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Bui TNT, Au RT, Janetzki JL, McMillan SS, Hotham E, Suppiah V. Metabolic Monitoring for Adults Living with a Serious Mental Illness on a Second-Generation Antipsychotic Agent: A Scoping Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01408-9. [PMID: 39154118 DOI: 10.1007/s10488-024-01408-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2024] [Indexed: 08/19/2024]
Abstract
Premature mortality in people living with a severe mental illness (SMI) is often attributed to multiple factors including the use of medicines such as antipsychotics. Second-generation antipsychotics (SGAs) are known to cause metabolic syndrome which can increase the risk of cardiovascular disease. Practice guidelines have recommended regular physical health monitoring, particularly of metabolic parameters, however, metabolic monitoring for people living with SMI using antipsychotics remains suboptimal. Therefore, highlighting the need for ongoing research. This scoping review aimed to provide an overview of current metabolic monitoring practices. We anticipate that this information will assist clinicians and policymakers and inform future research. The following databases were searched: MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), the Cochrane Database of Systemic Reviews (Wiley), APA PsycInfo (Ovid) and Scopus (Elsevier Science Publishers). The target group was adults (aged ≥ 18) diagnosed with SMI (including bipolar disorder, major depressive disorder and psychotic disorders) and taking SGAs. In total, 44 studies from 14 countries were retrieved. Our findings highlighted that most studies conducted in hospitals did not report on metabolic monitoring practices. Additionally, the roles and responsibilities of healthcare professionals in metabolic monitoring for SMI were infrequently described and parameters such as waist circumference and BMI were often poorly monitored. The scoping review highlights that no streamlined approach towards metabolic monitoring currently exists. There is a need to stipulate and define the roles and responsibilities of all health professionals involved in metabolic monitoring in SMI to optimise care for these individuals. Moreover, there is a need for ongoing research, particularly in the community setting, to promote increased accessibility to metabolic monitoring for SMI.
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Affiliation(s)
- Tien Ngoc Thi Bui
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Ruby Tszwai Au
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Jack Luke Janetzki
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Sara S McMillan
- Centre for Mental Health, Griffith University, Brisbane, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Cost, QLD, Australia
- School of Pharmacy and Medical Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Elizabeth Hotham
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Vijayaprakash Suppiah
- Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia.
- Australian Centre for Precision Health, University of South Australia, Adelaide, SA, Australia.
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Yang H, Zhu D, Liu Y, Xu Z, Liu Z, Zhang W, Cai J. Employing graph attention networks to decode psycho-metabolic interactions in Schizophrenia. Psychiatry Res 2024; 335:115841. [PMID: 38522150 DOI: 10.1016/j.psychres.2024.115841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/31/2024] [Accepted: 03/04/2024] [Indexed: 03/26/2024]
Abstract
Schizophrenia is a severe mental disorder characterized by intricate and underexplored interactions between psychological symptoms and metabolic health, presenting challenges in understanding the disease mechanisms and designing effective treatment strategies. To delve deeply into the complex interactions between mental and metabolic health in patients with schizophrenia, this study constructed a psycho-metabolic interaction network and optimized the Graph Attention Network (GAT). This approach reveals complex data patterns that traditional statistical analyses fail to capture. The results show that weight management and medication management play a central role in the interplay between psychiatric disorders and metabolic health. Furthermore, additional analysis revealed significant correlations between the history of psychiatric symptoms and physical health indicators, as well as the key roles of biochemical markers(e.g., triglycerides and low-density lipoprotein cholesterol), which have not been sufficiently emphasized in previous studies. This highlights the importance of medication management approaches, weight management, psychological treatment, and biomarker monitoring in comprehensive treatment and underscores the significance of the biopsychosocial model. This study is the first to utilize a GNN to explore the interactions between schizophrenia symptoms and metabolic features, providing new insights into understanding psychiatric disorders and guiding the development of more comprehensive treatment strategies for schizophrenia.
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Affiliation(s)
- Hongyi Yang
- School of Design, Shanghai Jiao Tong University, Shanghai, PR China
| | - Dian Zhu
- School of Design, Shanghai Jiao Tong University, Shanghai, PR China
| | - YanLi Liu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
| | - Zhiqi Xu
- School of Design, Shanghai Jiao Tong University, Shanghai, PR China
| | - Zhao Liu
- School of Design, Shanghai Jiao Tong University, Shanghai, PR China.
| | - Weibo Zhang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, PR China; Mental Health Branch, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, PR China.
| | - Jun Cai
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Mental Health Branch, China Hospital Development Institute, Shanghai Jiao Tong University, Shanghai, PR China.
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Al-Awad FA, Almutairi HA, Almutairi SA, Alessa OS, Alanazi SF, Alzain NM, Albakr DM, Alzahrani SI. Adherence to the monitoring of metabolic syndrome in patients receiving antipsychotics in outpatient clinics in Saudi Arabia. J Family Community Med 2024; 31:42-47. [PMID: 38406217 PMCID: PMC10883427 DOI: 10.4103/jfcm.jfcm_153_23] [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: 06/14/2023] [Revised: 10/24/2023] [Accepted: 11/05/2023] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Monitoring protocols have been developed because patients taking atypical antipsychotics are more prone to developing metabolic syndrome, which leads to possible increased mortality and morbidity. The aim of this study was to assess the degree of adherence to the recommendations of metabolic syndrome monitoring. MATERIALS AND METHODS This study was conducted in two large psychiatric facilities in the Eastern Province of Saudi Arabia. A retrospective analysis of the medical records of 350 patients taking antipsychotic medications was done, and an assessment was made of the frequency of metabolic monitoring at each of the intervals as suggested by the American Diabetes Association. Data was analyzed using SPSS; descriptive statistics. were computed and Chi-square test was used to determine statistical significance for association between categorical variable. RESULTS The mean age of the patients was 34.9 ± 18 years; 64.6% were males. Olanzapine was the most prescribed medication (43.7%, n = 153), followed by quetiapine (17.4%, n = 61). Only one-third of the patients (29.6%) completed all the baseline parameters. Documentation of baseline parameters was low for glucose level (38.9%), lipid panel (17.3%), weight (25.2%), and waist circumference (1.4%). Adherence to yearly monitoring was much lower than at baseline (mean percentage: 29.6% vs. 1.7%). Furthermore, 45% of the patients were classified as obese and 10% had metabolic comorbidity. CONCLUSION Individuals with mental illness who were taking antipsychotics did not undergo proper metabolic screening during antipsychotic treatment. Barriers to adherence to the monitoring guidelines should be examined and addressed. Giving assistance to practitioners to recall the required laboratory tests and vitals at certain intervals could help improve metabolic monitoring practices.
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Affiliation(s)
- Feras A. Al-Awad
- Department of Psychiatry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hussien A. Almutairi
- Department of Psychiatry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Saad A. Almutairi
- Department of Psychiatry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Othman S. Alessa
- Department of Psychiatry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Salman F. Alanazi
- Department of Psychiatry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nasser M. Alzain
- Department of Psychiatry, Eradah Complex and Mental Health, Dammam, Saudi Arabia
| | - Dalal M. Albakr
- Department of Psychiatry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Safa I. Alzahrani
- Department of Psychiatry, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Azfr Ali R, Jalal Z, Chandan JS, Subramanian A, Adderley NJ, Nirantharakumar K, Gokhale KM, Paudyal V. Cardiometabolic screening and monitoring in patients prescribed antipsychotic drugs in primary care: A population-based cohort study. Compr Psychiatry 2023; 127:152419. [PMID: 37717342 DOI: 10.1016/j.comppsych.2023.152419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND This study aimed to investigate the level of guideline adherence for cardiometabolic health monitoring for patients prescribed antipsychotic medicines in UK primary care. METHODS In this population-based retrospective open cohort study, we used dataset of patients from the IQVIA Medical Research Data (IMRD) database between 1st January 2003 to 31st December 2018. Clinical Read codes were used to identify a cohort of adult patients with a diagnosis of Schizophrenia and at least four prescriptions of an anti-psychotic medication within 12 months of diagnosis. We then extracted data in relation to monitoring of cardiometabolic parameters (body compositions, lipids, and glucose outcomes) at baseline, then at six weeks, 12 weeks, and then 12 months. The frequency of outcome monitoring was described using descriptive statistics. FINDINGS A total of 11,435 patients were eligible and of them (n = 9707; 84·8%) were prescribed second-generation antipsychotics (SGAs). Only a small portion of the cohort (≈2·0%) received complete monitoring (at time points) for certain outcomes. Just over half the patients (n = 6599, 52%) had evidence of any cardiometabolic baseline testing for any of the study outcomes and the high majority had at least one abnormal lab value at baseline (n = 4627, 96·7%). INTERPRETATION In UK primary care, cardiometabolic monitoring practices among patients prescribed antipsychotics remain suboptimal. There is a need to promote guideline adherence to prevent adverse outcomes in antipsychotic users.
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Affiliation(s)
- Ruba Azfr Ali
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; Clnical Pharmacy Department, Schoolof Pharmacy, Umm Al Qura University, Makkah, KSA
| | - Zahraa Jalal
- School of Pharmacy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Joht Singh Chandan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Nicola J Adderley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Krishna M Gokhale
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Vibhu Paudyal
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
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Olszanecka-Glinianowicz M, Mazur A, Chudek J, Kos-Kudła B, Markuszewski L, Dudek D, Major P, Małczak P, Tarnowski W, Jaworski P, Tomiak E. Obesity in Adults: Position Statement of Polish Association for the Study on Obesity, Polish Association of Endocrinology, Polish Association of Cardiodiabetology, Polish Psychiatric Association, Section of Metabolic and Bariatric Surgery of the Association of Polish Surgeons, and the College of Family Physicians in Poland. Nutrients 2023; 15:nu15071641. [PMID: 37049479 PMCID: PMC10097178 DOI: 10.3390/nu15071641] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 03/30/2023] Open
Abstract
Obesity in adults and its complications are among the most important problems of public health. The search was conducted by using PubMed/MEDLINE, Cochrane Library, Science Direct, MEDLINE, and EBSCO databases from January 2010 to December 2022 for English language meta-analyses, systematic reviews, randomized clinical trials, and observational studies from all over the world. Six main topics were defined in the joint consensus statement of the Polish Association for the Study on Obesity, the Polish Association of Endocrinology, the Polish Association of Cardio-diabetology, the Polish Psychiatric Association, the Section of Metabolic and Bariatric Surgery of the Society of Polish Surgeons, and the College of Family Physicians in Poland: (1) the definition, causes and diagnosis of obesity; (2) treatment of obesity; (3) treatment of main complications of obesity; (4) bariatric surgery and its limitations; (5) the role of primary care in diagnostics and treatment of obesity and barriers; and (6) recommendations for general practitioners, regional authorities and the Ministry of Health. This statement outlines the role of an individual and the adequate approach to the treatment of obesity: overcoming obstacles in the treatment of obesity by primary health care. The approach to the treatment of obesity in patients with its most common complications is also discussed. Attention was drawn to the importance of interdisciplinary cooperation and considering the needs of patients in increasing the long-term effectiveness of obesity management.
