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Monk NJ, Cunningham R, Stanley J, Crengle S, Fitzjohn J, Kerdemelidis M, Lockett H, McLachlan AD, Waitoki W, Lacey C. The physical health and premature mortality of Indigenous Māori following first-episode psychosis diagnosis: A 15-year follow-up study. Aust N Z J Psychiatry 2024:48674241270981. [PMID: 39169471 DOI: 10.1177/00048674241270981] [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: 08/23/2024]
Abstract
BACKGROUND People experiencing psychosis are at greater risk of physical health conditions and premature mortality. It is likely that Indigenous Māori youth, who experience additional systemic inequities caused by settler-colonisation, face even greater physical health and mortality risks following a diagnosis of first-episode psychosis. OBJECTIVE Compare Māori and non-Māori for risk of hospitalisation and mortality for up to 15 years following first-episode psychosis diagnosis. METHODS A cohort (N = 14,122) of young people (16-24 years) with first-episode psychosis diagnosis between 2001 and 2019 were identified. Using crude Kaplan-Meier and adjusted Cox proportional hazards models, Māori (n = 5211) and non-Māori (n = 8911) were compared on hospitalisation and mortality outcomes for up to 15 years. RESULTS In the 15 years following first-episode psychosis diagnosis, Māori had higher adjusted risk of all-cause mortality (hazard ratio = 1.21, 95% confidence interval = [1.01, 1.45]), hospitalisation with diabetes (hazard ratio = 1.44, 95% confidence interval = [1.15, 1.79]), injury/poisoning (hazard ratio = 1.11, 95% confidence interval = [1.05, 1.16]), general physical health conditions (hazard ratio = 1.07, 95% confidence interval = [1.02, 1.13]) and also appeared to be at greater risk of cardiovascular hospitalisations (hazard ratio = 1.34, 95% confidence interval = [0.97, 1.86]). Kaplan-Meier plots show hospitalisation and mortality inequities emerging approximately 4-7 years following first-episode psychosis diagnosis. CONCLUSIONS Māori are at greater risk for hospitalisation and premature mortality outcomes following first-episode psychosis. Early screening and intervention, facilitated by culturally safe health service delivery, is needed to target these inequities early.
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Affiliation(s)
- Nathan J Monk
- Department of Māori/Indigenous Health Innovation, University of Otago, Christchurch, New Zealand
| | - Ruth Cunningham
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Sue Crengle
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Christchurch, New Zealand
| | - Julie Fitzjohn
- Specialist Mental Health Service, Te Whatu Ora - Waitaha Canterbury, Christchurch, New Zealand
| | - Melissa Kerdemelidis
- Population Health Gain, Service Improvement and Innovation, Te Whatu Ora - Waitaha Canterbury, Christchurch, New Zealand
| | - Helen Lockett
- Department of Public Health, University of Otago, Wellington, New Zealand
- Te Pou, Wellington, New Zealand
| | - Andre D McLachlan
- Centre for Health and Social Practice, Waikato Institute of Technology, Hamilton, New Zealand
| | - Waikaremoana Waitoki
- Faculty of Māori and Indigenous Studies, The University of Waikato, Hamilton, New Zealand
| | - Cameron Lacey
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Ori APS, Olde Loohuis LM, Guintivano J, Hannon E, Dempster E, St Clair D, Bass NJ, McQuillin A, Mill J, Sullivan PF, Kahn RS, Horvath S, Ophoff RA. Meta-analysis of epigenetic aging in schizophrenia reveals multifaceted relationships with age, sex, illness duration, and polygenic risk. Clin Epigenetics 2024; 16:53. [PMID: 38589929 PMCID: PMC11003125 DOI: 10.1186/s13148-024-01660-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/16/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND The study of biological age acceleration may help identify at-risk individuals and reduce the rising global burden of age-related diseases. Using DNA methylation (DNAm) clocks, we investigated biological aging in schizophrenia (SCZ), a mental illness that is associated with an increased prevalence of age-related disabilities and morbidities. In a whole blood DNAm sample of 1090 SCZ cases and 1206 controls across four European cohorts, we performed a meta-analysis of differential aging using three DNAm clocks (i.e., Hannum, Horvath, and Levine). To dissect how DNAm aging contributes to SCZ, we integrated information on duration of illness and SCZ polygenic risk, as well as stratified our analyses by chronological age and biological sex. RESULTS We found that blood-based DNAm aging is significantly altered in SCZ independent from duration of the illness since onset. We observed sex-specific and nonlinear age effects that differed between clocks and point to possible distinct age windows of altered aging in SCZ. Most notably, intrinsic cellular age (Horvath clock) is decelerated in SCZ cases in young adulthood, while phenotypic age (Levine clock) is accelerated in later adulthood compared to controls. Accelerated phenotypic aging was most pronounced in women with SCZ carrying a high polygenic burden with an age acceleration of + 3.82 years (CI 2.02-5.61, P = 1.1E-03). Phenotypic aging and SCZ polygenic risk contributed additively to the illness and together explained up to 14.38% of the variance in disease status. CONCLUSIONS Our study contributes to the growing body of evidence of altered DNAm aging in SCZ and points to intrinsic age deceleration in younger adulthood and phenotypic age acceleration in later adulthood in SCZ. Since increased phenotypic age is associated with increased risk of all-cause mortality, our findings indicate that specific and identifiable patient groups are at increased mortality risk as measured by the Levine clock. Our study did not find that DNAm aging could be explained by the duration of illness of patients, but we did observe age- and sex-specific effects that warrant further investigation. Finally, our results show that combining genetic and epigenetic predictors can improve predictions of disease outcomes and may help with disease management in schizophrenia.
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Affiliation(s)
- Anil P S Ori
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Gonda Center, Room 4357B, 695 Charles E. Young Drive South, Los Angeles, CA, 90095-176, USA.
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Loes M Olde Loohuis
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Gonda Center, Room 4357B, 695 Charles E. Young Drive South, Los Angeles, CA, 90095-176, USA
| | - Jerry Guintivano
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Eilis Hannon
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Emma Dempster
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - David St Clair
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - Nick J Bass
- Division of Psychiatry, University College London, London, UK
| | | | - Jonathan Mill
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Patrick F Sullivan
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Rene S Kahn
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York, NY, USA
| | - Steve Horvath
- Department of Biostatistics, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Roel A Ophoff
- Center for Neurobehavioral Genetics, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Gonda Center, Room 4357B, 695 Charles E. Young Drive South, Los Angeles, CA, 90095-176, USA.
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
- Department of Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Chung W, Jiang SF, Milham MP, Merikangas KR, Paksarian D. Inequalities in the Incidence of Psychotic Disorders Among Racial and Ethnic Groups. Am J Psychiatry 2023; 180:805-814. [PMID: 37789743 DOI: 10.1176/appi.ajp.20220917] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVE The authors examined recent trends in incidence of psychotic disorders, demographic characteristics, and comorbid psychiatric and medical conditions among six racial/ethnic groups. METHOD A retrospective cohort study design was used to examine the incidence of psychotic disorders across race/ethnicity groups and comorbid psychiatric and medical conditions among members of Kaiser Permanente Northern California from 2009 to 2019 (N=5,994,758). Poisson regression was used to assess changes in annual incidence, and Cox proportional hazards and logistic regression models adjusted for age and sex were used to test correlates and consequences. RESULTS Overall, the incidence of nonaffective psychotic disorders decreased slightly over the study period. Compared with White members, the risk of nonaffective psychosis diagnosis was higher among Black (hazard ratio=2.13, 95% CI=2.02-2.24) and American Indian or Alaskan Native (AIAN) (hazard ratio=1.85, 95% CI=1.53-2.23) members and lower among Asian (hazard ratio=0.72, 95% CI=0.68-0.76) and Hispanic (hazard ratio=0.91, 95% CI=0.87-0.96) members, as well as those whose race/ethnicity was categorized as "other" (hazard ratio=0.92, 95% CI=0.86-0.99). Compared with White members, the risk of affective psychosis diagnosis adjusted for age and sex was higher among Black (hazard ratio=1.76, 95% CI=1.62-1.91), Hispanic (hazard ratio=1.09, 95% CI=1.02-1.16), and AIAN (hazard ratio=1.38, 95% CI=1.00-1.90) members and lower among Asian (hazard ratio=0.77, 95% CI=0.71-0.83), Native Hawaiian or other Pacific Islander (hazard ratio=0.69, 95% CI=0.48-0.99), and "other" (hazard ratio=0.86, 95% CI=0.77-0.96) members. Psychotic disorders were associated with significantly higher odds of suicide (odds ratio=2.65, 95% CI=2.15-3.28), premature death (odds ratio=1.30, 95% CI=1.22-1.39), and stroke (odds ratio=1.64, 95% CI=1.55-1.72) and lower odds of health care utilization (odds ratio=0.44, 95% CI=0.42-0.47). CONCLUSIONS This study demonstrates racial and ethnic variation in incident psychotic disorder diagnoses in the United States, compared with non-Hispanic Whites. Individuals diagnosed with psychosis face a greater burden of other negative health outcomes and lower odds of health care utilization, reflecting personal and economic impacts. Identifying risk factors for elevated rates and protective influences in subgroups can inform strategies for prevention and interventions to ameliorate severe consequences of psychotic syndromes.
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Affiliation(s)
- Winston Chung
- Department of Psychiatry, Kaiser Permanente Northern California, San Francisco (Chung); Division of Research, Kaiser Permanente Northern California, Oakland (Jiang); Center for the Developing Brain, Child Mind Institute, New York (Milham); Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, N.Y. (Milham); Genetic Epidemiology Research Branch, NIMH, Bethesda, Md. (Merikangas, Paksarian)
| | - Sheng-Fang Jiang
- Department of Psychiatry, Kaiser Permanente Northern California, San Francisco (Chung); Division of Research, Kaiser Permanente Northern California, Oakland (Jiang); Center for the Developing Brain, Child Mind Institute, New York (Milham); Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, N.Y. (Milham); Genetic Epidemiology Research Branch, NIMH, Bethesda, Md. (Merikangas, Paksarian)
| | - Michael P Milham
- Department of Psychiatry, Kaiser Permanente Northern California, San Francisco (Chung); Division of Research, Kaiser Permanente Northern California, Oakland (Jiang); Center for the Developing Brain, Child Mind Institute, New York (Milham); Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, N.Y. (Milham); Genetic Epidemiology Research Branch, NIMH, Bethesda, Md. (Merikangas, Paksarian)
| | - Kathleen R Merikangas
- Department of Psychiatry, Kaiser Permanente Northern California, San Francisco (Chung); Division of Research, Kaiser Permanente Northern California, Oakland (Jiang); Center for the Developing Brain, Child Mind Institute, New York (Milham); Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, N.Y. (Milham); Genetic Epidemiology Research Branch, NIMH, Bethesda, Md. (Merikangas, Paksarian)
| | - Diana Paksarian
- Department of Psychiatry, Kaiser Permanente Northern California, San Francisco (Chung); Division of Research, Kaiser Permanente Northern California, Oakland (Jiang); Center for the Developing Brain, Child Mind Institute, New York (Milham); Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, N.Y. (Milham); Genetic Epidemiology Research Branch, NIMH, Bethesda, Md. (Merikangas, Paksarian)
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Abstract
Musculoskeletal pain treatments are widespread in the clinical practice of physiotherapists. A multifaceted biopsychosocial approach should guide modern pain therapy. The study aimed to investigate the association of musculoskeletal problems with lifestyle behaviors. The study adopted a qualitative literature review methodology. About 200 papers have been reviewed for this study. The categories of the study had been classified according to the factors that are interconnected to the life intervention. The inclusion criteria of the selected literature depend upon the data received. This is a review-based study. The results of cross-sectional and correlational analysis dominated the literature on lifestyle implications on musculoskeletal health, which included pain and its correlated inflammation. Long-term prospective studies, however, are difficult to enroll in due to ethical concerns about denying patients' therapies shown to benefit them, notably lifestyle behavior modification. By conducting intervention studies, it determines lifestyle modifications that determine the beneficial aspects. These aspects are avoiding and reducing pain by increasing exercise capacity. The study concluded that the quantity of beneficial health practices boosted the health-related quality of life. To achieve long-term health, the complexity of the behaviour change needs to be supported by the individual's lifestyle pattern and the support of the data. Therefore, in this century characterized by chronic lifestyle-related illnesses, various health behavior modifications may be claimed to be a primary therapeutic skill of health professionals (individually and collectively).
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Affiliation(s)
- H Ahmed
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, Najran University, Najran, Saudi Arabia
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5
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Luthra S, Duggan L, Agrawal A, Kaur G, Luthra N. Prevalence of High-dose Antipsychotic Prescribing in Schizophrenia: A Clinical Audit in a Regional Queensland Mental Health Service. Int J Appl Basic Med Res 2023; 13:70-76. [PMID: 37614838 PMCID: PMC10443448 DOI: 10.4103/ijabmr.ijabmr_504_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 02/19/2023] [Accepted: 04/19/2023] [Indexed: 08/25/2023] Open
Abstract
Background Antipsychotic medication is widely recognized as a critical intervention in both acute and ongoing treatments of schizophrenia. Guidelines endorse the routine practice of monotherapy with antipsychotic medication at the minimum effective dose. Despite the recommendations, high-dose antipsychotic prescribing and polytherapy appear to be common practice. Objective The objective of this study was to determine the prevalence of high-dose antipsychotic prescribing in adult patients with schizophrenia in a regional Queensland hospital and to know if the prescribing practices are in keeping with the international guidelines and with the local policy introduced in December 2017. Methods This was a cross-sectional survey/clinical audit of 358 adult patients with schizophrenia open to the service in both community and inpatient settings. The individual prescribing practices of psychiatrists were also examined. Results A minority (15%) were prescribed high doses (high-dose single agent and high dose by polytherapy) and 20% were prescribed polytherapy (including high dose and within normal dose range). Conclusion Eighty-five percent of the patients with the diagnosis of schizophrenia open to the service were prescribed antipsychotic within the dose range. In this respect, prescribing was aligned with current evidence-based guidelines.
