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Brouwer JMJL, Wardenaar KJ, Liemburg EJ, Doornbos B, Mulder H, Cath DC. High persistence and low treatment rates of metabolic syndrome in patients with mood and anxiety disorders: A naturalistic follow-up study. J Affect Disord 2024; 354:451-462. [PMID: 38494132 DOI: 10.1016/j.jad.2024.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/21/2024] [Accepted: 03/09/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Patients with affective and anxiety disorders are at risk of metabolic syndrome (MetS) and, consequently, cardiovascular disease and premature death. In this study, the course and treatment of MetS was investigated using longitudinal data from a naturalistic sample of affective- and anxiety-disordered outpatients (Monitoring Outcome of psychiatric PHARmacotherapy [MOPHAR]). METHODS Demographics, clinical characteristics, medication use, and MetS components were obtained for n = 2098 patients at baseline and, in a FU-subsample of n = 507 patients, after a median follow-up (FU) of 11 months. Furthermore, pharmacological treatment rates of MetS were investigated at baseline and FU. Finally, demographic and clinical determinants of change in MetS (component) scores were investigated. RESULTS At baseline, 34.6 % of n = 2098 patients had MetS, 41.4 % of whom received treatment. Of patients with persisting MetS, 46.1 % received treatment for one (or more) MetS component(s) at baseline, and 56.6 % received treatment at FU. Treatment rates of solely elevated blood pressure and reduced HDL-cholesterol did significantly, but modestly, improve. Higher age, male sex, smoking behavior, low education, diabetes, and depressive versus anxiety disorder were predictors of worse outcome at FU on at least one MetS component. LIMITATIONS We did not have data on lifestyle interventions as a form of treatment, which might partly have explained the observed low pharmacotherapeutic treatment rates. CONCLUSION MetS (components) show high persistence rates in affective- and anxiety-disordered patients, and are, despite adequate monitoring, undertreated over time. This indicates that adherence and implementation of monitoring protocols should be crucially improved in psychiatric outpatients in secondary care.
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Affiliation(s)
- Jurriaan M J L Brouwer
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands; GGZ Drenthe Mental Health Services, Assen, the Netherlands; Research School of Behavioral and Cognitive Neurosciences, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands.
| | - Klaas J Wardenaar
- GGZ Drenthe Mental Health Services, Assen, the Netherlands; Department of Psychiatry, University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion regulation, University of Groningen, Groningen, the Netherlands; Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, the Netherlands
| | - Edith J Liemburg
- GGZ Drenthe Mental Health Services, Assen, the Netherlands; Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bennard Doornbos
- Lentis Psychiatric Institute, Lentis Research, Groningen, the Netherlands
| | - Hans Mulder
- Department of Clinical Pharmacy, Wilhelmina Hospital Assen, Assen, the Netherlands
| | - Danielle C Cath
- GGZ Drenthe Mental Health Services, Assen, the Netherlands; Research School of Behavioral and Cognitive Neurosciences, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands; Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Browne J, Naslund JA, Salwen-Deremer JK, Sarcione C, Cabassa LJ, Aschbrenner KA. Factors influencing engagement in in-person and remotely delivered lifestyle interventions for young adults with serious mental illness: A qualitative study. Early Interv Psychiatry 2024; 18:42-48. [PMID: 37220910 PMCID: PMC10665543 DOI: 10.1111/eip.13432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/20/2023] [Accepted: 04/27/2023] [Indexed: 05/25/2023]
Abstract
AIM Young adults (ages 18-35) are underrepresented in lifestyle interventions for people with serious mental illness (SMI), such as schizophrenia, bipolar disorder, and severe depression, and little is known about factors influencing their engagement in these programmes. This qualitative study examined factors affecting engagement amongst young adults with SMI who were enrolled in a lifestyle intervention trial at community mental health centres. METHODS Seventeen young adults with SMI participated in this qualitative study. Participants were drawn from a 12-month randomized controlled trial (n = 150) comparing an in-person group lifestyle intervention augmented with mobile health technology (PeerFIT) to one-on-one personalized remote health coaching (BEAT) using purposive sampling. The 17 participants completed semi-structured qualitative interviews at post-intervention to explore their perceived benefits of the intervention and factors impacting engagement. We used a team-based descriptive qualitative approach to code transcripts and identify themes in the data. RESULTS Participants across both interventions reported experiencing improved ability to engage in health behaviour change. Participants described managing psychosocial stressors and family and other responsibilities that limited their ability to attend in-person PeerFIT sessions. The remote and flexible BEAT remote health coaching intervention appeared to facilitate engagement even in the context of challenging life circumstances. CONCLUSIONS Remotely delivered lifestyle interventions can facilitate engagement amongst young adults with SMI navigating social stressors.
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Affiliation(s)
- Julia Browne
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, North Carolina, USA
- Research Service, VA Providence Health Care System, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica K Salwen-Deremer
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Carrie Sarcione
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Leopoldo J Cabassa
- Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
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Yuan CT, Daumit GL, Cooper LA, Cook C, Corches C, Dalcin AT, Eidman B, Fink T, Gennusa J, Goldsholl S, Liebrecht C, Minahan E, Osorio B, Smith SN, Wang NY, Woltmann E, Kilbourne AM. A Community-Engaged Process for Adapting a Cardiovascular Health Intervention for Persons with Serious Mental Illness. Ethn Dis 2023; DECIPHeR:27-34. [PMID: 38846722 PMCID: PMC11099524 DOI: 10.18865/ed.decipher.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Introduction People with serious mental illness experience grave disparities in cardiovascular disease risk factors. To promote scale-up of effective cardiovascular disease risk reduction interventions from clinical trials, it is important to involve end-users in adapting interventions to fit the needs of community-based settings. Objective We describe a novel, theory-informed process of garnering community input to adapt IDEAL Goals, an evidence-based intervention for improving cardiovascular disease risk factors in persons with serious mental illness. Setting Outpatient community mental health programs in Maryland and Michigan implementing behavioral health homes, which provide enhanced support to people living with both physical and mental illnesses. Participants Clinicians, frontline staff, and administrators from community mental health organizations and persons with serious mental illness. Methods Our approach to community engagement is based on the Replicating Effective Programs (REP) framework. During the REP preimplementation phase, we used 2 community engagement activities: (1) a "needs assessment" to identify anticipated implementation barriers and facilitators, and (2) "community working groups" to collaboratively engage with end-users in adapting the intervention and implementation strategies. Main Findings We used the Stakeholder Engagement Reporting Questionnaire to describe our processes for conducting a needs assessment, involving site-level surveys (N=26) and individual interviews (N=94), and convening a series of community working groups with clinicians and staff (mean, 24 per meeting) and persons with serious mental illness (mean, 8 per meeting). Conclusions By specifying the nature and extent of our community engagement activities, we aim to contribute to the evidence base of how to better integrate and measure community-engaged processes in the adaptation of evidence-based interventions.
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Affiliation(s)
- Christina T. Yuan
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Gail L. Daumit
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Lisa A. Cooper
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Courtney Cook
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Casey Corches
- Department of Learning Health Sciences, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Arlene T. Dalcin
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Benjamin Eidman
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Tyler Fink
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Joseph Gennusa
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Stacy Goldsholl
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Celeste Liebrecht
- Department of Learning Health Sciences, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Eva Minahan
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Brianna Osorio
- Department of Learning Health Sciences, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Shawna N. Smith
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI
| | - Nae-Yuh Wang
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
- Departments of Biostatistics and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Emily Woltmann
- Department of Learning Health Sciences, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Amy M. Kilbourne
- Department of Learning Health Sciences, Michigan Medicine, University of Michigan, Ann Arbor, MI
- Quality Enhancement Research Initiative (QUERI), US Department of Veterans Affairs, Washington, DC
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Wazni L, Gifford W, Perron A, Vandyk A. Understanding the Physical Health Problems of People with Psychotic Disorders Using Digital Storytelling. Issues Ment Health Nurs 2023; 44:690-701. [PMID: 37549316 DOI: 10.1080/01612840.2023.2229435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
People with psychotic disorders struggle to be heard and express concerns beyond their mental health, especially concerns related to the side effects of treatment. Using digital storytelling, this study aimed to uncover and expose the underlying systems that oppress people with psychotic disorders from meeting their physical health needs. The stories revealed two themes: body as a contested site and biological entity with society, and (in)visible patient and paternalism. Spivak's theory of subalternity provided the theoretical basis for a critical analysis and discussion of the experiences. More research is required to highlight the power relations and structures that lead to health disparity in psychiatry.
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Affiliation(s)
- Liquaa Wazni
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Wendy Gifford
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Amélie Perron
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Amanda Vandyk
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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Rindler GA, Gries A, Freidl W. Associations between overweight, obesity, and mental health: a retrospective study among European adults aged 50. Front Public Health 2023; 11:1206283. [PMID: 37533526 PMCID: PMC10390701 DOI: 10.3389/fpubh.2023.1206283] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023] Open
Abstract
Background The comorbidities associated with overweight and obesity have been well researched and scientifically proven while their relationship to mental health is still not verified. Methods This study is aimed at investigating reciprocal associations between obesity and mental health, and is intended to further analyze possible long-term effects using data from the Survey of Health, Ageing and Retirement in Europe (SHARE). In order to do that, waves 4 and 8, conducted in 2010 and 2019/20 of this survey, were analyzed in a cross-lagged panel approach including 16,184 adult Europeans (50+) using multiple linear regression analysis focusing on the Body Mass Index (BMI), depression status and quality of life (QoL). Results Findings yield significant cross-lagged effects in one direction regarding BMI predicting QoL and depression state, whereas depression state and QoL do not significantly predict BMI. Findings include people living with obesity, overweight, and underweight showing significantly decreased levels of QoL as well as increased depression scores compared to people of normal weight over a lag time of 10 years, where people living with obesity indicate the strongest effect. Conclusions However, results do not confirm reciprocal associations in the long term. Hence, there is a strong need to carry out further research on this issue.
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Affiliation(s)
| | - Anna Gries
- Division of Physiology and Pathophysiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University, Graz, Austria
| | - Wolfgang Freidl
- Institute of Social Medicine and Epidemiology, Medical University, Graz, Austria
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Bakkedal C, Persson F, Kriegbaum M, Andersen JS, Grant MK, Mohr GH, Lind BS, Andersen CL, Christensen MB, Siersma V, Rozing MP. Diabetes treatment for persons with severe mental illness: A registry-based cohort study to explore medication treatment differences for persons with type 2 diabetes with and without severe mental illness. PLoS One 2023; 18:e0287017. [PMID: 37310947 PMCID: PMC10263345 DOI: 10.1371/journal.pone.0287017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 05/29/2023] [Indexed: 06/15/2023] Open
Abstract
It has been argued that persons with severe mental illness (SMI) receive poorer treatment for somatic comorbidities. This study assesses the treatment rates of glucose-lowering and cardiovascular medications among persons with incident type 2 diabetes (T2D) and SMI compared to persons with T2D without SMI. We identified persons ≥30 years old with incident diabetes (HbA1c ≥ 48 mmol/mol and/or glucose ≥ 11.0 mmol/L) from 2001 through 2015 in the Copenhagen Primary Care Laboratory (CopLab) Database. The SMI group included persons with psychotic, affective, or personality disorders within five years preceding the T2D diagnosis. Using a Poisson regression model, we calculated the adjusted rate ratios (aRR) for the redemption of various glucose-lowering and cardiovascular medications up to ten years after T2D diagnosis. We identified 1,316 persons with T2D and SMI and 41,538 persons with T2D but no SMI. Despite similar glycemic control at diagnosis, persons with SMI redeemed a glucose-lowering medication more often than persons without SMI in the period 0.5-2 years after the T2D diagnosis; for example, the aRR was 1.05 (95% CI 1.00-1.11) in the period 1.5-2 years after the T2D diagnosis. This difference was mainly driven by metformin. In contrast, persons with SMI were less often treated with cardiovascular medications during the first 3 years after T2D diagnosis, e.g., in the period 1.5-2 years after T2D diagnosis, the aRR was 0.96 (95% CI 0.92-0.99). For people with SMI in addition to T2D, metformin is more likely to be used in the initial years after T2D diagnosis, while our results suggest potential room for improvement regarding the use of cardiovascular medications.