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Affiliation(s)
- Magdalena Olszanecka-Glinianowicz
- Health Promotion and Obesity Management Unit, Department of Pathophysiology, Medical Faculty in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
- Correspondence:
| | - Artur Mazur
- Institute of Medical Sciences, Medical College of Rzeszow University, University of Rzeszów, 35-601 Rzeszow, Poland;
| | - Jerzy Chudek
- Department of Internal Diseases and Oncological Chemotherapy, Medical Faculty in Katowice, Medical University of Silesia, 40-027 Katowice, Poland
| | - Beata Kos-Kudła
- Department of Endocrinology and Neuroendocrine Tumors, Department of Pathophysiology and Endocrinology, Medical University of Silesia, 40-055 Katowice, Poland
| | - Leszek Markuszewski
- Faculty of Medical Sciences and Health Sciences, University of Humanities and Technology in Radom, 26-600 Radom, Poland
| | - Dominika Dudek
- Department of Psychiatry, Jagiellonian University Medical College, 31-008 Cracow, Poland
| | - Piotr Major
- 2nd Department of General Surgery, Jagiellonian University Medical College, 31-008 Cracow, Poland
| | - Piotr Małczak
- 2nd Department of General Surgery, Jagiellonian University Medical College, 31-008 Cracow, Poland
| | - Wiesław Tarnowski
- Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, 00-416 Warsaw, Poland
| | - Paweł Jaworski
- Department of General, Oncological and Bariatric Surgery, Centre of Postgraduate Medical Education, Orłowski Hospital, 00-416 Warsaw, Poland
| | - Elżbieta Tomiak
- The College of Family Physicians in Poland, 00-209 Warsaw, Poland
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Qubad M, Bittner RA. Second to none: rationale, timing, and clinical management of clozapine use in schizophrenia. Ther Adv Psychopharmacol 2023; 13:20451253231158152. [PMID: 36994117 PMCID: PMC10041648 DOI: 10.1177/20451253231158152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/24/2023] [Indexed: 03/31/2023] Open
Abstract
Despite its enduring relevance as the single most effective and important evidence-based treatment for schizophrenia, underutilization of clozapine remains considerable. To a substantial degree, this is attributable to a reluctance of psychiatrists to offer clozapine due to its relatively large side-effect burden and the complexity of its use. This underscores the necessity for continued education regarding both the vital nature and the intricacies of clozapine treatment. This narrative review summarizes all clinically relevant areas of evidence, which support clozapine's wide-ranging superior efficacy - for treatment-resistant schizophrenia (TRS) and beyond - and make its safe use eminently feasible. Converging evidence indicates that TRS constitutes a distinct albeit heterogeneous subgroup of schizophrenias primarily responsive to clozapine. Most importantly, the predominantly early onset of treatment resistance and the considerable decline in response rates associated with its delayed initiation make clozapine an essential treatment option throughout the course of illness, beginning with the first psychotic episode. To maximize patients' benefits, systematic early recognition efforts based on stringent use of TRS criteria, a timely offer of clozapine, thorough side-effect screening and management as well as consistent use of therapeutic drug monitoring and established augmentation strategies for suboptimal responders are crucial. To minimize permanent all-cause discontinuation, re-challenges after neutropenia or myocarditis should be considered. Owing to clozapine's unique efficacy, comorbid conditions including substance use and most somatic disorders should not dissuade but rather encourage clinicians to consider clozapine. Moreover, treatment decisions need to be informed by the late onset of clozapine's full effects, which for reduced suicidality and mortality rates may not even be readily apparent. Overall, the singular extent of its efficacy combined with the high level of patient satisfaction continues to distinguish clozapine from all other available antipsychotics.
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Affiliation(s)
- Mishal Qubad
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
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Blood and Urinary Biomarkers of Antipsychotic-Induced Metabolic Syndrome. Metabolites 2022; 12:metabo12080726. [PMID: 36005598 PMCID: PMC9416438 DOI: 10.3390/metabo12080726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 12/15/2022] Open
Abstract
Metabolic syndrome (MetS) is a clustering of at least three of the following five medical conditions: abdominal obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein (HDL). Antipsychotic (AP)-induced MetS (AIMetS) is the most common adverse drug reaction (ADR) of psychiatric pharmacotherapy. Herein, we review the results of studies of blood (serum and plasma) and urinary biomarkers as predictors of AIMetS in patients with schizophrenia (Sch). We reviewed 1440 studies examining 38 blood and 19 urinary metabolic biomarkers, including urinary indicators involved in the development of AIMetS. Among the results, only positive associations were revealed. However, at present, it should be recognized that there is no consensus on the role of any particular urinary biomarker of AIMetS. Evaluation of urinary biomarkers of the development of MetS and AIMetS, as one of the most common concomitant pathological conditions in the treatment of patients with psychiatric disorders, may provide a key to the development of strategies for personalized prevention and treatment of the condition, which is considered a complication of AP therapy for Sch in clinical practice.
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Bui TNT, Hotham E, Kelly F, Suppiah V. Feasibility of a pharmacist-led physical health monitoring for patients on antipsychotic medications: protocol for a longitudinal study. BMJ Open 2022; 12:e059573. [PMID: 35725265 PMCID: PMC9214376 DOI: 10.1136/bmjopen-2021-059573] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/25/2022] Open
Abstract
INTRODUCTION Physical health conditions are the leading causes of death in people living with severe mental illness. In particular, the risk of metabolic syndrome; the constellation of abnormalities in weight, blood pressure, blood glucose and lipid levels, is high in this cohort. It has been recognised that commonly prescribed pharmacological agents for mental illness can further amplify the risk of developing metabolic syndrome; therefore, monitoring guidelines are in place for consumers prescribed antipsychotics. However, there is a disconnect between recommended guidelines and current practice. Our study aims to investigate: (1) the feasibility of a community pharmacist-led physical health monitoring for metabolic parameters in consumers with mental illness currently taking second generation antipsychotics and (2) the potential outcomes of the intervention (eg, rates and outcome of referrals to general practitioners, relationship between the pharmacist's lifestyle counselling advice and change in metabolic parameters). METHODS AND ANALYSIS We propose a longitudinal metabolic monitoring study led by community pharmacists with one-to-one consultations between trained pharmacists and participants at set intervals over a 12-month period. Our primary outcome is to determine the feasibility of the pharmacist-led intervention. The secondary outcome is to explore the overall health outcomes of consumers enrolled in the intervention. This is a mixed-methods study including both quantitative and qualitative outcomes. Qualitative data will be analysed via the process of data immersion, coding and identification of themes. Quantitative outcomes will be analysed using IBM Statistics SPSS software. Univariate descriptive, regression analysis and dependent t-tests will be performed. Statistical significance will be at α 0.05. ETHICS AND DISSEMINATION Our study has been approved by the institutional Human Research Ethics Committee (Protocol no: 203433). Findings will be made publicly available in peer-reviewed articles, conference presentations to health professionals, as well as other stakeholders. Protocol V.2.1, August 2021. TRIAL REGISTRATION NUMBER ACTRN12621001435875.
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Affiliation(s)
- Tien Ngoc Thi Bui
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Elizabeth Hotham
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Fiona Kelly
- Quality Use of Medicines Network, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Vijayaprakash Suppiah
- Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
- Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia, Australia
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Rubio JM, Kane JM. The pharmacological treatment of schizophrenia: How far have we come? PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2022; 1:e13. [PMID: 38868633 PMCID: PMC11114354 DOI: 10.1002/pcn5.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 06/14/2024]
Abstract
Schizophrenia is a chronic and often severe mental disorder for which antipsychotic drugs are the cornerstone of treatment. Although the essential mechanism of action of these drugs has not changed much since they were first discovered in the 1950s, there have been numerous advances in the context in which these drugs are prescribed, as well as in the considerations for their optimal use. In this review, we summarize five selected issues in which the psychopharmacological treatment of schizophrenia has most evolved. Namely, these are the shift of outcomes of interest from symptoms to recovery, the development of stratified approaches to select the most appropriate treatment for each individual, the recognition of treatment nonadherence as a critical factor determining outcomes, the recommendations for maintenance treatment, and, finally, the promise of new antipsychotic compounds that innovate in their mechanisms of action, improving efficacy/safety profiles. Finally, we discuss how some of these advances have already delivered to improved outcomes in the real world, whereas others have demonstrated efficacy under optimal circumstances yet have not been translated into better outcomes in the community. Thus, the road ahead includes both identifying novel treatments that engage the psychopathology of the illness and improve the efficacy/tolerability profile of currently available agents, as well as developing interventions that mitigate the barriers for the use of novel interventions, some of them already existing, in the real world.
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Affiliation(s)
- Jose M. Rubio
- Donald and Barbara Zucker School of Medicine at Hofstra—Northwell, Feinstein Institutes of Medical Research—Institute of Behavioral ScienceZucker Hillside Hospital—Northwell HealthGlen OaksNYUnited States
| | - John M. Kane
- Donald and Barbara Zucker School of Medicine at Hofstra—Northwell, Feinstein Institutes of Medical Research—Institute of Behavioral ScienceZucker Hillside Hospital—Northwell HealthGlen OaksNYUnited States
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Johnson K, Tepper M, Leff HS, Mullin BO, Cook BL, Progovac AM. Assessing the Long-Term Effectiveness of a Behavioral Health Home for Adults With Bipolar and Psychotic Disorders. Psychiatr Serv 2022; 73:172-179. [PMID: 34346734 DOI: 10.1176/appi.ps.202000589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to examine the impact of a behavioral health home (BHH) to better understand its potential to improve health for individuals with serious mental illness. METHODS Propensity score-weighted interrupted time series analysis was used to estimate service utilization and chronic disease management through 3.5 years after BHH implementation and to compre BHH enrollees (N=413) with other patients with serious mental illness in the same health system (N=1,929). RESULTS Relative to control group members, BHH patients had an immediate increase in primary care visits (+0.18 visits/month), which remained higher throughout follow-up, and an immediate decrease in emergency department visits (-0.031 visits/month). Behavioral health outpatient visits, which were increasing for BHH participants before implementation, began decreasing postimplementation; this decrease (-0.016 visits/month) was significantly larger than for the control group. Inpatient and outpatient visits for general medical health were decreasing over time for both groups before implementation but decreased more slowly for BHH patients postimplementation. Although behavioral health inpatient visits decreased for both groups around the start of the BHH program and remained lower, this initial drop was larger for the non-BHH group. BHH participation was associated with decreases in hemoglobin A1c values but no shift in low-density lipoprotein cholesterol values. CONCLUSIONS The results reflect the challenges of improving health for patients with serious mental illness, even as access to primary care is increased. Further study is needed about which complex interventions inside and outside of the health care system can help offset the 20- to 30-year mortality gap faced by this population.
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Affiliation(s)
- Karl Johnson
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Johnson); Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts (Tepper, Leff, Mullin, Cook, Progovac); Department of Psychiatry, Harvard Medical School, Boston (Tepper, Leff, Cook, Progovac)
| | - Miriam Tepper
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Johnson); Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts (Tepper, Leff, Mullin, Cook, Progovac); Department of Psychiatry, Harvard Medical School, Boston (Tepper, Leff, Cook, Progovac)
| | - H Stephen Leff
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Johnson); Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts (Tepper, Leff, Mullin, Cook, Progovac); Department of Psychiatry, Harvard Medical School, Boston (Tepper, Leff, Cook, Progovac)
| | - Brian O Mullin
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Johnson); Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts (Tepper, Leff, Mullin, Cook, Progovac); Department of Psychiatry, Harvard Medical School, Boston (Tepper, Leff, Cook, Progovac)
| | - Benjamin L Cook
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Johnson); Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts (Tepper, Leff, Mullin, Cook, Progovac); Department of Psychiatry, Harvard Medical School, Boston (Tepper, Leff, Cook, Progovac)
| | - Ana M Progovac
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Johnson); Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts (Tepper, Leff, Mullin, Cook, Progovac); Department of Psychiatry, Harvard Medical School, Boston (Tepper, Leff, Cook, Progovac)
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11
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Giusti L, Bianchini V, Aggio A, Mammarella S, Salza A, Necozione S, Alunno A, Ferri C, Casacchia M, Roncone R. Twelve-month outcomes in overweight/obese users with mental disorders following a multi-element treatment including diet, physical activity, and positive thinking: The real-world "An Apple a Day" controlled trial. Front Psychiatry 2022; 13:903759. [PMID: 36081460 PMCID: PMC9445251 DOI: 10.3389/fpsyt.2022.903759] [Citation(s) in RCA: 3] [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: 03/24/2022] [Accepted: 07/27/2022] [Indexed: 11/15/2022] Open
Abstract
The present study aimed to evaluate the 12-month effectiveness of a real-world weight loss transdiagnostic intervention in overweight/obese participants affected by mental disorders under psychopharmacological treatment. We conducted a real-world, controlled, pragmatic outpatient trial. We allocated 58 overweight/obese adults under psychopharmacological treatment from a mental health outpatient unit and 48 overweight/obese adults from a cardiovascular prevention outpatient unit, and assigned them to an intervention or treatment usual as condition (TAU) enriched by life-style advice. Participants in both intervention groups took part in a diet programme (the modified OMNIHeart dietary protocol) and monitoring of regular aerobic activity. A brief group programme ("An Apple a Day" Metacognitive Training, Apple-MCT) was added in the intervention group of participants affected by mental disorders. The primary outcome was weight loss. Secondary outcomes included anthropometric, clinical, and metabolic variables. Psychopathology and health-related quality of life were also evaluated in the psychiatric sample. At 12 months, both intervention groups showed a more marked mean decrease in weight (6.7 kg, SD: 3.57) than the TAU group (0.32 kg, SD: 1.96), and a statistically significant improvement in metabolic variables compared with the control groups. Furthermore, the participants affected by mental disorders included in the intervention group reported improved health-related quality of life. Our findings suggest the need to implement integrated interventions based on a dietary protocol, physical activity, and modification of cognitive style in overweight/obese users with mental disorders.
