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Comorbid physical illnesses in adult outpatients with psychotic disorders: risk factors, psychological functioning, and quality of life outcomes. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1633-1643. [PMID: 33616692 PMCID: PMC8429359 DOI: 10.1007/s00127-021-02034-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/29/2021] [Indexed: 12/25/2022]
Abstract
PURPOSE In contrast to global research, where physical comorbidity in psychotic disorders is established, only a few studies have been conducted in Southeast Asia. With a concerning trend of chronic physical illnesses emerging in adults below the age of 65, an investigation into comorbid chronic physical illnesses in adults diagnosed with psychotic disorders is necessary. This study aims to explore the risk factors, psychological functioning, and quality of life outcomes associated with comorbidity in adults below the age of 65, diagnosed with psychotic disorders, in a multi-ethnic non-Western setting. METHODS Electronic medical records of 364 patients with psychotic disorders who had provided written consent to participate were screened for co-occurring physical conditions. The majority of participants were female (53.7%), Chinese (69%), single (74.5%), and had tertiary and above education (43%). They were approximately 35 years old on average and the mean age of onset for psychosis was 26.7 years old. RESULTS Comorbid physical illnesses were present in approximately a third of adults with psychotic disorders (28%). They typically reported cardiovascular-related diseases, respiratory, and skin conditions. Comorbidity was significantly related to lower physical quality of life. As compared to other types of psychotic disorders, schizophrenia was significantly related to a greater frequency of comorbid physical conditions. Multinomial regression analyses revealed that age, age of onset, Malay and Indian ethnicities were significant factors. CONCLUSION Physical comorbidity in adults below the age of 65 is common, signifying an emerging need to place greater attention into the screening and emphasis on the physical care needs of this age group. Finally, more research is needed to understand the impact of common co-occurring acute and chronic cardiovascular, skin, and respiratory diseases locally.
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2
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Mellor C, Blackman J, Barker E, Bhula Z, Sibanda E, Rawlings E, Harrington D, Combe G. Wellbeing Wednesdays: nurse-led clinic for improving physical health care in a general adolescent inpatient unit. ACTA ACUST UNITED AC 2020; 29:230-235. [PMID: 32105537 DOI: 10.12968/bjon.2020.29.4.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Young people with mental illness are at high risk of physical health complications. Physical healthcare on a general adolescent inpatient unit is complex. AIM To establish a wellbeing clinic to improve efficiency and quality of the physical healthcare offered and increase health promotion. METHODS Plan, Do, Study, Act (PDSA) cycles were used to drive this quality-improvement project. The authors audited 12 records before establishing the clinic and 12 at three further time points (6, 18 and 30 months post-intervention) to guide changes. RESULTS Results progressively improved over PDSA cycles. Time taken for initial investigations dropped. Compliance with medication monitoring and management of important physical health domains rose from zero in some cases to 100% in all but one area. CONCLUSIONS Establishing a dedicated physical health clinic in this setting is feasible and leads to improved performance against local and national standards. Mental health teams need to ensure physical health is prioritised.