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Affiliation(s)
- Catrine Bakkedal
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Frederik Persson
- Complications Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Margit Kriegbaum
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John Sahl Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mia Klinten Grant
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Grimur Høgnason Mohr
- Centre for Neuropsychiatric Schizophrenia Research, CNSR Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Bent Struer Lind
- Department of Clinical Biochemistry, Copenhagen University Hospital, Hvidovre, Denmark
| | - Christen Lykkegaard Andersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Hematology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Bring Christensen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maarten Pieter Rozing
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department O Rigshospitalet, Psychiatric Center of Copenhagen, Copenhagen, Denmark
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Mpango RS, Ssembajjwe W, Rukundo GZ, Birungi C, Kalungi A, Gadow KD, Patel V, Nyirenda M, Kinyanda E. Physical and psychiatric comorbidities among patients with severe mental illness as seen in Uganda. Eur Arch Psychiatry Clin Neurosci 2023; 273:613-625. [PMID: 36002543 PMCID: PMC9950291 DOI: 10.1007/s00406-022-01478-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 08/02/2022] [Indexed: 11/03/2022]
Abstract
While psychiatric and physical comorbidities in severe mental illness (SMI) have been associated with increased mortality and poor clinical outcomes, problem has received little attention in low- and middle-income countries (LMICs). This study established the prevalence of psychiatric (schizophrenia, bipolar affective disorder, and recurrent major depressive disorder) and physical (HIV/AIDS, syphilis, hypertension and obesity) comorbidities and associated factors among 1201 out-patients with SMI (schizophrenia, depression and bipolar affective disorder) attending care at two hospitals in Uganda. Participants completed an assessment battery including structured, standardised and locally translated instruments. SMIs were established using the MINI International Neuropsychiatric Interview version 7.2. We used logistic regression to determine the association between physical and psychiatric comorbidities and potential risk factors. Bipolar affective disorder was the most prevalent (66.4%) psychiatric diagnoses followed by schizophrenia (26.6%) and recurrent major depressive disorder (7.0%). Prevalence of psychiatric comorbidity was 9.1%, while physical disorder comorbidity was 42.6%. Specific comorbid physical disorders were hypertension (27.1%), obesity (13.8%), HIV/AIDS (8.2%) and syphilis (4.8%). Potentially modifiable factors independently significantly associated with psychiatric and physical comorbidities were: use of alcohol for both syphilis and hypertension comorbidities; and use of a mood stabilisers and khat in comorbidity with obesity. Only psychiatric comorbidity was positively associated with the negative outcomes of suicidality and risky sexual behaviour. The healthcare models for psychiatric care in LMICs such as Uganda should be optimised to address the high burden of psychiatric and physical comorbidities.
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Affiliation(s)
- Richard Stephen Mpango
- MRC/UVRI and LSHTM Uganda Research Unit, Mental Health Section, P. O. Box, 49, Entebbe, Uganda.
- Senior Wellcome Trust Fellowship, Entebbe, Uganda.
- Brown School, Washington University, in St. Louis, St. Louis, MO, 63130, USA.
- Department of Mental Health, Soroti School of Health Sciences, Soroti University, P. O. Box 211, Soroti, Uganda.
- Butabika National Psychiatric Hospital, Kampala, Uganda.
| | - Wilber Ssembajjwe
- MRC/UVRI and LSHTM Uganda Research Unit, Mental Health Section, P. O. Box, 49, Entebbe, Uganda
- Senior Wellcome Trust Fellowship, Entebbe, Uganda
- Statistical Section, MRC/UVRI and LSHTM Uganda Research Unit, P. O. Box 49, Entebbe, Uganda
| | - Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda
| | - Carol Birungi
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Allan Kalungi
- MRC/UVRI and LSHTM Uganda Research Unit, Mental Health Section, P. O. Box, 49, Entebbe, Uganda
- Senior Wellcome Trust Fellowship, Entebbe, Uganda
| | - Kenneth D Gadow
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Massachusetts, USA
| | - Moffat Nyirenda
- MRC/UVRI and LSHTM Uganda Research Unit, Mental Health Section, P. O. Box, 49, Entebbe, Uganda
- Senior Wellcome Trust Fellowship, Entebbe, Uganda
- Global Non-Communicable Diseases (NCD) Section, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Eugene Kinyanda
- MRC/UVRI and LSHTM Uganda Research Unit, Mental Health Section, P. O. Box, 49, Entebbe, Uganda
- Senior Wellcome Trust Fellowship, Entebbe, Uganda
- Department of Psychiatry, College of Health Sciences, Makerere University, Kampala, Uganda
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Lee C, Waite F, Piernas C, Aveyard P. Development and initial evaluation of a behavioural intervention to support weight management for people with serious mental illness: an uncontrolled feasibility and acceptability study. BMC Psychiatry 2023; 23:130. [PMID: 36859248 PMCID: PMC9979581 DOI: 10.1186/s12888-023-04517-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 01/02/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND The rates of obesity and associated health problems are higher in people with serious mental illness (SMI), such as schizophrenia and bipolar disorder, than the general population. A primary care referral to a behavioural weight management programme can be an effective intervention, but people with SMI have reported barriers to engaging with them and bespoke options are rarely provided in routine practice. It is possible that adjunct support addressing these specific barriers could help. Here we report the development, feasibility and acceptability of an intervention to improve uptake and engagement with a mainstream weight management programme for people with SMI. METHODS We worked with people with a lived-experience of SMI and used the person-based approach to develop the 'Weight cHange for people with sErious mEntal iLlness' (WHEEL) intervention. It comprised a referral to a mainstream weight management programme (WW®) to be attended once a week, in-person or online, for 12-weeks. The adjunct support comprised a one-off, online consultation called Meet Your Mentor and weekly, telephone or email Mentor Check Ins for 12-weeks. We assessed the feasibility of WHEEL through the number of programme and adjunct support sessions that the participants attended. We analysed the acceptability of WHEEL using a thematic analysis of qualitative interviews conducted at baseline and at 12-week follow-up. Our exploratory outcome of clinical effectiveness was self-reported weight at baseline and at end-of-programme. RESULTS Twenty participants were assessed for eligibility and 17 enrolled. All 17 participants attended Meet Your Mentor and one was lost to follow-up (94% retention). Nine out of 16 attended ≥50% of the weekly programme sessions and 12/16 attended ≥50% of the weekly check-ins. Participants reported in the interviews that the adjunct support helped to establish and maintain a therapeutic alliance. While some participants valued the in-person sessions, others reported that they preferred the online sessions because it removed a fear of social situations, which was a barrier for some participants. The mean change in self-reported weight was - 4·1 kg (SD: 3·2) at 12-weeks. CONCLUSIONS A mainstream weight management programme augmented with brief and targeted education and low-intensity check-ins generated sufficient engagement and acceptability to warrant a future trial.
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Affiliation(s)
- Charlotte Lee
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, OX2 6GG, UK. .,Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK.
| | - Felicity Waite
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Headington, Oxford, Oxfordshire, OX3 7JX, UK.,Oxford Health NHS Foundation Trust, Warneford Lane, Headington, Oxford, Oxfordshire, OX3 7JX, UK
| | - Carmen Piernas
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, OX2 6GG, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford, OX2 6GG, UK.,Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
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Hanson P, Lange M, Oduro-Donkor D, Shuttlewood E, Weickert MO, Randeva HS, Menon V, Alexander RT, Basset P, Shankar R, Barber TM. The role of mindfulness training in sustaining weight reduction: retrospective cohort analysis. BJPsych Open 2022; 8:e198. [PMID: 36377522 PMCID: PMC9707508 DOI: 10.1192/bjo.2022.602] [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: 11/16/2022] Open
Abstract
BACKGROUND Psychological stress has an established bi-directional relationship with obesity. Mindfulness techniques reduce stress and improve eating behaviours, but their long-term impact remains untested. CALMPOD (Compassionate Approach to Living Mindfully for Prevention of Disease) is a psychoeducational mindfulness-based course evidenced to improve eating patterns across a 6-month period, possibly by reducing stress. However, no long-term evaluation of impact exists. AIMS This study retrospectively evaluates 2-year outcomes of CALMPOD on patient engagement, weight and metabolic markers. METHOD All adults with a body mass index >35 kg/m2 attending an UK obesity service during 2016-2020 were offered CALMPOD. Those who refused CALMPOD were offered standard lifestyle advice. Routine clinic data over 2 years, including age, gender, 6-monthly appointment attendance, weight, haemoglobin A1C and total cholesterol, were pooled and analysed to evaluate CALMPOD. RESULTS Of 289 patients, 163 participated in the CALMPOD course and 126 did not. No baseline demographic differences existed between the participating and non-participating groups. The CALMPOD group had improved attendance across all 6-monthly appointments compared with the non-CALMPOD group (P < 0.05). Mean body weight reduction at 2 years was 5.6 kg (s.d. 11.2, P < 0.001) for the CALMPOD group compared with 3.9 kg (s.d. 10.5, P < 0.001) for the non-CALMPOD group. No differences in haemoglobin A1C and fasting serum total cholesterol were identified between the groups. CONCLUSIONS The retrospective evaluation of CALMPOD suggests potential for mindfulness and compassion-based group educational techniques to improve longer-term patient and clinical outcomes. Prospective large-scale studies are needed to evaluate the impact of stress on obesity and the true impact of CALMPOD.
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Affiliation(s)
- Petra Hanson
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, UK; and NIHR CRF Human Metabolism Research Unit, University Hospitals Coventry and Warwickshire NHS Trust, UK
| | - Maria Lange
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, UK; and NIHR CRF Human Metabolism Research Unit, University Hospitals Coventry and Warwickshire NHS Trust, UK
| | - Dominic Oduro-Donkor
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, UK; and NIHR CRF Human Metabolism Research Unit, University Hospitals Coventry and Warwickshire NHS Trust, UK
| | - Emma Shuttlewood
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, UK
| | - Martin O Weickert
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, UK; NIHR CRF Human Metabolism Research Unit, University Hospitals Coventry and Warwickshire NHS Trust, UK; and Centre for Sport, Exercise and Life Sciences, Faculty of Health and Life Sciences, Coventry University, UK
| | - Harpal S Randeva
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, UK; NIHR CRF Human Metabolism Research Unit, University Hospitals Coventry and Warwickshire NHS Trust, UK; and Aston Medical Research Institute, Aston Medical School, Aston University, UK
| | - Vinod Menon
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, UK
| | - Regi T Alexander
- Adult Learning Disability Services, Hertfordshire Partnership University NHS Foundation Trust, Little Plumstead Hospital, Norwich, UK; and School of Life and Medical Sciences, University of Hertfordshire, UK
| | | | - Rohit Shankar
- Cornwall Institute of Intellectual Disability Research (CIDER), Peninsula Medical School, University of Plymouth, UK and Cornwall Partnership NHS Foundation Trust, UK
| | - Tom M Barber
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, UK; Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire NHS Trust, UK; and NIHR CRF Human Metabolism Research Unit, University Hospitals Coventry and Warwickshire NHS Trust, UK
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10
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Rossom RC, Hooker SA, O’Connor PJ, Crain AL, Sperl‐Hillen JM. Cardiovascular Risk for Patients With and Without Schizophrenia, Schizoaffective Disorder, or Bipolar Disorder. J Am Heart Assoc 2022; 11:e021444. [PMID: 35261265 PMCID: PMC9075298 DOI: 10.1161/jaha.121.021444] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background To compare estimated 10‐year and 30‐year cardiovascular risk in primary care patients with and without serious mental illness (SMI; bipolar disorder, schizophrenia, or schizoaffective disorder). Methods and Results All patients aged 18 to 75 years with a primary care visit in January 2016 to September 2018 were included and were grouped into those with and without SMI using diagnosis codes. Ten‐year cardiovascular risk was estimated using atherosclerotic cardiovascular disease scores for patients aged 40 to 75 years without cardiovascular disease; 30‐year cardiovascular risk was estimated using Framingham risk scores for patients aged 18 to 59 years without cardiovascular disease. Demographic, vital sign, medication, diagnosis, and health insurance data were collected from the electronic health record by a clinical decision support system. Descriptive statistics examined unadjusted differences, while general linear models examined differences for continuous variables and logistic regression models for categorical variables. Models were then adjusted for age, sex, race, ethnicity, and insurance type. A total of 11 333 patients with SMI and 579 924 patients without SMI were included. After covariate adjustment, 10‐year cardiovascular risk was significantly higher in patients with SMI (mean, 9.44%; 95% CI, 9.29%–9.60%) compared with patients without SMI (mean, 7.99%; 95% CI, 7.97–8.02). Similarly, 30‐year cardiovascular risk was significantly higher in those with SMI (25% of patients with SMI in the highest‐risk group compared with 11% of patients without SMI; P<0.001). The individual cardiovascular risk factors contributing most to increased risk for those with SMI were elevated body mass index and smoking. Among SMI subtypes, patients with bipolar disorder had the highest 10‐year cardiovascular risk, while patients with schizoaffective disorder had the highest 30‐year cardiovascular risk. Conclusions The significantly increased cardiovascular risk associated with SMI is evident even in young adults. This suggests the importance of addressing uncontrolled major cardiovascular risk factors in those with SMI at as early an age as possible. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02451670.