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Affiliation(s)
- Shalini Luthra
- Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Lorna Duggan
- Mental Health Alcohol and Other Drugs Services, Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Aanchal Agrawal
- Central Queensland Hospital and Health Service, Rockhampton, Australia
| | - Gurpreeti Kaur
- Department of Anaesthesia, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Neeru Luthra
- Department of Anaesthesia, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Evaluation of a training program to support the implementation of a community pharmacist-led support service for people living with severe and persistent mental illness. J Am Pharm Assoc (2003) 2023; 63:807-816.e2. [PMID: 36788042 DOI: 10.1016/j.japh.2023.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND With appropriate training, community pharmacists can support people living with severe and persistent mental illness (SPMI) by identifying and managing medication-related issues and physical health concerns. The Bridging the Gap between Physical and Mental Illness in Community Pharmacy (PharMIbridge) randomized controlled trial (RCT) tested the impact of an individualized, pharmacist-led support service for people living with SPMI. OBJECTIVE(S) To evaluate the impact of the PharMIbridge training program on pharmacy participants' knowledge and confidence, as well as stigma and attitudes, in relation to supporting, and providing services to, people living with SPMI; compared to Mental Health First Aid (MHFA) training alone. METHODS Pharmacy staff (n = 140) from 55 community pharmacies across four RCT regions attended face-to-face training. Both intervention group (IG) and comparator group (CG) participants received MHFA training while IG participants received additional PharMIbridge training, involving role-plays and mental health consumer educators (MHCEs). A questionnaire including validated instruments was administered at baseline, after training and after 12 months. Comparative analyses included paired t tests and mixed between/within analysis of variance (ANOVA). RESULTS Pre and post-training surveys were completed by 136 participants, most of which were pharmacists. Both IG and CG participants had significant reductions in stigma (P < 0.001) post-training. IG participants' confidence and knowledge regarding metabolic monitoring significantly improved compared to CG (P < 0.001). IG participants were significantly more confident and comfortable in providing medication counseling, compared to CG participants (P < 0.05). CONCLUSION MHFA training reduced participants' stigma toward mental health. However, the purpose-designed PharMIbridge training program provided pharmacists with additional knowledge and skills to confidently support the physical health care needs of people living with SPMI. The inclusion of role-plays and MHCEs allowed pharmacists to self-reflect and practice skills in safe, supportive environments. Future studies should continue to involve MHCEs in pharmacy training and explore whether these improvements are sustainable.
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Maharaj SS, Nuhu JM. Effect of treadmill walking for anxiety, depression and social well-being in women with diabetes type 2: A randomized controlled trial. Health Care Women Int 2022; 44:734-752. [PMID: 35763045 DOI: 10.1080/07399332.2022.2090566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Anxiety and depression are higher in persons with diabetes leading to poor glycaemic control and diabetes-related emotional distress. Some diabetic women do not engage in exercises perceiving it to make their diabetes worse. The researchers' objective of this treadmill walking program was to determine its effect on anxiety, depression and social well-being in women with diabetes type 2 (DT2). We randomized 49 sedentary women with DT2 into treadmill walking at moderate intensity of 40-60% of their age-adjusted maximal heart rate, three times per week on alternate days for 12 weeks. The control attended electronic lectures on diet, diabetes and mental health. The treadmill group had no adverse effects and their anxiety, depression and social well-being scores improved with no significant changes for the control. We offer women with DT2 an easy, safe indoors exercise preventing them from abuse from men, erratic drivers and extreme weather conditions with positive physiological responses.
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Affiliation(s)
- Sonill S. Maharaj
- Department of Physiotherapy, University of KwaZulu-Natal, Durban, South Africa
| | - Jibril M. Nuhu
- UKZN and Faculty of Allied Health Sciences, Department of Physiotherapy, Bayero University, Kano, Nigeria
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Spann G, Austin L, King E. Pharmacists in clozapine clinics improving physical health monitoring. Ment Health Clin 2022; 12:193-198. [PMID: 35801163 PMCID: PMC9190272 DOI: 10.9740/mhc.2022.06.193] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
People living with schizophrenia have a higher rate of comorbid physical health diseases and compared with the general population die earlier due to these diseases. A pharmacist working in an outpatient mental health clinic setting could assist with the management of physical health disease for this population. The aim of this study was to investigate whether having a pharmacist in a community clozapine clinic would improve adherence to physical health monitoring and whether this would have a positive effect on these physical health outcomes.
Methods
This retrospective observational study compared patient data from 2 clozapine clinics; one where a pharmacist engaged in medication reviews and management of medication side effects, and another that did not have a pharmacist. The rates of physical health monitoring and the changes from baseline of physical health outcomes (weight, BMI, BP, HbA1c, and lipids) were compared after the first pharmacist intervention (medication review).
Results
The pharmacist clinic had statistically higher rates of metabolic and ECG monitoring (glucose 48% vs 11%, P < .001; lipids 61% vs 7.1%, P < .001; ECG 15% vs 0%, P = .001). Positive trends in weight were identified in the pharmacist-group, although this failed to reach statistical significance.
Discussion
This study shows that pharmacists providing regular medication reviews improves physical health monitoring for patients receiving clozapine.
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Affiliation(s)
| | - Lewis Austin
- 2 Intern Pharmacist, Princess Alexandra Hospital, Metro South Hospital and Health Service, QLD, Australia
| | - Edward King
- 3 Pharmacist, Caboolture Hospital, Metro North Hospital and Health Service, QLD, Australia
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Hitch D, Vernon L, Collins R, Dun C, Palexas S, Lhuede K. The Pathways to Participation (P2P) Program: A Pilot Outcomes Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6088. [PMID: 35627625 PMCID: PMC9141954 DOI: 10.3390/ijerph19106088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/27/2022] [Accepted: 05/08/2022] [Indexed: 11/17/2022]
Abstract
Research has consistently found that people with mental illness (known as consumers) experience lower levels of participation in meaningful activities, which can limit their opportunities for recovery support. The aim of this study was to describe the outcomes of participation in a group program designed to address all stages of activity participation, known as Pathways to Participation (P2P). A descriptive longitudinal design was utilized, collecting data at three time points. Outcomes were measured by the Camberwell Assessment of Need Short Appraisal (CANSAS), Recovery Assessment Scale-Domains and Stages (RAS-DS), Behavior and Symptom Identification Scale (BASIS-24), Living in the Community Questionnaire (LCQ), and time-use diaries. All data were analyzed using descriptive statistics and Chi-square analyses. A total of 17 consumers completed baseline data, 11 contributed post-program data, and 8 provided follow-up data. Most were female (63.64%) and had been living with mental illness for 11.50 (±7.74) years on average. Reductions in unmet needs and improvements in self-rated recovery scores were reported, but no changes were identified in either time use or psychosocial health. The findings indicate that the P2P program may enable consumers to achieve positive activity and participation outcomes as part of their personal recovery.
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Affiliation(s)
- Danielle Hitch
- Occupational Science and Therapy, School of Health and Social Development, Deakin University, Geelong 3217, Australia
- North Western Mental Health, Melbourne Health, Parkville 3052, Australia; (L.V.); (R.C.); (C.D.); (S.P.)
| | - Lindsay Vernon
- North Western Mental Health, Melbourne Health, Parkville 3052, Australia; (L.V.); (R.C.); (C.D.); (S.P.)
| | - Rachel Collins
- North Western Mental Health, Melbourne Health, Parkville 3052, Australia; (L.V.); (R.C.); (C.D.); (S.P.)
| | - Carolyn Dun
- North Western Mental Health, Melbourne Health, Parkville 3052, Australia; (L.V.); (R.C.); (C.D.); (S.P.)
| | - Sarah Palexas
- North Western Mental Health, Melbourne Health, Parkville 3052, Australia; (L.V.); (R.C.); (C.D.); (S.P.)
| | - Kate Lhuede
- North Western Mental Health, Melbourne Health, Parkville 3052, Australia; (L.V.); (R.C.); (C.D.); (S.P.)
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10
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Thomson S, Galletly C, Prener C, Garverich S, Liu D, Lincoln A. Associations between health literacy, cognitive function and general literacy in people with schizophrenia attending community mental health clinics in Australia. BMC Psychiatry 2022; 22:245. [PMID: 35392852 PMCID: PMC8986965 DOI: 10.1186/s12888-022-03901-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/24/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Health literacy (HL) has been defined as the ability of individuals to access, understand, and utilise basic health information. HL is crucial to patient engagement in treatment through supporting patient autonomy, informed consent and collaborative care. In people with physical disorders, poor HL is associated with poor health outcomes, but less is known about HL in people with severe mental illness. This study aimed to assess HL and investigate the associations between education, cognitive function, general literacy, and HL in participants with schizophrenia attending community mental health clinics. METHOD Fifty-two outpatients with schizophrenia attending a public community mental health clinic in Adelaide, Australia completed the Test of Functional Health Literacy in Adults-Short Form (S-TOFHLA) along with tests of cognition, aural and reading literacy and numeracy including Digit Symbol Coding (DSC), verbal fluency, the Wechsler Adult Intelligence Scale (WAIS-IV), Woodcock-Johnson III (Part 4 and 9) and the Lipkus numeracy scale. Sixty-one percent of participants were male. Participants had a mean age of 41.2 (SD 9.9) years and a mean of 11.02 (SD 1.5) years of education. RESULTS The majority of participants had very poor aural and verbal literacy and poorer literacy correlated with fewer years of education. On the S-TOFHLA, 81% of participants had adequate HL; 6% were marginal and 13% were inadequate. There was a positive correlation between education and HL, with those with more years of education scoring higher for HL. There was also a significant association between better HL and better working memory and attention. CONCLUSIONS Consistent with previous research in schizophrenia, our participants had reduced educational attainment, aural and reading literacy and cognitive function compared to population norms. However, HL was better than expected given that previous research has found that people with psychiatric disorders tend to have lower HL, compared to the general population. This may reflect effective case management of our participants whilst attending the community clinics and supports ongoing research and intervention regarding HL in people living with mental illness.
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Affiliation(s)
- Sumana Thomson
- Northern Adelaide Local Health Network, Adelaide, South, Australia. .,Adelaide Medical School, The University of Adelaide, Adelaide, South, Australia.
| | - Cherrie Galletly
- Northern Adelaide Local Health Network, Adelaide, South Australia ,grid.1010.00000 0004 1936 7304Adelaide Medical School, The University of Adelaide, Adelaide, South Australia ,Ramsay Health Care (SA) Mental Health Services, Adelaide, South Australia
| | - Christopher Prener
- grid.262962.b0000 0004 1936 9342 Department of Sociology and Anthropology, Saint Louis University, St. Louis, MO USA
| | - Suzanne Garverich
- grid.261112.70000 0001 2173 3359Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA USA
| | - Dennis Liu
- Northern Adelaide Local Health Network, Adelaide, South Australia ,grid.1010.00000 0004 1936 7304Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
| | - Alisa Lincoln
- grid.261112.70000 0001 2173 3359Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA USA
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11
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Castle DJ, Hopwood M, Rege S, George DB. Reducing metabolic syndrome in Australian patients: Metabolic Management During Antipsychotic Prescribing (MMAP) programme. Australas Psychiatry 2022; 30:84-89. [PMID: 33969715 DOI: 10.1177/10398562211010792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David J Castle
- Scientific Director, Centre for Complex Interventions, Centre for Addictions and Mental Health.,Professor, Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Malcolm Hopwood
- Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Sanil Rege
- Vita Health Care and Psych Scene, Mount Eliza, VIC, Australia
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12
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Abstract
OBJECTIVE While there is considerable current emphasis on youth and early psychosis, relatively little is known about the lives of people who live with psychotic disorders into middle age and beyond. We investigated social functioning, physical health status, substance use and psychiatric symptom profile in people with psychotic disorders aged between 50 and 65 years. METHODS Data were collected as part of the Survey of High Impact Psychosis, a population-based survey of Australians aged 18-65 years with a psychotic disorder. We compared those aged 50-65 years (N = 347) with those aged 18-49 years (N = 1478) across a range of measures. RESULTS The older group contained more women and more people with affective psychoses compared to the younger group. They were also more likely to have had a later onset and a chronic course of illness. The older group were more likely to have negative symptoms but less likely to exhibit positive symptoms; they also had lower current cognition, compared to the younger group. Compared to the younger group, the older group were more likely to be divorced/separated, to be living alone and to be unemployed. They had substantially lower lifetime use of alcohol and illicit substances, but rates of obesity, metabolic syndrome and diabetes mellitus were higher. CONCLUSION Our findings suggest that the characteristics of people with psychosis change significantly as they progress into the middle age and beyond. A better understanding of these differences is important in informing targeted treatment strategies for older people living with psychosis.
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Affiliation(s)
- Cherrie Galletly
- Interim Dean and Discipline of Psychiatry, Department of Medical Specialties, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- Northern Adelaide Local Health Network (NALHN), Lyell McEwin Hospital, Adelaide, SA, Australia
- Ramsay Health Care (SA) Mental Health Services, The Adelaide Clinic, Gilberton, Australia
| | - Shuichi Suetani
- Physical and Mental Health Stream, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia
- Metro South Addiction and Mental Health Services, Woolloongabba, QLD, Australia
- Department of Medicine, Griffith University, Nathan, QLD, Australia
| | - Lisa Hahn
- Ramsay Health Care (SA) Mental Health Services, The Adelaide Clinic, Gilberton, Australia
| | - Duncan McKellar
- Northern Adelaide Local Health Network (NALHN), Lyell McEwin Hospital, Adelaide, SA, Australia
- Office of the Chief Psychiatrist, SA Department of Health and Wellbeing, Adelaide, SA, Australia
| | - David Castle
- The University of Melbourne, Department of Psychiatry Melbourne, VIC, Australia
- St Vincent's Health Australia, Melbourne, VIC, Australia
- Scientific Director, Centre for Complex Interventions, Centre for Addictions and Mental Health; and Professor, Department of Psychiatry, University of Toronto, Toronto, Canada
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13
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Heard, known and safe in general practice? An interview study with patients with severe and persistent mental illness. BJGP Open 2021; 6:BJGPO.2021.0201. [PMID: 34916224 PMCID: PMC9447307 DOI: 10.3399/bjgpo.2021.0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/13/2021] [Indexed: 12/02/2022] Open
Abstract
Background Although GPs provide care to many patients with severe and persistent mental illness, the role and skillset of the GP in this space are contested. Patients are less satisfied with GP care of mental health than physical health issues. Aim To explore patient expectations and experiences of GP roles in their mental health, and identify opportunities for improving mental health care in general practice. Design & setting Patient participants were recruited from community mental health clinics in Brisbane, Australia. Method Individual semi-structured interviews were conducted with a convenience sample of patients. Interviews were audio-recorded and transcribed professionally. The authors conducted an inductive thematic analysis, attending to participant vulnerability and reflexivity. Results Sixteen interviews were conducted by one author (RW), with an average duration of 29 minutes. Three overarching themes were identified: being heard, being known, and being safe. Participants greatly valued ‘good GPs’ who were able to detect early signs of relapse, and with whom they came to feel heard, known, and safe over time. Experiences of perfunctory, hurried care and avoidance of mental health issues were also reported. Many participants were uncertain whether GP training in mental health was sufficient to keep them safe. Patients may suspect GPs who predominantly engage with their physical health to have negative attitudes to mental illness. Conclusion Some GPs play central roles in patients’ mental health care. Barriers for others need further exploration, and may include time, confidence, and/or expertise. Findings challenge GPs to engage more actively and effectively with these patients in their general practice consultations.
