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Kuperberg M, Köhler-Forsberg O, Shannon AP, George N, Greenebaum S, Bowden CL, Calabrese JR, Thase M, Shelton RC, McInnis M, Deckersbach T, Tohen M, Kocsis JH, Ketter TA, Friedman ES, Iosifescu DV, Ostacher MJ, Sylvia LG, McElroy SL, Nierenberg AA. Cardiometabolic risk markers during mood-stabilizing treatment: Correlation with drug-specific effects, depressive symptoms and treatment response. J Affect Disord 2022; 300:41-49. [PMID: 34952123 DOI: 10.1016/j.jad.2021.12.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 12/05/2021] [Accepted: 12/18/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Patients with bipolar disorder have higher rates of cardiometabolic comorbidities and mortality. Although guidelines emphasize the importance of cardiovascular monitoring, few studies characterized the cardiometabolic risk profile during treatment and their relation to symptomatology and treatment response. METHODS We analyzed data from two similar 24-weeks comparative effectiveness trials, with a combined sample of 770 participants randomized to two different lithium doses, quetiapine (300 mg/day), or standard treatment without lithium. Glucose, lipids and vital signs were measured before and after 24 weeks of treatment. We calculated several cardiovascular risk scores, assessed baseline correlations and compared the four treatment arms via multiple linear regression models. RESULTS Higher cholesterol and LDL levels were associated with greater depression severity, showing differential correlations to specific symptoms, particularly agitation, low energy and suicidality. Those randomized to quetiapine showed a significant worsening of cardiometabolic markers during the 24-week trial. Neither baseline nor change in lipid levels correlated with differential treatment response. LIMITATIONS Study duration was short from the perspective of cardiometabolic risk markers, and all treatment arms included patients taking adjunct antipsychotics. The trials compared quetiapine to lithium, but not to other medications known to affect similar risk factors. CONCLUSIONS Treatment with 300 mg/day quetiapine for 24 weeks, representing a short and common dose course, resulted in increased cardiometabolic risk markers, emphasizing the importance of monitoring during mood-stabilizing treatment. The symptom-specific associations are in line with previous studies in unipolar depression, suggesting a cardiometabolic-depression link that needs to be further studied in bipolar depression.
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Affiliation(s)
- Maya Kuperberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Ole Köhler-Forsberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Alec P Shannon
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Nevita George
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Sophie Greenebaum
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Charles L Bowden
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA
| | - Joseph R Calabrese
- Department of Psychiatry, Case Western Reserve University, Cleveland, OH, USA
| | - Michael Thase
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Richard C Shelton
- Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Melvin McInnis
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Thilo Deckersbach
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Mauricio Tohen
- Department of Psychiatry, University of New Mexico Health Science Center, Albuquerque, NM, USA
| | - James H Kocsis
- Department of Psychiatry, Weill Cornell Medical College, New York, NY, USA
| | - Terence A Ketter
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Edward S Friedman
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Dan V Iosifescu
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Michael J Ostacher
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Louisa G Sylvia
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Susan L McElroy
- Department of Psychiatry and Behavioral Neuroscience, OH and Lindner Center of HOPE, University of Cincinnati College of Medicine, Cincinnati, Mason, OH, USA