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Affiliation(s)
- Rebecca C. Rossom
- HealthPartners InstituteMinneapolisMN
- University of Minnesota Medical SchoolMinneapolisMN
| | | | - Patrick J. O’Connor
- HealthPartners InstituteMinneapolisMN
- University of Minnesota Medical SchoolMinneapolisMN
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11
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Aschbrenner KA, Naslund JA, Gorin AA, Mueser KT, Browne J, Wolfe RS, Xie H, Bartels SJ. Group Lifestyle Intervention With Mobile Health for Young Adults With Serious Mental Illness: A Randomized Controlled Trial. Psychiatr Serv 2022; 73:141-148. [PMID: 34189933 DOI: 10.1176/appi.ps.202100047] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Evidence-based lifestyle interventions tailored to young adults with serious mental illness are needed to reduce their cardiometabolic risk. This study evaluated the effectiveness of a group lifestyle intervention ("PeerFIT") enhanced with mobile health (mHealth) compared with one-on-one mHealth coaching (basic education supported by activity tracking [BEAT]) for young adults with serious mental illness who were overweight or obese. METHODS Participants were young adults ages 18-35 years with serious mental illness and a body mass index ≥25 kg/m2, who were randomly assigned to PeerFIT or BEAT. Research staff collected data at baseline and at 6 and 12 months. Main outcomes were clinically significant changes from baseline in weight (≥5% weight loss), cardiorespiratory fitness (CRF; increase of >50 m on the 6-minute walk test), and cardiovascular disease (CVD) risk reduction (clinically significant weight loss or CRF improvement). RESULTS Participants were 150 young adults with a mean ± SD body mass index of 37.1±7.4. Intent-to-treat analyses revealed no significant between-group difference for weight-loss, CRF, or CVD outcomes at 6 and 12 months. Participants in both conditions achieved clinically significant CVD risk reduction, weight loss, and CRF from baseline to 6 and 12 months, and all these improvements were statistically significant (p<0.01). CONCLUSION The PeerFIT group lifestyle intervention was not superior to one-on-one mHealth coaching in achieving clinically significant changes in weight, CRF, and CVD risk reduction. Although both interventions improved outcomes, low-intensity mHealth coaching may be a more scalable approach for addressing modifiable cardiometabolic risk factors among young adults with serious mental illness.
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Affiliation(s)
- Kelly A Aschbrenner
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - John A Naslund
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Amy A Gorin
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Kim T Mueser
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Julia Browne
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Rosemarie S Wolfe
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Haiyi Xie
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
| | - Stephen J Bartels
- Department of Psychiatry (Aschbrenner, Wolfe) and Department of Biomedical Data Science (Xie), Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychology, University of Connecticut, Storrs (Gorin); Departments of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (Mueser); Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs (VA) Health Care System, Durham, North Carolina (Browne); Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston (Bartels)
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12
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Zurrón Madera P, Casaprima Suárez S, García Álvarez L, García-Portilla González MP, Junquera Fernández R, Lluch Canut MT. Eating and nutritional habits in patients with schizophrenia. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2022; 15:54-60. [PMID: 35105526 DOI: 10.1016/j.rpsmen.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/21/2019] [Indexed: 06/14/2023]
Abstract
BACKGROUND There are few studies that relate eating and nutritional habits to the severity of the disease and demographic profile in patients with schizophrenia. OBJECTIVE To describe eating and nutritional habits and their relationship with the severity of the disease in patients with schizophrenia. METHOD Cross-sectional descriptive study. SAMPLE 31 patients with schizophrenia (ICD-10) under outpatient treatment. INCLUSION CRITERIA age 18-65 years, clinically stable and, written informed consent. ASSESSMENT Demographic, clinical characteristics (CGI-SCH, length of illness, BMI, abdominal perimeter), ad hoc questionnaire (eating, nutritional, and physical activity). RESULTS Mean age 43.13(SD = 7.85) years, males 61.3%. Mean severity of illness was 3.94(SD = 1.06), mean duration of the illness 18.42(SD = 8.27) years. 74.2% used to eatweekly fat meat and 64.5% less than 3-4 servings of fish, 77.4% less than 3 servings of fruit per day, and 51.6% drink less than 1 L of water. 83.9% used to drink coffee daily, 2.81(SD = 2.02) cups per day. Patients showed lower levels of Vitamin A, D, E, K1, C, folic acid, and magnesium. 93.5% did not fulfill the WHO recommendations on physical activity. Only retinol (r = -0.602, P = .039) and vitamin K1 (r = -0.693, P = .012) in women were related to the severity of illness. CONCLUSIONS Outpatients with schizophrenia do not follow WHO recommendations on healthy diets, neither physical activity. Both clinical severity of the illness and marital status and cohabitation were associated with poor eating habits and nutrients deficit. These data should be taken into account by the nursing staff when implementing specific care in routine clinical practice.
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Affiliation(s)
- Paula Zurrón Madera
- Servicio de Salud del Principado de Asturias, SESPA, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Área de Psiquiatría, Facultad de Medicina, Universidad de Oviedo, Spain.
| | | | - Leticia García Álvarez
- Fundación para la Investigación y la Innovación Biosanitaria del Principado de Asturias (FINBA); Instituto de Investigación Sanitaria del Principado de Asturias (ISPA); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Área de Psiquiatría, Facultad de Medicina, Universidad de Oviedo, Spain; Instituto de Neurociencias del Principado de Asturias (INEUROPA), Spain
| | - María Paz García-Portilla González
- Servicio de Salud del Principado de Asturias, SESPA, Spain; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Área de Psiquiatría, Facultad de Medicina, Universidad de Oviedo, Spain; Instituto de Neurociencias del Principado de Asturias (INEUROPA), Spain
| | | | - María Teresa Lluch Canut
- Escuela de Enfermería, Facultad de Medicina Ciencias de la Salud, Campus Bellvitge Universidad de Barcelona, Spain
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13
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Gardner KN. Part I: Interactive case: Adverse effects associated with antipsychotic therapy. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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14
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Sud D, Laughton E, McAskill R, Bradley E, Maidment I. The role of pharmacy in the management of cardiometabolic risk, metabolic syndrome and related diseases in severe mental illness: a mixed-methods systematic literature review. Syst Rev 2021; 10:92. [PMID: 33789745 PMCID: PMC8015120 DOI: 10.1186/s13643-021-01586-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 01/06/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Individuals with severe mental illness, e.g. schizophrenia have up to a 20% shortened life expectancy compared to the general population. Cardiovascular disease, due to cardiometabolic risk and metabolic syndrome, accounts for most of this excess mortality. A scoping search revealed that there has not been a review of published studies on the role of pharmacy in relation to cardiometabolic risk, metabolic syndrome and related diseases (e.g. type 2 diabetes) in individuals with severe mental illness. METHODS A mixed-methods systematic review was performed. Eleven databases were searched using a comprehensive search strategy to identify English-language studies where pharmacy was involved in an intervention for cardiometabolic risk, metabolic syndrome or related diseases in severe mental illness in any study setting from any country of origin. First, a mapping review was conducted. Then, implementation strategies used to implement the study intervention were classified using the Cochrane Effective Practice and Organisation of Care Taxonomy. Impact of the study intervention on the process (e.g. rate of diagnosis of metabolic syndrome) and clinical (e.g. diabetic control) outcomes were analysed where possible (statistical tests of significance obtained for quantitative outcome parameters reported). Quality assessment was undertaken using a modified Mixed Methods Appraisal Tool. RESULTS A total of 33 studies were identified. Studies were heterogeneous for all characteristics. A total of 20 studies reported quantitative outcome data that allowed for detailed analysis of the impact of the study intervention. The relationship between the total number of implementation strategies used and impact on outcomes measured is unclear. Inclusion of face-to-face interaction in implementation of interventions appears to be important in having a statistically significantly positive impact on measured outcomes even when used on its own. Few studies included pharmacy staff in community or general practitioner practices (n = 2), clinical outcomes, follow up of individuals after implementation of interventions (n = 3). No studies included synthesis of qualitative data. CONCLUSIONS Our findings indicate that implementation strategies involving face-to-face interaction of pharmacists with other members of the multidisciplinary team can improve process outcomes when used as the sole strategy. Further work is needed on clinical outcomes (e.g. cardiovascular risk reduction), role of community pharmacy and qualitative studies. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018086411.
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Affiliation(s)
- Dolly Sud
- School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK.
| | - Eileen Laughton
- Pharmacy Department, Leicestershire Partnership NHS Trust, Bradgate Mental Health Site, Glenfield Hospital, Groby Road, Leicester, Leicestershire, LE3 9EJ, UK
| | - Robyn McAskill
- Pharmacy Department, Leicestershire Partnership NHS Trust, Bradgate Mental Health Site, Glenfield Hospital, Groby Road, Leicester, Leicestershire, LE3 9EJ, UK
| | - Eleanor Bradley
- College of Health, Life and Environmental Sciences, University of Worcester, Henwick Grove, Worcester, WR2 6AJ, UK
| | - Ian Maidment
- School of Life and Health Sciences, Aston University, Birmingham, B4 7ET, UK
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15
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Kanagasundaram P, Lee J, Prasad F, Costa-Dookhan KA, Hamel L, Gordon M, Remington G, Hahn MK, Agarwal SM. Pharmacological Interventions to Treat Antipsychotic-Induced Dyslipidemia in Schizophrenia Patients: A Systematic Review and Meta Analysis. Front Psychiatry 2021; 12:642403. [PMID: 33815174 PMCID: PMC8010007 DOI: 10.3389/fpsyt.2021.642403] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/16/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction: Antipsychotic-induced dyslipidemia represents a common adverse effect faced by patients with schizophrenia that increases risk for developing further metabolic complications and cardiovascular disease. Despite its burden, antipsychotic-induced dyslipidemia is often left untreated, and the effectiveness of pharmacological interventions for mitigating dyslipidemia has not been well-addressed. This review aims to assess the effectiveness of pharmacological interventions in alleviating dyslipidemia in patients with schizophrenia. Methods: Medline, PsychInfo, and EMBASE were searched for all relevant English articles from 1950 to November 2020. Randomized placebo-controlled trials were included. Differences in changes in triglycerides, HDL cholesterol, LDL cholesterol, and VLDL cholesterol levels between treatment and placebo groups were meta-analyzed as primary outcomes. Results: Our review identified 48 randomized controlled trials that comprised a total of 3,128 patients and investigated 29 pharmacological interventions. Overall, pharmacological interventions were effective in lowering LDL cholesterol, triglycerides, and total cholesterol levels while increasing the levels of HDL cholesterol. Within the intervention subgroups, approved lipid-lowering agents did not reduce lipid parameters other than total cholesterol level, while antipsychotic switching and antipsychotic add-on interventions improved multiple lipid parameters, including triglycerides, LDL cholesterol, HDL cholesterol, and total cholesterol. Off label lipid lowering agents improved triglycerides and total cholesterol levels, with statistically significant changes seen with metformin. Conclusion: Currently available lipid lowering agents may not work as well in patients with schizophrenia who are being treated with antipsychotics. Additionally, antipsychotic switching, antipsychotic add-ons, and certain off label interventions might be more effective in improving some but not all associated lipid parameters. Future studies should explore novel interventions for effectively managing antipsychotic-induced dyslipidemia. Registration: PROSPERO 2020 CRD42020219982; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020219982.
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Affiliation(s)
- Pruntha Kanagasundaram
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,School of Pharmacy, University of Waterloo, Waterloo, ON, Canada
| | - Jiwon Lee
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Femin Prasad
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Kenya A Costa-Dookhan
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Laurie Hamel
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Madeleine Gordon
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Gary Remington
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Margaret K Hahn
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Banting and Best Diabetes Centre, University of Toronto, Toronto, ON, Canada
| | - Sri Mahavir Agarwal
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Banting and Best Diabetes Centre, University of Toronto, Toronto, ON, Canada
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16
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Abstract
Abstract
Purpose of Review
Social support, especially from peers, has been found to contribute to successful weight loss and long-term weight loss maintenance. Peer support groups may represent a particularly effective intervention technique for weight loss. This review focuses upon peer support weight loss interventions with the objective of identifying common elements of successful programs.
Recent Findings
Peer support interventions often consist of expert-led educational content, supplemented by peer-led activities or discussion. Peer groups may provide support to individuals who have little social support in their normal lives. Interventions are often designed for pre-existing groups, especially high-risk groups such as women from ethnic minorities. Men are underrepresented in weight loss programs and often perceive “dieting” as feminine. However, several peer programs for male sports fans have successfully resulted in weight loss and fostering support for healthy lifestyle among male peers. In addition to professionally created peer support groups, many online weight loss communities are created and moderated by peers. Online communities allow participants to share peer support similar to in-person formats.