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14
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Porter C, Aggar C. A practical toolkit to support Australian mental health clinicians to manage Metabolic Syndrome: A pilot study. Int J Ment Health Nurs 2021; 30 Suppl 1:1417-1425. [PMID: 34117825 DOI: 10.1111/inm.12899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 04/28/2021] [Accepted: 05/12/2021] [Indexed: 11/30/2022]
Abstract
Metabolic syndrome (MetS) results in poor physical health outcomes and reduced life expectancy of up to 20 years less for people living with severe mental illness. The aim of this pilot study was to evaluate a locally developed practical toolkit (Let's Get Physical-Improved Physical Health in Mental Health Services-A Practical Toolkit) to support mental health clinicians to manage MetS. The study explored clinician's knowledge and attitudes towards managing MetS, confidence to screen for and intervene in MetS, and improvement in documentation. A longitudinal prospective study, utilizing audit and pre-post-questionnaire design, was conducted. Of the 60 clinicians who were employed in the regional inpatient unit, 65% (n = 39) participated in at least one of the intervention education sessions. The final sample comprised 17 clinicians with matched pre- and post-intervention data (28% of eligible participants). A total of 80 (20 per month) eMR metabolic monitoring form and patient file audits were conducted. Whilst the results were not statistically significant, this study found an overall improvement in clinicians' knowledge of, and confidence to screen for and intervene in, MetS. Attitude scores were overall positive. There was also overall improvement in MetS documentation. The implementation of the practical evidence-informed physical health in mental health services toolkit may have a positive impact on clinician knowledge, attitudes, and confidence in screening and intervening in MetS. Replicating this study with a larger sample is recommended.
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Affiliation(s)
- Cassandra Porter
- Mental Health Services, Northern NSW Local Health District, Tweed Heads, NSW, Australia
| | - Christina Aggar
- School of Health & Human Sciences, Southern Cross University, Lismore, NSW, Australia.,Nursing and Midwifery Directorate, Northern NSW Local Health District, Lismore, NSW, Australia
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15
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Onen S, Taymur I. Evidence for the atherogenic index of plasma as a potential biomarker for cardiovascular disease in schizophrenia. J Psychopharmacol 2021; 35:1120-1126. [PMID: 34176366 DOI: 10.1177/02698811211026450] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Schizophrenia is known to be accompanied with increased cardiovascular mortality, which causes reduced life expectancy. AIM The aim of the current study was to investigate if atherogenic index of plasma (AIP) could be a good marker in assessing cardiovascular disease (CVD) risk in patients with schizophrenia. METHODS Patients with schizophrenia (n = 328) and healthy controls (n = 141) were recruited. Schizophrenia patients were evaluated according to the presence of antipsychotic (AP) drug use as AP(+)Sch group and AP(-)Sch group. Atherogenic indices, such as AIP, Castelli's risk index-I (CRI-I), Castelli's risk index-II (CRI-II), and atherogenic coefficient (AC), were calculated according to the laboratory examination of serum lipid parameters. RESULTS According to the comparison of serum lipid levels, triglyceride (TG) levels were found to be highest and high-density lipoprotein-cholesterol levels were lowest in AP(+)Sch group than AP(-)Sch group and control group (CG) (p < 0.001). AIP, CRI-I, and CRI-II scores were found to be significantly higher in AP(+)Sch group than AP(-)Sch group, and in AP(-)Sch than healthy controls (p < 0.001). Mean AC scores were higher in AP(+)Sch group than both AP(-)Sch and CG and were similar in AP(-)Sch and control subjects (p < 0.001). According to the correlation analysis, AIP scores were positively correlated with duration of disease (r = 0.235; p = 0.002) and age (r = 0.226; p = 0.003) in AP(+)Sch group but not in drug-free subjects. In all groups, atherogenic indices of CRI-I, CRI-II, and AC scores were found to be positively correlated with AIP scores (p < 0.001). CONCLUSION Our results suggest that AIP is an easily calculable and reliable marker for determining the CVD risk in both drug-free schizophrenia patients and patients under AP treatment.
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Affiliation(s)
- Sinay Onen
- Department of Psychiatry, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
| | - Ibrahim Taymur
- Department of Psychiatry, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey
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16
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Morgan VA, Waterreus A, Ambrosi T, Badcock JC, Cox K, Watts GF, Shymko G, Velayudhan A, Dragovic M, Jablensky A. Mental health recovery and physical health outcomes in psychotic illness: Longitudinal data from the Western Australian survey of high impact psychosis catchments. Aust N Z J Psychiatry 2021; 55:711-728. [PMID: 32921130 DOI: 10.1177/0004867420954268] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is a dearth of longitudinal data on outcomes in prevalent cases of psychotic illness across a range of ages and levels of chronicity. Our aim was to describe changes over time in mental and physical health outcomes, as well as patterns of service utilisation that may have influenced outcomes, in a representative prevalence sample of 641 Western Australians with a psychotic illness who, at Wave 1, were part of the National Survey of High Impact Psychosis. METHODS In Wave 1 (2010, 2012), a two-phase design was employed to ensure representativeness: Phase 1 psychosis screening took place in public mental health and non-government organisation services, while, in Phase 2, a randomised sample was interviewed. In Wave 2, 380/641 (59%) of participants were re-interviewed, with interviews staggered between 2013 and 2016 (follow-up time: 2.3-5.6 years). Data collection covered mental and physical health, functioning, cognition, social circumstances and service utilisation. Mental health outcomes were categorised as symptomatic, functional and personal recovery. Physical health outcomes covered metabolic syndrome and its component criteria. RESULTS In mental health, there were encouraging improvements in symptom profiles, variable change in functional recovery and some positive findings for personal recovery, but not quality of life. Participants ranked physical health second among challenges. Metabolic syndrome had increased significantly. While treatment for underlying cardiovascular risk conditions had improved, rates of intervention were still very low. More people were accessing general practices and more frequently, but there were sharp and significant declines in access to community rehabilitation, psychosocial interventions and case management. CONCLUSION Although we observed some positive outcomes over time, the sharp decline in access to evidence-based interventions such as community rehabilitation, psychosocial interventions and case management is of great concern and augurs poorly for recovery-oriented practice. Changes in service utilisation appear to have influenced the patterns found.
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Affiliation(s)
- Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.,Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, The University of Western Australia, Perth, WA, Australia.,Clinical Research Centre, North Metropolitan Health Services Mental Health, Perth, WA, Australia
| | - Anna Waterreus
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.,Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, The University of Western Australia, Perth, WA, Australia
| | - Taryn Ambrosi
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Johanna C Badcock
- School of Psychological Science, The University of Western Australia, Perth, WA, Australia
| | - Kay Cox
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Gerald F Watts
- Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia.,Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Gordon Shymko
- South Metropolitan Health Service, Peel and Rockingham Kwinana Mental Health Service, Rockingham, WA, Australia
| | - Ajay Velayudhan
- Fremantle Hospital Mental Health Services, Fiona Stanley Fremantle Hospitals Group, South Metropolitan Health Service, Fremantle Hospital, Fremantle, WA, Australia
| | - Milan Dragovic
- Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, The University of Western Australia, Perth, WA, Australia.,Clinical Research Centre, North Metropolitan Health Services Mental Health, Perth, WA, Australia
| | - Assen Jablensky
- Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, Medical School, The University of Western Australia, Perth, WA, Australia
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17
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McWhinney S, Kolenic M, Franke K, Fialova M, Knytl P, Matejka M, Spaniel F, Hajek T. Obesity as a Risk Factor for Accelerated Brain Ageing in First-Episode Psychosis-A Longitudinal Study. Schizophr Bull 2021; 47:1772-1781. [PMID: 34080013 PMCID: PMC8530396 DOI: 10.1093/schbul/sbab064] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Obesity is highly prevalent in schizophrenia, with implications for psychiatric prognosis, possibly through links between obesity and brain structure. In this longitudinal study in first episode of psychosis (FEP), we used machine learning and structural magnetic resonance imaging (MRI) to study the impact of psychotic illness and obesity on brain ageing/neuroprogression shortly after illness onset. METHODS We acquired 2 prospective MRI scans on average 1.61 years apart in 183 FEP and 155 control individuals. We used a machine learning model trained on an independent sample of 504 controls to estimate the individual brain ages of study participants and calculated BrainAGE by subtracting chronological from the estimated brain age. RESULTS Individuals with FEP had a higher initial BrainAGE than controls (3.39 ± 6.36 vs 1.72 ± 5.56 years; β = 1.68, t(336) = 2.59, P = .01), but similar annual rates of brain ageing over time (1.28 ± 2.40 vs 1.07±1.74 estimated years/actual year; t(333) = 0.93, P = .18). Across both cohorts, greater baseline body mass index (BMI) predicted faster brain ageing (β = 0.08, t(333) = 2.59, P = .01). For each additional BMI point, the brain aged by an additional month per year. Worsening of functioning over time (Global Assessment of Functioning; β = -0.04, t(164) = -2.48, P = .01) and increases especially in negative symptoms on the Positive and Negative Syndrome Scale (β = 0.11, t(175) = 3.11, P = .002) were associated with faster brain ageing in FEP. CONCLUSIONS Brain alterations in psychosis are manifest already during the first episode and over time get worse in those with worsening clinical outcomes or higher baseline BMI. As baseline BMI predicted faster brain ageing, obesity may represent a modifiable risk factor in FEP that is linked with psychiatric outcomes via effects on brain structure.
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Affiliation(s)
- Sean McWhinney
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marian Kolenic
- National Institute of Mental Health, Klecany, Czech Republic,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Katja Franke
- Structural Brain Mapping Group, Department of Neurology, Jena University Hospital, Jena, Germany
| | - Marketa Fialova
- National Institute of Mental Health, Klecany, Czech Republic
| | - Pavel Knytl
- National Institute of Mental Health, Klecany, Czech Republic
| | - Martin Matejka
- National Institute of Mental Health, Klecany, Czech Republic,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Filip Spaniel
- National Institute of Mental Health, Klecany, Czech Republic,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tomas Hajek
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada,National Institute of Mental Health, Klecany, Czech Republic,To whom correspondence should be addressed; Department of Psychiatry, Dalhousie University, QEII HSC, A. J. Lane Building, Room 3093, 5909 Veteran’s Memorial Lane, Halifax, Nova Scotia B3H 2E2, Canada; tel: (902) 473-8299, fax: (902) 473-1583, e-mail:
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18
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Howard R, Kuhn L, Millar F, Street M. Physical health assessment and cardiometabolic monitoring practices across three adult mental health inpatient units - a retrospective cohort study. Int J Ment Health Nurs 2020; 29:1144-1156. [PMID: 32743951 DOI: 10.1111/inm.12755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 05/07/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023]
Abstract
Australians with lived experience of mental illness die on average 10 or more years earlier than the general population. Cardiometabolic disorders, including cardiovascular disease and diabetes mellitus, are common causes of premature death in this cohort. Little is known about cardiometabolic monitoring practices in mental health inpatient units. The aim of this study was to examine the characteristics of cardiometabolic monitoring and physical health assessments of adult mental health consumers within the first 72 hours of admission to an inpatient unit. We implemented a retrospective descriptive exploratory design by medical record audit. Data were collected using a pre-validated audit tool, adapted with recent literature and policy, from a randomly selected sample of consumers admitted to three acute mental health adult inpatient units of a large Australian metropolitan health service in 2016. Of 228 consumers, the mean age was 37.5 (range 18-64) years and 51.3% were women. Cardiometabolic risks were common, yet most consumers received incomplete cardiometabolic monitoring. While few consumers (15%) were diagnosed with cardiometabolic comorbidities, 67.5% were prescribed psychotropic medications with high cardiometabolic risk. Compliance with recommended cardiometabolic monitoring varied considerably between risk factors: for example, blood pressure was measured in 56.1% of consumers, whereas waist circumference was never recorded. There were no statistically significant associations between cardiometabolic monitoring completion and sex or cardiometabolic risk. These findings demonstrate the need for increased education and awareness of cardiometabolic risk and identify a critical gap between physical health assessment practices and recommendations for this cohort.
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Affiliation(s)
- Rebekah Howard
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.,Eastern Health, Adult Mental Health Services, Melbourne, Victoria, Australia
| | - Lisa Kuhn
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | | | - Maryann Street
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia.,Centre for Quality and Patient Safety Research - Eastern Health Partnership, Melbourne, Victoria, Australia
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19
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Wu YY, Chang ET, Yang YC, Chen SF, Hsu CY, Shen YC. Risk of obstructive sleep apnea in patients with schizophrenia: a nationwide population-based cohort study. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1671-1677. [PMID: 32405791 DOI: 10.1007/s00127-020-01870-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Patients with schizophrenia (SCZ) have a higher prevalence of known risk factors for obstructive sleep apnea (OSA). This study aims to determine if SCZ patients are at increased risk of incident OSA. METHODS A total of 5092 newly diagnosed SCZ patients and 5092 non-SCZ controls matched by gender, age, and index year were included between 2000 and 2012 and followed to 2013. Participants newly diagnosed with OSA were defined as incidents. Cox regression analysis was used to calculate the hazard ratio (HR) with 95% confidence intervals (CI) of the OSA incidence rate between the two groups studied. RESULTS SCZ patients were at increased risk of OSA compared to non-SCZ controls after adjusting for gender, age, comorbidities, and duration of antipsychotic use (2.12 versus 1.01 per 1000 person-years, HR: 1.97, 95% CI: 1.36-2.85). Also, this study confirmed the existence of some known risk factors for OSA, including male gender (HR 1.65, 95% CI 1.14-2.37), obesity (HR 2.62, 95% CI 1.19-5.80), hypertension (HR 1.61, 95% CI 1.06-2.47), hyperlipidemia (HR 1.55, 95% CI 1.04-2.38), diabetes (HR 1.53, 95% CI 1.01-2.38), and antipsychotic use (duration < 1 year (HR 1.57, 95% CI 1.13-2.37), 1-3 years (HR 1.62, 95% CI 1.06-2.82), and 3-5 years (HR 1.45, 95% CI 1.06-2.44)). CONCLUSION This study shows SCZ patients are at increased risk of OSA, and there is still an association with higher risk of OSA after controlling for known risk factors, indicating that it is necessary to develop targeted interventions in SCZ patients to reduce the negative impact of OSA on health.