| | - Andrew A Nierenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Gregório ML, Wazen GLL, Kemp AH, Milan-Mattos JC, Porta A, Catai AM, de Godoy MF. Non-linear analysis of the heart rate variability in characterization of manic and euthymic phases of bipolar disorder. J Affect Disord 2020; 275:136-144. [PMID: 32658816 DOI: 10.1016/j.jad.2020.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/18/2020] [Accepted: 07/05/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND - Bipolar Disorder (BD) has been associated with autonomic nervous system (ANS) dysregulation, with a consequent increase in mortality. Recent work highlights the non-linear analysis of ANS function. Our objective was to compare ANS modulation using recurrence plots (RP) and symbolic analysis (SA) in manic and euthymic phases of BD to controls. METHODS - Eighteen male patients (33.1 ± 12.0 years) were assessed during mania and at discharge in the euthymic phase compared and to a healthy group matched by age (33.9 ± 10.8 years). Electrocardiographic series (1000 RR intervals, at rest, in supine position) were captured using Polar Advantage RS800CX equipment and Heart Rate Variability (HRV) was analysed using RP and SA. Statistical analysis was performed using ANOVA with Tukey's post-test. The threshold for statistical significance was set at P < 0.05 and Cohen's d effect size was also quantified considering d > 0.8 as an important effect. The study was registered into the Clinical Trials Registration (ClinicalTrials.gov: NCT01272518). RESULTS Manic group presented significantly higher linearity before treatment (P<0.05) compared to controls considering RP variables. Cohen's d values had a large effect size ranging from 0.888 to 1.227. In the manic phase, SA showed predominance of the sympathetic component (OV%) with reduction of the parasympathetic component (2LV% and 2UV%) with reversion post treatment including higher Shannon Entropy (SE) indicating higher complexity. LIMITATIONS - short follow-up (1 month) and small number of patients. CONCLUSIONS - Non-linear analyzes may be used as supplementary tools for understanding autonomic function in BD during mania and after drug treatment.
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Affiliation(s)
- Michele Lima Gregório
- Transdisciplinary Nucleus for the Study of Chaos and Complexity, NUTECC, São José do Rio Preto Medical School, FAMERP, Avenida Brigadeiro Faria Lima, 54-16 CEP, 15090-000 São José do Rio Preto, SP, Brazil.
| | - Guilherme Luiz Lopes Wazen
- Department of Psychiatry, São José do Rio Preto Medical School, FAMERP, Avenida Brigadeiro Faria Lima, 54-16 CEP, 15090-000 São José do Rio Preto, SP, Brazil
| | - Andrew Haddon Kemp
- Department of Psychology, College of Human and Health Sciences, Swansea University, Singleton Park, Wales SA2 8PP, United Kingdom
| | - Juliana Cristina Milan-Mattos
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Paulo, Brazil
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, Milan, Italy.
| | - Aparecida Maria Catai
- Cardiovascular Physical Therapy Laboratory, Department of Physical Therapy, Federal University of São Carlos, São Paulo, Brazil.
| | - Moacir Fernandes de Godoy
- Transdisciplinary Nucleus for the Study of Chaos and Complexity, NUTECC, São José do Rio Preto Medical School, FAMERP, Avenida Brigadeiro Faria Lima, 54-16 CEP, 15090-000 São José do Rio Preto, SP, Brazil; Department of Cardiology and Cardiovascular Surgery, São José do Rio Preto Medical School, FAMERP, Avenida Brigadeiro Faria Lima, 5416 CEP, 15090-000 São José do Rio Preto, SP, Brazil
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3
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Lee SM, Liao DL. Improving physical health in patients with severe mental illness. TAIWANESE JOURNAL OF PSYCHIATRY 2020. [DOI: 10.4103/tpsy.tpsy_7_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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4
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Anjum S, Bathla M, Panchal S. Prevalence and predictors of metabolic syndrome in drug naïve bipolar patients. Diabetes Metab Syndr 2019; 13:12-17. [PMID: 30641682 DOI: 10.1016/j.dsx.2018.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 08/09/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Shazia Anjum
- MM Institute of Medical Sciences and Research, Mullana, Ambala, India
| | - Manish Bathla
- MM Institute of Medical Sciences and Research, Mullana, Ambala, India.