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Affiliation(s)
- Laura Giusti
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Valeria Bianchini
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Annalisa Aggio
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Silvia Mammarella
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Anna Salza
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Stefano Necozione
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessia Alunno
- Division of Internal Medicine and Nephrology, School of Internal Medicine-San Salvatore Hospital, Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Claudio Ferri
- Division of Internal Medicine and Nephrology, School of Internal Medicine-San Salvatore Hospital, Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Massimo Casacchia
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rita Roncone
- University Unit Rehabilitation Treatment, Early Interventions in Mental Health-San Salvatore Hospital, Department of Life, Health, and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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12
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[Antipsychotic prescription prevalence and metabolic monitoring of patients under chronic treatment]. REVISTA DE LA FACULTAD DE CIENCIAS MÉDICAS 2021. [PMID: 34596370 DOI: 10.31053/1853.0605.v78.n3.32653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction Antipsychotics agents increase morbidity and mortality due to their metabolic impact. Information on its prescription and follow-up is scarce. The objective of this study was to estimate the chronic antipsychotic prescription prevalence and to evaluate the metabolic monitoring of patients treated with these medications. Methods We examined a retrospective cohort of patients older than 18 years treated in the outpatient setting of a hospital in Argentina. The crude and adjusted prevalence of chronic antipsychotic prescription was estimated by indirect standardization of the World Health Organization population, with its confidence interval (95%). It was evaluated whether the patients had biochemical determinations, systolic blood pressure (SBP), and body mass index (BMI) at the beginning and at 12 months of their treatment. Results The crude antipsychotic prescription prevalence was 23.8 ‰ (95% CI 23.0 - 24.6) and the adjusted prevalence was 10.1 ‰ (95% CI 9.5-10.7). 3702 patients were evaluated. The male:female ratio was 0.6. Median age 77.5 years (IQR 25-75: 59.5-86.1). Quetiapine was the most frequently prescribed. Initial determinations: Lipid profile 1804 (48.7%), blood glucose 2034 (54.9%), SBP 2546 (68.8%) and BMI 1584 (42.8%). At 12 months: Lipid profile 680 (18.4%), blood glucose 898 (24.3%), SAT 1609 (43.5%), and BMI 1584 (21.7%). Conclusions We observed a higher prevalence of atypical antipsychotic prescription in the elderly and female population and scarce registry of biochemical determinations for adverse effects follow-up.
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13
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Woldekidan NA, Mohammed AS, Degu A, Tadiwos Y. Prevalence of metabolic syndrome and associated factors among psychiatric patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia. PLoS One 2021; 16:e0256195. [PMID: 34437577 PMCID: PMC8389454 DOI: 10.1371/journal.pone.0256195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 08/03/2021] [Indexed: 01/22/2023] Open
Abstract
Background Psychiatric patients are at increased risk of being overweight or obese, and subsequently develop metabolic syndrome. Nevertheless, data regarding associated factors for weight gain are limited and inconsistent. Objective The present study aimed to determine the risk of metabolic syndrome and its associated factors among psychiatric patients. Method A cross-sectional quantitative study was conducted among all psychiatric patients at the Psychiatric Unit of the University of Gondar Comprehensive Specialized Hospital from March 1- April 1, 2018. All eligible psychiatric patients were interviewed about their socio-demographic status,and clinical characteristics and useful parameters for the study were recorded from the medical records of the patients and by measuring waist to height ratio. Descriptive statistics were used to summarize baseline information.Binary logistic regression was used to determine the associated factors and P-value <0.05 and confidence interval (CI) of 95% were used as cut off points for determining statistical significance. Result From 300 patients included in the study, 168(56%) patients were females,and around 50.3% of the study participants had low literacy levels. As per waist to a height ratio scale, 58% (174) of the patients had a risk of metabolic syndrome. The Binary logistic regression analysis indicated that sex (p-<0.0001), occupation (p -0.032), marital status (p-0.006), and distance from the hospital (p<0.0001) were statistically significant determinants of metabolic syndrome risk in the psychiatric patient in our setting. Conclusion The majority of the psychiatric patients in the study setting had a risk of metabolic syndrome. Sex, marital status, employment status, and distance to the hospital were significantly associated with metabolic syndrome. Routine physical and laboratory investigations to detect metabolic syndrome are indispensable in psychiatric patients to prevent cardiovascular complications.
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Affiliation(s)
- Nigist Alemayehu Woldekidan
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ammas Siraj Mohammed
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Amsalu Degu
- School of Pharmacy and Health Sciences, United States International University Africa, Nairobi, Kenya
| | - Yohannes Tadiwos
- Department of Pharmacology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Noelia Vivacqua M, Abudarham T, Pagotto V, Luis Faccioli J. [Antipsychotic prescription prevalence and metabolic monitoring of patients under chronic treatment]. REVISTA DE LA FACULTAD DE CIENCIAS MÉDICAS 2021; 78. [PMID: 34596370 PMCID: PMC8760904 DOI: 10.3105310.31053/1853.0605.v78.n3.32653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Antipsychotics agents increase morbidity and mortality due to their metabolic impact. Information on its prescription and follow-up is scarce. The objective of this study was to estimate the chronic antipsychotic prescription prevalence and to evaluate the metabolic monitoring of patients treated with these medications. METHODS We examined a retrospective cohort of patients older than 18 years treated in the outpatient setting of a hospital in Argentina. The crude and adjusted prevalence of chronic antipsychotic prescription was estimated by indirect standardization of the World Health Organization population, with its confidence interval (95%). It was evaluated whether the patients had biochemical determinations, systolic blood pressure (SBP), and body mass index (BMI) at the beginning and at 12 months of their treatment. RESULTS The crude antipsychotic prescription prevalence was 23.8 ‰ (95% CI 23.0 - 24.6) and the adjusted prevalence was 10.1 ‰ (95% CI 9.5-10.7). 3702 patients were evaluated. The male:female ratio was 0.6. Median age 77.5 years (IQR 25-75: 59.5-86.1). Quetiapine was the most frequently prescribed. Initial determinations: Lipid profile 1804 (48.7%), blood glucose 2034 (54.9%), SBP 2546 (68.8%) and BMI 1584 (42.8%). At 12 months: Lipid profile 680 (18.4%), blood glucose 898 (24.3%), SAT 1609 (43.5%), and BMI 1584 (21.7%). CONCLUSIONS We observed a higher prevalence of atypical antipsychotic prescription in the elderly and female population and scarce registry of biochemical determinations for adverse effects follow-up.
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Affiliation(s)
| | - Tomás Abudarham
- Hospital Italiano de Buenos AiresCiudad Autónoma de Buenos AiresArgentina
| | - Vanina Pagotto
- Hospital Italiano de Buenos AiresCiudad Autónoma de Buenos AiresArgentina
| | - José Luis Faccioli
- Hospital Italiano de Buenos AiresCiudad Autónoma de Buenos AiresArgentina
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15
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Progovac AM, Tepper MC, Stephen Leff H, Cortés DE, (Cohen) Colts A, Ault-Brutus A, Hou SSY, Lu F, Banbury S, Sunder D, Cook BL. Patient and provider perception of appropriateness, acceptability, and feasibility of behavioral health home (BHH) core components based on program implementation in an urban, safety-net health system. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2:26334895211043791. [PMID: 37089996 PMCID: PMC9978621 DOI: 10.1177/26334895211043791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background This manuscript evaluates patient and provider perspectives on the core components of a Behavioral Health Home (BHH) implemented in an urban, safety-net health system. The BHH integrated primary care and wellness services (e.g., on-site Nurse Practitioner and Care Manager, wellness groups and tools, population health management) into an existing outpatient clinic for people with serious mental illness (SMI). Methods As the qualitative component of a Hybrid Type I effectiveness-implementation study, semi-structured interviews were conducted with providers and patients 6 months after program implementation, and responses were analyzed using thematic analysis. Valence coding (i.e., positive vs. negative acceptability) was also used to rate interviewees' transcriptions with respect to their feedback of the appropriateness, acceptability, and feasibility/sustainability of 9 well-described and desirable Integrated Behavioral Health Core components (seven from prior literature and two additional components developed for this intervention). Themes from the thematic analysis were then mapped and organized by each of the 9 components and the degree to which these themes explain valence ratings by component. Results Responses about the team-based approach and universal screening for health conditions had the most positive valence across appropriateness, acceptability, and feasibility/sustainability by both providers and patients. Areas of especially high mismatch between perceived provider appropriateness and measures of acceptability and feasibility/sustainability included population health management and use of evidence-based clinical models to improve physical wellness where patient engagement in specific activities and tools varied. Social and peer support was highly valued by patients while incorporating patient voice was also found to be challenging. Conclusions Findings reveal component-specific challenges regarding the acceptability, feasibility, and sustainability of specific components. These findings may partly explain mixed results from BHH models studied thus far in the peer-reviewed literature and may help provide concrete data for providers to improve BHH program implementation in clinical settings. Plain language abstract Many people with serious mental illness also have medical problems, which are made worse by lack of access to primary care. The Behavioral Health Home (BHH) model seeks to address this by adding primary care access into existing interdisciplinary mental health clinics. As these models are implemented with increasing frequency nationwide and a growing body of research continues to assess their health impacts, it is crucial to examine patient and provider experiences of BHH implementation to understand how implementation factors may contribute to clinical effectiveness. This study examines provider and patient perspectives of acceptability, appropriateness, and feasibility/sustainability of BHH model components at 6-7 months after program implementation at an urban, safety-net health system. The team-based approach of the BHH was perceived to be highly acceptable and appropriate. Although providers found certain BHH components to be highly appropriate in theory (e.g., population-level health management), their acceptability of these approaches as implemented in practice was not as high, and their feedback provides suggestions for model improvements at this and other health systems. Similarly, social and peer support was found to be highly appropriate by both providers and patients, but in practice, at months 6-7, the BHH studied had not yet developed a process of engaging patients in ongoing program operations that was highly acceptable by providers and patients alike. We provide these data on each specific BHH model component, which will be useful to improving implementation in clinical settings of BHH programs that share some or all of these program components.
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Affiliation(s)
- Ana M Progovac
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA,
USA
| | - Miriam C Tepper
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA,
USA
| | - H. Stephen Leff
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Dharma E Cortés
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA,
USA
| | | | - Andrea Ault-Brutus
- Office of Health Equity, Nassau County Department of
Health, Mineola, NY, USA
| | - Sherry S-Y Hou
- Department of Epidemiology, McGill University, Montreal, Quebec, Canada
| | - Frederick Lu
- Boston University School of
Medicine, Boston, MA, USA
| | - Sara Banbury
- University of Pennsylvania Perelman
School of Medicine, Philadelphia, PA, USA
| | | | - Benjamin L Cook
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA,
USA
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Avery N, Patterson S. Physical Health in Public Mental Health Care: A Qualitative Study Employing the COM‐B Model of Behaviour to Describe Views and Practices of Australian Psychologists. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Natalie Avery
- Royal Brisbane and Women's Hospital, Metro North Mental Health, Metro North Hospital and Health Service,
- Charles Sturt University,
| | - Sue Patterson
- Royal Brisbane and Women's Hospital, Metro North Mental Health, Metro North Hospital and Health Service,
- Griffith University,
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Vadiei N, Howe CL, Zerr B, Ladziak N, Fain MJ, Lee JK. Psychotropic medication use patterns in home-based primary care: A scoping review. Ment Health Clin 2020; 10:282-290. [PMID: 33062554 PMCID: PMC7534817 DOI: 10.9740/mhc.2020.09.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Up to a third of patients seen by home-based primary care (HBPC) providers suffer from mental health problems. These conditions tend to be underrecognized and undertreated for patients receiving HBPC. The purpose of this scoping review is to evaluate current psychotropic use patterns for patients receiving HBPC services. Methods The following databases were searched for articles reporting on studies conducted in HBPC settings that identified patterns of psychotropic medication prescription and use: Ovid/MEDLINE, Cochrane Library, Embase, Scopus, Web of Science, CINAHL, and PsycInfo. Studies that only reported on patients in hospice, rehabilitation, or long-term care facilities were excluded as were drug trials, opinion pieces, case studies, case series, meeting abstracts, and other reviews. Results Of 4542 articles initially identified, 74 were selected for full text screening. Of these, only 2 met full criteria and were included in the data extraction and analysis. In 1 study, 41.7% patients enrolled were prescribed an antidepressant, 21.5% were prescribed an antipsychotic (12.7% prescribed both), and 5% to 7% of patients were prescribed benzodiazepines/hypnotics. In the other study, 9% of patients were prescribed an antipsychotic, and 7% were prescribed a benzodiazepine. Discussion There are extremely limited data on psychotropic prescribing patterns in HBPC in published studies. Because a significant number of HBPC patients suffer from mental health conditions in addition to other chronic illnesses, treatment can be complex. More studies are needed on current psychotropic prescribing trends to help determine what type of interventions are needed to promote patient safety in this setting.