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Affiliation(s)
- Ying-Ying Wu
- Department of Psychiatry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 707, Sec. 3, Chung Yang Rd, Hualien, 970, Taiwan
| | - En-Ting Chang
- Department of Chest Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Yu-Cih Yang
- Management Office for Health Data, Medical University Hospital, and College of Medicine, China Medical University, Taichung, Taiwan
| | - Shih-Fen Chen
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Chung-Y Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Yu-Chih Shen
- Department of Psychiatry, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 707, Sec. 3, Chung Yang Rd, Hualien, 970, Taiwan. .,School of Medicine, Tzu Chi University, Hualien, Taiwan.
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20
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Smith J, Griffiths LA, Band M, Horne D. Cardiometabolic Risk in First Episode Psychosis Patients. Front Endocrinol (Lausanne) 2020; 11:564240. [PMID: 33329382 PMCID: PMC7732528 DOI: 10.3389/fendo.2020.564240] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/19/2020] [Indexed: 12/18/2022] Open
Abstract
Previous research in patients with schizophrenia in European and USA population groups has demonstrated a high prevalence of metabolic syndrome and disease progression (~35%-40%) and increased risk for cardiovascular disease and long-term mortality. Limited research has determined the prevalence of existing cardiometabolic risk factors at onset of a first episode psychosis. This cross-sectional study presents a clinical overview of the cardiometabolic risk profile in young people with first episode psychosis in the UK. Forty-six participants (72% male) clinically diagnosed with first episode psychosis (n = 25), schizophrenia (n = 13), bipolar disorder (n = 4), unspecified non-organic psychosis (n = 2) or acute psychotic episode (n = 2) with < 6 months Duration of Untreated Psychosis (DUP; mean 33.4 ± 37.2 days) were assessed for anthropometric, health risk behaviors and clinical measurements including resting heart rate, blood pressure, blood lipids, glycated hemoglobin, and prolactin. Overall, participants (aged 18-37 years) had a high prevalence of cardiometabolic risk factors due to: elevated values for BMI (73%) and abdominal adiposity (50%), blood pressure (47% prehypertensive; 23% hypertensive), resting heart rate (43%); hypercholesterolemia (32%); suboptimal HDL-C levels (36%); and hypertriglyceridemia (40%). Participants also self-reported poor health risk habits including smoking (55%), alcohol use (39%), substance use (18%), poor diet (52%), and sedentary behavior (29%). Young people with psychosis are at increased risk for cardiometabolic disorders due to elevated clinical markers and health risk behaviors. Physical health interventions (including health behavior advice) are needed early in the treatment process to address this increased risk for cardiometabolic disorders in individuals recently diagnosed with psychosis.
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Affiliation(s)
- Jo Smith
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
| | - Lisa A. Griffiths
- Department of Nutrition, Food and Exercise Science, Florida State University, Tallahassee, FL, United States
| | - Marie Band
- Moorfields Eye Hospital NHS Foundation Trust, National Health Service, London, United Kingdom
| | - Dominic Horne
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
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21
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Smith J, Griffiths LA, Band M, Hird-Smith R, Williams B, Bold J, Bradley E, Dilworth R, Horne D. Early Intervention in Psychosis: Effectiveness and Implementation of a Combined Exercise and Health Behavior Intervention Within Routine Care. Front Endocrinol (Lausanne) 2020; 11:577691. [PMID: 33193094 PMCID: PMC7649318 DOI: 10.3389/fendo.2020.577691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/30/2020] [Indexed: 12/20/2022] Open
Abstract
Aim Young people with psychosis have higher rates of obesity, premature cardiovascular disease, and death compared to non-psychotic peers in the general population due to changes in metabolic regulation linked to antipsychotic medication and adverse health risk behaviors. The aim of this paper is to outline the development, implementation, and evaluation of a combined 12-week exercise and health behavior intervention delivered as part of an Early Intervention in Psychosis (EIP) routine service, within the UK. Methods Participants (n = 27) completed a 12-week combined intervention program, engaging in weekly, 90-min sessions comprising a healthy behavior education session (45 min), followed by a facilitated exercise session (45 min). Anthropometric data from participants (n = 26) were collected at baseline, 12 weeks, and 12 months post-intervention. Health behaviors and clinical measurements were assessed at baseline and 12 months. Results Mean baseline data suggests participants were at an increased health risk on entry to the program, with elevated values in mean body mass index (BMI; 70% overweight/obese), waist circumference, resting heart rate, and triglycerides. Fifty percent reported smoking daily, 64% ate < 5 fruits/vegetables per day, and 52% of participants were prescribed highly obesogenic antipsychotic medications (i.e., Olanzapine). At 12 weeks and 12 months, no changes were observed in mean BMI, waist circumference or any other clinical variable (p > 0.05). At 12 months, participants reported a positive impact on health behaviors including improved diet, increased physical activity levels, and cessation of substance use (n = 2), alcohol use (n = 2), and smoking (n = 4). Focus groups captured participant experiences, engagement with and satisfaction with the program, including challenges/barriers to program adherence. Conclusions The 12-week exercise and health behaviors program supported participants to attenuate their physical health risk which was sustained at 12-month follow-up. Self-reported positive health behavior changes are likely to have contributed to the prevention of excessive weight gain in this high-risk period. The evaluation was designed to have validity for a "real world EIP setting" and reflect the complexity of delivery to this participant group. Evaluation findings influenced subsequent commissioning of the physical health intervention as an ongoing element of routine EIP care within the participant site.
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Affiliation(s)
- Jo Smith
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
| | - Lisa A. Griffiths
- Department of Nutrition, Food and Exercise Science, Florida State University, Tallahassee, FL, United States
| | - Marie Band
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Rachael Hird-Smith
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
| | - Briony Williams
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
| | - Justine Bold
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
- Centre for Medical Education, Medical School, Cardiff University, Cardiff, United Kingdom
| | - Eleanor Bradley
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
| | - Richard Dilworth
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
| | - Dominic Horne
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
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22
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Thomson S, Doan T, Liu D, Schubert KO, Toh J, Boyd MA, Galletly C. Supporting the vulnerable: developing a strategic community mental health response to the COVID-19 pandemic. Australas Psychiatry 2020; 28:492-499. [PMID: 32729320 PMCID: PMC7394039 DOI: 10.1177/1039856220944701] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The COVID-19 pandemic poses significant risks to the vulnerable patient population supported by community mental health (CMH) teams in South Australia. This paper describes a plan developed to understand and mitigate these risks. METHODS Public health and psychiatric literature was reviewed and clinicians in CMH teams and infectious disease were consulted. Key risks posed by COVID-19 to CMH patients were identified and mitigation plans were prepared. RESULTS A public health response plan for CMH teams was developed to support vulnerable individuals and respond to the COVID-19 pandemic. This plan will be reviewed regularly to respond to changes in public health recommendations, research findings and feedback from patients and clinicians. CONCLUSIONS The strategic response plan developed to address risks to vulnerable patients from COVID-19 can assist other CMH services in managing the COVID-19 pandemic.
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Affiliation(s)
- Sumana Thomson
- Northern Adelaide Local Health Network, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Australia
| | - Trung Doan
- Northern Adelaide Local Health Network, Australia
| | - Dennis Liu
- Northern Adelaide Local Health Network, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Australia
| | - Klaus Oliver Schubert
- Northern Adelaide Local Health Network, Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Australia
| | - Julian Toh
- Northern Adelaide Local Health Network, Australia
| | - Mark A Boyd
- Northern Adelaide Local Health Network, Australia.,Infectious Disease Medicine, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Australia
| | - Cherrie Galletly
- Northern Adelaide Local Health Network, Australia.,Medical Specialties, Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Australia.,Ramsay Health Care (SA) Mental Health Services, Australia
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23
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Kolenič M, Španiel F, Hlinka J, Matějka M, Knytl P, Šebela A, Renka J, Hajek T. Higher Body-Mass Index and Lower Gray Matter Volumes in First Episode of Psychosis. Front Psychiatry 2020; 11:556759. [PMID: 33173508 PMCID: PMC7538831 DOI: 10.3389/fpsyt.2020.556759] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 09/02/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Neurostructural alterations are often reported in first episode of psychosis (FEP), but there is heterogeneity in the direction and location of findings between individual studies. The reasons for this heterogeneity remain unknown. Obesity is disproportionately frequent already early in the course of psychosis and is associated with smaller brain volumes. Thus, we hypothesized that obesity may contribute to brain changes in FEP. METHOD We analyzed MRI scans from 120 participants with FEP and 114 healthy participants. In primary analyses, we performed voxel-based morphometry (VBM) with small volume corrections to regions associated with FEP or obesity in previous meta-analyses. In secondary analyses, we performed whole-brain VBM analyses. RESULTS In primary analyses, we found that when controlling for BMI, FEP had lower GM volume than healthy participants in a) left fronto-temporal region (pTFCE = 0.008) and b) left postcentral gyrus (pTFCE = 0.043). When controlling for FEP, BMI was associated with lower GM volume in left cerebellum (pTFCE < 0.001). In secondary analyses, we found that when controlling for BMI, FEP had lower GM volume than healthy participants in the a) cerebellum (pTFCE = 0.004), b) left frontal (pTFCE = 0.024), and c) right temporal cortex (pTFCE = 0.031). When controlling for FEP, BMI was associated with lower GM volume in cerebellum (pTFCE = 0.004). Levels of C-reactive protein, HDL and LDL-cholesterol correlated with obesity related neurostructural alterations. CONCLUSIONS This study suggests that higher BMI, which is frequent in FEP, may contribute to cerebellar alterations in schizophrenia. As previous studies showed that obesity-related brain alterations may be reversible, our findings raise the possibility that improving the screening for and treatment of obesity and associated metabolic changes could preserve brain structure in FEP.
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Affiliation(s)
- Marián Kolenič
- Department of Applied Neuroscience and Neuroimaging, National Institute of Mental Health, Klecany, Czechia
- 3rd Faculty of Medicine, Charles University, Prague, Czechia
| | - Filip Španiel
- Department of Applied Neuroscience and Neuroimaging, National Institute of Mental Health, Klecany, Czechia
| | - Jaroslav Hlinka
- Department of Applied Neuroscience and Neuroimaging, National Institute of Mental Health, Klecany, Czechia
- Department of Complex Systems, Institute of Computer Science of the Czech Academy of Sciences, Prague, Czechia
| | - Martin Matějka
- Department of Applied Neuroscience and Neuroimaging, National Institute of Mental Health, Klecany, Czechia
- 3rd Faculty of Medicine, Charles University, Prague, Czechia
| | - Pavel Knytl
- Department of Applied Neuroscience and Neuroimaging, National Institute of Mental Health, Klecany, Czechia
- 3rd Faculty of Medicine, Charles University, Prague, Czechia
| | - Antonín Šebela
- Department of Applied Neuroscience and Neuroimaging, National Institute of Mental Health, Klecany, Czechia
| | - Jiří Renka
- Department of Applied Neuroscience and Neuroimaging, National Institute of Mental Health, Klecany, Czechia
- 3rd Faculty of Medicine, Charles University, Prague, Czechia
| | - Tomas Hajek
- Department of Applied Neuroscience and Neuroimaging, National Institute of Mental Health, Klecany, Czechia
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
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24
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Lewis M, Chondros P, Mihalopoulos C, Lee YY, Gunn JM, Harvey C, Furler J, Osborn D, Castle D, Davidson S, Jayaram M, Kenny A, Nelson MR, Morgan VA, Harrap S, McKenzie K, Potiriadis M, Densley K, Palmer VJ. The assertive cardiac care trial: A randomised controlled trial of a coproduced assertive cardiac care intervention to reduce absolute cardiovascular disease risk in people with severe mental illness in the primary care setting. Contemp Clin Trials 2020; 97:106143. [PMID: 32931919 DOI: 10.1016/j.cct.2020.106143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) accounts for 40% of the excess mortality identified in people with severe mental illness (SMI). Modifiable CVD risk factors are higher and can be exacerbated by the cardiometabolic impact of psychotropic medications. People with SMI frequently attend primary care presenting a valuable opportunity for early identification, prevention and management of cardiovascular health. The ACCT Healthy Hearts Study will test a coproduced, nurse-led intervention delivered with general practitioners to reduce absolute CVD risk (ACVDR) at 12 months compared with an active control group. METHODS/DESIGN ACCT is a two group (intervention/active control) individually randomised (1:1) controlled trial (RCT). Assessments will be completed baseline (pre-randomisation), 6 months, and 12 months. The primary outcome is 5-year ACVDR measured at 12 months. Secondary outcomes include 6-month ACVDR; and blood pressure, lipids, HbA1c, BMI, quality of life, physical activity, motivation to change health behaviour, medication adherence, alcohol use and hospitalisation at 6 and 12 months. Linear mixed-effects regression will estimate mean difference between groups for primary and secondary continuous outcomes. Economic cost-consequences analysis will be conducted using quality of life and health resource use information and routinely collected government health service use and medication data. A parallel process evaluation will investigate implementation of the intervention, uptake and outcomes. DISCUSSION ACCT will deliver a coproduced and person-centred, guideline level cardiovascular primary care intervention to a high need population with SMI. If successful, the intervention could lead to the reduction of the mortality gap and increase opportunities for meaningful social and economic participation. Trial registration ANZCTR Trial number: ACTRN12619001112156.
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Affiliation(s)
- Matthew Lewis
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Patty Chondros
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Cathrine Mihalopoulos
- Deakin University, Geelong, Deakin Health Economics Unit, Faculty of Health, Australia
| | - Yong Yi Lee
- Deakin University, Geelong, Deakin Health Economics Unit, Faculty of Health, Australia; School of Public Health, The University of Queensland, Australia; Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Australia
| | - Jane M Gunn
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Carol Harvey
- The Department of Psychiatry, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia; NorthWestern Mental Health, Melbourne, Australia
| | - John Furler
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - David Osborn
- Division of Psychiatry, Faculty of Brain Sciences, University College London, Australia; Camden and Islington NHS Foundation Trust, NW1OPE, United Kingdom
| | - David Castle
- The Department of Psychiatry, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Sandra Davidson
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Mahesh Jayaram
- The Department of Psychiatry, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia; NorthWestern Mental Health, Melbourne, Australia
| | - Amanda Kenny
- College of Science, Health and Engineering, La Trobe Rural Health School, Violet Vines Marshman Centre for Rural Health Research, La Trobe University, Australia
| | - Mark R Nelson
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Vera A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, University of Western Australia, Australia; Centre for Clinical Research in Neuropsychiatry, Division of Psychiatry, University of Western Australia, Australia
| | - Stephen Harrap
- Department of Physiology, University of Melbourne, Australia
| | - Kylie McKenzie
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Maria Potiriadis
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Konstancja Densley
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia
| | - Victoria J Palmer
- The Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia.