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Affiliation(s)
- Catriona Mellor
- Specialty Doctor in Child and Adolescent Psychiatry, Oxford Health NHS Foundation Trust
| | - Jonathan Blackman
- Specialty Registrar in Old Age Psychiatry, Aneurin Bevan University Health Board
| | | | | | - Evelyn Sibanda
- Health Care Support Worker, Oxford Health NHS Foundation Trust
| | - Emma Rawlings
- Health Care Support Worker, Oxford Health NHS Foundation Trust
| | | | - Gillian Combe
- Consultant Child and Adolescent Psychiatrist, Oxford Health NHS Foundation Trust
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3
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McCombe G, Harrold A, Brown K, Hennessy L, Clarke M, Hanlon D, O'Brien S, Lyne J, Corcoran C, McGorry P, Cullen W. Key Worker-Mediated Enhancement of Physical Health in First Episode Psychosis: Protocol For a Feasibility Study in Primary Care. JMIR Res Protoc 2019; 8:e13115. [PMID: 31293240 PMCID: PMC6652125 DOI: 10.2196/13115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/27/2019] [Accepted: 03/30/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Studies have demonstrated that, for patients with psychosis, a majority of the decline in health status and functioning emerges during the first few years after the onset of illness. This knowledge led to the development of specialized early intervention services (EISs) targeting patients experiencing their first episode of psychosis. The central component of EISs is often assertive case management delivered by a multidisciplinary team, where an appointed key worker is responsible for coordinating treatment and delivering various psychosocial interventions to service users. OBJECTIVE This paper outlines the protocol for a feasibility study examining how key workers may enhance physical health by supporting integration between primary and secondary care. METHODS Semistructured interviews were conducted with key stakeholder groups (General Practitioners and health care professionals working in mental health services). The interviews informed the development of the complex intervention involving a longitudinal pre-post intervention in 8 general practices in 2 regions in Ireland (one urban and one rural). Patients with first episode psychosis (FEP) will be identified from clinical records at general practices and mental health services. RESULTS Baseline and follow-up data (at 6 months) will be collected, examining measures of feasibility, acceptability, and intervention effect size. CONCLUSIONS Study findings will inform future practice by examining feasibility of key workers enhancing physical health through improved interaction between primary and secondary care. By identifying issues involved in enhancing recruitment and retention, as well as the likely effect size, the study will inform a future definitive intervention. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/13115.
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Affiliation(s)
- Geoff McCombe
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Aine Harrold
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Katherine Brown
- Dr Steeven's Hospital, Health Service Executive, Dublin, Ireland
| | | | | | | | | | - John Lyne
- Royal College of Surgeons Ireland, Dublin, Ireland.,North Dublin Mental Health Services, Dublin, Ireland
| | | | - Patrick McGorry
- University of Melbourne, Melbourne, Australia.,The National Centre of Excellence in Youth Mental Health, Orygen, Melbourne, Australia
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4
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Griffiths R, Mansell W, Edge D, Tai S. Sources of Distress in First-Episode Psychosis: A Systematic Review and Qualitative Metasynthesis. QUALITATIVE HEALTH RESEARCH 2019; 29:107-123. [PMID: 30066602 DOI: 10.1177/1049732318790544] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In this study, we aim to increase our understanding of the self-reported sources of distress among people who have experienced first-episode psychosis. Following a systematic literature search, 33 relevant studies containing first-person accounts of first-episode psychosis were identified, which were synthesized using thematic analysis. Two interrelated superordinate themes were identified: intrapersonal distress and interpersonal distress. Participants reported multiple, diverse, and multifaceted sources of distress across both themes. These were substantially different from those routinely recognized and targeted in clinical practice. This review suggests that practitioners who maintain a stance of genuine curiosity about the potential sources of distress for this population will be perceived as more helpful. The findings also highlight the importance of being service user-led when planning and delivering mental health care. Additional clinical and research implications are discussed.
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Affiliation(s)
- Robert Griffiths
- 1 Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Warren Mansell
- 2 The University of Manchester, Manchester, United Kingdom
| | - Dawn Edge
- 2 The University of Manchester, Manchester, United Kingdom
| | - Sara Tai
- 2 The University of Manchester, Manchester, United Kingdom
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5
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John A, McGregor J, Jones I, Lee SC, Walters JTR, Owen MJ, O'Donovan M, DelPozo-Banos M, Berridge D, Lloyd K. Premature mortality among people with severe mental illness - New evidence from linked primary care data. Schizophr Res 2018; 199:154-162. [PMID: 29728293 DOI: 10.1016/j.schres.2018.04.009] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/19/2018] [Accepted: 04/03/2018] [Indexed: 02/04/2023]
Abstract
Studies assessing premature mortality in people with severe mental illness (SMI) are usually based in one setting, hospital (secondary care inpatients and/or outpatients) or community (primary care). This may lead to ascertainment bias. This study aimed to estimate standardised mortality ratios (SMRs) for all-cause and cause-specific mortality in people with SMI drawn from linked primary and secondary care populations compared to the general population. SMRs were calculated using the indirect method for a United Kingdom population of almost four million between 2004 and 2013. The all-cause SMR was higher in the cohort identified from secondary care hospital admissions (SMR: 2.9; 95% CI: 2.8-3.0) than from primary care (SMR: 2.2; 95% CI: 2.1-2.3) when compared to the general population. The SMR for the combined cohort was 2.6 (95% CI: 2.5-2.6). Cause specific SMRs in the combined cohort were particularly elevated in those with SMI relative to the general population for ill-defined and unknown causes, suicide, substance abuse, Parkinson's disease, accidents, dementia, infections and respiratory disorders (particularly pneumonia), and Alzheimer's disease. Solely hospital admission based studies, which have dominated the literature hitherto, somewhat over-estimate premature mortality in those with SMI. People with SMI are more likely to die by ill-defined and unknown causes, suicide and other less common and often under-reported causes. Comprehensive characterisation of mortality is important to inform policy and practice and to discriminate settings to allow for proportionate interventions to address this health injustice.