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Affiliation(s)
- Nina Vadiei
- Assistant Professor, University of Arizona College of Pharmacy, Tucson, Arizona; Assistant Professor, University of Arizona College of Medicine, Tucson, Arizona,
| | - Carol L Howe
- Librarian, University of Arizona Health Sciences Library, Tucson, Arizona; Librarian, Arizona Center on Aging, Tucson, Arizona
| | - Beth Zerr
- Assistant Professor, University of Arizona College of Pharmacy, Tucson, Arizona
| | - Nicholas Ladziak
- Assistant Professor, University of Arizona College of Pharmacy, Tucson, Arizona
| | - Mindy J Fain
- Professor, University of Arizona College of Medicine, Tucson, Arizona; Co-Director, Arizona Center on Aging, Tucson, Arizona
| | - Jeannie K Lee
- Assistant Dean and Associate Professor, University of Arizona College of Pharmacy, Tucson, Arizona; Clinical Associate Professor, University of Arizona College of Medicine, Tucson, Arizona; Research Associate, Arizona Center on Aging, Tucson, Arizona
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Poojari PG, Khan SA, Shenoy S, Acharya LD, Shetty S, Bose S, Pai K, Kunhikatta V, Thunga G. Identification of risk factors and metabolic monitoring practices in patients on antipsychotic drugs in South India. Asian J Psychiatr 2020; 53:102186. [PMID: 32563106 DOI: 10.1016/j.ajp.2020.102186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 05/23/2020] [Accepted: 05/26/2020] [Indexed: 01/14/2023]
Abstract
The objectives of this study were to identify the risk factors for metabolic syndrome in patients on antipsychotics and to compare the frequency of metabolic monitoring with evidence-based guidelines. We conducted a retrospective cohort study in a tertiary care health institution of South India. The study included patients with schizophrenia, bipolar disorder, and schizoaffective disorders prescribed with antipsychotic drugs. Data was collected from the medical records department. American Diabetic Association/American Psychiatric Association (ADA/APA) guidelines were used as a reference standard to assess the monitoring for metabolic parameters. Diagnosis of metabolic syndrome was done according to the National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) guidelines. Risk factors for metabolic syndrome and frequency of metabolic monitoring were analyzed. A total of 668 patients were included for clinical audit. About 16.5 % of the patients were diagnosed with metabolic syndrome. Age >50 years (Odds Ratio (OR) 2.00; p value <0.001) and duration of antipsychotic treatment>5 years (OR 1.55; p value< 0.05) were recognized as the independent risk factors for metabolic syndrome using multiple logistic regression. Blood pressure (BP) and fasting blood sugar (FBS) levels were documented in 99.7 % and 47 % of cases at baseline respectively, however, subsequent annual data on BP and FBS monitoring was reduced to 72.7 % and 46 % respectively. Weight was documented in 60 % of the cases at baseline, whereas the subsequent data on four times the annual assessment of weight was reduced to 9.8 %. The extent of documentation of metabolic monitoring parameters was inadequate.
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Affiliation(s)
- Pooja Gopal Poojari
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
| | - Sohil A Khan
- School of Pharmacy and Pharmacology, Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.
| | - Sonia Shenoy
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
| | - Leelavathi D Acharya
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
| | - Sahana Shetty
- Department of Endocrinology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
| | - Swarnali Bose
- Department of Clinical Psychology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
| | - Keshava Pai
- Department of Psychiatry, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Mangalore 575002, Karnataka, India.
| | - Vijayanarayana Kunhikatta
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
| | - Girish Thunga
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, Karnataka, India.
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Progovac AM, Cortés DE, Chambers V, Adams LB, Jean‐Claude S, Willison CE, Flores M, Creedon TB, Cook BL. Addressing Major Health Disparities Related to Coronavirus for People With Behavioral Health Conditions Requires Strength-Based Capacity Building and Intentional Community Partnership. WORLD MEDICAL & HEALTH POLICY 2020; 12:242-255. [PMID: 32904922 PMCID: PMC7461022 DOI: 10.1002/wmh3.364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/27/2020] [Indexed: 11/07/2022]
Abstract
Far from being an equalizer, as some have claimed, the COVID‐19 pandemic has exposed just how vulnerable many of our social, health, and political systems are in the face of major public health shocks. Rapid responses by health systems to meet increased demand for hospital beds while continuing to provide health services, largely via a shift to telehealth services, are critical adaptations. However, these actions are not sufficient to mitigate the impact of coronavirus for people from marginalized communities, particularly those with behavioral health conditions, who are experiencing disproportional health, economic, and social impacts from the evolving pandemic. Helping these communities weather this storm requires partnering with existing community‐based organizations and local governments to rapidly and flexibly meet the needs of vulnerable populations.
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Holmes A, Handrinos D, Jones S, Huang B. The impact of increasing general hospital admissions on Consultation-Liaison Psychiatry. Australas Psychiatry 2020; 28:459-462. [PMID: 32469643 DOI: 10.1177/1039856220926941] [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 The objective of this study was to identify changes in patients referred to CLP at a typical inner urban teaching hospital over two decades in the context of increased hospital admissions. METHOD Multivariate analyses were conducted on data collected for all referrals to CLP at Royal Melbourne Hospital between 1998 and 2017. Analyses were conducted with reason for referral, current psychiatric contact, psychiatric diagnosis, discharge destination and follow up as dependent variables, and the year and annual hospital admissions as independent variables. RESULTS Annual hospital admissions grew at a rate (4.6%), greater than the annual increase in beds (2.0%). Psychosis, suicide attempt, past psychiatric history and behaviour became more common reasons for referral, whilst depression and somatisation became less common. Transfers to and from mental health inpatient units increased. CONCLUSIONS An increasing proportion of patients seen by CLP have 'acute' problems. Patients with somatisation and depression are seen less frequently. These findings indicate that CLP services need to provide timely assessment and work closely with other elements of the local mental health service in order to optimise patient flow and ensure continuity of care. Local strategies may be required to ensure an adequate breadth of experience for trainees.
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Affiliation(s)
- Alex Holmes
- Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Australia; and Consultation-Liaisons Psychiatry, Royal Melbourne Hospital, Australia
| | - Dennis Handrinos
- Department of Psychiatry, University of Melbourne, Royal Melbourne Hospital, Australia
| | - Simon Jones
- Consultation-Liaisons Psychiatry, Royal Melbourne Hospital, Australia
| | - Beatrice Huang
- Consultation-Liaisons Psychiatry, Royal Melbourne Hospital, Australia
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21
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Tyerman Z, Mehaffey JH, Hawkins RB, Dahl J, Narahari A, Chancellor WZ, Yount K, Yarboro LT, Teman NR, Ailawadi G. History of Serious Mental Illness Is a Predictor of Morbidity and Mortality in Cardiac Surgery. Ann Thorac Surg 2020; 111:109-116. [PMID: 32544450 DOI: 10.1016/j.athoracsur.2020.04.118] [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] [Received: 03/23/2019] [Revised: 03/18/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Serious mental illness (SMI), defined as a mental disorder causing functional impairment, affects 9.8 million Americans. SMI correlates with earlier onset, more extensive cardiac disease, and reduced life expectancy by 25 years. The impact of SMI on patients undergoing cardiac surgery has not been extensively studied. We hypothesized that patients with SMI have worse cardiac surgery outcomes. METHODS Using our institution's Society of Thoracic Surgeons database of 16,781 cardiac operations (2002-2017), a total of 1445 (8.7%) patients with SMI were identified and stratified into anxiety, mood disorders, and psychosis. The risk-adjusted impact on morbidity and mortality were evaluated using multivariable regression. RESULTS Patients with SMI were more often female patients, were younger, and had more comorbid disease. SMI patients were more likely to have had previous cardiac surgery and require urgent or emergent procedures (both P < .05). Among specific SMI diagnoses, patients with psychosis had worse outcomes compared with the general population, with higher operative mortality (9.1% vs 4.2%; P = .001), major morbidity (30.4% vs 15.8%; P < .0001), and cost ($50,211 vs $38,820; P < .001). After multivariable risk adjustment, SMI and psychosis remained independently associated with composite mortality and major morbidity (odds ratio, 1.21; P = .012; and odds ratio, 1.68; P = .003, respectively). CONCLUSIONS SMI is independently associated with morbidity and mortality after cardiac surgery. SMI patients, especially the subset with psychosis, are complicated, high-risk, and resource-consuming. Refined strategies to reduce postoperative complications and improve care coordination are necessary in this population.
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Affiliation(s)
- Zachary Tyerman
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - J Hunter Mehaffey
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - Robert B Hawkins
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - Jolian Dahl
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - Adishesh Narahari
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - William Z Chancellor
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - Kenan Yount
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - Leora T Yarboro
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - Nicholas R Teman
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia
| | - Gorav Ailawadi
- Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia.
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Primary Care Quality Improvement Metrics and National Committee on Quality Assurance Medical Home Recognition for Children With Medical Complexity. Pediatr Qual Saf 2019; 4:e231. [PMID: 32010857 PMCID: PMC6946232 DOI: 10.1097/pq9.0000000000000231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/15/2019] [Indexed: 11/29/2022] Open
Abstract
The Complex Care Center at Cincinnati Children’s Hospital Medical Center developed and implemented a set of evidence-based clinical process measures of immunization delivery, preventive and chronic condition laboratory screening, and behavioral health medication surveillance for use in the primary care setting.
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The effects of antipsychotic medications on microbiome and weight gain in children and adolescents. BMC Med 2019; 17:112. [PMID: 31215494 PMCID: PMC6582584 DOI: 10.1186/s12916-019-1346-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 05/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Atypical antipsychotics, also known as second-generation antipsychotics, are commonly prescribed as treatment for psychotic disorders in adults, as well as in children and adolescents with behavioral problems. However, in many cases, second-generation antipsychotics have unwanted side effects, such as weight gain, potentially further increasing risk for morbidities including obesity, diabetes, and cardiovascular disease. While various mechanisms for this weight gain have been proposed, including effects on metabolic hormone signaling, recent evidence points to the importance of the gut microbiome in this process. The microbial communities residing within the gut are affected by second-generation antipsychotics and can confer weight gain. MAIN TEXT This review summarizes recent findings and presents data linking second-generation antipsychotics, gut microbiota alterations and weight gain. The review focuses on children and adolescent populations, which have not previously received much attention, but are of great interest because they may be most vulnerable to gut microbiome changes and may carry long-term metabolic effects into adulthood. CONCLUSIONS We present correlations between second-generation antipsychotics, gut microbiota alterations and weight gain, and suggest some mechanisms that may link them. A better understanding of the underlying mechanisms may lead to the design of improved treatments for psychotic disorders with fewer harmful side effects.
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Valdes F, Keary CJ, Mullett JE, Palumbo ML, Waxler JL, Pober BR, McDougle CJ. Brief Report: Major Depressive Disorder with Psychotic Features in Williams Syndrome: A Case Series. J Autism Dev Disord 2019; 48:947-952. [PMID: 29164439 DOI: 10.1007/s10803-017-3384-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Descriptions of individuals with Williams syndrome (WS) and co-morbid major depressive disorder (MDD) with psychotic features have not appeared in the literature. In addition to reviewing previous reports of psychotic symptoms in persons with WS, this paper introduces clinical histories and therapeutic management strategies for three previously unreported adults with WS diagnosed with co-morbid MDD with psychotic features. Co-morbid medical disorders common in WS are highlighted with regard to safe and appropriate pharmacological treatment. The importance of assessment for co-morbid MDD with psychotic features in individuals with WS is emphasized.
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Affiliation(s)
| | - Christopher J Keary
- Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421-3114, USA
- Harvard Medical School, Boston, MA, USA
| | - Jennifer E Mullett
- Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421-3114, USA
| | - Michelle L Palumbo
- Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421-3114, USA
- Harvard Medical School, Boston, MA, USA
| | - Jessica L Waxler
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | - Barbara R Pober
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Christopher J McDougle
- Lurie Center for Autism, Massachusetts General Hospital, One Maguire Road, Lexington, MA, 02421-3114, USA.
- Harvard Medical School, Boston, MA, USA.