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25
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Ronaldson A, Elton L, Jayakumar S, Jieman A, Halvorsrud K, Bhui K. Severe mental illness and health service utilisation for nonpsychiatric medical disorders: A systematic review and meta-analysis. PLoS Med 2020; 17:e1003284. [PMID: 32925912 PMCID: PMC7489517 DOI: 10.1371/journal.pmed.1003284] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 08/10/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Psychiatric comorbidity is known to impact upon use of nonpsychiatric health services. The aim of this systematic review and meta-analysis was to assess the specific impact of severe mental illness (SMI) on the use of inpatient, emergency, and primary care services for nonpsychiatric medical disorders. METHODS AND FINDINGS PubMed, Web of Science, PsychINFO, EMBASE, and The Cochrane Library were searched for relevant studies up to October 2018. An updated search was carried out up to the end of February 2020. Studies were included if they assessed the impact of SMI on nonpsychiatric inpatient, emergency, and primary care service use in adults. Study designs eligible for review included observational cohort and case-control studies and randomised controlled trials. Random-effects meta-analyses of the effect of SMI on inpatient admissions, length of hospital stay, 30-day hospital readmission rates, and emergency department use were performed. This review protocol is registered in PROSPERO (CRD42019119516). Seventy-four studies were eligible for review. All were observational cohort or case-control studies carried out in high-income countries. Sample sizes ranged from 27 to 10,777,210. Study quality was assessed using the Newcastle-Ottawa Scale for observational studies. The majority of studies (n = 45) were deemed to be of good quality. Narrative analysis showed that SMI led to increases in use of inpatient, emergency, and primary care services. Meta-analyses revealed that patients with SMI were more likely to be admitted as nonpsychiatric inpatients (pooled odds ratio [OR] = 1.84, 95% confidence interval [CI] 1.21-2.80, p = 0.005, I2 = 100%), had hospital stays that were increased by 0.59 days (pooled standardised mean difference = 0.59 days, 95% CI 0.36-0.83, p < 0.001, I2 = 100%), were more likely to be readmitted to hospital within 30 days (pooled OR = 1.37, 95% CI 1.28-1.47, p < 0.001, I2 = 83%), and were more likely to attend the emergency department (pooled OR = 1.97, 95% CI 1.41-2.76, p < 0.001, I2 = 99%) compared to patients without SMI. Study limitations include considerable heterogeneity across studies, meaning that results of meta-analyses should be interpreted with caution, and the fact that it was not always possible to determine whether service use outcomes definitively excluded mental health treatment. CONCLUSIONS In this study, we found that SMI impacts significantly upon the use of nonpsychiatric health services. Illustrating and quantifying this helps to build a case for and guide the delivery of system-wide integration of mental and physical health services.
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Affiliation(s)
- Amy Ronaldson
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Lotte Elton
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Simone Jayakumar
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Anna Jieman
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Kristoffer Halvorsrud
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Kamaldeep Bhui
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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26
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Lederman O, Ward PB, Rosenbaum S, Maloney C, Watkins A, Teasdale S, Morell R, Curtis J. Stepping up early treatment for help-seeking youth with at-risk mental states: Feasibility and acceptability of a real-world exercise program. Early Interv Psychiatry 2020; 14:450-462. [PMID: 31531959 DOI: 10.1111/eip.12871] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 06/18/2019] [Accepted: 08/25/2019] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Youth with at-risk mental states (ARMS) have low levels of physical activity (PA), reduced fitness levels and experience poor sleep quality. These lifestyle factors exacerbate mental health symptoms and increase cardiometabolic disease risk. PA interventions can help prevent this decline in physical health whilst reducing mental health symptom severity. Whether PA interventions are feasible and acceptable amongst youth with ARMS is unclear. METHODS This study evaluated the feasibility and acceptability of headspace Active, a pragmatic PA program offered to 14 to 25 year olds with ARMS. The 12-week exercise physiologist-led intervention was conducted in adjunct to usual care. Feasibility was determined by number of referrals, attendance, engagement in exercise sessions and dropout from the intervention. Acceptability was assessed by a 10-item questionnaire. Secondary outcomes included anthropometry, cardiorespiratory fitness and strength. Subjective PA levels, symptoms of depression and anxiety, sleep, motivation and quality of life were also assessed. RESULTS Within 12 months, 77% of referrals completed the 12-week intervention (n = 20), with six dropouts. Of the 20 "completers", 95% attended at least five sessions over the 12-week intervention. Participants found the program highly acceptable (mean = 41.2/50 on the 10-item acceptability questionnaire) and experienced significant improvements in PA, strength, motivation, depressive symptoms and sleep quality post-intervention. No changes in anthropometry were observed. CONCLUSION Results suggest headspace Active was feasible and acceptable and was associated with improvements in physical and mental health outcomes among ARMS youth. Given the potential scalability of this real-world PA program to other youth mental health settings, these data have implications for best practice implementation of PA interventions for individuals with emerging mental illness.
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Affiliation(s)
- Oscar Lederman
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.,School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Philip B Ward
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Schizophrenia Research Unit, Liverpool Hospital and Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| | - Simon Rosenbaum
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Black Dog Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Chris Maloney
- School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Watkins
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.,Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Scott Teasdale
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.,School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Rachel Morell
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.,School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Jackie Curtis
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia.,School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
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27
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Pilot cohort study of obstructive sleep apnoea in community-dwelling people with schizophrenia. Ir J Psychol Med 2020; 38:23-29. [DOI: 10.1017/ipm.2020.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objectives:We aimed to assess the incidence of obstructive sleep apnoea (OSA) in people with schizophrenia, to explore clinical associates with OSA and how well OSA screening tools perform in this population.Methods:All patients registered in a community outpatient Clozapine clinic, between January 2014 and March 2016, were consecutively approached to participate. Participants were screened for OSA using at home multichannel polysomnography (PSG) and were diagnosed with OSA if the apnoea-hypopnoea index (AHI) was >10 events/hr. Univariate comparison of participants to determine whether AHI > 10 events/hr was associated with demographic factors, anthropometric measures and psychiatric symptoms and cognition was performed. The sensitivity, specificity, positive predictive value and negative predictive value of the commonly used sleep symptoms scales and OSA screening tools were also determined.Results:Thirty participants were recruited, 24 men and 6 women. Mean age was 38.8 (range: 25–60), and mean body mass index (BMI) was 35.7 (range 19.9–62.1). The proportion of participants with OSA (AHI > 10 events/hr) was 40%, 18 (60%) had no OSA, 4 (13%) had mild OSA (AHI 10.1–20), zero participants had moderate OSA (AHI 20.1–30) and 8 (27%) had severe OSA (AHI > 30). Diagnosis of OSA was significantly associated with increased weight, BMI, neck circumference and systolic blood pressure. Diagnosis of OSA was not significantly associated with Positive and Negative Symptoms Scale, Montgomery Asperger’s Depression Rating Scale, Personal and Social Performance scale or Brief Assessment of Cognition for Schizophrenia scores. All OSA screening tools demonstrated poor sensitivity and specificity for a diagnosis of OSA.Conclusion:OSA was highly prevalent in this cohort of people with schizophrenia and was associated with traditional anthropometric OSA risk factors.
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28
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Lane AR, Myles H, Foley S, Siskind D. Screening for obstructive sleep apnoea in an early psychosis cohort: a pilot study. Australas Psychiatry 2020; 28:180-185. [PMID: 31595776 DOI: 10.1177/1039856219878650] [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]
Abstract
OBJECTIVE Rates of obstructive sleep apnoea (OSA) appear to be lower in the youth population (< 4%) compared to the general population (6%-17%); rates in people with psychotic illness are estimated at 13.5%-57.1%. We hypothesised that this comorbidity extends to early psychosis (EP) populations, and used previously validated OSA questionnaires to screen for OSA in an EP cohort. METHOD Fifty-three patients were screened using the OSA50 and STOP-Bang questionnaires with collection of anthropometric measures. Patients who screened positively were referred for polysomnography. RESULTS Fifteen per cent (8/53) screened positively; most frequently endorsed measures included BMI > 25, snoring, hypertension, neck circumference (> 40 cm) and male gender. Only 2/8 patients accepted polysomnography. CONCLUSIONS Screening indicates OSA may be more prevalent in EP populations than age-equivalent cohorts, but ongoing research is required.
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Affiliation(s)
- Abigail R Lane
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - Hannah Myles
- Northern Adelaide Local Health Network, Adelaide, SA.,Discipline of Psychiatry, Adelaide Medical School, Adelaide, SA, Australia
| | - Sharon Foley
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, QLD.,Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
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29
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Bailey JM, Clinton-McHarg TL, Wye PM, Wiggers JH, Bartlem KM, Bowman JA. Preventive care for physical activity and fruit and vegetable consumption: a survey of family carer expectations of health service delivery for people with a mental health condition. BMC Health Serv Res 2020; 20:201. [PMID: 32164730 PMCID: PMC7068924 DOI: 10.1186/s12913-020-5059-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/28/2020] [Indexed: 11/07/2022] Open
Abstract
Background Chronic disease is a leading cause of death globally, where inadequate fruit and vegetable consumption and inadequate physical activity are consistently implicated as key contributing risk factors for such diseases. People with a mental health condition are reported to experience a higher prevalence of such risks and experience an increased morbidity and mortality from resultant chronic disease. Despite guidelines identifying a need for services accessed by people with a mental health condition to provide care to address such health risk behaviours, sub-optimal care is frequently reported suggesting a need for innovative strategies to increase the provision of physical health care. An exploratory study was conducted to examine: 1) family carers’ expectations of care provision regarding fruit and vegetable consumption and physical activity by health and community services for people with a mental health condition; 2) carer’s own health risk behaviour status and perceptions of the influence of the health risk behaviours on mental health; and 3) possible associations of socio-demographic, clinical and attitudinal factors with carer expectations of care provision for fruit and vegetable consumption and physical activity. Methods Family carers (n = 144) of a person with a mental health condition completed a cross-sectional survey. Participants were members of a mental health carer support organisation operating in New South Wales, Australia. Results A high proportion of participants considered care for fruit and vegetable consumption and physical activity respectively should be provided by: mental health hospitals (78.5, 82.7%); community mental health services (76.7, 85.9%); general practice (81.1, 79.2%); and non-government organisations (56.2, 65.4%). Most participants perceived adequate fruit and vegetable consumption (55.9%), and physical activity (71.3%) would have a very positive impact on mental health. Carers who perceived adequate fruit and vegetable consumption and physical activity would have a positive impact on mental health were more likely to expect care for such behaviours from some services. Conclusions The majority of participants expected care for fruit and vegetable consumption and physical activity be provided by all services catering for people with a mental health condition, reinforcing the appropriateness for such services to provide physical health care for clients in a systematic manner.
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Affiliation(s)
- Jacqueline M Bailey
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.
| | - Tara L Clinton-McHarg
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Paula M Wye
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - John H Wiggers
- Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Kate M Bartlem
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Jennifer A Bowman
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
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30
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Experiences of Tobacco Use among Chinese Individuals with Schizophrenia in Community-Based Residential Settings: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17010321. [PMID: 31906522 PMCID: PMC6981445 DOI: 10.3390/ijerph17010321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/28/2019] [Accepted: 12/31/2019] [Indexed: 11/17/2022]
Abstract
Although there is a high prevalence of smoking among individuals with schizophrenia, no previous attempt has been made to explore experiences of tobacco use and cessation within a Chinese sample of this population. A qualitative descriptive study was conducted to explore through the use of individual and semi-structured interviews the experiences of tobacco use and quitting in a sample Chinese population with schizophrenia. Twenty-three eligible participants with schizophrenia who currently smoke were recruited from three community residential mental health service settings. Four main themes representing the experiences of the participants were uncovered in this study: (1) smoking and illness; (2) environment and culture; (3) reasons for smoking; and (4) beliefs about cessation methods. The findings indicated that the participants considered the disease to be far more harmful than smoking, and perceived many benefits to smoking. Although some thought of quitting at times, most gave up the idea or failed to quit due to internal factors such as disease-related suffering, the use of an avoidance coping strategy, and a lack of cessation support. The most notable finding concerns the use of avoidance coping by the participants, who relied on smoking as a way to avoid the suffering brought about by the disease.
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31
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Suetani S, Stubbs B, McGrath JJ, Scott JG. Physical activity of people with mental disorders compared to the general population: a systematic review of longitudinal cohort studies. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1443-1457. [PMID: 31444516 DOI: 10.1007/s00127-019-01760-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 08/20/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE We investigated if (a) people with lower physical activity have an increased risk of subsequent mental disorders (compared to those with higher physical activity); and (b) people with mental disorders have reduced subsequent physical activity (compared to those without mental disorders). METHODS A systematic review of population-based longitudinal studies examining physical activity and mental disorders was conducted. Mental disorders were defined by International Classification of Diseases or Diagnostic and Statistical Manual of Mental Disorders. The results were described in a narrative summary. RESULTS Twenty-two studies were included. The majority (19) examined mood disorders and physical activity. Only two studies found consistent association between lower physical activity and a reduced risk of subsequent mental disorders. One study found the bidirectional association between physical activity and major depression. Twelve studies found mixed results (i.e., no consistency in direction and significance of the findings), and seven studies found no association between the variables of interest. CONCLUSIONS There is a lack of consistent evidence linking physical activity to be either a risk factor or consequence of mental disorders. PROSPERO REGISTRATION ID CRD42017071737.
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Affiliation(s)
- Shuichi Suetani
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, 4076, Australia. .,Queensland Brain Institute, The University of Queensland, St Lucia, Australia. .,Metro South Addiction and Mental Health Services, Brisbane, Australia.
| | - Brendon Stubbs
- Department of Health Service and Population Research, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - John J McGrath
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, 4076, Australia.,Queensland Brain Institute, The University of Queensland, St Lucia, Australia.,National Centre for Register-based Research, The Aarhus University, Aarhus C, Denmark
| | - James G Scott
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, 4076, Australia.,School of Public Health, The University of Queensland, Herston, Australia.,Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, Australia
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Current evidence of childhood traumatic experiences in psychosis - focus on gender differences. Psychiatry Res 2019; 281:112507. [PMID: 31465988 DOI: 10.1016/j.psychres.2019.112507] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/01/2019] [Accepted: 08/04/2019] [Indexed: 02/07/2023]
Abstract
Childhood abuse is common among people with psychosis and it is associated with poor illness outcomes. Some forms of childhood abuse are more common in women, but the impact of gender and childhood abuse in psychosis has been little investigated and evidence has never been put into a congruent frame. Herein, we conducted a narrative review to assess the impact of gender and childhood abuse in psychosis. Research articles were identified (n = 44) using a comprehensive electronic search of PubMed, Web-of-Science, Scopus and Cochrane databases. Women appeared to be at greater risk of sexual abuse than men. Women with childhood abuse report more positive and mood symptoms, and more suicide attempts compared to men. In addition, women exposed to childhood abuse display an earlier age of onset compared to not exposed, but this association is not present in men. Conversely, men with childhood abuse show more negative symptoms, substance use and a poorer cognitive performance compared to women. It seems therefore confirmed that gender and childhood abuse may impact on the outcome of psychosis, since not all gender differences found in patients who had been abused in their childhood are accounted by the overall differences between men and women with psychosis.