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Affiliation(s)
- Ann John
- Farr Institute, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK; National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK.
| | - Joanna McGregor
- Farr Institute, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK; National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Ian Jones
- National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK; MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ, UK
| | - Sze Chim Lee
- Farr Institute, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK; National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - James T R Walters
- National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK; MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ, UK
| | - Michael J Owen
- National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK; MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ, UK
| | - Michael O'Donovan
- National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK; MRC Centre for Neuropsychiatric Genetics and Genomics, School of Medicine, Cardiff University, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff CF24 4HQ, UK
| | - Marcos DelPozo-Banos
- Farr Institute, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK; National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
| | - Damon Berridge
- Farr Institute, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK
| | - Keith Lloyd
- Farr Institute, Swansea University Medical School, Singleton Park, Swansea SA2 8PP, UK; National Centre for Mental Health, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff CF24 4HQ, UK
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Onwumere J, Howes S, Shiers D, Gaughran F. Physical health problems in people with psychosis: The issue for informal carers. Int J Soc Psychiatry 2018; 64:381-388. [PMID: 29584519 DOI: 10.1177/0020764018763684] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Reduced life expectancies are recorded in adults with psychotic disorders. Informal carers play key roles in improving illness outcomes for patients, including significantly reducing rates of relapse and hospitalisation. There is, however, a dearth of literature detailing carers' perspectives on physical health problems in the relatives they care for and implications for those in the caregiving role. The study sought to explore carers' subjective experiences of supporting a relative with psychosis and physical health problems. METHODS Carers of adults with psychosis were interviewed individually, or as part of a group, about physical health problems in the relatives they care for. RESULTS Five key themes were identified from the interviews that reflected (1) ubiquity of physical health problems in psychosis, (2) gaps in service provision for those living with mental and physical health problems, (3) carers' role in responding to service gaps, (4) difficult conversations and (5) impact on carer health. CONCLUSION Service initiatives that are designed to improve patient physical health in psychosis should not overlook the role that informal carers might have in supporting this process. The implications that patient physical health problems present for carer well-being and the quality of the caregiving relationship in psychosis deserve further investigation.