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Kusumi I, Arai Y, Okubo R, Honda M, Matsuda Y, Matsuda Y, Tochigi A, Takekita Y, Yamanaka H, Uemura K, Ito K, Tsuchiya K, Yamada J, Yoshimura B, Mitsui N, Matsubara S, Segawa T, Nishi N, Sugawara Y, Kako Y, Shinkawa I, Shinohara K, Konishi A, Iga J, Hashimoto N, Inomata S, Tsukamoto N, Ito H, Ito YM, Sato N. Predictive factors for hyperglycaemic progression in patients with schizophrenia or bipolar disorder. BJPsych Open 2018; 4:454-460. [PMID: 30450224 PMCID: PMC6235992 DOI: 10.1192/bjo.2018.56] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 06/26/2018] [Accepted: 08/22/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Patients with schizophrenia or bipolar disorder have a high risk of developing type 2 diabetes. AIMS To identify predictive factors for hyperglycaemic progression in individuals with schizophrenia or bipolar disorder and to determine whether hyperglycaemic progression rates differ among antipsychotics in regular clinical practice. METHOD We recruited 1166 patients who initially had normal or prediabetic glucose levels for a nationwide, multisite, l-year prospective cohort study to determine predictive factors for hyperglycaemic progression. We also examined whether hyperglycaemic progression varied among patients receiving monotherapy with the six most frequently used antipsychotics. RESULTS High baseline serum triglycerides and coexisting hypertension significantly predicted hyperglycaemic progression. The six most frequently used antipsychotics did not significantly differ in their associated hyperglycaemic progression rates over the 1-year observation period. CONCLUSIONS Clinicians should carefully evaluate baseline serum triglycerides and coexisting hypertension and perform strict longitudinal monitoring irrespective of the antipsychotic used. DECLARATION OF INTEREST The authors report no financial or other relationship that is relevant to the subject of this article. Relevant financial activities outside the submitted work are as follows. I.K. has received honoraria from Astellas, Chugai Pharmaceutical, Daiichi Sankyo, Dainippon Sumitomo Pharma, Eisai, Eli Lilly, Janssen Pharmaceutical, Kyowa Hakko Kirin, Meiji Seika Pharma, MSD, Nippon Chemiphar, Novartis Pharma, Ono Pharmaceutical, Otsuka Pharmaceutical, Pfizer, Tanabe Mitsubishi Pharma, Shionogi and Yoshitomiyakuhin; has received research/grant support from AbbVie GK, Asahi Kasei Pharma, Astellas, Boehringer Ingelheim, Chugai Pharmaceutical, Daiichi Sankyo, Dainippon Sumitomo Pharma, Eisai, Eli Lilly, GlaxoSmithKline, Kyowa Hakko Kirin, Meiji Seika Pharma, MSD, Novartis Pharma, Ono Pharmaceutical, Otsuka Pharmaceutical, Pfizer, Takeda Pharmaceutical, Tanabe Mitsubishi Pharma, Shionogi and Yoshitomiyakuhin; and is a member of the advisory boards of Dainippon Sumitomo Pharma and Tanabe Mitsubishi Pharma. Y.T. has received speaker's honoraria from Dainippon-Sumitomo Pharma, Otsuka, Meiji-Seika Pharma, Janssen Pharmaceutical, Daiichi-Sankyo Company, UCB Japan and Ono Pharmaceutical. K.U. has received honoraria from Dainippon Sumitomo Pharma, Eisai, Eli Lilly, Janssen Pharmaceutical, Kyowa Hakko Kirin, Meiji Seika Pharma, MSD, Takeda Pharmaceutical, Hisamitsu Pharmaceutical, Otsuka Pharmaceutical, Pfizer, Tanabe Mitsubishi Pharma, Shionogi and Yoshitomiyakuhin. B.Y. has received speaker's honoraria from Otsuka Pharmaceutical and Janssen Pharmaceutical. J. I. has received honoraria from Dainippon Sumitomo Pharma, Eli Lilly, Janssen Pharmaceutical, Meiji Seika Pharma, MSD, Novartis Pharma, Otsuka Pharmaceutical and Mochida Pharma.
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Affiliation(s)
- Ichiro Kusumi
- Professor, Department of Psychiatry, Hokkaido University Graduate School of Medicine, Japan
| | - Yuki Arai
- Doctor, Department of Psychiatry, Wakkanai City Hospital, Japan
| | - Ryo Okubo
- Doctor, Department of Psychiatry, Hokkaido University Graduate School of Medicine and Honda Memorial Hospital, Japan
| | | | - Yasuhiro Matsuda
- Assistant Professor, Department of Psychiatry, Nara Medical University, Japan
| | | | | | - Yoshiteru Takekita
- Lecturer, Department of Neuropsychiatry, Kansai Medical University, Japan
| | | | - Keiichi Uemura
- Doctor, Department of Psychiatry, Sapporo City General Hospital, Japan
| | - Koichi Ito
- Vice Director, Sapporo Hanazono Hospital, Japan
| | | | | | | | - Nobuyuki Mitsui
- Assistant Professor, Department of Psychiatry, Hokkaido University Graduate School of Medicine and Department of Psychiatry, Wakkanai City Hospital, Japan
| | - Sigehiro Matsubara
- General Manager, Department of Neuropsychiatry, Obihiro National Hospital, Japan
| | | | | | | | - Yuki Kako
- Lecturer, Department of Psychiatry, Hokkaido University Graduate School of Medicine, Japan
| | | | | | | | - Junichi Iga
- Associate Professor, Department of Psychiatry, Tokushima University and Department of Psychiatry, Ehime University, Japan
| | - Naoki Hashimoto
- Associate Professor, Department of Psychiatry, Hokkaido University Graduate School of Medicine, Japan
| | | | | | - Hiroto Ito
- Director, National Institute of Occupational Safety and Health, National Center of Neurology and Psychiatry, Japan
| | - Yoichi M Ito
- Associate Professor, Department of Biostatistics, Hokkaido University Graduate School of Medicine, Japan
| | - Norihiro Sato
- Professor, Hokkaido University Hospital Clinical Research and Medical Innovation Center, Japan
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Abstract
UNLABELLED ABSTRACTBackground:The atypical antipsychotics (AAPs) are associated with a recognized class effect of glucose and lipid dysregulation. The use of these medications is rapidly increasing in elderly patients with, and without, dementia. However, the metabolic risks specific to elderly remain poorly studied. METHODS Design: A case-control study. SETTING Psychogeriatric service in Auckland, New Zealand. PARTICIPANTS Elderly patients either receiving AAP treatment (cases) or not (controls) between 1 Jan 2008 and 1 Jan 2014. MAIN OUTCOME MEASURES metabolic data of glucose, HbA1c, lipids, and cardiovascular events and death. The data were analyzed using t-tests and linear regression models for each metabolic outcome. RESULTS There were 330 eligible cases and 301 controls from a total study population of 5,307. There was a statistically significant change in the HbA1c over time, within the cases group of -1.14 mmol/mol (p = 0.018, 95% CI -0.19 to -2.09). Also statistically significant was the reduction in total cholesterol of -0.13 mmol/L (p = 0.036, 95% CI -0.008 to -0.245). The only significant difference found between cases and controls was in the change in cholesterol ratio of 0.16 mmol/L between groups (95%CI 0.01-0.31, p = 0.036). CONCLUSIONS AAP use was not associated with any clinically significant change in metabolic outcomes in this study population.
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Severi E, Ferrara M, Tedeschini E, Vacca F, Mungai F, Amendolara R, Baccari F, Starace F. Assessment of cardiovascular risk in an Italian psychiatric outpatient sample: A chart review of patients treated with second-generation antipsychotics. Int J Ment Health Nurs 2018; 27:1002-1008. [PMID: 29197134 DOI: 10.1111/inm.12407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2017] [Indexed: 12/22/2022]
Abstract
Despite the call by the scientific community for a systematic monitoring of physical health in people with psychiatric illnesses, national and international audits have reported poor quality of cardiovascular risk assessments and management in this vulnerable population. Available evidence indicates that in people affected by mental illness, life expectancy is reduced by 10-20 years, mainly due to cardiovascular accidents and metabolic syndrome (MetS)-related diseases. The primary aim of the present study was to evaluate the accuracy of cardiovascular risk monitoring in an outpatient sample of patients taking second-generation antipsychotics. The sample consisted of 200 patients consecutively recruited from two community mental health centres. A clinical chart review was performed on the following laboratory tests: total cholesterol, high- and low-density lipoprotein, serum triglycerides, fasting blood glucose, γ-glutamyl transpeptidase. Blood pressure and waist circumference were measured. A complete cardiovascular risk assessment was available only in 60 patients out of 200 (33.3%). The only variable associated with laboratory tests for MetS was receiving three or more psychotropic medications, which increased fourfold the probability of metabolic screening. In the subsample of patients with full screening, the prevalence of MetS was 33.3%. Our findings suggest that mental health professionals working in community mental health services should incorporate a more systematic assessment of physical health in their practice, and intervene proactively to reduce the significant cardiovascular burden carried by people with several mental illness.
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Affiliation(s)
- Elena Severi
- Department of Mental Health and Drug Abuse, Azienda Unità Sanitaria Locale Modena, Modena, Italy
| | - Maria Ferrara
- Department of Mental Health and Drug Abuse, Azienda Unità Sanitaria Locale Modena, Modena, Italy
| | - Enrico Tedeschini
- Department of Mental Health and Drug Abuse, Azienda Unità Sanitaria Locale Modena, Modena, Italy
| | - Francesca Vacca
- Department of Mental Health and Drug Abuse, Azienda Unità Sanitaria Locale Modena, Modena, Italy
| | - Francesco Mungai
- Department of Mental Health and Drug Abuse, Azienda Unità Sanitaria Locale Modena, Modena, Italy
| | - Rocco Amendolara
- Department of Mental Health and Drug Abuse, Azienda Unità Sanitaria Locale Modena, Modena, Italy
| | - Flavia Baccari
- Department of Mental Health and Drug Abuse, Azienda Unità Sanitaria Locale Modena, Modena, Italy
| | - Fabrizio Starace
- Department of Mental Health and Drug Abuse, Azienda Unità Sanitaria Locale Modena, Modena, Italy
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Coughlin M, Goldie CL, Tregunno D, Tranmer J, Kanellos-Sutton M, Khalid-Khan S. Enhancing metabolic monitoring for children and adolescents using second-generation antipsychotics. Int J Ment Health Nurs 2018; 27:1188-1198. [PMID: 29205757 DOI: 10.1111/inm.12417] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/17/2017] [Indexed: 01/08/2023]
Abstract
The prevalence of children and adolescents using second-generation antipsychotics (SGAs) has increased significantly in recent years. In this population, SGAs are used to treat mood and behavioural disorders although considered 'off-label' or not approved for these indications. Metabolic monitoring is the systematic physical health assessment of antipsychotic users utilized to detect cardiovascular and endocrine side effects and prevent adverse events such as weight gain, hyperglycaemia, hyperlipidemia, and arrhythmias. This practice ensures safe and efficacious SGA use among children and adolescents. Despite widely available, evidence-based metabolic monitoring guidelines, rates of monitoring continue to be suboptimal; this exposes children to the unnecessary risk of developing poor cardiovascular health and long-term disease. In this discursive paper, existing approaches to metabolic monitoring as well as challenges to implementing monitoring guidelines in practice are explored. The strengths and weaknesses of providing metabolic monitoring across outpatient psychiatry, primary care, and collaborative community settings are discussed. We suggest that there is no one-size-fits-all solution to improving metabolic monitoring care for children and adolescents using SGA in all settings. However, we advocate for a pragmatic global approach to enhance safety of children and adolescents taking SGAs through collaboration among healthcare disciplines with a focus on integrating nurses as champions of metabolic monitoring.
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Affiliation(s)
- Mary Coughlin
- Faculty of Health Sciences, School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Catherine L Goldie
- Faculty of Health Sciences, School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Deborah Tregunno
- Faculty of Health Sciences, School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Joan Tranmer
- Faculty of Health Sciences, School of Nursing, Queen's University, Kingston, Ontario, Canada
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Farzbod A, Moon H. Integration of reconfigurable potentiometric electrochemical sensors into a digital microfluidic platform. Biosens Bioelectron 2018; 106:37-42. [DOI: 10.1016/j.bios.2018.01.048] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 01/17/2018] [Accepted: 01/23/2018] [Indexed: 01/02/2023]
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Gonzalez C, Ahammed N, Fisher R. Improving physical health monitoring for out-patients on antipsychotic medication. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.108.021212] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodMental illness is associated with increased physical morbidity. We aimed to assess and improve the routine blood testing of prescribed antipsychotics in out-patients from a busy London inner city area. Audit findings were presented locally to prescribers, together with educational suggestions to improve physical health assessment.ResultsInitially, the numbers monitored were low in the overall number of 126 patients included in the first audit. Following the intervention, this improved significantly in the second audit (of 106 patients).Clinical implicationsA simple one-page monitoring prompt and an educational intervention could significantly increase the adherence to routine blood-testing guidelines. Better physical screening may help reduce physical morbidity and mortality, and improve the quality of life of individuals with mental illness.