| | - Saminder Panchal
- MM Institute of Medical Sciences and Research, Mullana, Ambala, India
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5
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Ho VP, Steinhagen E, Angell K, Navale SM, Schiltz NK, Reimer AP, Madigan EA, Koroukian SM. Psychiatric disease in surgically treated colorectal cancer patients. J Surg Res 2017; 223:8-15. [PMID: 29433889 DOI: 10.1016/j.jss.2017.06.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/30/2017] [Accepted: 06/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Underlying psychiatric conditions may affect outcomes of surgical treatment for colorectal cancer (CRC) because of complex clinical presentation and treatment considerations. We hypothesized that patients with psychiatric illness (PSYCH) would have evidence of advanced disease at presentation, as manifested by higher rates of colorectal surgery performed in the presence of obstruction, perforation, and/or peritonitis (OPP-surgery). MATERIALS AND METHODS Using data from the 2007-2011 National Inpatient Sample, we identified patients with a diagnosis of CRC undergoing colorectal surgery. In addition to somatic comorbid conditions flagged in the National Inpatient Sample, we used the Clinical Classification Software to identify patients with PSYCH, including schizophrenia, delirium/dementia, developmental disorders, alcohol/substance abuse, and other psychiatric conditions. Our study outcome was OPP-surgery. In addition to descriptive analysis, we conducted multivariable logistic regression analysis to analyze the independent association between each of the PSYCH conditions and OPP-surgery, after adjusting for patient demographics and somatic comorbidities. RESULTS Our study population included 591,561 patients with CRC and undergoing colorectal cancer surgery, of whom 60.6% were aged 65 years or older, 49.4% were women, and 6.3% had five or more comorbid conditions. Then, 17.9% presented with PSYCH. The percent of patients undergoing OPP-surgery was 13.9% in the study population but was significantly higher for patients with schizophrenia (19.3%), delirium and dementia (18.5%), developmental disorders (19.7%), and alcohol/substance abuse (19.5%). In multivariable analysis, schizophrenia, delirium/dementia, and alcohol/substance abuse were each independently associated with increased rates of OPP-surgery. CONCLUSIONS Patients with PSYCH may have obstacles in receiving optimal care for CRC. Those with PSYCH diagnoses had significantly higher rates of OPP-surgery. Additional evaluation is required to further characterize the clinical implications of advanced disease presentation for patients with PSYCH diagnoses and colorectal cancer.
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Affiliation(s)
- Vanessa P Ho
- Division of Trauma, Surgical Critical Care, and Acute Care Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio.
| | - Emily Steinhagen
- Division of Trauma, Surgical Critical Care, and Acute Care Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Kelsey Angell
- Division of Trauma, Surgical Critical Care, and Acute Care Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Suparna M Navale
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Nicholas K Schiltz
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Andrew P Reimer
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio; Critical Care Transport, Cleveland Clinic, Cleveland, Ohio
| | - Elizabeth A Madigan
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
| | - Siran M Koroukian
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio
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Metabolic dysfunction related to typical and atypical antipsychotics in drug-naive patients with nonaffective psychosis. MIDDLE EAST CURRENT PSYCHIATRY 2017. [DOI: 10.1097/01.xme.0000516722.23761.98] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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7
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Kraal AZ, Ward KM, Ellingrod VL. Sex Differences in Antipsychotic Related Metabolic Functioning in Schizophrenia Spectrum Disorders. PSYCHOPHARMACOLOGY BULLETIN 2017; 47:8-21. [PMID: 28626268 PMCID: PMC5472174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
The adverse metabolic risks associated with second generation antipsychotics (SGAs) are well known, and likely contribute to the high rate of premature mortality due to cardiovascular disease in schizophrenia. Female schizophrenia patients appear to be diagnosed with metabolic diseases at higher rates than males, which may reflect disparate adverse responses to SGAs. However, the relationship between sex, metabolic risk, and drug use is less developed. We aimed to explore this relationship further by identifying rates of metabolic disease in community dwelling schizophrenia patients by sex and SGA risk. Schizophrenia participants (N = 287, 40.4% female) were included in this analysis. Oneway-ANOVA and Fisher's Exact Test were used to compare groups, as appropriate, and Cohen's d was employed to estimate the effect size of sex. In the group as a whole, the rate of metabolic syndrome was higher than previously reported, but did not differ by sex. For females, greater metabolic disturbances across all medication risk groups were seen in BMI and waist circumference (p < 0.005) but most commonly in those receiving high risk medication (clozapine or olanzapine). Additionally, the number of participants receiving medications for these metabolic disturbances was extremely low (<30%). These results suggest that female schizophrenia patients taking clozapine or olanzapine represent a group at uniquely high risk for metabolic dysfunction and future adverse cardiovascular outcomes, and warrant close monitoring by clinicians to prevent worsening of metabolic risk through proper monitoring and interventions.