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Morell R, Curtis J, Watkins A, Poole J, Fibbins H, Rossimel E, Gerrard M, White A, Teasdale S, Ward PB, Lappin J. Cardio-metabolic risk in individuals prescribed long-acting injectable antipsychotic medication. Psychiatry Res 2019; 281:112606. [PMID: 31629301 DOI: 10.1016/j.psychres.2019.112606] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 12/24/2022]
Abstract
People living with severe mental illness (SMI) experience significant physical health co-morbidity. Few studies have focused on physical health outcomes for those prescribed long-acting injectable (LAI) antipsychotics. This observational cross-sectional study aimed to assess the prevalence of metabolic syndrome (MetS) and other cardio-metabolic risk factors in a large cohort prescribed LAI and managed by community mental health services. For participants with elevated cardio-metabolic risk factors, the proportion receiving appropriate management was assessed. Of the 301 eligible participants, many met the full criteria for MetS (44%) and its components. Cardio-metabolic risk factors were largely under- or un-treated. Smoking rates were very high (62%) along with reported high rates of physical inactivity and poor dietary intake. The vast majority (89%) reported seeing their general practitioner in the preceding twelve months. Individuals prescribed LAI have a very high prevalence of MetS and potentially modifiable risk factors for cardiovascular disease. Routine monitoring accompanied by evidence-based treatment of cardiometabolic abnormalities which contribute to significant morbidity, disability and premature death should be prioritised. Better collaboration between mental health services and primary care providers should be pursued to optimise the delivery of effective physical health care to individuals living with SMI.
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Affiliation(s)
- Rachel Morell
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia; School of Psychiatry, UNSW Sydney, Kensington, NSW, Australia.
| | - Jackie Curtis
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia; School of Psychiatry, UNSW Sydney, Kensington, NSW, Australia
| | - Andrew Watkins
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia
| | - Josephine Poole
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia
| | - Hamish Fibbins
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia; School of Psychiatry, UNSW Sydney, Kensington, NSW, Australia
| | - Elisa Rossimel
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia
| | - Mark Gerrard
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia
| | - Annette White
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia
| | - Scott Teasdale
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia; School of Psychiatry, UNSW Sydney, Kensington, NSW, Australia
| | - Philip B Ward
- School of Psychiatry, UNSW Sydney, Kensington, NSW, Australia; Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, NSW, Austraila
| | - Julia Lappin
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia; School of Psychiatry, UNSW Sydney, Kensington, NSW, Australia
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Happell B, Platania-Phung C, Watkins A, Scholz B, Curtis J, Goss J, Niyonsenga T, Stanton R. Developing an Evidence-Based Specialist Nursing Role to Improve the Physical Health Care of People with Mental Illness. Issues Ment Health Nurs 2019; 40:832-838. [PMID: 31070501 DOI: 10.1080/01612840.2019.1584655] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The substantial physical health disadvantage experienced by people diagnosed with mental illness is now identified in a growing body of research evidence. The recent promulgation of improved physical health care as a goal of contemporary Australian Mental Health Policy should provide impetus for initiatives and strategies to address this inequity. To date increased knowledge of the problem has not resulted in obvious and sustained changes. The aim of this article is to introduce the role of the Physical Health Nurse Consultant as a potential strategy. The potential contribution and value of this role is considered by reviewing the evidence from the perspective of multiple stakeholders and considering the suitability of nursing to meet the complex needs involved in improving physical health. The requirement for a multi-faceted and comprehensive evaluation is also articulated. A robust, prospective and long-term evaluation plan includes physical health measures, changes in health behaviours, cost-benefit analysis and consumer acceptability to ensure the intervention is effective in the long term. This thorough approach is essential to provide the level of evidence required to facilitate changes at the practice and policy levels. The specialist nursing role presented in this article, subject to the comprehensive evaluation proposed, could become an integral component of a comprehensive approach to addressing physical health inequities in people with mental illness.
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Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, University of Newcastle , New South Wales , Australia
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle , New South Wales , Australia
| | - Andrew Watkins
- Keeping the Body in Mind Program, NSW Health , Bondi Junction, Australia
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University , Canberra , Australia
| | - Jackie Curtis
- Youth Mental Health, South Eastern Sydney Local Health District, University of New South Wales, New South Wales, Australia
| | - John Goss
- Centre for Research & Action in Public Health, UC Health Research Institute, University of Canberra, Canberra , Australia
| | | | - Robert Stanton
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
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Scott EM, Carpenter JS, Iorfino F, Cross SPM, Hermens DF, Gehue J, Wilson C, White D, Naismith SL, Guastella AJ, Hickie IB. What is the prevalence, and what are the clinical correlates, of insulin resistance in young people presenting for mental health care? A cross-sectional study. BMJ Open 2019; 9:e025674. [PMID: 31138580 PMCID: PMC6550004 DOI: 10.1136/bmjopen-2018-025674] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To report the distribution and predictors of insulin resistance (IR) in young people presenting to primary care-based mental health services. DESIGN Cross-sectional. SETTING Headspace-linked clinics operated by the Brain and Mind Centre of the University of Sydney. PARTICIPANTS 768 young people (66% female, mean age 19.7±3.5, range 12-30 years). MAIN OUTCOME MEASURES IR was estimated using the updated homeostatic model assessment (HOMA2-IR). Height and weight were collected from direct measurement or self-report for body mass index (BMI). RESULTS For BMI, 20.6% of the cohort were overweight and 10.2% were obese. However, <1% had an abnormally high fasting blood glucose (>6.9 mmol/L). By contrast, 9.9% had a HOMA2-IR score >2.0 (suggesting development of IR) and 11.7% (n=90) had a score between 1.5 and 2. Further, there was a positive correlation between BMI and HOMA2-IR (r=0.44, p<0.001). Participants in the upper third of HOMA2-IR scores are characterised by younger age, higher BMIs and depression as a primary diagnosis. HOMA2-IR was predicted by younger age (β=0.19, p<0.001) and higher BMI (β=0.49, p<0.001), together explaining 22% of the variance (F(2,361)=52.1, p<0.001). CONCLUSIONS Emerging IR is evident in a significant subgroup of young people presenting to primary care-based mental health services. While the major modifiable risk factor is BMI, a large proportion of the variance is not accounted for by other demographic, clinical or treatment factors. Given the early emergence of IR, secondary prevention interventions may need to commence prior to the development of full-threshold or major mood or psychotic disorders.
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Affiliation(s)
- Elizabeth M Scott
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia
| | - Joanne S Carpenter
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Frank Iorfino
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Shane P M Cross
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Daniel F Hermens
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
- Sunshine Coast Mind and Neuroscience Thompson Institute, Birtinya, Queensland, Australia
| | - Jeanne Gehue
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Chloe Wilson
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Django White
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Sharon L Naismith
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Adam J Guastella
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian B Hickie
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
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Conn A, Bourke N, James C, Haracz K. Occupational therapy intervention addressing weight gain and obesity in people with severe mental illness: A scoping review. Aust Occup Ther J 2019; 66:446-457. [PMID: 30972772 DOI: 10.1111/1440-1630.12575] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Individuals diagnosed with severe mental illness have higher rates of obesity than the general population due to a range of factors, including: medication side effects, poor nutrition and reduced physical activity. Obesity is associated with increased mortality and reduced quality of life. Evidence suggests that lifestyle interventions can be effective in addressing this issue. While such interventions would appear to fit within the scope of practice of occupational therapy, there is no publication synthesising the existing literature regarding occupational therapy interventions addressing lifestyle factors associated with obesity. AIM To determine what is known from the existing literature about occupational therapy interventions addressing weight gain and obesity in adults diagnosed with severe mental illness. METHODS A scoping review was conducted. Searches were performed in online databases, occupational therapy journals and grey literature databases. Thematic analysis occurred across all articles included in the review. RESULTS A total of 14 articles were included in the review. Analysis revealed a central theme of supporting occupational performance and participation in health promoting occupations. This central theme consisted of four categories; facilitating client-centred practice, addressing personal performance issues, addressing environmental barriers and providing the 'just right' challenge. CONCLUSION/SIGNIFICANCE These findings suggest occupational therapists are providing occupation focused interventions that are aligned with current clinical guidelines. However, more research is required to strengthen evidence-based occupational therapy practice in this important area.
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Affiliation(s)
- Aleisha Conn
- Marathon Health, Dubbo, New South Wales, Australia
| | - Nicola Bourke
- Morisset Hospital, Morisett, New South Wales, Australia
| | - Carole James
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
| | - Kirsti Haracz
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia
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Cocks N, Brophy L, Segan C, Stratford A, Jones S, Castle D. Psychosocial Factors Affecting Smoking Cessation Among People Living With Schizophrenia: A Lived Experience Lens. Front Psychiatry 2019; 10:565. [PMID: 31474884 PMCID: PMC6704230 DOI: 10.3389/fpsyt.2019.00565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 07/18/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: People living with schizophrenia smoke at much higher rates than the general population, and find it more difficult to quit. To date, lived experience has received little attention from researchers. Personal recovery perspectives may generate further insights into established psychosocial barriers and enablers of smoking cessation. Methods and Results: A lived experience account is provided by one of our authors that places the current evidence in context, and highlights the role of marginalization and stigma in reinforcing smoking. Key concepts from the personal recovery paradigm, such as connectedness, hope, and empowerment are discussed. The relevance of these factors and the value of shared lived experience in challenging stigma, marginalization, and low expectations demonstrates the contribution that peer support can offer to support smoking cessation. Conclusions: Recovery-oriented approaches when integrated with existing evidence-based treatments designed to meet the needs of people living with schizophrenia have potential to improve outcomes by helping to take a more holistic approach to break down barriers and facilitate increased uptake of treatment and support. Further research to evaluate the effectiveness of integrated approaches is warranted.
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Affiliation(s)
- Nadine Cocks
- Research and Advocacy, Mind Australia Limited, Heidelberg, VIC, Australia
| | - Lisa Brophy
- Research and Advocacy, Mind Australia Limited, Heidelberg, VIC, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia
| | - Catherine Segan
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,Quit Victoria, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Anthony Stratford
- Research and Advocacy, Mind Australia Limited, Heidelberg, VIC, Australia
| | - Simon Jones
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - David Castle
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.,Department of Psychiatry, St Vincent’s Hospital Melbourne, Fitzroy, VIC, Australia
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Baker AL, Turner A, Beck A, Berry K, Haddock G, Kelly PJ, Bucci S. Telephone-delivered psychosocial interventions targeting key health priorities in adults with a psychotic disorder: systematic review. Psychol Med 2018; 48:2637-2657. [PMID: 29798730 PMCID: PMC6236444 DOI: 10.1017/s0033291718001125] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/04/2018] [Accepted: 04/06/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND The mental and physical health of individuals with a psychotic illness are typically poor. Access to psychosocial interventions is important but currently limited. Telephone-delivered interventions may assist. In the current systematic review, we aim to summarise and critically analyse evidence for telephone-delivered psychosocial interventions targeting key health priorities in adults with a psychotic disorder, including (i) relapse, (ii) adherence to psychiatric medication and/or (iii) modifiable cardiovascular disease risk behaviours. METHODS Ten peer-reviewed and four grey literature databases were searched for English-language studies examining psychosocial telephone-delivered interventions targeting relapse, medication adherence and/or health behaviours in adults with a psychotic disorder. Study heterogeneity precluded meta-analyses. RESULTS Twenty trials [13 randomised controlled trials (RCTs)] were included, involving 2473 participants (relapse prevention = 867; medication adherence = 1273; and health behaviour = 333). Five of eight RCTs targeting relapse prevention and one of three targeting medication adherence reported at least 50% of outcomes in favour of the telephone-delivered intervention. The two health-behaviour RCTs found comparable levels of improvement across treatment conditions. CONCLUSIONS Although most interventions combined telephone and face-to-face delivery, there was evidence to support the benefit of entirely telephone-delivered interventions. Telephone interventions represent a potentially feasible and effective option for improving key health priorities among people with psychotic disorders. Further methodologically rigorous evaluations are warranted.
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Affiliation(s)
- Amanda L. Baker
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Alyna Turner
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Alison Beck
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Peter J. Kelly
- Illawarra Institute for Mental Health, School of Psychology and the Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, Australia
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Myles H, Vincent A, Myles N, Adams R, Chandratilleke M, Liu D, Mercer J, Vakulin A, Wittert G, Galletly C. Obstructive sleep apnoea is more prevalent in men with schizophrenia compared to general population controls: results of a matched cohort study. Australas Psychiatry 2018; 26:600-603. [PMID: 29737184 DOI: 10.1177/1039856218772241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES: Obstructive sleep apnoea (OSA) may be more common in people with schizophrenia compared to the general population, but the relative prevalence is unknown. Here, we determine the relative prevalence of severe OSA in a cohort of men with schizophrenia compared to representative general population controls, and investigate the contribution of age and body mass index (BMI) to differences in prevalence. METHODS: Rates of severe OSA (apnoea-hypopnoea index > 30) were compared between male patients with schizophrenia and controls from a representative general population study of OSA. RESULTS: The prevalence of severe OSA was 25% in the schizophrenia group and 12.3% in the general population group. In subgroups matched by age, the relative risk of severe OSA was 2.9 ( p = 0.05) in the schizophrenia subjects, but when adjusted for age and BMI, the relative risk dropped to 1.7 and became non-significant ( p = 0.17). CONCLUSIONS: OSA is prevalent in men with schizophrenia. Obesity may be an important contributing factor to the increased rate of OSA.