Summary
Many peer support interventions show significant short-term weight loss. Group members frequently report that peer support was critical to their weight loss success. A sense of community among likeminded individuals with similar goals was frequently cited. Online peer support groups are becoming increasingly prevalent, may fulfill similar needs to in-person groups, and have additional advantages in accessibility, and access to a larger peer network, and may facilitate long-term adherence.
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17
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Agaba DC, Migisha R, Katamba G, Ashaba S. Cardio-metabolic abnormalities among patients with severe mental illness at a Regional Referral Hospital in southwestern Uganda. PLoS One 2020; 15:e0235956. [PMID: 32678850 PMCID: PMC7367467 DOI: 10.1371/journal.pone.0235956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 06/26/2020] [Indexed: 12/12/2022] Open
Abstract
Patients with severe mental illness (SMI) have a higher burden of premature cardio-metabolic abnormalities, including diabetes mellitus, hypertension, hyperlipidemia, and obesity resulting into a 3-fold increase in mortality, and up to 20% reduction in life expectancy compared to the general population. Although over 30% of Ugandans have some form of mental illness, there are no national or hospital-based screening guidelines for cardio-metabolic abnormalities among these patients a general trend in most low-income countries. The screening rates for cardio-metabolic abnormalities in most low-income countries are at only 0.6%. The objective of this study was to describe the cardio-metabolic abnormalities among patients with SMI at Mbarara Regional Referral Hospital. Through a cross-sectional study, we recruited 304 patients with SMI and evaluated them for cardio-metabolic abnormalities using the National Cholesterol Education Programme Adult Treatment Panel III criteria for dyslipidemias, World Health Organisation criteria for diabetes mellitus, obesity, and the Joint national committee criteria for hypertension. We then determined the proportion of participants who met the criteria for each of the individual cardio-metabolic abnormalities. Of the 304 participants, 44.41% were male and 55.59% female with a mean age of 38.56±13.66 years. Almost half (46.38%) of the participants were either overweight or obese, 33.22% had abdominal obesity, 40.46% were hypertensive, 34.11% had low high-density lipoproteins, 37.42% had hypertriglyceridemia and 34.77% had hypercholesterolemia. Based on fasting blood sugar, 11.18% and 9.87% had pre-diabetes and diabetes respectively. There is a high level of cardio-metabolic abnormalities among patients with psychiatric disorders and thus metabolic screening for these abnormalities should be done routinely during psychiatric reviews. There is a need for national guidelines for screening of metabolic abnormalities among patients with SMI so that these abnormalities can be detected early enough at stages where they can be either reversed or delayed to progress to cardiovascular disease.
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Affiliation(s)
- David Collins Agaba
- Department of Physiology, Mbarara University of Science and Technology, Mbarara, Uganda
- * E-mail:
| | - Richard Migisha
- Department of Physiology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Godfrey Katamba
- Department of Physiology, King Ceasor University, Kampala, Uganda
| | - Scholastic Ashaba
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Psychiatry, Kamapala International University, Kampala, Uganda
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18
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Daumit GL, Dalcin AT, Dickerson FB, Miller ER, Evins AE, Cather C, Jerome GJ, Young DR, Charleston JB, Gennusa JV, Goldsholl S, Cook C, Heller A, McGinty EE, Crum RM, Appel LJ, Wang NY. Effect of a Comprehensive Cardiovascular Risk Reduction Intervention in Persons With Serious Mental Illness: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e207247. [PMID: 32530472 PMCID: PMC7293000 DOI: 10.1001/jamanetworkopen.2020.7247] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE Persons with serious mental illness have a cardiovascular disease mortality rate more than twice that of the overall population. Meaningful cardiovascular risk reduction requires targeted efforts in this population, who often have psychiatric symptoms and cognitive impairment. OBJECTIVE To determine the effectiveness of an 18-month multifaceted intervention incorporating behavioral counseling, care coordination, and care management for overall cardiovascular risk reduction in adults with serious mental illness. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted from December 2013 to November 2018 at 4 community mental health outpatient programs in Maryland. The study recruited adults with at least 1 cardiovascular disease risk factor (hypertension, diabetes, dyslipidemia, current tobacco smoking, and/or overweight or obesity) attending the mental health programs. Of 398 participants screened, 269 were randomized to intervention (132 participants) or control (137 participants). Data collection staff were blinded to group assignment. Data were analyzed on the principle of intention to treat, and data analysis was performed from November 2018 to March 2019. INTERVENTIONS A health coach and nurse provided individually tailored cardiovascular disease risk reduction behavioral counseling, collaborated with physicians to implement appropriate risk factor management, and coordinated with mental health staff to encourage attainment of health goals. Programs offered physical activity classes and received consultation on serving healthier meals; intervention and control participants were exposed to these environmental changes. MAIN OUTCOMES AND MEASURES The primary outcome was the change in the risk of cardiovascular disease from the global Framingham Risk Score (FRS), which estimates the 10-year probability of a cardiovascular disease event, from baseline to 18 months, expressed as percentage change for intervention compared with control. RESULTS Of 269 participants randomized (mean [SD] age, 48.8 [11.9] years; 128 men [47.6%]), 159 (59.1%) had a diagnosis of schizophrenia or schizoaffective disorder, 67 (24.9%) had bipolar disorder, and 38 (14.1%) had major depressive disorder. At 18 months, the primary outcome, FRS, was obtained for 256 participants (95.2%). The mean (SD) baseline FRS was 11.5% (11.5%) (median, 8.6%; interquartile range, 3.9%-16.0%) in the intervention group and 12.7% (12.7%) (median, 9.1%; interquartile range, 4.0%-16.7%) in the control group. At 18 months, the mean (SD) FRS was 9.9% (10.2%) (median, 7.7%; interquartile range, 3.1%-12.0%) in the intervention group and 12.3% (12.0%) (median, 9.7%; interquartile range, 4.0%-15.9%) in the control group. Compared with the control group, the intervention group experienced a 12.7% (95% CI, 2.5%-22.9%; P = .02) relative reduction in FRS at 18 months. CONCLUSIONS AND RELEVANCE An 18-month behavioral counseling, care coordination, and care management intervention statistically significantly reduced overall cardiovascular disease risk in adults with serious mental illness. This intervention provides the means to substantially reduce health disparities in this high-risk population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02127671.
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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
| | - 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
| | - A. Eden Evins
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Corinne Cather
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Gerald J. Jerome
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Kinesiology, Towson University, Towson, Maryland
| | - Deborah R. Young
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - 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
| | - 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
| | - Ann Heller
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emma E. McGinty
- 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
| | - Rosa M. Crum
- 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
| | - 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
| | - 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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Correll C, Cañas F, Larmo I, Levy P, Montes JM, Fagiolini A, Papageorgiou G, Rossi A, Sturlason R, Zink M. Individualizing antipsychotic treatment selection in schizophrenia: characteristics of empirically derived patient subgroups. Eur Psychiatry 2020; 26:3-16. [DOI: 10.1016/s0924-9338(11)71709-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
AbstractTreatment of schizophrenia with antipsychotic drugs is frequently sub-optimal. One reason for this may be heterogeneity between patients with schizophrenia. The objectives of this study were to identify patient, disease and treatment attributes that are important for physicians in choosing an antipsychotic drug, and to identify empirically subgroups of patients who may respond differentially to antipsychotic drugs. The survey was conducted by structured interview of 744 randomly-selected psychiatrists in four European countries who recruited 3996 patients with schizophrenia. Information on 39 variables was collected. Multiple component analysis was used to identify dimensions that explained the variance between patients. Three axes, accounting for 99% of the variance, were associated with disease severity (64%), socioeconomic status (27%) and patient autonomy (8%). These dimensions discriminated between six discrete patient subgroups, identified using ascending hierarchical classification analysis. The six subgroups differed regarding educational level, illness severity, autonomy, symptom presentation, addictive behaviors, comorbidities and cardiometabolic risk factors. Subgroup 1 patients had moderately severe physician-rated disease and addictive behaviours (23.2%); Subgroup 2 patients were well-integrated and autonomous with mild to moderate disease (6.7%); Subgroup 3 patients were less well-integrated with mild to moderate disease, living alone (11.2%); Subgroup 4 patients were women with low education levels (5.4%), Subgroup 5 patients were young men with severe disease (36.8%); and Subgroup 6 patients were poorly-integrated with moderately severe disease, needing caregiver support (16.7%). The presence of these subgroups, which require confirmation and extension regarding potentially identifiable biological markers, may help individualizing treatment in patients with schizophrenia.
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Taipale H, Tanskanen A, Mehtälä J, Vattulainen P, Correll CU, Tiihonen J. 20-year follow-up study of physical morbidity and mortality in relationship to antipsychotic treatment in a nationwide cohort of 62,250 patients with schizophrenia (FIN20). World Psychiatry 2020; 19:61-68. [PMID: 31922669 PMCID: PMC6953552 DOI: 10.1002/wps.20699] [Citation(s) in RCA: 199] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Antipsychotics are effective in preventing relapses of schizophrenia, but it is generally believed that their long-term use is harmful for patients' physical well-being. However, there are no long-term studies which have verified this view. This nationwide, register-based cohort study aimed to assess the risk of hospitalization due to physical health problems, as a marker for severe physical morbidity, and the risk of all-cause mortality, as well as of cardiovascular and suicidal death, associated with antipsychotic use in all patients treated for schizophrenia in inpatient care between 1972 and 2014 in Finland (N=62,250), with up to 20 years of follow-up (median: 14.1 years). The use of antipsychotic drugs (i.e., use of any antipsychotic compared with non-use) and the use of specific antipsychotics were investigated, and outcomes were somatic and cardiovascular hospitalization, and all-cause, cardiovascular and suicide death. Hospitalization-based outcomes were analyzed by a within-individual design to eliminate selection bias, comparing use and non-use periods in the same individual by stratified Cox model. Mortality outcomes were assessed by traditional between-individual Cox multivariate models. The adjusted hazard ratios (aHRs) for any somatic hospitalization and cardiovascular hospitalization were 1.00 (95% CI: 0.98-1.03) and 1.00 (95% CI: 0.92-1.07) during use of any antipsychotic compared to non-exposure periods within the same individual. The aHRs were 0.48 (95% CI: 0.46-0.51) for all-cause mortality, 0.62 (95% CI: 0.57-0.67) for cardiovascular mortality, and 0.52 (95% CI: 0.43-0.62) for suicide mortality during use vs. non-use of any antipsychotic. The most beneficial mortality outcome was associated with use of clozapine in terms of all-cause (aHR=0.39, 95% CI: 0.36-0.43), cardiovascular (aHR=0.55, 95% CI: 0.47-0.64) and suicide mortality (aHR=0.21, 95% CI: 0.15-0.29). The cumulative mortality rates during maximum follow-up of 20 years were 46.2% for no antipsychotic use, 25.7% for any antipsychotic use, and 15.6% for clozapine use. These data suggest that long-term antipsychotic use does not increase severe physical morbidity leading to hospitalization, and is associated with substantially decreased mortality, especially among patients treated with clozapine.
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Affiliation(s)
- Heidi Taipale
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden,Department of Forensic PsychiatryUniversity of Eastern Finland, Niuvanniemi HospitalKuopioFinland,School of Pharmacy, University of Eastern Finland, KuopioFinland
| | - Antti Tanskanen
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden,Department of Forensic PsychiatryUniversity of Eastern Finland, Niuvanniemi HospitalKuopioFinland,Public Health Evaluation and Projection Unit, National Institute for Health and WelfareHelsinkiFinland
| | | | | | - Christoph U. Correll
- Department of Psychiatry, Zucker Hillside HospitalNorthwell HealthGlen OaksNYUSA,Department of Psychiatry and Molecular MedicineZucker School of Medicine at Hofstra/NorthwellHempsteadNYUSA,Center for Psychiatric Neuroscience, Feinstein Institute for Medical ResearchManhassetNYUSA,Department of Child and Adolescent PsychiatryCharité UniversitätsmedizinBerlinGermany
| | - Jari Tiihonen
- Department of Clinical NeuroscienceKarolinska InstitutetStockholmSweden,Department of Forensic PsychiatryUniversity of Eastern Finland, Niuvanniemi HospitalKuopioFinland,Center for Psychiatry Research, Stockholm City CouncilStockholmSweden
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21
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Zurrón Madera P, Casaprima Suárez S, García Álvarez L, García-Portilla González MP, Junquera Fernández R, Canut MTL. Eating and nutritional habits in patients with schizophrenia. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2019; 15:S1888-9891(19)30098-9. [PMID: 31864966 DOI: 10.1016/j.rpsm.2019.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/03/2019] [Accepted: 10/21/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND There are few studies that relate eating and nutritional habits to the severity of the disease and demographic profile in patients with schizophrenia. OBJECTIVE To describe eating and nutritional habits and their relationship with the severity of the disease in patients with schizophrenia. METHOD Cross-sectional descriptive study. SAMPLE 31 patients with schizophrenia (ICD-10) under outpatient treatment. INCLUSION CRITERIA age 18-65 years, clinically stable and, written informed consent. ASSESSMENT Demographic, clinical characteristics (CGI-SCH, length of illness, BMI, abdominal perimeter), ad hoc questionnaire (eating, nutritional, and physical activity). RESULTS Mean age 43.13(SD=7.85) years, males 61.3%. Mean severity of illness was 3.94(SD=1.06), mean duration of the illness 18.42(SD=8.27) years. 74.2% used to eat weekly fat meat and 64.5% less than 3-4 servings of fish, 77.4% less than 3 servings of fruit per day, and 51.6% drink less than 1l of water. 83.9% used to drink coffee daily, 2.81(SD=2.02) cups per day. Patients showed lower levels of Vitamin A, D, E, K1, C, folic acid, and magnesium. 93.5% did not fulfill the WHO recommendations on physical activity. Only retinol (r=-0.602, p=0.039) and vitamin K1 (r=-0.693, p=0.012) in women were related to the severity of illness. CONCLUSIONS Outpatients with schizophrenia do not follow WHO recommendations on healthy diets, neither physical activity. Both clinical severity of the illness and marital status and cohabitation were associated with poor eating habits and nutrients deficit. These data should be taken into account by the nursing staff when implementing specific care in routine clinical practice.