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31
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Bainbridge E, Gallagher A, McDonald G, McDonald C, Ahmed M. General practitioners' attitudes on who should manage metabolic dysregulations associated with antipsychotics. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.110.031351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodTo assess attitudes of general practitioners (GPs) on who should be responsible for managing metabolic dysregulations associated with the use of antipsychotics prescribed by psychiatrists. A total of 121 GPs in West Galway catchment area were surveyed using a simple questionnaire.ResultsA total of 104 GPs responded (86% response rate). The vast majority of responders (82%) believed that medical management should be provided within primary care. However, 46% indicated that initial screening and simple non-pharmacological management should be provided by mental health services.Clinical implicationsThe vast majority of GPs appear willing to take over the medical management of metabolic dysregulations emerging from antipsychotic prescribing in secondary care. Clearly defined roles for mental health services and primary care in the management of metabolic complications are of paramount importance, and individual mental health services should implement protocols for screening, non-pharmacological management and referral to primary care.
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32
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Pharmacological Approaches to Minimizing Cardiometabolic Side Effects of Mood Stabilizing Medications. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s40501-017-0131-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Pringsheim T, Kelly M, Urness D, Teehan M, Ismail Z, Gardner D. Physical Health and Drug Safety in Individuals with Schizophrenia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:673-683. [PMID: 28718324 PMCID: PMC5593246 DOI: 10.1177/0706743717719898] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND While antipsychotic medications are the mainstay of therapy for individuals with schizophrenia and psychotic disorders, their use is associated with adverse effects on physical health that require the attention and care of prescribers. METHODS We used the ADAPTE process to adapt existing guideline recommendations from the National Institute for Health and Care Excellence (NICE) and Scottish Intercollegiate Guidelines Network (SIGN) guidelines on the dosing of antipsychotics and antipsychotic polypharmacy, screening for adverse effects of antipsychotics, and management of metabolic and extrapyramidal side effects to the Canadian context. RESULTS Prescribers are encouraged to use the lowest effective dose and to avoid the routine use of multiple antipsychotics. Scheduled monitoring of body mass index, waist circumference, blood pressure, glucose, lipids, prolactin, electrocardiograms, and extrapyramidal symptoms is recommended. Lifestyle interventions are recommended to mitigate antipsychotic-induced weight gain. Prescribers should follow Canadian guidelines on the treatment of obesity, dyslipidemia, and diabetes. Recommendations on antipsychotic drug choice are made for users particularly concerned about extrapyramidal symptoms. CONCLUSION Careful monitoring and attention by prescribers may mitigate adverse effects associated with antipsychotic medications.
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Affiliation(s)
- Tamara Pringsheim
- 1 Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta
| | - Martina Kelly
- 2 Department of Family Medicine, University of Calgary, Alberta
| | - Doug Urness
- 3 Clinical Department Head, Addiction and Mental Health, Central Zone, Alberta Health Services, Edmonton, Alberta
| | - Michael Teehan
- 4 Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia
| | - Zahinoor Ismail
- 5 Department of Psychiatry and Clinical Neurosciences, University of Calgary, Calgary, Alberta
| | - David Gardner
- 6 Department of Psychiatry and College of Pharmacy, Dalhousie University, Halifax, Nova Scotia
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Teasdale SB, Samaras K, Wade T, Jarman R, Ward PB. A review of the nutritional challenges experienced by people living with severe mental illness: a role for dietitians in addressing physical health gaps. J Hum Nutr Diet 2017; 30:545-553. [PMID: 28419586 DOI: 10.1111/jhn.12473] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
People experiencing a severe mental illness (SMI), such as schizophrenia, schizoaffective disorder, bipolar affective disorder or depression with psychotic features, have a 20-year mortality gap compared to the general population. This 'scandal of premature mortality' is primarily driven by preventable cardiometabolic disease, and recent research suggests that the mortality gap is widening. Multidisciplinary mental health teams often include psychiatrists, clinical psychologists, specialist mental health nurses, social workers and occupational therapists, offering a range of pharmacological and nonpharmacological treatments to enhance the recovery of clients who have experienced, or are experiencing a SMI. Until recently, lifestyle and life skills interventions targeting the poor physical health experienced by people living with SMI have not been offered in most routine clinical settings. Furthermore, there are calls to include dietary intervention as mainstream in psychiatry to enhance mental health recovery. With the integration of dietitians being a relatively new approach, it is important to review and assess the literature to inform practice. This review assesses the dietary challenges experienced by people with a SMI and discusses potential strategies for improving mental and physical health.
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Affiliation(s)
- S B Teasdale
- Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, Australia.,School of Psychiatry, University of New South Wales, Kensington, Australia
| | - K Samaras
- Department of Endocrinology, St Vincent's Hospital, Darlinghurst, Australia.,Diabetes and Metabolism Division, Garvan Institute of Medical Research, Darlinghurst, Australia
| | - T Wade
- Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, Australia
| | - R Jarman
- Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, Australia
| | - P B Ward
- School of Psychiatry, University of New South Wales, Kensington, Australia.,Schizophrenia Research Unit, South Eastern Sydney Local Health District & Ingham Institute for Applied Medical Research, Liverpool, Australia
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Lambert TJ, Reavley NJ, Jorm AF, Oakley Browne MA. Royal Australian and New Zealand College of Psychiatrists expert consensus statement for the treatment, management and monitoring of the physical health of people with an enduring psychotic illness. Aust N Z J Psychiatry 2017; 51:322-337. [PMID: 28343435 DOI: 10.1177/0004867416686693] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To use expert consensus to inform the development of policy and guidelines for the treatment, management and monitoring of the physical health of people with an enduring psychotic illness. METHOD The Delphi method was used. A systematic search of websites, books and journal articles was conducted to develop a 416-item survey containing strategies that health professionals should use to treat, manage and monitor the physical health of people with an enduring psychotic illness. Three panels of Australian experts (55 clinicians, 21 carers and 20 consumers) were recruited and independently rated the items over three rounds, with strategies reaching consensus on a priori-defined levels of importance written into the expert consensus statement. RESULTS The participation rate for the clinicians across all three rounds was 65%, with consumers and carers only completing one round due to high endorsement rates. Finally, 386 strategies were endorsed as essential or important by one or all panels. The endorsed strategies provided information on engagement and collaborative partnerships; clinical governance; risk factors, morbidity and mortality in people with enduring psychotic illness; assessment, including initial and follow-up assessments; barriers to care; strategies to improve care of people with enduring psychotic illness; education and training; treatment recommendations; medication side effects; and the role of health professionals. CONCLUSION The consensus statement is intended to be used by health professionals, people with an enduring psychotic illness and their families and carers. The next step needed is an implementation strategy by the Royal Australian and New Zealand College of Psychiatrists and other stakeholders.
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Affiliation(s)
- Timothy Jr Lambert
- 1 Collaborative Centre for Cardiometabolic Health in Psychosis, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, Australia.,2 Sydney Medical School and the Discipline of Psychiatry, Sydney, Australia
| | - Nicola J Reavley
- 3 Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Anthony F Jorm
- 3 Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Mark A Oakley Browne
- 3 Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
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36
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Ndukwe HC, Nishtala PS. Glucose monitoring in new users of second-generation antipsychotics in older people. Arch Gerontol Geriatr 2017; 70:136-140. [PMID: 28131975 DOI: 10.1016/j.archger.2017.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 01/05/2017] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Treatment guidelines published world-wide have highlighted concerns of increased metabolic risks associated with second-generation antipsychotics (SGAs). The aim of the study was to evaluate blood glucose monitoring rates for SGA new users in older people aged 65 years and above during the study period 2006-2012, and investigate the pre-post 2007 Best Practice Advocacy Centre's (bpacnz) glucose monitoring recommendation in New Zealand. METHODS The study was a population-based retrospective cohort of SGA new users (365days without pre-exposure to antipsychotics). Pharmaceutical collections data were extracted and used to identify older people dispensed SGAs and linked to the National Minimum Dataset and Laboratory Claims collection. WHO Methodology's Anatomical Therapeutic Chemical method's classification was used to characterise the SGAs dispensed. RESULTS Of the 25,603 new users dispensed SGAs, 63.5% received glycaemic control monitoring at least once during the study period. Of these, only 20.1% were monitored at baseline, 38.7% were monitored for glycaemic control within the first 90 days. Glycaemic control monitoring within the first 180days increased to more than half (57.5%) of the SGA new users. Proportion of individuals monitored were independent (χ2=6.1; P=0.4) of pre-post bpacnz recommendation. CONCLUSIONS Blood glucose monitoring was underutilized in new SGA users. No significant improvement in glycaemic control monitoring was observed after the 2007 bpacnz consensus statement release at baseline, 90days and at 180 days. Prescribers must be cautioned about the metabolic risks posed by SGAs and recommend glycaemic control monitoring.
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Affiliation(s)
- Henry C Ndukwe
- School of Pharmacy, P.O. Box 56, University of Otago, Dunedin, New Zealand.
| | - Prasad S Nishtala
- School of Pharmacy, P.O. Box 56, University of Otago, Dunedin, New Zealand.
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Baeza I, Vigo L, de la Serna E, Calvo-Escalona R, Merchán-Naranjo J, Rodríguez-Latorre P, Arango C, Castro-Fornieles J. The effects of antipsychotics on weight gain, weight-related hormones and homocysteine in children and adolescents: a 1-year follow-up study. Eur Child Adolesc Psychiatry 2017; 26:35-46. [PMID: 27209421 DOI: 10.1007/s00787-016-0866-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 05/10/2016] [Indexed: 12/21/2022]
Abstract
To analyze weight gain, metabolic hormones, and homocysteine (Hcys) levels in children and adolescents on antipsychotics (AP) during a year-long follow-up. 117 patients, AP-naïve or quasi-naïve (less than 30 days on AP), were included. Weight, body mass index (BMI), BMI z-score (z-BMI), and levels of leptin, insulin, insulin resistance (HOMA-IR), adiponectin, ghrelin, thyroid stimulating hormone (TSH), free thyroxine (FT4), and Hcys were measured at baseline, and at 3, 6, and 12 months, while patients remained on the same AP. Patients (mean age: 14.4 ± 3 years; 64.1 % male) were on risperidone (N = 84), olanzapine (N = 20) or quetiapine (N = 13) from baseline up to 1-year follow-up and significantly increased weight (5.8 ± 4.3 kg at 3-month, 8.1 ± 6.1 kg at 6-month, and 11.6 ± 7.0 kg at 1 year), BMI, and z-BMI. Leptin levels significantly increased from baseline to 3 and 6 months, as did TSH levels from baseline to 3 months, while FT4 levels decreased from baseline to 3 and 6 months. Patients with BMI >85th percentile at baseline (N = 16) significantly increased weight, BMI, and z-BMI, more than patients with normal BMI over time. Higher baseline levels of insulin, HOMA-IR, and leptin were associated with increased weight/BMI during follow-up, while higher baseline levels of FT4, adiponectin, and ghrelin were associated with lower weight/BMI during follow-up. All AP were associated with increased weight and BMI/z-BMI in all of the assessments; however, at 1-year assessment, this increase was significantly higher for patients on quetiapine. Both higher baseline levels of insulin, HOMA-IR, and leptin, as well as being overweight/obese at baseline were associated with increased weight/BMI during 1-year follow-up in children and adolescents on AP. Awareness of weight-related parameters in this population may help inform decisions regarding AP prescriptions.
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Affiliation(s)
- Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, SGR-489, Institut Clinic of Neurosciences, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi Sunyer), Hospital Clínic Universitari of Barcelona, Villarroel, 170, Barcelona, 08036, Spain. .,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Laura Vigo
- Adolescent Service, Mapther house, Maudsley Hospital, London, UK
| | - Elena de la Serna
- Department of Child and Adolescent Psychiatry and Psychology, SGR-489, Institut Clinic of Neurosciences, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi Sunyer), Hospital Clínic Universitari of Barcelona, Villarroel, 170, Barcelona, 08036, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Rosa Calvo-Escalona
- Department of Child and Adolescent Psychiatry and Psychology, SGR-489, Institut Clinic of Neurosciences, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi Sunyer), Hospital Clínic Universitari of Barcelona, Villarroel, 170, Barcelona, 08036, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Jessica Merchán-Naranjo
- Child and adolescent Psychiatry Department, School of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, IISGM, CIBERSAM, Madrid, Spain
| | - Pamela Rodríguez-Latorre
- Child and adolescent Psychiatry Department, School of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, IISGM, CIBERSAM, Madrid, Spain
| | - Celso Arango
- Child and adolescent Psychiatry Department, School of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, IISGM, CIBERSAM, Madrid, Spain
| | - Josefina Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, SGR-489, Institut Clinic of Neurosciences, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi Sunyer), Hospital Clínic Universitari of Barcelona, Villarroel, 170, Barcelona, 08036, Spain.,Department of Psychiatry and Psychobiology, University of Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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Fontanella CA, Hiance-Steelesmith DL, Gilchrist R, Bridge JA, Weston D, Campo JV. Quality of care for Medicaid-enrolled youth with bipolar disorders. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 42:126-38. [PMID: 24729042 DOI: 10.1007/s10488-014-0553-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This study examined conformance to clinical practice guidelines for children and adolescents with bipolar disorders and identified patient and provider factors associated with guideline concordant care. Administrative records were examined for 4,047 Medicaid covered youth aged 5-18 years with new episodes of bipolar disorder during 2006-2010. Main outcome measures included 5 claims-based quality of care measures reflecting national treatment guidelines. Measures addressed appropriate pharmacotherapy, therapeutic drug monitoring, and psychosocial treatment. The results indicated that current treatment practices for youth diagnosed with bipolar disorder typically fall short of recommended practice guidelines. Although the majority of affected youth are treated with recommended first-line pharmacotherapy, only a minority receive therapeutic drug monitoring and/or psychotherapy of recommended duration, underscoring the need for quality improvement initiatives.