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Affiliation(s)
- Juliana Onwumere
- 1 Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Sophia Howes
- 1 Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - David Shiers
- 2 Psychosis Research Unit, Prestwich Hospital Manchester, Manchester, UK.,3 The University of Manchester, Manchester, UK
| | - Fiona Gaughran
- 4 Department of Psychosis Studies, Institute of Psychosis, Psychology and Neuroscience, King's College, London
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Pedley R, Lovell K, Bee P, Bradshaw T, Gellatly J, Ward K, Woodham A, Wearden A. Collaborative, individualised lifestyle interventions are acceptable to people with first episode psychosis; a qualitative study. BMC Psychiatry 2018; 18:111. [PMID: 29699527 PMCID: PMC5921748 DOI: 10.1186/s12888-018-1692-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 04/16/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The adverse impact of unhealthy lifestyle choices and the prescription of antipsychotic medications contribute to weight gain, poor cardiovascular health and reduced life expectancy for people with psychosis. The present study aimed to explore the acceptability and perceived outcomes of a lifestyle intervention designed to prevent or reduce weight gain in people with first-episode psychosis. METHODS This was a qualitative study using a data-driven approach. People recovering from first-episode psychosis recruited from UK early intervention services and taking part in the active arm of a randomised controlled trial of a lifestyle intervention (the InterACT trial), were interviewed using a semi-structured interview schedule. Interviews were transcribed verbatim and analysed using Framework Analysis. RESULTS Participants valued the collaborative and individualised approach taken by the intervention deliverers, and formed high quality relationships with them. Aspects of the intervention that were positively appraised included goal setting, social opportunities, and progress monitoring. Benefits of the intervention, including increased levels of exercise; improved diet and physical health; increased psychological wellbeing (e.g. confidence, self-esteem); and improved social relationships, were identified by participants, independent of actual weight loss. CONCLUSIONS Future interventions should ensure that workers have the skills to form high quality relationships with users, and to individualise the intervention according to users' needs and preferences. Future trials that test healthy living interventions should consider supplementing physical outcome measures with wider psychosocial outcome assessments, in particular social relationship quality, psychological wellbeing, self-esteem and self-efficacy. TRIAL REGISTRATION Current Controlled Trials: ISRCTN22581937 . Date of registration: 27 October 2010 (retrospectively registered).
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Affiliation(s)
- Rebecca Pedley
- Division of Nursing, Midwifery & Social Work, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Karina Lovell
- 0000000121662407grid.5379.8Division of Nursing, Midwifery & Social Work, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Penny Bee
- 0000000121662407grid.5379.8Division of Nursing, Midwifery & Social Work, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Tim Bradshaw
- 0000000121662407grid.5379.8Division of Nursing, Midwifery & Social Work, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Judith Gellatly
- 0000000121662407grid.5379.8Division of Nursing, Midwifery & Social Work, The University of Manchester, Manchester Academic Health Science Centre, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL UK
| | - Kate Ward
- Mersey Care NHS Foundation Trust, Ashworth High Secure Hospital, Ashworth Research Centre, Parkbourn, Maghull, Liverpool, L31 1HW UK
| | - Adrine Woodham
- 0000000121662407grid.5379.8Division of Population Health, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL UK
| | - Alison Wearden
- 0000000121662407grid.5379.8Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Coupland 1 Building, Oxford Road, Manchester, M13 9PL UK
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8
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Bailey S, Thorpe L, Smith G. Using the lever of parity of esteem between mental and physical health to close the mental health gap -a call for action. Int Psychiatry 2018. [DOI: 10.1192/s1749367600003829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This paper provides a six-point definition of what parity of esteem for mental health means in practice. It highlights examples of the current disparity between mental and physical health and the importance of redressing this. The significance of securing a legislative basis for parity in England is discussed. The authors make a call for action, and pose six questions for international readers to consider and respond to.
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McCloughen A, Foster K, Kerley D, Delgado C, Turnell A. Physical health and well-being: Experiences and perspectives of young adult mental health consumers. Int J Ment Health Nurs 2016; 25:299-307. [PMID: 26856981 DOI: 10.1111/inm.12189] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 09/04/2015] [Accepted: 09/10/2015] [Indexed: 11/29/2022]
Abstract
Compromised physical health and raised levels of morbidity and mortality are experienced by young people (16-24 years) with mental illness, and are compounded by psychotropic medication. How this group conceives and experiences physical health is not well understood. We investigated the meanings, beliefs, and endeavours of young people that impact their physical health understandings and behaviours. The present study formed the qualitative phase of a sequential mixed-methods study, and incorporated semistructured interviews with 12 hospitalized young people. Qualitative content analysis was used to analyse data. Participants held a holistic ideal of physical health that they did not meet. Weight change, poor sleep, and limited exercise adversely impacted their lives and self-image. Sedentary behaviour, reduced energy, and limited health literacy compromised effective management of physical health. Young people needed structure and support to assist them in addressing their physical health needs when amotivation overwhelmed their internal resources. Nurses are well placed to help young people increase their competency for health management. Individualized information and methods to promote good physical health are required for this group in jeopardy from physical morbidity and mortality.