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Affiliation(s)
- Paula Zurrón Madera
- Servicio de Salud del Principado de Asturias, SESPA, España; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), España; Área de Psiquiatría, Facultad de Medicina, Universidad de Oviedo, España.
| | | | - Leticia García Álvarez
- Fundación para la Investigación y la Innovación Biosanitaria del Principado de Asturias (FINBA); Instituto de Investigación Sanitaria del Principado de Asturias (ISPA); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), España; Área de Psiquiatría, Facultad de Medicina, Universidad de Oviedo, España; Instituto de Neurociencias del Principado de Asturias (INEUROPA), España
| | - María Paz García-Portilla González
- Servicio de Salud del Principado de Asturias, SESPA, España; Instituto de Investigación Sanitaria del Principado de Asturias (ISPA); Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), España; Área de Psiquiatría, Facultad de Medicina, Universidad de Oviedo, España; Instituto de Neurociencias del Principado de Asturias (INEUROPA), España
| | | | - María Teresa Lluch Canut
- Escuela de Enfermería, Facultad de Medicina Ciencias de la Salud, Campus Bellvitge Universidad de Barcelona, España
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22
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Cocoman AM, Gallagher D. A Retrospective Chart Review of Screening on the Prevalence of Metabolic Syndrome (MetS) in an Irish Community Mental Health Service. Issues Ment Health Nurs 2019; 40:895-901. [PMID: 31295053 DOI: 10.1080/01612840.2019.1609636] [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] [Indexed: 10/26/2022]
Abstract
Individuals who are treated with antipsychotic medications are at risk of developing metabolic syndrome (MetS). The comorbidity of a severe mental illness (SMI) and a physical illness has a major impact on the quality of life of these individuals. We conducted a retrospective chart review (RCR) of 214 individuals with a diagnosis of schizophrenia who had been receiving antipsychotic medications for at least 6 months, in five clinical settings in an Irish community mental health service. The aim was to determine the presence of MetS to assist in improving screening practices and directing future practice. The National Cholesterol Education Program High Blood Cholesterol Adult Treatment Panel 111 (NCEP ATP 111) metabolic diagnostic criteria were utilised to determine prevalence. After examining 214 charts we observed that waist circumference varied from 68 to 142 cm, elevated waist circumference over the recommended parameters was recorded in 145 charts. Forty-five percent (n = 98) had blood pressure (BP) readings over 130/85. The range for body mass index (BMI)'s varied from 16 to 54, BMIs over 25 was recorded in 44% (n = 95) of charts. Elevated triglycerides (TG) were recorded in 37% (n = 80) and 45% (n = 97) had reduced HDL-C levels. Elevated glucose levels were found in 25% (n = 54) of the charts examined. The chart review found an overall prevalence rate of 44% (n = 94) for this sample. Regular audit of screening data used for the presence of MetS in individuals with SMI is essential in the detection of physical comorbidities and to improving the quality of life and prevention of premature deaths.
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Affiliation(s)
- Angela M Cocoman
- Faculty of Science and Health, School of Nursing and Human Sciences, Dublin City University , Dublin , Ireland
| | - Darren Gallagher
- Faculty of Science and Health, School of Nursing and Human Sciences, Dublin City University , Dublin , Ireland
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23
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Janney CA, Greenberg JM, Moin T, Kim HM, Holleman RG, Hughes M, Damschroder LJ, Richardson CR, Young AS, Steinle N. Does mental health influence weight loss in adults with prediabetes? Findings from the VA Diabetes Prevention Program. Gen Hosp Psychiatry 2018; 53:32-37. [PMID: 29729586 DOI: 10.1016/j.genhosppsych.2018.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Mental illness may impact outcomes from structured behavioral weight loss interventions. This secondary analysis investigated the influence of mental health on weight loss among Veterans with prediabetes enrolled in either an in-person diabetes prevention program (DPP) or the usual care weight management program (MOVE!) designed to help patients achieve weight loss through changes in physical activity and diet. METHODS Prediabetes was defined by Hemoglobin A1c between 5.7 and 6.4% or Fasting Plasma Glucose 100-125 mg/dL and no use of antiglycemic medications during the past six months. Veterans Health Administrative data were used to assign Veterans into one of three mental health diagnoses: severe mental illness (SMI), affective disorder (AD) without SMI, or No SMI/No AD. The influence of mental health on weight changes at 6 and 12 months was modeled using linear mixed-effects regression. RESULTS On average, Veterans with prediabetes (n = 386) were 59 years old (SD = 10.0 years), with a BMI of 34.8 kg/m2 (SD = 5.3 kg/m2) and A1c of 6.0% (SD = 0.2%). The sample consisted of 12% (n = 47), 39% (n = 150), and 49% (n = 189) diagnosed with SMI, AD and No SMI/No AD, respectively. Across interventions, Veterans with SMI lost less weight than those with AD or No SMI/No AD. From baseline to 6 months, weight loss was significantly less for Veterans with SMI (1.53 kg) compared to Veterans with AD (3.85 kg) or No SMI/No AD (3.73 kg). This weight loss trend by mental health diagnosis continued from baseline to 12 months but was no longer statistically significant at 12 months. CONCLUSION Weight loss was not clinically or statistically different among Veterans with prediabetes diagnosed with AD or No SMI/No AD. However, Veterans diagnosed with SMI exhibited less weight loss over 6 months than Veterans with AD or No SMI/No AD and though not statistically significant, the trend continued to 12 months, suggesting that SMI may influence weight loss outcomes.
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Affiliation(s)
- Carol A Janney
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States; Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine - Midland Regional Campus 4611 Campus Ridge Drive, Midland, MI 48670, United States.
| | - Jared M Greenberg
- VA Greater Los Angeles Health Care System and David Geffen School of Medicine at UCLA, United States
| | - Tannaz Moin
- VA Greater Los Angeles Health Care System and David Geffen School of Medicine at UCLA, United States
| | - Hyungjin Myra Kim
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States; Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, United States
| | - Robert G Holleman
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Maria Hughes
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Laura J Damschroder
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Caroline R Richardson
- Department of Family Medicine, University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - Alexander S Young
- VA Greater Los Angeles Health Care System and David Geffen School of Medicine at UCLA, United States
| | - Nanette Steinle
- University of Maryland Baltimore, School of Medicine and the Maryland VA Health Care System, United States
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24
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Cocoman AM, Casey M. The Physical Health of Individuals Receiving Antipsychotic Medication: A Qualitative Inquiry on Experiences and Needs. Issues Ment Health Nurs 2018; 39:282-289. [PMID: 29333898 DOI: 10.1080/01612840.2017.1386744] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Individuals with a mental illness are reported to have a reduced life expectancy and a greater risk of being affected by preventable physical illnesses such as cardiovascular disease and Type 2 diabetes. This inquiry sought to identify the physical health beliefs, experiences and needs of individuals with mental health problems in receipt of antipsychotic medication who live in the community. A qualitative inquiry was undertaken using three focus groups in a community mental health service in Ireland with 21 participants with mental health problems who were treated with antipsychotic medication. The participants were clear about the importance of good physical health as well as good mental health. They disliked the adverse effects of antipsychotic medication and experienced many barriers in accessing general practitioners/primary care services. They also preferred to receive health advice and self-management advice from the mental health services. The participants in this study were aware of the need to engage in health protective behaviours but were often overwhelmed by their comorbid health issues and the organizational and communication barriers in accessing their general practitioners.
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Affiliation(s)
- Angela M Cocoman
- a School of Nursing and Human Sciences, Faculty of Science and Health , Dublin City University , Dublin 9, Dublin , Ireland
| | - Mary Casey
- b School of Nursing, Midwifery and Health Systems, College of Health and Agricultural Sciences , University College Dublin , Dublin , Ireland
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25
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Black DR. Preparing the workforce for integrated healthcare: A systematic review. SOCIAL WORK IN HEALTH CARE 2017; 56:914-942. [PMID: 28862917 DOI: 10.1080/00981389.2017.1371098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Integrated healthcare is recommended to deliver care to individuals with co-occurring medical and mental health conditions. This literature review was conducted to identify the knowledge and skills required for behavioral health consultants in integrated settings. A review from 1999 to 2015 identified 68 articles. Eligible studies examined care to the U.S. adult population at the highest level of integration. The results provide evidence of specific knowledge of medical and mental health diagnoses, screening instruments, and intervention skills in integrated primary care, specialty medical, and specialty mental health. Further research is required to identify methods to develop knowledge/skills in the workforce.
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Affiliation(s)
- Denise R Black
- a College of Social Work , University of Tennessee , Knoxville , TN , USA
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26
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Wynaden D, Heslop B, Heslop K, Barr L, Lim E, Chee GL, Porter J, Murdock J. The chasm of care: Where does the mental health nursing responsibility lie for the physical health care of people with severe mental illness? Int J Ment Health Nurs 2016; 25:516-525. [PMID: 27416949 DOI: 10.1111/inm.12242] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/17/2016] [Accepted: 04/18/2016] [Indexed: 12/20/2022]
Abstract
The poor physical health of people with a severe mental illness is well documented and health professionals' attitudes, knowledge and skills are identified factors that impact on clients' access to care for their physical health needs. An evaluation was conducted to determine: (i) mental health nurses' attitudes and beliefs about providing physical health care; and, (ii) the effect that participant demographics may have on attitudes to providing physical health care. It was hypothesized that workplace culture would have the largest effect on attitudes. Nurses at three health services completed the "Mental health nurses' attitude towards the physical health care of people with severe and enduring mental illness survey" developed by Robson and Haddad (2012). The 28-item survey measured: nurses' attitudes, confidence, identified barriers to providing care and attitudes towards clients smoking cigarettes. The findings demonstrated that workplace culture did influence the level of physical health care provided to clients. However, at the individual level, nurses remain divided and uncertain where their responsibilities lie. Nursing leadership can have a significant impact on improving clients' physical health outcomes. Education is required to raise awareness of the need to reduce cigarette smoking in this client population.