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Affiliation(s)
- A Zarina Kraal
- Ms. Kraal, University of Michigan, Department of Psychology, Ann Arbor, MI, USA. Dr. Ward, University of Michigan, College of Pharmacy, Ann Arbor, MI, USA. Dr. Ellingrod, University of Michigan, College of Pharmacy, Ann Arbor, MI, USA
| | - Kristen M Ward
- Ms. Kraal, University of Michigan, Department of Psychology, Ann Arbor, MI, USA. Dr. Ward, University of Michigan, College of Pharmacy, Ann Arbor, MI, USA. Dr. Ellingrod, University of Michigan, College of Pharmacy, Ann Arbor, MI, USA
| | - Vicki L Ellingrod
- Ms. Kraal, University of Michigan, Department of Psychology, Ann Arbor, MI, USA. Dr. Ward, University of Michigan, College of Pharmacy, Ann Arbor, MI, USA. Dr. Ellingrod, University of Michigan, College of Pharmacy, Ann Arbor, MI, USA
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8
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Gill SK, Saini G, Relova RM, Lee T, Yasmin S, Drag L. Health Care Utilization of Veterans With Serious Mental Illness. Fed Pract 2017; 34:S14S-S19S. [PMID: 30766307 PMCID: PMC6375500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Outreach regarding veteran-specific factors can help determine which targeted interventions reduce the need for chronic mental illness inpatient hospitalization.
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Affiliation(s)
- Supria K Gill
- is a postdoctoral psychology resident at Kaiser Permanente Vacaville Medical Center and adjunct faculty at Palo Alto University. is a clinical research coordinator at Stanford University School of Medicine. is research health scientist, is staff psychiatrist and deputy chief of service for mental health, and is a staff psychiatrist and inpatient mental health director, all at the VA Palo Alto Health Care System. is a staff neuropsychologist at Stanford Hospitals and Clinics in Palo Alto, all in California
| | - Gopin Saini
- is a postdoctoral psychology resident at Kaiser Permanente Vacaville Medical Center and adjunct faculty at Palo Alto University. is a clinical research coordinator at Stanford University School of Medicine. is research health scientist, is staff psychiatrist and deputy chief of service for mental health, and is a staff psychiatrist and inpatient mental health director, all at the VA Palo Alto Health Care System. is a staff neuropsychologist at Stanford Hospitals and Clinics in Palo Alto, all in California
| | - Rona Margaret Relova
- is a postdoctoral psychology resident at Kaiser Permanente Vacaville Medical Center and adjunct faculty at Palo Alto University. is a clinical research coordinator at Stanford University School of Medicine. is research health scientist, is staff psychiatrist and deputy chief of service for mental health, and is a staff psychiatrist and inpatient mental health director, all at the VA Palo Alto Health Care System. is a staff neuropsychologist at Stanford Hospitals and Clinics in Palo Alto, all in California
| | - Tina Lee
- is a postdoctoral psychology resident at Kaiser Permanente Vacaville Medical Center and adjunct faculty at Palo Alto University. is a clinical research coordinator at Stanford University School of Medicine. is research health scientist, is staff psychiatrist and deputy chief of service for mental health, and is a staff psychiatrist and inpatient mental health director, all at the VA Palo Alto Health Care System. is a staff neuropsychologist at Stanford Hospitals and Clinics in Palo Alto, all in California
| | - Sarah Yasmin
- is a postdoctoral psychology resident at Kaiser Permanente Vacaville Medical Center and adjunct faculty at Palo Alto University. is a clinical research coordinator at Stanford University School of Medicine. is research health scientist, is staff psychiatrist and deputy chief of service for mental health, and is a staff psychiatrist and inpatient mental health director, all at the VA Palo Alto Health Care System. is a staff neuropsychologist at Stanford Hospitals and Clinics in Palo Alto, all in California
| | - Lauren Drag