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Affiliation(s)
| | - Kim Foster
- Disciplines of Nursing and Midwifery, University of Canberra
| | - David Kerley
- Mental Health Service, Sydney Local Health District
| | - Cynthia Delgado
- Sydney Nursing School.,Sydney Local Health District, Sydney, New South Wales
| | - Adrienne Turnell
- School of Psychology, University of Sydney.,School of Psychology, Australian National University, Canberra, Australian Capital Territory, Australia
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Patel R. Venous thromboembolism prophylaxis in mental healthcare: do the benefits outweigh the risks? BJPsych Bull 2015; 39:61-4. [PMID: 26191434 PMCID: PMC4478902 DOI: 10.1192/pb.bp.113.046680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 05/18/2014] [Accepted: 06/10/2014] [Indexed: 12/01/2022] Open
Abstract
Venous thromboembolism is an important cause of morbidity and mortality. In recent years, growing awareness has led to the development of strategies to prevent venous thromboembolism in individuals admitted to hospital who are deemed to be at high risk. However, there remains a considerable degree of uncertainty over whether these strategies are of overall benefit and there are few published studies on people who are admitted to psychiatric hospitals. In this editorial I review current clinical practice and areas of uncertainty with respect to venous thromboembolism prophylaxis and its implementation in mental healthcare settings.
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McCloughen A, Foster K, Marabong N, Miu D, Fethney J. Physical Health Risk Behaviours in Young People with Mental Illness. Issues Ment Health Nurs 2015; 36:781-90. [PMID: 26514256 DOI: 10.3109/01612840.2015.1036480] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Comorbid physical health conditions, commonly associated with mental illness, contribute to increased morbidity and reduced life expectancy. The trajectory to poorer health begins with the onset of mental illness. For young people with mental illness, health risk behaviours and poor physical health can progress to adulthood with long-term detrimental impacts. Using a cross-sectional survey design, self-reported health risk behaviours were gathered from 56 young (16-25 years) Australians who had been hospitalised for mental illness and taking psychotropic medication. Smoking, alcohol use, minimal physical activity, and lack of primary health care were evident. While these behaviours are typical of many young people, those with mental illness have substantially increased vulnerability to poor health and reduced life expectancy. Priority needs to be given to targeted health promotion strategies for young people with mental illness to modify their risky long-term health behaviours and improve morbidity and mortality outcomes. Nurses in mental health settings play a vital role in promoting young peoples' well-being and preventing poorer physical health outcomes. Implementation of a cardiometabolic health nurse role in inpatient settings for young people with mental illness could facilitate prevention and early intervention for health risk behaviours.
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Affiliation(s)
| | - Kim Foster
- b University of Canberra, Faculty of Health, Disciplines of Nursing and Midwifery , Canberra , Australia
| | - Nikka Marabong
- c South Western Sydney Local Health District, Campbelltown Hospital , Sydney , Australia
| | - David Miu
- c South Western Sydney Local Health District, Campbelltown Hospital , Sydney , Australia
| | - Judith Fethney
- a University of Sydney, School of Nursing , Sydney , Australia
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Abstract
PURPOSE OF REVIEW It is well established that depression is associated with increased risk of incident coronary heart disease (CHD). The strong research focus on this particular comorbidity may obscure an appreciation of the breadth of mental disorder-medical comorbidities. Some of the most prevalent of these are highlighted in this review, which features recent research on epidemiological associations of depression and anxiety disorders with a range of cardiometabolic diseases. The clinical implications of this broader set of mental-physical connections are discussed. RECENT FINDINGS New findings support the existence of an association between depression and a range of subtypes of heart disease, stroke and diabetes. The associations between anxiety and coronary heart disease are robust and there is emerging evidence of associations of anxiety with stroke and diabetes. SUMMARY The predictive associations of mental disorders with incident medical diseases extend well beyond the established association between depression and CHD. The breadth of mental-physical associations suggests a need for greater clinical attention to the physical health and health-related behavior of young people with persistent mental disorders of all types, at the time of life when the seeds of mental-physical comorbidity are sown.