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Affiliation(s)
- Dianne Wynaden
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Brett Heslop
- Rockingham/ Peel Mental Health Service, Rockingham, Western Australia, Australia
| | - Karen Heslop
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Lesley Barr
- State Forensic Mental Health Service, Brockway, Western Australia, Australia
| | - Eric Lim
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Gin-Liang Chee
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - James Porter
- Rockingham/ Peel Mental Health Service, Rockingham, Western Australia, Australia
| | - Jane Murdock
- Fremantle Mental Health Services, Fremantle, Western Australia, Australia
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27
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Aschbrenner KA, Naslund JA, Bartels SJ. A mixed methods study of peer-to-peer support in a group-based lifestyle intervention for adults with serious mental illness. Psychiatr Rehabil J 2016; 39:328-334. [PMID: 27560454 PMCID: PMC5125856 DOI: 10.1037/prj0000219] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE There is potential for peer support to enhance healthy lifestyle interventions targeting changes in body weight and fitness for adults with serious mental illness. The purpose of this study was to explore peer-to-peer support among individuals participating in a group lifestyle intervention that included social media to enhance in-person weight management sessions. METHOD A mixed methods study design was used to explore participants' perceptions and experiences of support from other group members during a 6-month group lifestyle intervention. Twenty-five individuals with serious mental illness reported their perceptions of the peer group environment and social support during the intervention. Seventeen of these individuals also participated in focus group interviews further exploring their experiences with group members. RESULTS More than 80% of participants agreed that other group members were trustworthy and dependable, and 92% reported a high level of shared purpose and active participation in the group. Participants described how shared learning and group problem-solving activities fostered friendships and provided essential support for health behavior change. Sharing information, personal successes and challenges, and "being in the same boat" as other group members were key features of peer-to-peer support. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Findings from this exploratory study suggest that participants enrolled in a group-based lifestyle intervention for people with serious mental illness experience peer-to-peer support in various ways that promote health behavior change. These findings highlight opportunities to enhance future lifestyle interventions with collaborative learning and social network technologies that foster peer support among participants. (PsycINFO Database Record
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Affiliation(s)
| | - John A Naslund
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College
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Diabetes and Cardiovascular Care Among People with Severe Mental Illness: A Literature Review. J Gen Intern Med 2016; 31:1083-91. [PMID: 27149967 PMCID: PMC4978675 DOI: 10.1007/s11606-016-3712-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 03/17/2016] [Accepted: 04/05/2016] [Indexed: 01/20/2023]
Abstract
Close to 19 million US adults have severe mental illnesses (SMI), and they die, on average, 25 years earlier than the general population, most often from cardiovascular disease (CVD). Many of the antipsychotic medications used to treat SMI contribute to CVD risk by increasing risk for obesity, type 2 diabetes, dyslipidemia, and hypertension. Based on compelling evidence, the American Diabetes Association and the American Psychiatric Association developed guidelines for metabolic screening and monitoring during use of these medications.In this manuscript, we have reviewed the evidence on diabetes and other CVD risk screening, prevalence, and management among populations with SMI. We also review differences in screening among subpopulations with SMI (e.g., racial/ethnic minorities, women, and children). We found that despite national guidelines for screening for diabetes and other cardiovascular risk factors, up to 70 % of people taking antipsychotics remain unscreened and untreated. Based on estimates that 20 % of the 19 million US adults with SMI have diabetes and 70 % of them are not screened; it is likely that over 2 million Americans with SMI have unidentified diabetes. Given that undiagnosed diabetes costs over $4,000 per person, this failure to identify diabetes among people with SMI represents a missed opportunity to prevent morbidity and translates to over $8 billion in annual preventable costs to our healthcare system.Given the high burden of disease and significant evidence of suboptimal medical care received by people with SMI, we propose several clinical and policy recommendations to improve diabetes and other CVD risk screening and care for this highly vulnerable population. These recommendations include reducing antipsychotic medication dose or switching antipsychotic medications, enhancing smoking cessation efforts, sharing electronic health records between physical and mental health care systems, and promoting integration of care.
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Tang VK, Pato MT, Sobell JL, Hammond TC, Valdez MM, Lane CJ, Pato CN. Substance use associated with short sleep duration in patients with schizophrenia or schizoaffective disorder. Am J Med Genet B Neuropsychiatr Genet 2016; 171:525-33. [PMID: 26345478 DOI: 10.1002/ajmg.b.32374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/18/2015] [Indexed: 11/05/2022]
Abstract
STUDY OBJECTIVES To examine the association between substance use and short sleep duration in individuals with schizophrenia or schizoaffective disorder, depressive type (SADD). DESIGN Cross-sectional, retrospective study. SETTING Urban, suburban, and rural centers across the United States. PARTICIPANTS 2,462 consented, adult individuals with schizophrenia or schizoaffective disorder, depressive type (SADD). Participants included inpatients in acute or chronic care settings as well as outpatients and residents in community dwellings. MEASUREMENTS Substance use was assessed with 10 questions adopted from well-validated measures (e.g., CAGE questionnaire) for alcohol, marijuana, and illicit drugs. Short sleep duration was defined as <6 hr of self-reported sleep per night. RESULTS Close to 100% of our sample used nicotine while 83% used substances other than nicotine. More importantly, there was a significant association between substance use and short sleep duration. Interestingly, this association was strongest among African-Americans with schizophrenia or SADD. CONCLUSIONS Because psychiatric medications often target chemical receptors involved with both sleep and substance use, understanding the association between short sleep duration and substance use in individuals with schizophrenia and SADD is important. Given that the majority of premature deaths in individuals with psychotic illness are due to medical conditions associated with modifiable risk factors, prospective studies designed to examine the effect of short sleep duration on behaviors like substance use should be undertaken. Finally, analyzing genetic and environmental data in a future study might help illuminate the strong association found between short sleep duration and substance use in African-Americans with schizophrenia and SADD. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Vivian K Tang
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, Los Angeles, California
| | - Michele T Pato
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, Los Angeles, California
| | - Janet L Sobell
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, Los Angeles, California
| | - Terese C Hammond
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, Los Angeles, California
| | - Mark M Valdez
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, Los Angeles, California
| | - Christianne J Lane
- Department of Preventive Medicine, Keck School of Medicine, Los Angeles, California
| | | | - Carlos N Pato
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, Los Angeles, California
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Lui K, Randhawa G, Totten V, Smith AE, Raese J. Is Metabolic Syndrome On the Radar? Improving Real-Time Detection of Metabolic Syndrome and Physician Response by Computerized Scan of the Electronic Medical Record. Prim Care Companion CNS Disord 2016; 18:15m01849. [PMID: 27247842 DOI: 10.4088/pcc.15m01849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 11/19/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Metabolic syndrome is a common underdiagnosed condition among psychiatric patients exacerbated by second-generation antipsychotics, with the exception of aripiprazole and ziprasidone. This study evaluated the prescribing and treating behavior with regard to antipsychotics and metabolic syndrome of psychiatrists before and after implementation of a mandatory admission order set and electronic notification of results. METHOD Baseline data from 9,100 consecutive psychiatric admissions to a mental health hospital (July 2013-July 2014) were compared to postintervention data (July 2014-January 2015), which included 1,499 consecutive patient records. The intervention initiated standardized admission testing with electronic notification to psychiatrists when patients met metabolic syndrome criteria (according to Axis III of the DSM-IV). Charts were examined for inclusion of this diagnosis at discharge and for treatment changes. RESULTS At baseline, only 2.4% of patients (n = 214) were evaluated for metabolic syndrome. Of these, 34.5% (0.8% of the total sample) met metabolic syndrome criteria. Only 15 patients (0.16%) were comprehensively treated. No chart listed metabolic syndrome under Axis III of the DSM-IV. After the intervention, the diagnosis of patients meeting the criteria for metabolic syndrome increased from 0% to 29.3%. Less than 3% of patients were switched to drugs with a more benign metabolic profile. All patients who continued on second-generation antipsychotics had metabolic retesting. Thirty-eight experienced a significant and rapid increase in triglyceride levels after only 3 to 17 days. CONCLUSIONS Mandatory intake testing increases the number of patients evaluated for metabolic syndrome. Electronic alerts increase the inclusion of metabolic syndrome among discharge diagnoses but rarely affect prescribing practices.
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Affiliation(s)
| | | | | | - Adam E Smith
- Statistical and Research Consultant, Kaweah Delta Health Care District, Visalia, California
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Is bipolar disorder associated with accelerating aging? A meta-analysis of telomere length studies. J Affect Disord 2015; 186:241-8. [PMID: 26253905 DOI: 10.1016/j.jad.2015.06.034] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 06/18/2015] [Accepted: 06/20/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Bipolar disorder (BD) is associated with a reduced life expectancy compared to the general population mainly due to a high prevalence of comorbid somatic illnesses. A model of accelerated aging has been proposed as a potential explanation to these epidemiological findings. Nevertheless, studies measuring telomere length (TL) in patients with BD compared to healthy controls have provided mixed results. OBJECTIVE To compare TL between BD patients and healthy controls, and to search for potential modeP<rators for observed differences. METHODS We performed a systematic review and meta-analysis of original studies comparing TL in patients with BD vs. healthy controls published up to February 24th, 2015 in main electronic databases. Heterogeneity was explored through meta-regression and subgroup analysis. RESULTS Seven studies met inclusion criteria (N=1115). There was no difference in TL between participants with BD and healthy controls (Hedges's g=-0.012; 95% CI=-0.418 to 0.393, P=0.952). There was no evidence for publication bias. Heterogeneity was high (I(2)=89.65%). In meta-regression analyses, the percentage of females in healthy control samples (P=0.04) and the methodological quality of included studies (P<0.001) emerged as significant moderators, while subgroup analyses suggest that the type of assay employed to measure TL and age- and gender-matching of BD and HC participants may contribute to heterogeneity. CONCLUSIONS Telomere length does not differ between participants with BD vs. healthy controls; this finding does not support the view of BD as an illness associated with accelerated cellular aging. However, more studies controlling for potential confounders are necessary.
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Abstract
The objective of this analysis was to evaluate the effect of 12 months of treatment with lurasidone on weight in patients with schizophrenia. Post-hoc, observed-case analysis included pooled data from six studies on 40-160 mg/day lurasidone; two studies included active comparators (2-6 mg/day risperidone or 200-800 mg/day quetiapine XR). Overall, 593 patients completed 12 months of treatment (N=471 lurasidone, N = 89 risperidone, N = 33 quetiapine XR). The mean baseline weight was 72.8, 80.8, and 72.4 kg in the lurasidone, risperidone, and quetiapine XR groups, respectively. The mean weight change at month 12 was -0.4 kg with lurasidone, +2.6 kg with risperidone, and +1.2 kg with quetiapine XR. Weight gain of at least 7% from study baseline was observed in 16.0, 25.8, and 15.2% of patients, and weight loss of at least 7% was seen in 18.5, 6.7, and 9.1% of patients treated with lurasidone, risperidone, and quetiapine XR, respectively. A shift from normal/underweight baseline BMI status to overweight/obese at month 12 occurred in 10.2, 27.6, and 15.0% of patients in the lurasidone, risperidone, and quetiapine XR groups, respectively. Conversely, 14.3, 1.7, and 7.7% of patients, respectively, shifted from overweight/obese to normal/underweight. In summary, a low potential for clinically significant weight gain was observed in patients with schizophrenia treated continuously with lurasidone for 12 months.
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Bartoli F, Crocamo C, Caslini M, Clerici M, Carrà G. Schizoaffective disorder and metabolic syndrome: A meta-analytic comparison with schizophrenia and other non-affective psychoses. J Psychiatr Res 2015; 66-67:127-34. [PMID: 26004300 DOI: 10.1016/j.jpsychires.2015.04.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/16/2015] [Accepted: 04/30/2015] [Indexed: 12/20/2022]
Abstract
People with psychotic disorders, including schizophrenia (SCZ), schizoaffective disorder (SD), or other non-affective psychoses (ONAP), have a higher risk of metabolic syndrome (MetS) than general population. However, previous meta-analyses failed to explore if people with SD are more likely to suffer from MetS than SCZ and ONAP. We carried out a systematic review and meta-analysis comparing rates of MetS in SD with those in SCZ or ONAP. We searched main electronic databases for relevant articles published up to January 2015, and for unpublished data, contacting corresponding authors, to minimize selective reporting bias. Odds ratios (ORs) based on random effects models, with 95% confidence intervals (CIs), and heterogeneity (I(2)), were estimated. We performed leave-one-out, quality-based, and subgroups analyses to check findings validity. Testing for publication bias, Egger's test estimates were reported. We included 7616 individuals (1632 with SD and 5984 with SCZ/ONAP) from 30 independent samples. SD, as compared with SCZ/ONAP, had a random-effect pooled OR (95%CI) for MetS of 1.41 (1.23-1.61; p < 0.001; I(2) = 5%). No risk of publication bias was found (p = 0.85). Leave-one-out, sensitivity, and subgroups analyses confirmed the association. To our knowledge, this is the first meta-analysis comparing MetS comorbidity between individuals with SD and those with SCZ or ONAP. SD subjects are more likely to suffer from MetS, with consistent findings across the studies included. However, the role of explanatory factors of this association, and the relative contribution of MetS subcomponents, deserve further research.