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Affiliation(s)
- Cynthia A Fontanella
- Department of Psychiatry, College of Medicine, The Ohio State University, 1670 Upham Road, Columbus, OH, 43210, USA,
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Abstract
INTRODUCTION Patients with major mental illness are recognised to be at risk of premature death for a multitude of reasons. This initiative aimed to improve the physical health monitoring of patients prescribed depot antipsychotic medication in a catchment area of ~36 000 in Ireland. OBJECTIVES International best practice recommends monitoring of blood tests, physical parameters such as weight, BMI, waist circumference and blood pressure, and side effects of patients prescribed antipsychotic medication. A clinic was established to target these interventions. METHODS A cohort of patients receiving antipsychotics in long-acting injectable form was chosen. A twice-yearly, multidisciplinary health monitoring clinic was established. Evaluation involved an audit of medical records which measured the proportion of those attending the clinic who had blood test monitoring and physical parameters recorded. RESULTS Before the clinic's implementation, 30% of patients had evidence of some blood test monitoring, 9% had evidence of complete blood testing and one patient had evidence of physical health parameters having been recorded. One year after the implementation 78% of patients had evidence of some blood test monitoring, 61% had evidence of full blood test monitoring and 100% had evidence of physical parameters recorded. CONCLUSIONS The clinic was positively received by patients, and led to improved teamwork. Recommendations include organising concurrent psychiatric and phlebotomy clinics so that patients may avail of psychiatric review and blood testing at a single appointment. As a result of the increased focus on physical health monitoring, a similar project is planned to target all patients prescribed antipsychotics.
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Wei Xin Chong J, Hsien-Jie Tan E, Chong CE, Ng Y, Wijesinghe R. Atypical antipsychotics: A review on the prevalence, monitoring, and management of their metabolic and cardiovascular side effects. Ment Health Clin 2016; 6:178-184. [PMID: 29955467 PMCID: PMC6007719 DOI: 10.9740/mhc.2016.07.178] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction Excessive weight gain, glucose intolerance, and dyslipidemia are well-known physical side effects of the metabolic syndrome commonly associated with atypical antipsychotic (AAP) treatment. We review these side effects of AAPs and their monitoring and management strategies. Methods A literature search was conducted to identify articles published on the prevalence, monitoring, and management of cardiometabolic side effects of AAPs. Results Comparative risk of AAPs on weight gain, hyperlipidemia, glucose intolerance, and QT interval corrected for heart rate prolongation varies across the AAPs currently available. Likewise, pharmacologic and nonpharmacologic options investigated for management of these side effects, and monitoring those at appropriate intervals, differ based on the clinical condition and risk factors identified. Discussion Atypical antipsychotics in general have little difference among them in short-term efficacy; however, the prevalence of their physical side effects substantially distinguishes them. It is of importance that clinicians carefully select AAPs bearing in mind the presence of risk factors, initiating patients directly on AAPs with a low risk of cardiometabolic side effects, and monitoring and managing those side effects at appropriate intervals.
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Affiliation(s)
| | - Earl Hsien-Jie Tan
- Pharmacist, Department of Pharmacy, Institute of Mental Health, Singapore
| | - Chia Eng Chong
- Senior Pharmacist, Department of Pharmacy, Institute of Mental Health, Singapore
| | - Yiwei Ng
- Pharmacist, Department of Pharmacy, Institute of Mental Health, Singapore
| | - Ruki Wijesinghe
- Principal Clinical Pharmacist, Specialist Pharmacist in Advanced Pharmacotherapy (Psychiatry), Department of Pharmacy, Institute of Mental Health, Singapore,
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Baxter AJ, Harris MG, Khatib Y, Brugha TS, Bien H, Bhui K. Reducing excess mortality due to chronic disease in people with severe mental illness: meta-review of health interventions. Br J Psychiatry 2016; 208:322-9. [PMID: 26941263 DOI: 10.1192/bjp.bp.115.163170] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 09/21/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND People with severe mental illness (SMI) have high rates of chronic disease and premature death. AIMS To explore the strength of evidence for interventions to reduce risk of mortality in people with SMI. METHOD In a meta-review of 16 systematic reviews of controlled studies, mortality was the primary outcome (8 reviews). Physiological health measures (body mass index, weight, glucose levels, lipid profiles and blood pressure) were secondary outcomes (14 reviews). RESULTS Antipsychotic and antidepressant medications had some protective effect on mortality, subject to treatment adherence. Integrative community care programmes may reduce physical morbidity and excess deaths, but the effective ingredients are unknown. Interventions to improve unhealthy lifestyles and risky behaviours can improve risk factor profiles, but longer follow-up is needed. Preventive interventions and improved medical care for comorbid chronic disease may reduce excess mortality, but data are lacking. CONCLUSIONS Improved adherence to pharmacological and physical health management guidelines is indicated.
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Affiliation(s)
- Amanda J Baxter
- Amanda J. Baxter, PhD, Meredith G. Harris, MPH, MPASR, University of Queensland, School of Public Health, Herston, and Policy and Epidemiology Group, Queensland Centre for Mental Health, Wacol, Australia; Yasmin Khatib, PhD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK; Traolach S. Brugha, MD, PhD, Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester, UK; Heidrun Bien, PhD, Kamaldeep Bhui, MD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Meredith G Harris
- Amanda J. Baxter, PhD, Meredith G. Harris, MPH, MPASR, University of Queensland, School of Public Health, Herston, and Policy and Epidemiology Group, Queensland Centre for Mental Health, Wacol, Australia; Yasmin Khatib, PhD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK; Traolach S. Brugha, MD, PhD, Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester, UK; Heidrun Bien, PhD, Kamaldeep Bhui, MD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Yasmin Khatib
- Amanda J. Baxter, PhD, Meredith G. Harris, MPH, MPASR, University of Queensland, School of Public Health, Herston, and Policy and Epidemiology Group, Queensland Centre for Mental Health, Wacol, Australia; Yasmin Khatib, PhD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK; Traolach S. Brugha, MD, PhD, Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester, UK; Heidrun Bien, PhD, Kamaldeep Bhui, MD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Traolach S Brugha
- Amanda J. Baxter, PhD, Meredith G. Harris, MPH, MPASR, University of Queensland, School of Public Health, Herston, and Policy and Epidemiology Group, Queensland Centre for Mental Health, Wacol, Australia; Yasmin Khatib, PhD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK; Traolach S. Brugha, MD, PhD, Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester, UK; Heidrun Bien, PhD, Kamaldeep Bhui, MD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Heidrun Bien
- Amanda J. Baxter, PhD, Meredith G. Harris, MPH, MPASR, University of Queensland, School of Public Health, Herston, and Policy and Epidemiology Group, Queensland Centre for Mental Health, Wacol, Australia; Yasmin Khatib, PhD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK; Traolach S. Brugha, MD, PhD, Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester, UK; Heidrun Bien, PhD, Kamaldeep Bhui, MD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK
| | - Kamaldeep Bhui
- Amanda J. Baxter, PhD, Meredith G. Harris, MPH, MPASR, University of Queensland, School of Public Health, Herston, and Policy and Epidemiology Group, Queensland Centre for Mental Health, Wacol, Australia; Yasmin Khatib, PhD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK; Traolach S. Brugha, MD, PhD, Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester, UK; Heidrun Bien, PhD, Kamaldeep Bhui, MD, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine and Dentistry, Queen Mary University of London, UK
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Laugharne J, Waterreus AJ, Castle DJ, Dragovic M. Screening for the metabolic syndrome in Australia: a national survey of psychiatrists' attitudes and reported practice in patients prescribed antipsychotic drugs. Australas Psychiatry 2016; 24:62-6. [PMID: 26635377 DOI: 10.1177/1039856215618521] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate current reported psychiatric practice in relation to screening for the metabolic syndrome in patients prescribed antipsychotic drugs within Australia. METHOD A postal survey of all Fellows of the Royal Australian and New Zealand College of Psychiatrists. A 28-item questionnaire inquired into different aspects of screening and monitoring for metabolic syndrome in patients on antipsychotic medication. RESULTS Of 3123 questionnaires sent, 955 were returned. Of respondents, 55% had no established metabolic monitoring protocol or guidelines in their work place, with 13% saying they did not know what to monitor to detect metabolic syndrome. Altogether, 76% reported there was no reliable system in place to remind them when to monitor. Fewer than 50% of respondents routinely check weight, fasting glucose or lipids in their patients on antipsychotics and under than 30% checked blood pressure. Waist circumference was routinely checked in fewer than 7% of patients. Basic monitoring equipment was reported unavailable in more than 50% of clinical settings. However, more than 80% of respondents considered monitoring for metabolic syndrome to be their responsibility and 83% felt they had a medicolegal obligation in this respect. CONCLUSIONS Routine screening for metabolic syndrome in patients on antipsychotic agents, by Australian psychiatrists, is inadequate. Interventions to improve screening rates need to be developed, implemented and evaluated.
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Affiliation(s)
- Jonathan Laugharne
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia
| | - Anna J Waterreus
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, WA, Australia
| | - David J Castle
- St Vincent's Hospital and The University of Melbourne, Melbourne, NSW, Australia
| | - Milan Dragovic
- Clinical Research Centre, North Metropolitan Health Service Mental Health, Perth, WA, Australia
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Lui K, Randhawa G, Totten V, Smith AE, Raese J. Is Metabolic Syndrome On the Radar? Improving Real-Time Detection of Metabolic Syndrome and Physician Response by Computerized Scan of the Electronic Medical Record. Prim Care Companion CNS Disord 2016; 18:15m01849. [PMID: 27247842 DOI: 10.4088/pcc.15m01849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 11/19/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Metabolic syndrome is a common underdiagnosed condition among psychiatric patients exacerbated by second-generation antipsychotics, with the exception of aripiprazole and ziprasidone. This study evaluated the prescribing and treating behavior with regard to antipsychotics and metabolic syndrome of psychiatrists before and after implementation of a mandatory admission order set and electronic notification of results. METHOD Baseline data from 9,100 consecutive psychiatric admissions to a mental health hospital (July 2013-July 2014) were compared to postintervention data (July 2014-January 2015), which included 1,499 consecutive patient records. The intervention initiated standardized admission testing with electronic notification to psychiatrists when patients met metabolic syndrome criteria (according to Axis III of the DSM-IV). Charts were examined for inclusion of this diagnosis at discharge and for treatment changes. RESULTS At baseline, only 2.4% of patients (n = 214) were evaluated for metabolic syndrome. Of these, 34.5% (0.8% of the total sample) met metabolic syndrome criteria. Only 15 patients (0.16%) were comprehensively treated. No chart listed metabolic syndrome under Axis III of the DSM-IV. After the intervention, the diagnosis of patients meeting the criteria for metabolic syndrome increased from 0% to 29.3%. Less than 3% of patients were switched to drugs with a more benign metabolic profile. All patients who continued on second-generation antipsychotics had metabolic retesting. Thirty-eight experienced a significant and rapid increase in triglyceride levels after only 3 to 17 days. CONCLUSIONS Mandatory intake testing increases the number of patients evaluated for metabolic syndrome. Electronic alerts increase the inclusion of metabolic syndrome among discharge diagnoses but rarely affect prescribing practices.