- is a postdoctoral psychology resident at Kaiser Permanente Vacaville Medical Center and adjunct faculty at Palo Alto University. is a clinical research coordinator at Stanford University School of Medicine. is research health scientist, is staff psychiatrist and deputy chief of service for mental health, and is a staff psychiatrist and inpatient mental health director, all at the VA Palo Alto Health Care System. is a staff neuropsychologist at Stanford Hospitals and Clinics in Palo Alto, all in California
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9
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Wynaden D, Heslop B, Heslop K, Barr L, Lim E, Chee GL, Porter J, Murdock J. The chasm of care: Where does the mental health nursing responsibility lie for the physical health care of people with severe mental illness? Int J Ment Health Nurs 2016; 25:516-525. [PMID: 27416949 DOI: 10.1111/inm.12242] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/17/2016] [Accepted: 04/18/2016] [Indexed: 12/20/2022]
Abstract
The poor physical health of people with a severe mental illness is well documented and health professionals' attitudes, knowledge and skills are identified factors that impact on clients' access to care for their physical health needs. An evaluation was conducted to determine: (i) mental health nurses' attitudes and beliefs about providing physical health care; and, (ii) the effect that participant demographics may have on attitudes to providing physical health care. It was hypothesized that workplace culture would have the largest effect on attitudes. Nurses at three health services completed the "Mental health nurses' attitude towards the physical health care of people with severe and enduring mental illness survey" developed by Robson and Haddad (2012). The 28-item survey measured: nurses' attitudes, confidence, identified barriers to providing care and attitudes towards clients smoking cigarettes. The findings demonstrated that workplace culture did influence the level of physical health care provided to clients. However, at the individual level, nurses remain divided and uncertain where their responsibilities lie. Nursing leadership can have a significant impact on improving clients' physical health outcomes. Education is required to raise awareness of the need to reduce cigarette smoking in this client population.
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Affiliation(s)
- Dianne Wynaden
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Brett Heslop
- Rockingham/ Peel Mental Health Service, Rockingham, Western Australia, Australia
| | - Karen Heslop
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Lesley Barr
- State Forensic Mental Health Service, Brockway, Western Australia, Australia
| | - Eric Lim
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Gin-Liang Chee
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - James Porter
- Rockingham/ Peel Mental Health Service, Rockingham, Western Australia, Australia
| | - Jane Murdock
- Fremantle Mental Health Services, Fremantle, Western Australia, Australia
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Antipsychotic Cardiometabolic Side Effect Monitoring in a State Community Mental Health System. Community Ment Health J 2015; 51:685-94. [PMID: 25645893 DOI: 10.1007/s10597-015-9833-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 01/22/2015] [Indexed: 01/28/2023]
Abstract
Antipsychotic medications can cause serious cardiometabolic side effects. No recent research has broadly evaluated monitoring and strategies to improve monitoring in U.S. public mental health systems. To address this knowledge gap, we evaluated education with audit and feedback to leaders to improve cardiometabolic monitoring in a state mental health system. We used Chi square statistics and logistic regressions to explore changes in monitoring recorded in randomly sampled records over 2 years. In 2009, assessment of patients on antipsychotics was 29.6 % for cholesterol, 40.4 % for glucose, 29.1 % for triglycerides, 54.3 % for weight, 33.6 % for blood pressure, and 5.7 % for abdominal girth. In 2010, four of ten mental health centers improved their rate of adult laboratory monitoring. Overall monitoring in the state did not increase. Education for prescribers with audit and feedback to leaders can improve monitoring in some settings, but more intensive and/or prolonged interventions may be required.