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Affiliation(s)
- Francesco Bartoli
- Department of Surgery and Translational Medicine, University of Milano Bicocca, Via Cadore 48, 20900, Monza, MB, Italy.
| | - Cristina Crocamo
- Department of Surgery and Translational Medicine, University of Milano Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Manuela Caslini
- Department of Surgery and Translational Medicine, University of Milano Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Massimo Clerici
- Department of Surgery and Translational Medicine, University of Milano Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Giuseppe Carrà
- Division of Psychiatry, Faculty of Brain Sciences, University College London, Charles Bell House, 67-73 Riding House Street, London, W1W7EJ, UK
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Janssen EM, McGinty EE, Azrin ST, Juliano-Bult D, Daumit GL. Review of the evidence: prevalence of medical conditions in the United States population with serious mental illness. Gen Hosp Psychiatry 2015; 37:199-222. [PMID: 25881768 PMCID: PMC4663043 DOI: 10.1016/j.genhosppsych.2015.03.004] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 02/25/2015] [Accepted: 03/05/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Persons with serious mental illness (SMI) have high rates of premature mortality from preventable medical conditions, but this group is underrepresented in epidemiologic surveys and we lack national estimates of the prevalence of conditions such as obesity and diabetes in this group. We performed a comprehensive review to synthesize estimates of the prevalence of 15 medical conditions among the population with SMI. METHOD We reviewed studies published in the peer-reviewed literature from January 2000 to August 2012. Studies were included if they assessed prevalence in a sample of 100 or more United States (US) adults with schizophrenia or bipolar disorder. RESULTS A total of 57 studies were included in the review. For most medical conditions, the prevalence estimates varied considerably. For example, estimates of obesity prevalence ranged from 26% to 55%. This variation appeared to be due to differences in measurement (e.g., self-report versus clinical measures) and underlying differences in study populations. Few studies assessed prevalence in representative, community samples of persons with SMI. CONCLUSIONS In many studies, the prevalence of medical conditions among the population with SMI was higher than among the overall US population. Screening for and monitoring of these conditions should be common practice in clinical settings serving persons with SMI.
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Affiliation(s)
- Ellen M Janssen
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA.
| | - Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Room 359, Baltimore, MD 21205, USA.
| | - Susan T Azrin
- National Institute of Mental Health, 6001 Executive Boulevard, Room 7145 MSC 9631, Rockville, MD 20852, USA.
| | - Denise Juliano-Bult
- National Institute of Mental Health, 6001 Executive Boulevard, Room 7144 MSC 9631, Rockville, MD 20852, USA.
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, 2024 East Monument Street, Suite 2-620, Baltimore, MD 21205, USA.
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Chwastiak LA, Freudenreich O, Tek C, McKibbin C, Han J, McCarron R, Wisse B. Clinical management of comorbid diabetes and psychotic disorders. Lancet Psychiatry 2015; 2:465-476. [PMID: 26360289 DOI: 10.1016/s2215-0366(15)00105-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 03/06/2015] [Accepted: 03/09/2015] [Indexed: 12/17/2022]
Abstract
Individuals with psychotic disorders experience substantial health disparities with respect to diabetes, including increased risk of incident diabetes and of poor diabetes outcomes (eg, diabetes complications and mortality). Low-quality medical care for diabetes is a significant contributor to these poor health outcomes. A thoughtful approach to both diabetes pharmacotherapy and drug management for psychotic disorders is essential, irrespective of whether treatment is given by a psychiatrist, a primary care provider, or an endocrinologist. Exposure to drugs with high metabolic liability should be minimised, and both psychiatric providers and medical providers need to monitor patients to ensure that medical care for diabetes is adequate. Promising models of care management and team approaches to coordination and integration of care highlight the crucial need for communication and cooperation among medical and psychiatric providers to improve outcomes in these patients. Evidence-based programmes that promote weight loss or smoking cessation need to be more accessible for these patients, and should be available in all the settings where they access care.
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Affiliation(s)
- Lydia A Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
| | - Oliver Freudenreich
- Department of Psychiatry, Massachusetts General Hospital, Harvard University School of Medicine, Boston, MA, USA
| | - Cenk Tek
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | | | - Jaesu Han
- Department of Psychiatry, University of California, Davis, Sacramento, CA, USA; Department of Family and Community Medicine, University of California, Davis, Sacramento, CA, USA
| | - Robert McCarron
- Department of Psychiatry, University of California, Davis, Sacramento, CA, USA; Department of Family and Community Medicine, University of California, Davis, Sacramento, CA, USA
| | - Brent Wisse
- Department of Medicine, Division of Endocrinology, University of Washington School of Medicine, Seattle, WA, USA
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Health risks and changes in self-efficacy following community health screening of adults with serious mental illnesses. PLoS One 2015; 10:e0123552. [PMID: 25875181 PMCID: PMC4395322 DOI: 10.1371/journal.pone.0123552] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 03/04/2015] [Indexed: 12/21/2022] Open
Abstract
Physical health screenings were conducted by researchers and peer wellness specialists for adults attending publicly-funded community mental health programs. A total of 457 adults with serious mental illnesses attended health fairs in 4 U.S. states and were screened for 8 common medical co-morbidities and health risk factors. Also assessed were self-reported health competencies, medical conditions, and health service utilization. Compared to non-institutionalized U.S. adults, markedly higher proportions screened positive for obesity (60%), hypertension (32%), diabetes (14%), smoking (44%), nicotine dependence (62%), alcohol abuse (17%), drug abuse (11%), and coronary heart disease (10%). A lower proportion screened positive for hyperlipidemia (7%). Multivariable random regression analysis found significant pre- to post-screening increases in participants’ self-rated abilities for health practices, competence for health maintenance, and health locus of control. Screening identified 82 instances of undiagnosed diabetes, hypertension or hyperlipidemia, and 76 instances where these disorders were treated but uncontrolled. These results are discussed in the context of how this global public health approach holds promise for furthering the goal of integrating health and mental health care.
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Swarbrick M, Rockson L, Pratt C, Yudof J, Nemec P. Perceptions of Overall Health and Recency of Screenings. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2015. [DOI: 10.1080/15487768.2015.1001703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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De Hert M, Eramo A, Landsberg W, Kostic D, Tsai LF, Baker RA. Efficacy and safety of aripiprazole once-monthly in obese and nonobese patients with schizophrenia: a post hoc analysis. Neuropsychiatr Dis Treat 2015; 11:1299-306. [PMID: 26064048 PMCID: PMC4455850 DOI: 10.2147/ndt.s80479] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To assess the efficacy and safety of aripiprazole once-monthly 400 mg (AOM 400), an extended-release injectable suspension of aripiprazole, in obese and nonobese patients. PATIENTS AND METHODS This post hoc analysis of a 38-week randomized, double-blind, active-controlled, noninferiority study (NCT00706654) compared the clinical profile of AOM 400 in obese (body mass index [BMI] ≥30 kg/m(2)) and nonobese (BMI <30 kg/m(2)) patients with schizophrenia for ≥3 years. Patients were randomized 2:2:1 to AOM 400, oral aripiprazole 10-30 mg/d, or aripiprazole once-monthly 50 mg (AOM 50 mg) (subtherapeutic dose). Within obese and nonobese patient subgroups, treatment-group differences in Kaplan-Meier estimated relapse rates at week 26 (z-test) and in observed rates of impending relapse through week 38 (chi-square test) were analyzed. Treatment-emergent adverse events (TEAEs) (>10% in any treatment group) were summarized. RESULTS At baseline of the randomized phase, obesity rates were similar among patients randomized to AOM 400 (n=95/265, 36%), oral aripiprazole (n=95/266, 36%), and AOM 50 mg (n=43/131, 33%). In both obese and nonobese patients, relapse rates through week 38 for patients randomized to AOM 400 (obese, 7.4%; nonobese, 8.8%) were similar to those in patients on oral aripiprazole (obese, 8.4%; nonobese, 7.6%), whereas relapse rates were significantly lower with AOM 400 versus AOM 50 mg (obese, 27.9% [P=0.0012]; nonobese, 19.3% [P=0.0153]). The most common TEAEs with AOM 400 in obese and nonobese patients were insomnia (12.6% and 11.2%), headache (12.6% and 8.2%), injection site pain (11.6% and 5.3%), akathisia (10.5% and 10.6%), upper respiratory tract infection (10.5% and 4.7%), weight increase (10.5% and 8.2%), and weight decrease (6.3% and 11.8%). Within the AOM 400 group, 7.6% of patients who were nonobese at baseline became obese, and 17.9% of obese patients became nonobese during randomized treatment. CONCLUSION The clinical profile of AOM 400 was similar in obese and nonobese patients.
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Affiliation(s)
| | | | | | - Dusan Kostic
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
| | - Lan-Feng Tsai
- Otsuka Pharmaceutical Development & Commercialization, Inc., Rockville, MD, USA
| | - Ross A Baker
- Otsuka Pharmaceutical Development & Commercialization, Inc., Princeton, NJ, USA
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Littman AJ, Damschroder LJ, Verchinina L, Lai Z, Kim HM, Hoerster KD, Klingaman EA, Goldberg RW, Owen RR, Goodrich DE. National evaluation of obesity screening and treatment among veterans with and without mental health disorders. Gen Hosp Psychiatry 2015; 37:7-13. [PMID: 25500194 DOI: 10.1016/j.genhosppsych.2014.11.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 11/10/2014] [Accepted: 11/13/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective was to determine whether obesity screening and weight management program participation and outcomes are equitable for individuals with serious mental illness (SMI) and depressive disorder (DD) compared to those without SMI/DD in Veterans Health Administration (VHA), the largest integrated US health system, which requires obesity screening and offers weight management to all in need. METHODS We used chart-reviewed, clinical and administrative VHA data from fiscal years 2010-2012 to estimate obesity screening and participation in the VHA's weight management program (MOVE!) across groups. Six- and 12-month weight changes in MOVE! participants were estimated using linear mixed models adjusted for confounders. RESULTS Compared to individuals without SMI/DD, individuals with SMI or DD were less frequently screened for obesity (94%-94.7% vs. 95.7%) but had greater participation in MOVE! (10.1%-10.4% vs. 7.4%). MOVE! participants with SMI or DD lost approximately 1 lb less at 6 months. At 12 months, average weight loss for individuals with SMI or neither SMI/DD was comparable (-3.5 and -3.3 lb, respectively), but individuals with DD lost less weight (mean=-2.7 lb). CONCLUSIONS Disparities in obesity screening and treatment outcomes across mental health diagnosis groups were modest. However, participation in MOVE! was low for every group, which limits population impact.
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Affiliation(s)
- Alyson J Littman
- VA Puget Sound Healthcare System, Seattle Division Epidemiologic Research and Information Center (ERIC), Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA.
| | - Laura J Damschroder
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, USA.
| | - Lilia Verchinina
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, USA.
| | - Zongshan Lai
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, USA; Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109-2800, USA.
| | - Hyungjin Myra Kim
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, USA; Center for Statistical Consultation & Research, University of Michigan, Ann Arbor, MI.
| | - Katherine D Hoerster
- VA Puget Sound Healthcare System, Seattle Division Mental Health Service; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
| | - Elizabeth A Klingaman
- VA Capitol Health Care Network Mental Illness Research, Education, and Clinical Center, Baltimore, MD; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD.
| | - Richard W Goldberg
- VA Capitol Health Care Network Mental Illness Research, Education, and Clinical Center, Baltimore, MD.
| | - Richard R Owen
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR; Department of Psychiatry, University of Arkansas for Medical Sciences College of Medicine, Little Rock, AR.
| | - David E Goodrich
- Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, 48105, USA; Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109-2800, USA.
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Managing the side effects associated with commonly used treatments for bipolar depression. J Affect Disord 2014; 169 Suppl 1:S34-44. [PMID: 25533913 DOI: 10.1016/s0165-0327(14)70007-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 08/08/2014] [Accepted: 09/03/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND The most commonly used pharmacologic therapies for bipolar depression are mood stabilizers, atypical antipsychotics, and antidepressants. This paper reviews common side effects associated with these medications and provides recommendations for managing adverse medication effects in clinical practice. METHODS Narrative review based on literature searches of Medline and evidence-based treatment guidelines for agents that have been approved by the US Food and Drug Administration and/or are commonly used to treat bipolar depression. RESULTS Side effects of bipolar depression pharmacotherapies are common and vary by medication, with weight gain, metabolic dysregulation, sedation/somnolence, and akathisia among those observed most frequently. These adverse events (weight gain and sedation/somnolence, in particular) negatively affect treatment adherence in patients with bipolar disorder. Furthermore, endocrine and metabolic comorbidities, weight gain, and obesity may reduce the likelihood of positive clinical responses to pharmacologic therapies. Clinicians may consider switching patients to bipolar depression medication(s) with a lower propensity for sedation or adverse metabolic effects. Lifestyle modification (e.g., dietary changes, exercise) is an important component in the treatment of weight gain/obesity, dyslipidemia, hypertension, and hyperglycemia; in addition, a wide range of medications are available as therapeutic options for patients in whom non-pharmacologic management strategies are insufficient. The use of adjunctive medication may also reduce treatment-related sedation and somnolence. LIMITATIONS The selection of relevant studies from the literature search relied primarily on the author's expertise in the area of bipolar depression and knowledge of the issues addressed. CONCLUSION Successful treatment of bipolar depression extends beyond managing mood symptoms to also monitoring adverse medication events and managing associated medical disorders.