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Affiliation(s)
- Hannah Myles
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, and; Country Health (SA) Mental Health; Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Andrew Vincent
- School of Medicine, University of Adelaide, Adelaide, SA, and; Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, SA, Australia
| | - Nicholas Myles
- School of Medicine, University of Queensland, Herston, QLD, and; Haematology Directorate, SA Pathology, Adelaide, SA, Australia
| | - Robert Adams
- School of Medicine, University of Adelaide, and; The Health Observatory, Discipline of Medicine, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - Madhu Chandratilleke
- Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Daw Park, SA, Australia
| | - Dennis Liu
- Discipline of Psychiatry, The University of Adelaide, Adelaide, SA, and; Northern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Jeremy Mercer
- Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Daw Park, SA, Australia
| | - Andrew Vakulin
- NeuroSleep and Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, and; Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Daw Park, SA, Australia
| | - Gary Wittert
- School of Medicine, University of Adelaide, and; Freemasons Foundation Centre for Men's Health, University of Adelaide, Australia
| | - Cherrie Galletly
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, and; Ramsay Health Care (SA) Mental Health, Adelaide, SA, and; Northern Adelaide Local Health Network, Adelaide, SA, Australia
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Myles H, Myles N, Coetzer CLC, Adams R, Chandratilleke M, Liu D, Mercer J, Vakulin A, Vincent A, Wittert G, Galletly C. Cognition in schizophrenia improves with treatment of severe obstructive sleep apnoea: A pilot study. SCHIZOPHRENIA RESEARCH-COGNITION 2018; 15:14-20. [PMID: 30450286 PMCID: PMC6226616 DOI: 10.1016/j.scog.2018.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 09/20/2018] [Accepted: 09/20/2018] [Indexed: 01/19/2023]
Abstract
Previous studies have shown that people with schizophrenia have high rates of Obstructive Sleep Apnoea (OSA). Despite this, intervention studies to treat OSA in this population have not been undertaken. The ASSET (Assessing Sleep in Schizophrenia and Evaluating Treatment) pilot study investigated Continuous Positive Airway Pressure (CPAP) treatment of severe OSA in participants recruited from a clozapine clinic in Adelaide. Participants with severe untreated OSA (Apnoea-Hypopnoea Index (AHI) > 30), were provided with CPAP treatment, and assessed at baseline and six months across the following domains: physical health, quality of sleep, sleepiness, cognition, psychiatric symptoms and CPAP adherence. Six of the eight ASSET participants with severe OSA accepted CPAP. At baseline, half of the cohort had hypertension, all were obese with a mean BMI of 45, and they scored on average 1.47 standard deviations below the normal population in cognitive testing. The mean AHI was 76.8 and sleep architecture was markedly impaired with mean rapid eye movement (REM) sleep 4.1% and mean slow wave sleep (SWS) 4.8%. After six months of treatment there were improvements in cognition (BACS Z score improved by an average of 0.59) and weight loss (mean weight loss 7.3 ± 9 kg). Half of the participants no longer had hypertension and sleep architecture improved with mean REM sleep 31.4% of the night and mean SWS 24% of the night. Our data suggests CPAP may offer novel benefits to address cognitive impairment and sleep disturbance in people with schizophrenia.
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Affiliation(s)
- Hannah Myles
- School of Medicine, Adelaide University, Adelaide, Australia
- Country Health SA, Mental Health, Australia
| | | | - Ching Li Chai Coetzer
- Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Australia
- Sleep Health Service, Southern Adelaide Local Health Network, SA Health, Australia
| | - Robert Adams
- School of Medicine, Adelaide University, Adelaide, Australia
- The Royal Adelaide Hospital, SA, Australia
- The Health Observatory, Discipline of Medicine, TQEH, Australia
| | - Madhu Chandratilleke
- Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Australia
| | - Dennis Liu
- School of Medicine, Adelaide University, Adelaide, Australia
- Northern Adelaide Local Health Network (NALHN), Australia
| | - Jeremy Mercer
- Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Australia
- Sleep Health Service, Southern Adelaide Local Health Network, SA Health, Australia
| | - Andrew Vakulin
- Adelaide Institute for Sleep Health: A Flinders Centre for Research Excellence, Flinders University, Australia
- NeuroSleep and Woolcock Institute of Medical Research, University of Sydney, Australia
| | - Andrew Vincent
- School of Medicine, Adelaide University, Adelaide, Australia
- Freemasons Foundation Centre for Men's Health, Australia
| | - Gary Wittert
- School of Medicine, Adelaide University, Adelaide, Australia
- Freemasons Foundation Centre for Men's Health, Australia
| | - Cherrie Galletly
- School of Medicine, Adelaide University, Adelaide, Australia
- Northern Adelaide Local Health Network (NALHN), Australia
- Ramsey Health Care (SA) Mental Health, Australia
- Corresponding author at: The Adelaide Clinic, 33 Park Tce, Gilberton, SA 5081, Australia.
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Happell B, Curtis J, Banfield M, Goss J, Niyonsenga T, Watkins A, Platania-Phung C, Moon L, Batterham P, Scholz B, Prescott V, Stanton R. Improving the cardiometabolic health of people with psychosis: A protocol for a randomised controlled trial of the Physical Health Nurse Consultant service. Contemp Clin Trials 2018; 73:75-80. [PMID: 30208344 DOI: 10.1016/j.cct.2018.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/29/2018] [Accepted: 09/04/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Over 690,000 Australians experience psychosis annually, significantly impacting cardiometabolic illness and healthcare costs. Current models of care are fragmented and a critical implementation gap exists regarding the delivery of coordinated physical healthcare for Australians with psychosis. OBJECTIVES To describe a trial implementing a Physical Health Nurse Consultant (PHNC) role to coordinate physical health care in a community mental health setting. DESIGN/METHODS In this 24-month, 2-group randomised controlled trial, 160 adults with psychosis will be randomised to usual care, or to the PHNC in addition to usual care. Using the Positive Cardiometabolic Health treatment framework and working in collaborative partnerships with consumers (consumer-led co-design), the PHNC will provide care coordination including referral to appropriate programmes or services based on the treatment framework, with the consumer. Burden of Disease risk factors will be collected according to Australian Bureau of Statistics' National Health Survey guidelines. Consumer experience will be assessed using the 'Access', 'Acceptability' and 'Shared Decision Making' dimensions of the Patient Experiences in Primary Healthcare Survey. Cost-effectiveness will be modelled from Burden of Disease data using the Assessing Cost Effectiveness Prevention methodology. RESULTS Data collection of two years duration will commence in late 2018. Preliminary findings are expected in December 2019. Primary outcomes will be the effect of the PHNC role on physical healthcare in community-based adults with psychosis. CONCLUSIONS The PHNC is an innovative approach to physical health care for adults with psychosis which aims to meet the physical health needs of consumers by addressing barriers to physical health care.
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Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, University of Newcastle University Drive Callaghan New South Wales, 2308, Australia.
| | - Jackie Curtis
- Youth Mental Health, South Eastern Sydney Local Health District and Conjoint Senior Lecturer, University of New South Wales, Australia.
| | - Michelle Banfield
- Head, ACACIA: The ACT Consumer & Carer Mental Health Research Unit, Centre for Mental Health Australian National University, Australia.
| | - John Goss
- UC Health Research Institute, University of Canberra, Australia.
| | | | - Andrew Watkins
- Co-clinical lead - Keeping the Body in Mind Program, NSW Health, Australia.
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle University Drive Callaghan New South Wales, 2308, Australia
| | - Lynelle Moon
- Head, Health Group, Australian Institute for Health and Welfare, Australia.
| | - Philip Batterham
- Centre for Mental Health Research, Research School of Population Health, Australian National University, Australia.
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Australia.
| | - Vanessa Prescott
- Senior Data analyst/project manager, Australian Institute of Health and Welfare, Australia.
| | - Robert Stanton
- Research Cluster Leader - Muscular and Skeletal Health, School of Health, Medical and Applied Sciences, Central Queensland University, Australia.
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42
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Happell B, Platania-Phung C, Bocking J, Ewart SB, Scholz B, Stanton R. Consumers at the centre: interprofessional solutions for meeting mental health consumers’ physical health needs. J Interprof Care 2018; 33:226-234. [DOI: 10.1080/13561820.2018.1516201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia
| | | | - Julia Bocking
- Synergy, Nursing and Midwifery Research Centre, University of Canberra, WODEN, Australia
| | | | - Brett Scholz
- Research Fellow ANU Medical School, College of Health and Medicine, The Australian National University, Woden Canberra, Australia
| | - Robert Stanton
- School of Medical and Applied Sciences Bruce Highway, Central Queensland University, Rockhampton, Australia
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Cardio-metabolic risk and its management in a cohort of clozapine-treated outpatients. Schizophr Res 2018; 199:367-373. [PMID: 29486959 DOI: 10.1016/j.schres.2018.02.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/13/2017] [Accepted: 02/19/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To comprehensively assess cardio-metabolic risk factors and their management in a large sample of outpatients treated with clozapine. METHODS Observational cross-sectional study of all clozapine users attending specialized clozapine monitoring outpatient clinics in three public hospitals in Sydney, Australia were approached to participate over the one-year period 01/10/2015-30/09/2016. Cardio-metabolic risk factors including metabolic syndrome, risk for future development of diabetes, smoking, physical activity, nutrition, and prescribed medications were assessed at face-to-face interview and through medical record review. Among patients who had cardio-metabolic risk factors, the proportion receiving appropriate management was assessed. RESULTS Of 451 registered clozapine clinic attenders, 92.2% completed questionnaires and anthropometric measurements. 58.3% met criteria for metabolic syndrome. 79.6% were overweight or obese. 55.9% had blood pressure meeting metabolic syndrome criteria. 46.6% had elevated fasting blood glucose and 55.2% had elevated blood triglycerides. 43.6% were current smokers. Only 10% achieved recommended weekly physical activity levels. Unhealthy food categories were highly consumed. 32.1% were on additional antipsychotics. In the majority of individuals, cardio-metabolic risk factors were untreated or under-treated. CONCLUSIONS Clozapine use was associated with very high rates of cardiovascular and metabolic risk factors, which were frequently under-treated. Management of both physical and mental health should be prioritized. Polypharmacy should be rationalized. Future research should investigate the effectiveness of smoking cessation and lifestyle interventions in this high-risk population.
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Battersby M, Kidd MR, Licinio J, Aylward P, Baker A, Ratcliffe J, Quinn S, Castle DJ, Zabeen S, Fairweather-Schmidt AK, Lawn S. Improving cardiovascular health and quality of life in people with severe mental illness: study protocol for a randomised controlled trial. Trials 2018; 19:366. [PMID: 29996886 PMCID: PMC6042320 DOI: 10.1186/s13063-018-2748-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 06/19/2018] [Indexed: 11/30/2022] Open
Abstract
Background The estimated 300,000 adults in Australia with severe mental illness (SMI) have markedly reduced life expectancy compared to the general population, mainly due to physical health comorbidities. Cardiovascular disease (CVD) is the commonest cause of early death and people with SMI have high rates of most modifiable risk factors, with associated quality of life (QoL) reduction. High blood pressure, smoking, dyslipidaemia, diabetes and obesity are major modifiable CVD risk factors. Poor delivery of recommended monitoring and risk reduction is a national and international problem. Therefore, effective preventive interventions to safeguard and support physical health are urgently needed in this population. Methods This trial used a rigorous process, including extensive piloting, to develop an intervention that delivers recommended physical health care to reduce CVD risk and improve QoL for people with SMI. Components of this intervention are integrated using the Flinders Program of chronic condition management (CCM) which is a comprehensive psychosocial care planning approach that places the patient at the centre of their care, and focuses on building their self-management capacity within a collaborative approach, therefore providing a recovery-oriented framework. The primary project aim is to evaluate the effectiveness and health economics of the CCM intervention. The main outcome measures examine CVD risk and quality of life. The second aim is to identify essential components, enablers and barriers at patient, clinical and organisational levels for national, sustained implementation of recommended physical health care delivery to people with SMI. Participants will be recruited from a community-based public psychiatric service. Discussion This study constitutes the first large-scale trial, worldwide, using the Flinders Program with this population. By combining a standardised yet flexible motivational process with a targeted set of evidence-based interventions, the chief aim is to reduce CVD risk by 20%. If achieved, this will be a ground-breaking outcome, and the program will be subsequently translated nationwide and abroad. The trial will be of great interest to people with mental illness, family carers, mental health services, governments and primary care providers because the Flinders Program can be delivered in diverse settings by any clinical discipline and supervised peers. Trial registration Australian and New Zealand Clinical Trials Registry, ACTRN12617000474358. Registered on 31 March 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2748-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Malcolm Battersby
- Mental Health Services, Southern Adelaide Local Health Network (SAHLN), Margaret Tobin Centre, Bedford Park, South Australia, 5042, Australia.,Flinders Human Behaviour & Health Research Unit (FHBHRU), Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Margaret Tobin Centre, GPO Box 2100, Adelaide, South Australia, 5001, Australia
| | - Michael R Kidd
- Department of Family & Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.,Global Primary Care, Southgate Institute for Health, Society and Equity, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia
| | - Julio Licinio
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, 5000, Australia
| | - Philip Aylward
- Division of Medicine, Cardiac and Critical Care Services, Southern Adelaide Local Health Network (SALHN), Flinders Cardiac Clinic, Flinders Private Hospital, Bedford Park, South Australia, 5042, Australia
| | - Amanda Baker
- NHMRC Centre of Research Excellence in Mental Health and Substance Use, NHMRC Senior Research Fellow, School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia
| | - Julie Ratcliffe
- Health Economics in the Institute for Choice, School of Business, University of South Australia, City West Campus (WL3-65), GPO Box 2471, Adelaide, South Australia, 5001, Australia
| | - Stephen Quinn
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, ATC-922, John Street, Hawthorn, VIC, 3122, Australia
| | - David J Castle
- St. Vincent's Hospital Melbourne and The University of Melbourne, PO Box 2900, Fitzroy, VIC, 3065, Australia
| | - Sara Zabeen
- Flinders Human Behaviour & Health Research Unit (FHBHRU), Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Margaret Tobin Centre, GPO Box 2100, Adelaide, South Australia, 5001, Australia
| | - A Kate Fairweather-Schmidt
- Flinders Human Behaviour & Health Research Unit (FHBHRU), Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Margaret Tobin Centre, GPO Box 2100, Adelaide, South Australia, 5001, Australia
| | - Sharon Lawn
- Flinders Human Behaviour & Health Research Unit (FHBHRU), Discipline of Psychiatry, College of Medicine and Public Health, Flinders University, Margaret Tobin Centre, GPO Box 2100, Adelaide, South Australia, 5001, Australia.