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Affiliation(s)
| | | | | | - Adam E Smith
- Statistical and Research Consultant, Kaweah Delta Health Care District, Visalia, California
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Ronsley R, Nguyen D, Davidson J, Panagiotopoulos C. Increased Risk of Obesity and Metabolic Dysregulation Following 12 Months of Second-Generation Antipsychotic Treatment in Children: A Prospective Cohort Study. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:441-50. [PMID: 26720191 PMCID: PMC4679120 DOI: 10.1177/070674371506001005] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 04/01/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the risk of developing obesity and related metabolic complications in children following long-term treatment with risperidone or quetiapine. METHODS This was a 1-year naturalistic longitudinal study conducted between February 2009 and March 2012. A total of 130 children aged 2 to 18 years without prior exposure to second-generation antipsychotics (SGAs) were enrolled at initiation of treatment with either risperidone or quetiapine. Metabolic parameters were measured at baseline and months 6 and 12. Data of 37 participants (20 treated with risperidone and 17 treated with quetiapine) who completed 12-month monitoring were used in the analysis. RESULTS After 1 year of SGA treatment, mean weight increased significantly by 10.8 kg (95% CI 7.9 kg to 13.7 kg) for risperidone and 9.7 kg (95% CI 6.5 kg to 12.8 kg) for quetiapine. Body mass index z score also increased significantly in both groups (P < 0.001). There was a high incidence of children becoming overweight or obese (6/15 [40.0%] for risperidone-treated and 7/14 [50.0%] for quetiapine-treated). The mean levels of fasting glucose (for risperidone-treated) and ratio of total cholesterol to high-density lipoprotein cholesterol (for quetiapine-treated) increased significantly by 0.23 mmol/L (95% CI 0.03 mmol/L to 0.42 mmol/L) and 0.48 mmol/L (95% CI 0.15 mmol/L to 0.80 mmol/L), respectively. CONCLUSION Children treated with risperidone or quetiapine are at a significant risk for developing obesity, elevated waist circumference, and dyslipidemia during 12 months of treatment. These data emphasize the importance of regular monitoring for early identification and treatment of metabolic side effects.
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Affiliation(s)
- Rebecca Ronsley
- Pediatrics Resident, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital, Vancouver, British Columbia
| | - Duc Nguyen
- Research Coordinator and Statistical Analyst, Department of Pediatrics, University of British Columbia, British Columbia Children's Hospital, Vancouver, British Columbia
| | - Jana Davidson
- Vice President Medical Affairs and Psychiatrist in Chief, Children's and Women's Mental Health and Substance Use Programs, British Columbia Children's Hospital, Vancouver, British Columbia; Clinical Professor, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Constadina Panagiotopoulos
- Pediatric Endocrinologist, British Columbia Children's Hospital, Vancouver, British Columbia; Clinical Professor, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
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Ventriglio A, Gentile A, Stella E, Bellomo A. Metabolic issues in patients affected by schizophrenia: clinical characteristics and medical management. Front Neurosci 2015; 9:297. [PMID: 26388714 PMCID: PMC4558473 DOI: 10.3389/fnins.2015.00297] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Accepted: 08/06/2015] [Indexed: 12/25/2022] Open
Abstract
Patients affected by psychotic disorders are more likely to develop high rates of co-morbidities, such as obesity, type 2 diabetes, dyslipidemias, hypertension, metabolic syndrome, myocardial infarction, stroke etc., in the long-term. These morbidities have a significant impact on the life-expectancy of these patients. Patients with chronic psychoses show a 2–3-fold increased risk of death mostly from cardiovascular and metabolic diseases. Although there may be an independent link, between schizophrenia and metabolic conditions the cardio-metabolic risk is mostly related to an unhealthy lifestyle and the usage of antipsychotic agents (especially Second Generation Antipsychotics or atypical) even when these remain effective treatments in the management of major psychoses. Recently, many international organizations have developed screening and monitoring guidelines for the control of modifiable risk factors in order to reduce the rate of co-morbidity and mortality among patients affected by schizophrenia. This paper is a review of current knowledge about the metabolic issues of patients affected by schizophrenia and describes clinical characteristics and medical management strategies for such conditions.
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Affiliation(s)
- Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia Foggia, Italy
| | - Alessandro Gentile
- Department of Clinical and Experimental Medicine, University of Foggia Foggia, Italy
| | - Eleonora Stella
- Department of Clinical and Experimental Medicine, University of Foggia Foggia, Italy
| | - Antonello Bellomo
- Department of Clinical and Experimental Medicine, University of Foggia Foggia, Italy
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Hemmati M, Zohoori E, Mehrpour O, Karamian M, Asghari S, Zarban A, Nasouti R. Anti-atherogenic potential of jujube, saffron and barberry: anti-diabetic and antioxidant actions. EXCLI JOURNAL 2015; 14:908-15. [PMID: 26600752 PMCID: PMC4650949 DOI: 10.17179/excli2015-232] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/26/2015] [Indexed: 11/10/2022]
Abstract
Atherogenic dyslipidemia, characterized by an increased level of lipoprotein (a) and a decreased level of adiponectin, is a major risk factor for cardiovascular diseases in diabetic patients. To reduce cardiovascular risk in diabetic patients, use of agents with antidiabetic and anti-atherogenic potential is required. Using an animal model of diabetes, we investigated the antiatherogenic potential of extracts of three medicinal plants: jujube, barberry, and saffron. For this, serum level of fasting blood glucose, lipid profile, malondialdehyde, total antioxidant capacity, adiponectin and lipoprotein (a) in diabetic control and extract treated groups were measured. Statistical analysis of measurements showed that serum levels of fasting blood glucose, triglyceride, and VLDL decreased significantly (P < 0.05) in all treated groups. Treatment with all extracts reduced lipid peroxidation and increased antioxidant capacity of the experimental diabetic groups. Serum adiponectin levels increased in all treated groups, whereas lipoprotein (a) levels decreased, most markedly when treated with jujube extract. Jujube, saffron, and barberry extracts are beneficial in ameliorating oxidative stress and atherogenic risk of diabetic rats. This highlights the benefits of further investigating the cardio-protective potential of medicinal plant extracts and evaluating their usefulness as cardio protective agents in clinical practice.
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Affiliation(s)
- Mina Hemmati
- Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, Iran ; Department of Biochemistry, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Elham Zohoori
- Department of Biochemistry, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Omid Mehrpour
- Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Mehdi Karamian
- Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Somaye Asghari
- Department of Biochemistry, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Asghar Zarban
- Department of Biochemistry, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | - Roya Nasouti
- Department of Biochemistry, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran
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Lake JK, Vogan V, Sawyer A, Weiss JA, Lunsky Y. Psychotropic medication use among adolescents and young adults with an autism spectrum disorder: parent views about medication use and healthcare services. J Child Adolesc Psychopharmacol 2015; 25:260-8. [PMID: 25803636 DOI: 10.1089/cap.2014.0106] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Psychotropic medications are frequently used to treat mental health and behavioral issues in adolescents and adults with an autism spectrum disorder (ASD). Although parents of individuals with ASD frequently take on medication management for their child, there is limited literature on parent perspectives of their child's medication use or their views about the healthcare services they receive, particularly in adulthood. The current study examined and compared parents of adolescents and of young adults with ASD regarding their child's psychotropic medication use and their views about healthcare services. METHODS One hundred parents of adolescents and young adults with ASD (ages 12-30 years) completed an online survey about their experience with their child's healthcare services and medication use. RESULTS Parents of young adults were less likely to use nonpharmacological services before using a psychotropic medication than were parents of adolescents. Parents of young adults were also less likely to believe that their prescribing healthcare provider had adequate expertise in ASD, and were less satisfied with how their prescriber monitored their child's medication use. CONCLUSION Findings highlight the need to build capacity among healthcare providers supporting individuals with ASD as they transition into adulthood. There is also a need for improved medication monitoring and increased awareness of the different mental health challenges that individuals with ASD encounter as they age.
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Affiliation(s)
- Johanna K Lake
- 1 Centre for Addiction and Mental Health, Dual Diagnosis Service , Toronto, Ontario, Canada
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Abstract
The metabolic side effects of atypical antipsychotics (AAPs) have been widely studied in younger populations, but research investigating these sequelae in the elderly is lacking. This article reviews the available literature examining the use of AAPs in the elderly, evaluating their association with weight gain and changes in blood glucose and lipid parameters. We find a relative paucity of studies in this area; while some data highlight significant, collective changes in metabolic parameters, the majority suggests an apparent low vulnerability to these side effects. We conclude that the risk and clinical implications of unfavorable metabolic changes in the elderly being treated with AAP medications remain largely undetermined, and we caution against drawing firm conclusions based on the available data. The conflicting evidence leaves us recommending that metabolic monitoring be implemented, with regular follow-up as advocated in other populations.
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Millar F, Sands N, Elsom S. Factors influencing cardiometabolic monitoring practices in an adult community mental health service. Int J Ment Health Nurs 2014; 23:479-89. [PMID: 25069903 DOI: 10.1111/inm.12085] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
People with serious mental illness are reported to live up to 25 years less than the general population. Cardiovascular disease and diabetes risk factors, as well as mental health, treatment, lifestyle, service provision, and socioeconomic factors, all contribute to this health inequity. Cardiometabolic monitoring (CMM) is one strategy used to attend to some cardiometabolic risk factors. The present study aimed to explore factors that influence decisions to undertake CMM in an Australian adult community mental health service. A CMM audit tool was designed to capture demographic, clinical, and care-provision factors. A 6-month retrospective file audit from the total population of consumers of an adult community mental health service was undertaken, where no existing CMM guidelines or practices were in place. The study findings confirmed a higher prevalence of cardiometabolic disorders in the study population compared to the general population. Complete CMM occurred in 24% of the study population (n = 94). No consumer demographic, socioeconomic, or clinical characteristics, or care-provision factors, were found to be predictors of complete CMM. The random manner in which CMM was observed to occur in the study highlights the need for standardized CMM guidelines and capacity-building strategies to improve current CMM practices.
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Schneiderhan ME, Shuster SM, Davey CS. Twelve-month prospective randomized study of pharmacists utilizing point-of-care testing for metabolic syndrome and related conditions in subjects prescribed antipsychotics. Prim Care Companion CNS Disord 2014; 16:14m01669. [PMID: 25667811 DOI: 10.4088/pcc.14m01669] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 07/22/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Determine the percentage of subjects taking antipsychotics who meet criteria for metabolic syndrome based on point-of-care testing analyses. Evaluate pharmacist comprehensive medication management services using point-of-care tests to reduce the mean difference in number of metabolic syndrome risk parameters at 6 and 12 months. METHOD This 12-month, prospective, multisite, randomized, controlled study included 120 subjects taking antipsychotics (mean [SD] age of 42.9 [11.3] years) recruited from 3 community mental health clinics in Minnesota. Subjects consented to receive either pharmacist (PCS; n = 60) or no pharmacist (NCS; n = 60) comprehensive medication management services. Data were collected from February 2010 to January 2012. RESULTS No statistical differences in metabolic syndrome based on point-of-care tests were observed between the 2 groups at baseline (PCS: 85.2%, n = 46 versus NCS: 71.2%, n = 42, P = .073) or at 12 months (PCS: 84.4%, n = 38 versus NCS: 70.2%, n = 33, P = .104). Subjects, overall, screened positive at baseline for dyslipidemia (85.8%, n = 106), hypertension (52.5%, n = 63), and diabetes (22.5%, n = 27) based on point-of-care testing for metabolic risk criteria. After 12 months, a nonsignificant (P = .099) higher adjusted mean number of metabolic syndrome parameters in PCS subjects compared to NCS subjects (mean difference [95% CI] = 0.41 [-0.08 to 0.90]) were found. CONCLUSIONS A relatively high proportion of subjects met criteria for metabolic syndrome, although no significant improvement was observed between the groups after 12 months. Point-of-care test analyses identified a high proportion of subjects meeting criteria for dyslipidemia, hypertension, and diabetes. Utilizing point-of-care tests in mental health settings and fostering interprofessional partnerships with comprehensive medication management pharmacists may improve identification and long-term management of metabolic risks among patients prescribed antipsychotics. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02029989.
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Affiliation(s)
- Mark E Schneiderhan
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, College of Pharmacy, Duluth (Dr Schneiderhan); St Luke's Hospital, Duluth, Minnesota (Dr Shuster); and Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis (Ms Davey)
| | - Sara M Shuster
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, College of Pharmacy, Duluth (Dr Schneiderhan); St Luke's Hospital, Duluth, Minnesota (Dr Shuster); and Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis (Ms Davey)
| | - Cynthia S Davey
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota, College of Pharmacy, Duluth (Dr Schneiderhan); St Luke's Hospital, Duluth, Minnesota (Dr Shuster); and Biostatistical Design and Analysis Center, University of Minnesota, Minneapolis (Ms Davey)
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