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Chwastiak L, Vanderlip E, Katon W. Treating complexity: collaborative care for multiple chronic conditions. Int Rev Psychiatry 2014; 26:638-47. [PMID: 25553781 DOI: 10.3109/09540261.2014.969689] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Individuals with co-morbid chronic medical illness and psychiatric illness are a costly and complex patient population, at high risk for poor outcomes. Health-risk behaviours (e.g. smoking, poor diet, and sedentary lifestyle), side effects from psychiatric medications, and poor quality medical care all contribute to poor outcomes. Individuals with major depression die, on average, 5 to 10 years before their age-matched counterparts. For individuals with severe mental illness such as bipolar disorder or schizophrenia, life expectancy may be up to 20 years shorter. As the majority of this premature mortality is due to cardiovascular disease, there is a critical need to engage these individuals around the care of chronic medical illness.
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Affiliation(s)
- Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine , Seattle, Washington , USA
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Vassas TJ, Burghardt KJ, Ellingrod VL. Pharmacogenomics of sterol synthesis and statin use in schizophrenia subjects treated with antipsychotics. Pharmacogenomics 2014; 15:61-7. [PMID: 24329191 DOI: 10.2217/pgs.13.157] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Patients with schizophrenia treated with antipsychotics often develop metabolic side effects including dyslipidemia. Antipsychotics potentially upregulate gene expression of a lipid metabolism pathway protein called SREBP via SREB transcription factors (SREBFs). Genetic variation within SREBF may contribute to dyslipidemias and lipid medication efficacy within schizophrenia. RESULTS A cross-sectional study of 157 patients were genotyped for SREBF1 (rs11868035) and SREBF2 (rs1057217) variants, and assessed for fasting lipids. The cohort's mean age was 46.6 years, was 64% male and 86% were using atypical antipsychotics. When stratified by statin use, those receiving a statin and carrying the SREBF1 T allele exhibited higher total cholesterol levels (p = 0.01), triglyceride levels (p = 0.04) and low-density lipoprotein levels (p = 0.03). A regression analysis controlling for gender differences in lipids showed that the SREBF1 T allele and statin interaction remained only for total cholesterol levels (F[4,149] = 5.8; p < 0.0001). CONCLUSION For schizophrenia individuals with the SREBF1 rs11868035 T allele, incomplete response to statin medications may be seen. Future investigations may allow for personalizing dyslipidemia treatment based on pharmacogenetics within schizophrenia.
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Affiliation(s)
- Thomas J Vassas
- Clinical & Translational Pharmacy, University of Michigan College of Pharmacy, 428 Church Street, Ann Arbor, MI 48109, USA
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Abstract
Audit has been defined as "a quality improvement process that seeks to improve patient care and outcome, through systematic review of care and comparison with explicit criteria, followed by the implementation of change". As of May 2011, under the Medical Practitioners Act 2007, doctors are legally obliged to join in professional competence schemes, following requirements set by the Medical Council. These include the obligation for doctors to conduct one clinical audit per year. In Ireland and elsewhere, audit provides an opportunity for services to create an "environment in which clinical care will flourish".
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Affiliation(s)
- Lydia Chwastiak
- Department of Psychiatry and Behavioral Sciences, University of Washington School of MedicineSeattle, WA, USA
| | - Cenk Tek
- Department of Psychiatry, Yale University School of MedicineNew Haven, CT, USA
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Bradshaw T, Mairs H. Obesity and Serious Mental Ill Health: A Critical Review of the Literature. Healthcare (Basel) 2014; 2:166-82. [PMID: 27429268 PMCID: PMC4934464 DOI: 10.3390/healthcare2020166] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Revised: 03/14/2014] [Accepted: 03/17/2014] [Indexed: 12/31/2022] Open
Abstract
Individuals who experience serious mental ill health such as schizophrenia are more likely to be overweight or obese than others in the general population. This high prevalence of obesity and other associated metabolic disturbances, such as type 2 diabetes and cardiovascular disease, contribute to a reduced life expectancy of up to 25 years. Several reasons have been proposed for high levels of obesity including a shared biological vulnerability between serious mental ill health and abnormal metabolic processes, potentially compounded by unhealthy lifestyles. However, emerging evidence suggests that the most significant cause of weight gain is the metabolic side effects of antipsychotic medication, usual treatment for people with serious mental ill health. In this paper we review the prevalence of obesity in people with serious mental ill health, explore the contribution that antipsychotic medication may make to weight gain and discuss the implications of this data for future research and the practice of mental health and other professionals.
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Affiliation(s)
- Tim Bradshaw
- Mental Health Nursing, School of Nursing, Midwifery and Social Work, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
| | - Hilary Mairs
- Mental Health Nursing, School of Nursing, Midwifery and Social Work, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
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High rates of obstructive sleep apnea symptoms among patients with schizophrenia. PSYCHOSOMATICS 2014; 56:59-66. [PMID: 25023923 DOI: 10.1016/j.psym.2014.02.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 02/23/2014] [Accepted: 02/24/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients with schizophrenia have high rates of obesity and cardiovascular morbidity, which are strongly associated with obstructive sleep apnea (OSA). The prevalence and risk factors for OSA are not well studied in patients with schizophrenia. OBJECTIVE The purpose of this study was to evaluate the frequency of OSA symptoms in a sample of outpatients with schizophrenia. METHODS This cross-sectional study was a secondary analysis of data generated from an insomnia study that evaluated 175 outpatients with schizophrenia or schizoaffective disorder in a single, large urban community mental health center. Results of scales evaluating insomnia were used to complete the STOP questionnaire, which is a screening tool for OSA validated in surgical populations. Appropriate statistical analysis was done to compare participants across groups. RESULTS Patients were classified into high risk for OSA (STOP ≥ 2) (57.7%), and low risk for OSA (STOP score < 2) (42.3%). We also identified patients with a known diagnosis of OSA (14.9%). Patients with diagnosed OSA had significantly higher STOP scores (mean 2.7 vs. 1.6 [t = 6.3; p < 0.001]). Only 23.8% of patients in the high-risk group were diagnosed with OSA. Body mass index was significantly higher in the diagnosed group (F[2,169] = 25; p < 0.001) as was diabetes (χ2 [2, N = 175] = 35, p < 0.001). CONCLUSION A large number of outpatients with severe mental illness are at high risk for OSA. The STOP questionnaire is easy to use and appears to have a very high clinical utility to detect OSA. Based on our findings, further studies are warranted to validate the tool in patients with severe mental illness.
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Vanderlip ER, Cerimele JM, Monroe-Devita M. A comparison of assertive community treatment fidelity measures and patient-centered medical home standards. Psychiatr Serv 2013; 64:1127-33. [PMID: 23820753 PMCID: PMC4001829 DOI: 10.1176/appi.ps.201200469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This study compared program measures of assertive community treatment (ACT) with standards of accreditation for the patient-centered medical home (PCMH) to determine whether there were similarities in the infrastructure of the two methods of service delivery and whether high-fidelity ACT teams would qualify for medical home accreditation. METHODS The authors compared National Committee for Quality Assurance PCMH standards with two ACT fidelity measures (the Dartmouth Assertive Community Treatment Scale and the Tool for Measurement of Assertive Community Treatment [TMACT]) and with national ACT program standards. RESULTS PCMH standards pertaining to enhanced access and continuity, management of care, and self-care support demonstrated strong overlap across ACT measures. Standards for identification and management of populations, care coordination and follow-up, and quality improvement demonstrated less overlap. The TMACT and the program standards had sufficient overlap to score in the range of a level 1 PCMH, but no ACT measure sufficiently detailed methods of population-based screening and tracking of referrals to satisfy "must-pass" elements of the standards. CONCLUSIONS ACT measures and medical home standards had significant overlap in innate infrastructure. ACT teams following the program standards or undergoing TMACT fidelity review could have the necessary infrastructure to serve as medical homes if they were properly equipped to supervise general medical care and administer activities to improve management of chronic diseases.
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Vancampfort D, Wampers M, Mitchell AJ, Correll CU, De Herdt A, Probst M, De Hert M. A meta-analysis of cardio-metabolic abnormalities in drug naïve, first-episode and multi-episode patients with schizophrenia versus general population controls. World Psychiatry 2013; 12:240-50. [PMID: 24096790 PMCID: PMC3799255 DOI: 10.1002/wps.20069] [Citation(s) in RCA: 187] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A meta-analysis was conducted to explore the risk for cardio-metabolic abnormalities in drug naïve, first-episode and multi-episode patients with schizophrenia and age- and gender- or cohort-matched general population controls. Our literature search generated 203 relevant studies, of which 136 were included. The final dataset comprised 185,606 unique patients with schizophrenia, and 28 studies provided data for age- and gender-matched or cohort-matched general population controls (n=3,898,739). We found that multi-episode patients with schizophrenia were at increased risk for abdominal obesity (OR=4.43; CI=2.52-7.82; p<0.001), hypertension (OR=1.36; CI=1.21-1.53; p<0.001), low high-density lipoprotein cholesterol (OR=2.35; CI=1.78-3.10; p<0.001), hypertriglyceridemia (OR=2.73; CI=1.95-3.83; p<0.001), metabolic syndrome (OR=2.35; CI=1.68-3.29; p<0.001), and diabetes (OR=1.99; CI=1.55-2.54; p<0.001), compared to controls. Multi-episode patients with schizophrenia were also at increased risk, compared to first-episode (p<0.001) and drug-naïve (p<0.001) patients, for the above abnormalities, with the exception of hypertension and diabetes. Our data provide further evidence supporting WPA recommendations on screening, follow-up, health education and lifestyle changes in people with schizophrenia.
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Affiliation(s)
- Davy Vancampfort
- University Psychiatric Centre KU Leuven, Campus Kortenberg, Leuvensesteenweg 517, 3070 Kortenberg, Belgium; KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
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Detection of metabolic syndrome in schizophrenia and implications for antipsychotic therapy : is there a role for folate? Mol Diagn Ther 2013; 17:21-30. [PMID: 23341251 DOI: 10.1007/s40291-013-0017-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In general, the presence of metabolic syndrome is associated with significant cardiovascular mortality and represents a growing public health concern in the USA. Patients with schizophrenia have a three times greater risk of death than the general population, with cardiovascular disease being the most common cause of this mortality. Use of atypical antipsychotics (AAPs) to treat schizophrenia contributes significantly to this cardiovascular risk. While several different clinical guidelines currently exist to monitor the metabolic consequences of AAP use, implementation is lacking. Because of under-monitoring of side effects and the lack of alternative treatment choices in schizophrenia, research has focused on identification of various biomarkers and pharmacogenomic targets to focus on the patients at greatest risk of metabolic syndrome, thus aiming to increase the efficacy and minimize the side effects of AAPs. This has led to several different lines of research. This review focuses on summarizing the differing metabolic syndrome criteria, monitoring guidelines for use of AAPs, and the role of folic acid as it relates to metabolic syndrome within the schizophrenia population. It concentrates not only on the pharmacogenomics of folic acid metabolism but also on its epigenetic interaction with the environment. From this work, genetic variation within both the methylenetetrahydrofolate reductase (MTHFR) gene and the catechol-O-methyltransferase (COMT) gene has been associated with an increased risk of metabolic syndrome in schizophrenia patients treated with AAPs. Furthermore, work on the combination of folate pharmacogenetics and epigenetics has uncovered relationships between methylation, schizophrenia disease, treatment type, and metabolic syndrome. Despite several areas of biomarker research into schizophrenia-related metabolic syndrome, translation into the clinical setting is still lacking, and further studies are needed to bridge this gap. In the future, folate supplementation may prove to be an easy and effective clinical tool for prevention and/or treatment of metabolic syndrome associated with AAP treatment, but clearly more research needs to be done in this area.
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Abstract
To review the data with respect to prevalence of metabolic syndrome (MetS) and its correlates in schizophrenia. For this review, electronic search engines PUBMED, Sciencedirect, and Google Scholar were used. Available data suggests that most of the studies have been of cross-sectional design. Prevalence rates of MetS have varied from 11% to 69% in medicated patients, and 4-26% in drug naive patients in cross-sectional evaluations. Longitudinal studies have shown the prevalence rates to range from 0% to 14% at the baseline in drug naive patients, which increase to as high as 52.4% by 3 months of antipsychotic medication treatment. The prevalence rates of MetS in patients with schizophrenia are much higher than that seen in general population or healthy controls. Though there is no causal association with any demographic or clinical variables, the risk increases with increase in age. Among antipsychotics, there seems to be an association between MetS and atypical antipsychotics like clozapine and olanzapine. Therefore, the psychiatrists should be more vigilant regarding the presence of MetS in these high risk groups. Research on biological correlates of MetS in schizophrenia is still in its primitive stage, however, these is some evidence to suggest an association of MetS with adiponectin levels, hematological indices, methylenetetrahydrofolate reductase (MTHFR) and Alpha-1A adrenergic receptor (ADRA1A) gene. These areas hold promise, and targeting these with appropriate interventions may help us to prevent the occurrence of MetS in patients with schizophrenia in future.
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Affiliation(s)
- Nidhi Malhotra
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parmanand Kulhara
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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