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Bartels-Velthuis AA, Visser E, Arends J, Pijnenborg GHM, Wunderink L, Jörg F, Veling W, Liemburg EJ, Castelein S, Knegtering H, Bruggeman R. Towards a comprehensive routine outcome monitoring program for people with psychotic disorders: The Pharmacotherapy Monitoring and Outcome Survey (PHAMOUS). Schizophr Res 2018; 197:281-287. [PMID: 29395613 DOI: 10.1016/j.schres.2018.01.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 10/02/2017] [Accepted: 01/17/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Patients with psychotic disorders are at risk of developing mental health and social problems, and physical disorders. To monitor and treat these problems when indicated, an annual routine outcome monitoring program, Pharmacotherapy Monitoring and Outcome Survey (PHAMOUS), was developed. This paper presents the background and content of PHAMOUS, implementation of PHAMOUS, characteristics of the patients screened in 2015, and the outcome of patients with three annual screenings between 2011 and 2015. METHODS PHAMOUS was implemented in four mental health institutions in the Northern Netherlands in 2006. During the PHAMOUS screening, patients are assessed on socio-demographics, psychiatric symptoms, medication, physical parameters, lifestyle, (psycho)social functioning and quality of life, using internationally validated instruments. RESULTS In 2015, 1955 patients with psychotic disorders were enrolled in the PHAMOUS screening. The majority (72%) was receiving mental healthcare for ten years or longer. A small group was hospitalized (10%) in the past year. Half of the patients were in symptomatic remission. Less than 10% had a paid job. More than half of the patients fulfilled the criteria for metabolic syndrome (54%). The subsample with three annual screenings from 2011 to 2015 (N = 1230) was stable, except the increasing prevalence of high glucose levels and satisfaction with social relationships (Cochran's Q = 16.33, p = .001 resp. Q = 14.79, p = .001). CONCLUSION The annual PHAMOUS screening enables to follow the mental, physical and social health problems of patients, which offers a good basis for shared-decision making with regard to updating the annual treatment plan, next to a wealth of data for scientific research.
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Affiliation(s)
- Agna A Bartels-Velthuis
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Hanzeplein 1 (CC72), 9713 GZ Groningen, The Netherlands; Lentis Mental Health Institution, Hereweg 80, 9725 AG Groningen, The Netherlands.
| | - Ellen Visser
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Hanzeplein 1 (CC72), 9713 GZ Groningen, The Netherlands.
| | - Johan Arends
- GGZ Drenthe, Mental Health Institution, Dennenweg 9, 9404 LA Assen, The Netherlands.
| | - Gerdina H M Pijnenborg
- GGZ Drenthe, Mental Health Institution, Dennenweg 9, 9404 LA Assen, The Netherlands; University of Groningen, Faculty of Behavioural and Social Sciences, Department of Clinical Psychology & Experimental Psychopathology, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands.
| | - Lex Wunderink
- GGZ Friesland Mental Health Institution, Sixmastraat 2, 8932 PA Leeuwarden, The Netherlands.
| | - Frederike Jörg
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Hanzeplein 1 (CC72), 9713 GZ Groningen, The Netherlands; GGZ Friesland Mental Health Institution, Sixmastraat 2, 8932 PA Leeuwarden, The Netherlands.
| | - Wim Veling
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Psychosis Department, Hanzeplein 1 (CC60), 9713 GZ Groningen, The Netherlands.
| | - Edith J Liemburg
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Hanzeplein 1 (CC72), 9713 GZ Groningen, The Netherlands.
| | - Stynke Castelein
- Lentis Mental Health Institution, Hereweg 80, 9725 AG Groningen, The Netherlands.
| | - Henderikus Knegtering
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Hanzeplein 1 (CC72), 9713 GZ Groningen, The Netherlands; Lentis Mental Health Institution, Hereweg 80, 9725 AG Groningen, The Netherlands.
| | - Richard Bruggeman
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Hanzeplein 1 (CC72), 9713 GZ Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Pharmacy, Division of Pharmacotherapy and Pharmaceutical Care, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands.
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Mucheru D, Hanlon MC, Campbell LE, McEvoy M, MacDonald-Wicks L. Cardiovascular disease lifestyle risk factors in people with psychosis: a cross-sectional study. BMC Public Health 2018; 18:742. [PMID: 29907101 PMCID: PMC6003197 DOI: 10.1186/s12889-018-5649-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 05/31/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND People with psychosis die on average 25 years earlier than those in the general population, with cardiovascular disease (CVD) contributing to much of the excess mortality. This cross-sectional study aimed to identify the relationship between lifestyle risk factors for CVD - poor nutrition, smoking and low physical activity levels - and dyslipidaemia, hypertension and hyperglycaemia while controlling for potential confounders in 1825 people from the Survey of High Impact Psychosis (SHIP) in Australia. We also aimed to identify clustering patterns of lifestyle risk factors and associated demographic variables. METHODS Three logistic regressions were used to predict the effect of nutrition, smoking and physical activity on dyslipidaemia, hypertension and hyperglycaemia while controlling for clozapine use, sex and age. Clustering patterns of nutrition, smoking and physical activity were examined using the two-step cluster method which is based on hierarchical cluster analysis. Demographic variables associated with different clusters were identified using measures of association. RESULTS Smoking status had a positive association with dyslipidaemia (adjusted odds ratio = 0.50; 95% confidence interval = 0.32-0.78; p = 0.002). Other cardiovascular disease lifestyle risk factors did not have a significant relationship with dyslipidaemia, hypertension and hyperglycaemia. Clustering patterns of lifestyle risk factors showed that younger men, with low education levels, and relying on a government pension, were most likely to display the poorest lifestyle risk behaviours. The largest cluster (42%) of participants was characterised by a mixed demographic profile and were most likely to display poor nutrition and low physical activity levels but less likely to smoke. CONCLUSIONS Only smoking status had a significant positive association with dyslipidaemia which could indicate that there are additional factors affecting the relationship between other cardiovascular lifestyle risk factors and dyslipidaemia, hypertension and hyperglycaemia in people with psychosis. Unknown confounders and traditional lifestyle risk factors may explain the high rates of CVD in this group. Clustering of lifestyle risk factors and their demographic profiles could help the design of intervention programs in people with psychosis.
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Affiliation(s)
- Doreen Mucheru
- Faculty Health and Medicine, The University of Newcastle, Callaghan, 2308 Australia
| | - Mary-Claire Hanlon
- Faculty Health and Medicine, The University of Newcastle, Callaghan, 2308 Australia
- Brain and Mental Health Program, Hunter Medical Research Institute, New Lambton, 2305 Australia
- Priority Research Centre for Brain and Mental Health, The University of Newcastle, Callaghan, 2308 Australia
- School of Medicine and Public Health, The University of Newcastle, Callaghan, 2308 Australia
| | - Linda E. Campbell
- Brain and Mental Health Program, Hunter Medical Research Institute, New Lambton, 2305 Australia
- Faculty of Science, The University of Newcastle, Callaghan, 2308 Australia
- Priority Research Centre GrowUpWell, The University of Newcastle, Callaghan, 2308 Australia
| | - Mark McEvoy
- Faculty Health and Medicine, The University of Newcastle, Callaghan, 2308 Australia
- Centre for Clinical Epidemiology & Biostatistics, Hunter Medical Research Institute, New Lambton, 2305 Australia
| | - Lesley MacDonald-Wicks
- Faculty Health and Medicine, The University of Newcastle, Callaghan, 2308 Australia
- Brain and Mental Health Program, Hunter Medical Research Institute, New Lambton, 2305 Australia
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, 2308 Australia
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The "Double Whammy": Women's Experiences of Weight Gain After Diagnosis and Treatment for Schizophrenia Spectrum Disorders. J Nerv Ment Dis 2018. [PMID: 29528882 DOI: 10.1097/nmd.0000000000000803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
High levels of lifestyle risk factors compound medication side effects, resulting in high rates of obesity among people with schizophrenia spectrum disorders (SSDs). Obesity and related comorbidities increase the levels of disability and disadvantage in this population. Little research has explored the lived experiences in relation to this issue, and less has considered the experiences of women. Our aim in this study was to understand the experiences of women who gained weight after their diagnosis and treatment for SSDs. We carried out up to three in-depth qualitative interviews with 11 women over 2 years. Data were analyzed using constructivist grounded theory procedures. The women described a "double whammy"-like experience whereby weight gain and obesity came with their diagnosis and treatment of an SSD and brought with it additional challenges. The double whammy parallels the co-occurrence of mental illness and substance misuse. Implications of these parallels for service provision are discussed.
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Ringen PA, Faerden A, Antonsen B, Falk RS, Mamen A, Rognli EB, Solberg DK, Andreassen OA, Martinsen EW. Cardiometabolic risk factors, physical activity and psychiatric status in patients in long-term psychiatric inpatient departments. Nord J Psychiatry 2018. [PMID: 29523041 DOI: 10.1080/08039488.2018.1449012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Cardiovascular diseases are a major cause for the markedly reduced life expectancy in people with severe mental illness (SMI). Hospital departments should provide adequate prevention of cardiometabolic risk by optimizing prevention and treatment. Characteristics of cardiometabolic risk factors in inpatients are still not well known. We aimed to describe the status of cardiometabolic risk factors in inpatients with SMI and identify associations with psychiatric status and treatment. METHODS A cross sectional descriptive study of inpatients with SMI from long term psychosis treatment wards in South Eastern Norway was performed. Comprehensive assessments of cardiometabolic risk factors, physical activity, lifestyle habits, symptoms, life satisfaction and treatment were made. Associations and potential prognostic factors were analyzed using linear and logistic regressions. RESULTS A total of 83 patients were included in the study, but many individual datasets were incomplete. Over half of the subjects had unhealthy eating habits. Obesity (class 1-3) was found in 44%, 23% had elevated fasting triglycerides, 26% had elevated blood pressure and 78% smoked daily. Low levels of physical activity were significantly associated with higher levels of depression (p = .007). A nominal increase in cardiometabolic risk factors was found for olanzapine and clozapine users. CONCLUSION Inpatients in long term psychosis treatment wards have alarmingly high cardiometabolic risk. Level of physical activity was associated with both psychiatric and somatic health. Focus on lifestyle and somatic health should be an integral part of the treatment for hospitalized SMI patients.
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Affiliation(s)
- Petter Andreas Ringen
- a Division of Mental Health and Addiction , Oslo University Hospital , Oslo , Norway.,b NORMENT, KG Jebsen Centre, Oslo University Hospital , Oslo , Norway
| | - Ann Faerden
- a Division of Mental Health and Addiction , Oslo University Hospital , Oslo , Norway
| | - Bjørnar Antonsen
- c Department of Psychiatry , Lovisenberg Diaconal Hospital , Oslo , Norway
| | - Ragnhild S Falk
- d Oslo Centre for Biostatistics and Epidemiology , Oslo University Hospital , Oslo , Norway
| | - Asgeir Mamen
- e Insitute for Health Sciences, Kristiania University College , Oslo , Norway
| | - Eline B Rognli
- f Division of Mental Health and Addiction , Oslo University Hospital, Ullevål Hospital , Oslo , Norway
| | - Dag K Solberg
- g Skjelfoss Psychiatric Center, Lukas Foundation and Center for Psychopharmacology , Diakonhjemmet Hospital , Oslo , Norway
| | - Ole A Andreassen
- b NORMENT, KG Jebsen Centre, Oslo University Hospital , Oslo , Norway.,h University of Oslo, Ullevål Hospital , Oslo , Norway
| | - Egil W Martinsen
- a Division of Mental Health and Addiction , Oslo University Hospital , Oslo , Norway.,h University of Oslo, Ullevål Hospital , Oslo , Norway
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Fraser SJ, Brown WJ, Whiteford HA, Burton NW. Impact of nurse-led behavioural counselling to improve metabolic health and physical activity among adults with mental illness. Int J Ment Health Nurs 2018; 27:619-630. [PMID: 28466504 DOI: 10.1111/inm.12343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2017] [Indexed: 01/27/2023]
Abstract
The life expectancy of adults with mental illness is significantly less than that of the general population, and this is largely due to poor physical health. Behavioural counselling can improve physical health indicators among people with non-communicable disease. This repeated-measures, single-group intervention trial evaluated the effects of a 19-week behavioural counselling programme on metabolic health indicators and physical activity levels of outpatient adults with mental illness. Sixteen participants completed the intervention that comprised individual face-to-face counselling sessions with a registered nurse every 3 weeks, and progress reviews with a medical practitioner every 6 weeks. Assessment included self-report and objective measurement of physical activity, and measures of blood pressure and anthropometry. Statistically-significant changes were demonstrated between baseline and post intervention for participants' waist circumference (P = 0.035) and waist-to-height ratio (P = 0.037). Non-significant improvements were demonstrated in weight and physical activity. The findings indicated that adults with mental illness can engage in a nurse-led behavioural counselling intervention, with improvements in some metabolic health measures after 19 weeks. It is recommended that behavioural counselling programmes for adults with mental illness be sustained over time and have an 'open door' policy to allow for attendance interruptions, such as hospitalization.
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Affiliation(s)
- Sarah J Fraser
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Wendy J Brown
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Harvey A Whiteford
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Nicola W Burton
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
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Castle DJ, Chung E. Cardiometabolic comorbidities and life expectancy in people on medication for schizophrenia in Australia. Curr Med Res Opin 2018; 34:613-618. [PMID: 29276845 DOI: 10.1080/03007995.2017.1419946] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to assess the risks of people on medication for schizophrenia developing different components of the metabolic syndrome and their life expectancy, through reference to a representative population of Australians without schizophrenia. METHOD Pharmacy payment-claim records from the Pharmaceutical Benefits Scheme were analyzed based on a representative 10% sample of Medicare numbers supplied by the Department of Human Services. Records were analyzed based on the date of supply of the prescription and the dataset included year of death information. Two major analyses were conducted for 9,533 people on medication for schizophrenia and a 1:1 sex/age matched control, followed for up to 7 years. Patient life expectancy was estimated by performing a Kaplan Meier survival analysis. RESULTS People on medication for schizophrenia compared to controls were 1.91-times (95% CI = 1.66-2.21) and 1.28-times (95% CI = 1.15-1.43) more likely to start treatment for diabetes and hyperlipidemia, respectively, but were no more likely to start treatment for hypertension (hazard ratio = 0.87; 95% CI = 0.78-0.97). Overall, people on medication for schizophrenia were 1.32-times more likely to start treatment for one of these three comorbidities. Median life expectancy was assessed as 80 years for people on medication for schizophrenia, and 91 years for controls. CONCLUSIONS The results for this study confirm in a large representative Australian sample of people on medication for schizophrenia, an excess risk of components of the metabolic syndrome and early death.
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Affiliation(s)
- David J Castle
- a St Vincent's Hospital , Melbourne , Australia
- b Department of Psychiatry, The University of Melbourne , Australia
| | - Eric Chung
- c Prospection Pty Ltd , Sydney , Australia
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