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11
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Bartoli F, Crocamo C, Caslini M, Clerici M, Carrà G. Schizoaffective disorder and metabolic syndrome: A meta-analytic comparison with schizophrenia and other non-affective psychoses. J Psychiatr Res 2015; 66-67:127-34. [PMID: 26004300 DOI: 10.1016/j.jpsychires.2015.04.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 04/16/2015] [Accepted: 04/30/2015] [Indexed: 12/20/2022]
Abstract
People with psychotic disorders, including schizophrenia (SCZ), schizoaffective disorder (SD), or other non-affective psychoses (ONAP), have a higher risk of metabolic syndrome (MetS) than general population. However, previous meta-analyses failed to explore if people with SD are more likely to suffer from MetS than SCZ and ONAP. We carried out a systematic review and meta-analysis comparing rates of MetS in SD with those in SCZ or ONAP. We searched main electronic databases for relevant articles published up to January 2015, and for unpublished data, contacting corresponding authors, to minimize selective reporting bias. Odds ratios (ORs) based on random effects models, with 95% confidence intervals (CIs), and heterogeneity (I(2)), were estimated. We performed leave-one-out, quality-based, and subgroups analyses to check findings validity. Testing for publication bias, Egger's test estimates were reported. We included 7616 individuals (1632 with SD and 5984 with SCZ/ONAP) from 30 independent samples. SD, as compared with SCZ/ONAP, had a random-effect pooled OR (95%CI) for MetS of 1.41 (1.23-1.61; p < 0.001; I(2) = 5%). No risk of publication bias was found (p = 0.85). Leave-one-out, sensitivity, and subgroups analyses confirmed the association. To our knowledge, this is the first meta-analysis comparing MetS comorbidity between individuals with SD and those with SCZ or ONAP. SD subjects are more likely to suffer from MetS, with consistent findings across the studies included. However, the role of explanatory factors of this association, and the relative contribution of MetS subcomponents, deserve further research.
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Affiliation(s)
- Francesco Bartoli
- Department of Surgery and Translational Medicine, University of Milano Bicocca, Via Cadore 48, 20900, Monza, MB, Italy.
| | - Cristina Crocamo
- Department of Surgery and Translational Medicine, University of Milano Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Manuela Caslini
- Department of Surgery and Translational Medicine, University of Milano Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Massimo Clerici
- Department of Surgery and Translational Medicine, University of Milano Bicocca, Via Cadore 48, 20900, Monza, MB, Italy
| | - Giuseppe Carrà
- Division of Psychiatry, Faculty of Brain Sciences, University College London, Charles Bell House, 67-73 Riding House Street, London, W1W7EJ, UK
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12
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Copeland LA, Zeber JE, Sako EY, Mortensen EM, Pugh MJ, Wang CP, Restrepo MI, Flynn J, MacCarthy AA, Lawrence VA. Serious mental illnesses associated with receipt of surgery in retrospective analysis of patients in the Veterans Health Administration. BMC Surg 2015; 15:74. [PMID: 26084521 PMCID: PMC4472400 DOI: 10.1186/s12893-015-0064-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 06/11/2015] [Indexed: 11/10/2022] Open
Abstract
Background The STOPP study (Surgical Treatment Outcomes for Patients with Psychiatric Disorders) analyzed variation in rates and types of major surgery by serious mental illness status among patients treated in the Veterans Health Administration (VA). VA patients are veterans of United States military service who qualify for federal care by reason of disability, special service experiences, or poverty. Methods STOPP conducted a secondary data analysis of medical record extracts for seven million VA patients treated Oct 2005-Sep 2009. The retrospective study aggregated inpatient surgery events, comorbid diagnoses, demographics, and postoperative 30-day mortality. Results Serious mental illness -- schizophrenia, bipolar disorder, posttraumatic stress disorder, or major depressive disorder, was identified in 12 % of VA patients. Over the 4-year study period, 321,131 patients (4.5 %) underwent surgery with same-day preoperative or immediate post-operative admission including14 % with serious mental illness. Surgery patients were older (64 vs. 61 years) and more commonly African-American, unmarried, impoverished, highly disabled (24 % vs 12 % were Priority 1), obese, with psychotic disorder (4.3 % vs 2.9 %). Among surgery patients, 3.7 % died within 30 days postop. After covariate adjustment, patients with pre-existing serious mental illness were relatively less likely to receive surgery (adjusted odds ratios 0.4-0.7). Conclusions VA patients undergoing major surgery appeared, in models controlling for comorbidity and demographics, to disproportionately exclude those with serious mental illness. While VA preferentially treats the most economically and medically disadvantaged veterans, the surgery subpopulation may be especially ill, potentially warranting increased postoperative surveillance.