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Gaughran F, Stahl D, Ismail K, Atakan Z, Lally J, Gardner-Sood P, Patel A, David A, Hopkins D, Harries B, Lowe P, Orr D, Arbuthnot M, Murray RM, Greenwood KE, Smith S. Improving physical health and reducing substance use in psychosis--randomised control trial (IMPACT RCT): study protocol for a cluster randomised controlled trial. BMC Psychiatry 2013; 13:263. [PMID: 24131496 PMCID: PMC3852764 DOI: 10.1186/1471-244x-13-263] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 09/19/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Cardiovascular morbidity and mortality is increased in individuals with severe mental illnesses.We set out to establish a multicentre, two arm, parallel cluster randomized controlled trial (RCT) of a health promotion intervention (HPI), IMPACT Therapy. The patient-tailored IMPACT Therapy aims to target one or more health behaviours from a pre-defined list that includes cannabis use; alcohol use; other substance use; cigarette smoking; exercise; diet and diabetic control, prioritising those identified as problematic by the patient, taking a motivational interviewing and CBT approach. METHODS Impact therapy will be delivered by care coordinators in the community to the treatment group and will be compared to treatment as usual (TAU). The main hypothesis is that the addition of IMPACT Therapy (HPI) to TAU will be more effective than TAU alone in improving patients' quality of life as measured by the Short Form-36, including mental health and physical health subscales on completion of the intervention at 12 months post randomisation. A subsidiary hypothesis will be that addition of IMPACT Therapy (HPI) will be more cost-effective than TAU alone in improving health in people with SMI 12 months from baseline. The IMPACT therapy patient groups' improvement in quality of life, as well as its cost effectiveness, is hypothesised to be maintained at 15 months. Outcomes will be analyzed on an intention-to-treat (ITT) basis. DISCUSSION The results of the trial will provide information about the effectiveness of the IMPACT therapy programme in supporting community mental health teams to address physical comorbidity in severe mental illness. TRIAL REGISTRATION ISRCTN58667926.
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Affiliation(s)
- Fiona Gaughran
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK.
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, King’s College London, London, UK
| | - Khalida Ismail
- Institute of Psychiatry, King’s College London, London, UK,King’s College Hospital NHS Foundation Trust, London, UK
| | - Zerrin Atakan
- Section of Neuroimaging, Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - John Lally
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK,Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Poonam Gardner-Sood
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Anita Patel
- Centre for the Economics of Mental and Physical Health (CEMPH), Institute of Psychiatry at King's College London, London, UK
| | - Anthony David
- Institute of Psychiatry, King’s College London, London, UK
| | - David Hopkins
- Division of Ambulatory Care & Local Networks, King’s College Hospital NHS Foundation Trust, London, UK,King’s College London School of Medicine, London, UK
| | - Bee Harries
- Department of Mental Health Sciences, Royal Free and University College Medical School, London, UK
| | - Philippa Lowe
- Department of Mental Health Sciences, Royal Free and University College Medical School, London, UK
| | - Diana Orr
- Department of Mental Health Sciences, Royal Free and University College Medical School, London, UK
| | - Maurice Arbuthnot
- Department of Mental Health Sciences, Royal Free and University College Medical School, London, UK
| | - Robin M Murray
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK,Institute of Psychiatry, King’s College London, London, UK
| | - Kathryn E Greenwood
- School of Psychology, University of Sussex, Brighton, UK,Early Intervention in Psychosis Service, Sussex Partnership NHS Foundation Trust, Worthing, West Sussex, UK
| | - Shubulade Smith
- Institute of Psychiatry, King’s College London, London, UK,South London and Maudsley NHS Foundation Trust, London, UK
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Langan J, Mercer SW, Smith DJ. Multimorbidity and mental health: can psychiatry rise to the challenge? Br J Psychiatry 2013; 202:391-3. [PMID: 23732931 DOI: 10.1192/bjp.bp.112.123943] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Multimorbidity--the co-occurrence of two or more long-term conditions in an individual - is highly relevant to psychiatry. Changes to training and a more integrated model of psychiatric and physical healthcare are needed in the future if we are to improve the long-term health of our patients.
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