33431
| | - R Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
| | - Danielle Cornaccio
- School of Integrated Science and Humanity, Florida International University
| | - L Fochtmann
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
| | - PD Harvey
- Department of Psychiatry, University of Miami Miller School of Medicine
| | - EJ Bromet
- Department of Psychiatry, Stony Brook University, Stony Brook, New York
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Naslund JA, Aschbrenner KA, Pratt SI, Lohman MC, Scherer EA, McHugo GJ, Marsch LA, Unützer J, Bartels SJ. Association Between Cardiovascular Risk and Depressive Symptoms Among People With Serious Mental Illness. J Nerv Ment Dis 2017; 205:634-640. [PMID: 28240625 PMCID: PMC5533633 DOI: 10.1097/nmd.0000000000000669] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Depressive symptoms have debilitating effects on the physical health and functioning of people with serious mental illness. We examined change in depressive symptoms among overweight and obese adults with serious mental illness (n = 343) using data combined from two randomized trials comparing the 12-month In SHAPE program to a gym membership control condition. In SHAPE consists of a gym membership, weekly individual meetings with a fitness trainer, and instruction on healthy eating and nutrition. Depressive symptoms were measured at baseline, 3, 6, and 12 months. Change in depressive symptoms did not differ between groups, but depressive symptoms decreased over time across the entire sample (p = 0.045). At 12 months, reduced depressive symptoms were associated with clinically significant improved cardiorespiratory fitness (p = 0.030), 10% or more weight loss (p = 0.044), and cardiovascular risk reduction (p = 0.028) across both groups. Our findings suggest that participation in health promotion programs resulting in cardiovascular risk reduction may be associated with reduced depressive symptoms.
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Affiliation(s)
- John A. Naslund
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
| | - Kelly A. Aschbrenner
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Sarah I. Pratt
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Matthew C. Lohman
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
| | - Emily A. Scherer
- Department of Biomedical Data Sciences, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Gregory J. McHugo
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Lisa A. Marsch
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Department of Biomedical Data Sciences, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- The Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Stephen J. Bartels
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
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48
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Affiliation(s)
- Lisa Whitehead
- a School of Nursing and Midwifery , Edith Cowan University , Joondalup , Western Australia , Australia
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49
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Naslund JA, Whiteman KL, McHugo GJ, Aschbrenner KA, Marsch LA, Bartels SJ. Lifestyle interventions for weight loss among overweight and obese adults with serious mental illness: A systematic review and meta-analysis. Gen Hosp Psychiatry 2017; 47:83-102. [PMID: 28807143 PMCID: PMC5575752 DOI: 10.1016/j.genhosppsych.2017.04.003] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/04/2017] [Accepted: 04/05/2017] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To conduct a systematic review and meta-analysis to estimate effects of lifestyle intervention participation on weight reduction among overweight and obese adults with serious mental illness. METHOD We systematically searched electronic databases for randomized controlled trials comparing lifestyle interventions with other interventions or usual care controls in overweight and obese adults with serious mental illness, including schizophrenia spectrum or mood disorders. Included studies reported change in weight [kg] or body mass index (BMI) [kg/m2] from baseline to follow-up. Standardized mean differences (SMD) were calculated for change in weight from baseline between intervention and control groups. RESULTS Seventeen studies met inclusion criteria (1968 participants; 50% male; 66% schizophrenia spectrum disorders). Studies were grouped by intervention duration (≤6-months or ≥12-months). Lifestyle interventions of ≤6-months duration showed greater weight reduction compared with controls as indicated by effect size for weight change from baseline (SMD=-0.20; 95% CI=-0.34, -0.05; 10 studies), but high statistical heterogeneity (I2=90%). Lifestyle interventions of ≥12-months duration also showed greater weight reduction compared with controls (SMD=-0.24; 95% CI=-0.36, -0.12; 6 studies) with low statistical heterogeneity (I2=0%). CONCLUSION Lifestyle interventions appear effective for treating overweight and obesity among people with serious mental illness. Interventions of ≥12-months duration compared to ≤6-months duration appear to achieve more consistent outcomes, though effect sizes are similar for both shorter and longer duration interventions.
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Affiliation(s)
- John A Naslund
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States; Health Promotion Research Center at Dartmouth, Lebanon, NH, United States.
| | - Karen L Whiteman
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States
| | - Gregory J McHugo
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Kelly A Aschbrenner
- Health Promotion Research Center at Dartmouth, Lebanon, NH, United States; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Lisa A Marsch
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
| | - Stephen J Bartels
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States; Health Promotion Research Center at Dartmouth, Lebanon, NH, United States; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
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50
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Closing the False Divide: Sustainable Approaches to Integrating Mental Health Services into Primary Care. J Gen Intern Med 2017; 32:404-410. [PMID: 28243873 PMCID: PMC5377893 DOI: 10.1007/s11606-016-3967-9] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 11/21/2016] [Accepted: 12/06/2016] [Indexed: 01/18/2023]
Abstract
Mental disorders account for 25% of all health-related disability worldwide. More patients receive treatment for mental disorders in the primary care sector than in the mental health specialty setting. However, brief visits, inadequate reimbursement, deficits in primary care provider (PCP) training, and competing demands often limit the capacity of the PCP to produce optimal outcomes in patients with common mental disorders. More than 80 randomized trials have shown the benefits of collaborative care (CC) models for improving outcomes of patients with depression and anxiety. Six key components of CC include a population-based approach, measurement-based care, treatment to target strategy, care management, supervision by a mental health professional (MHP), and brief psychological therapies. Multiple trials have also shown that CC for depression is equally or more cost-effective than many of the current treatments for medical disorders. Factors that may facilitate the implementation of CC include a more favorable alignment of medical and mental health services in accountable care organizations and patient-centered medical homes; greater use of telecare as well as automated outcome monitoring; identification of patients who might benefit most from CC; and systematic training of both PCPs and MHPs in integrated team-based care.
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