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Affiliation(s)
- Laurel A Copeland
- Veterans Affairs: Central Texas Veterans Health Care System, Center for Applied Health Research, 2102 Birdcreek Drive, Temple, TX, 76502, USA. .,Baylor Scott & White Health: Center for Applied Health Research, 2102 Birdcreek Drive, Temple, TX, 76502, USA. .,Texas A&M Health Science Center, College of Medicine, Bryan, TX, USA. .,UT Health Science Center San Antonio, San Antonio, TX, USA.
| | - John E Zeber
- Veterans Affairs: Central Texas Veterans Health Care System, Center for Applied Health Research, 2102 Birdcreek Drive, Temple, TX, 76502, USA.,Baylor Scott & White Health: Center for Applied Health Research, 2102 Birdcreek Drive, Temple, TX, 76502, USA.,Texas A&M Health Science Center, College of Medicine, Bryan, TX, USA.,UT Health Science Center San Antonio, San Antonio, TX, USA
| | - Edward Y Sako
- UT Health Science Center San Antonio, San Antonio, TX, USA
| | - Eric M Mortensen
- Veterans Affairs: North Texas Veterans Health Care System, 4500 S. Lancaster Rd, Dallas, TX, 75216, USA.,UT Southwestern Medical Center, Dallas, TX, USA
| | - Mary Jo Pugh
- UT Health Science Center San Antonio, San Antonio, TX, USA.,Veterans Affairs: South Texas Veterans Health Care System, 7400 Merton Minter (11c6), San Antonio, TX, 78229, USA
| | - Chen-Pin Wang
- UT Health Science Center San Antonio, San Antonio, TX, USA.,Veterans Affairs: South Texas Veterans Health Care System, 7400 Merton Minter (11c6), San Antonio, TX, 78229, USA
| | - Marcos I Restrepo
- UT Health Science Center San Antonio, San Antonio, TX, USA.,Veterans Affairs: South Texas Veterans Health Care System, 7400 Merton Minter (11c6), San Antonio, TX, 78229, USA
| | - Julianne Flynn
- Veterans Affairs: South Texas Veterans Health Care System, 7400 Merton Minter (11c6), San Antonio, TX, 78229, USA
| | - Andrea A MacCarthy
- Veterans Affairs: South Texas Veterans Health Care System, 7400 Merton Minter (11c6), San Antonio, TX, 78229, USA
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von Esenwein SA, Druss BG. Using electronic health records to improve the physical healthcare of people with serious mental illnesses: a view from the front lines. Int Rev Psychiatry 2014; 26:629-37. [PMID: 25553780 DOI: 10.3109/09540261.2014.987221] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Individuals with serious mental illnesses (SMI) treated in the public mental health sector die decades younger than the general population. Poor quality and fragmentation of care are risk factors underlying the poor health of this population. Integrated electronic health records (EHR) can play a vital role in efforts to improve quality and outcomes of care in patients with SMI. The objective of this paper is to describe the current state of efforts to integrate and improve the mental and physical care of individuals with SMI in the public sector, with an emphasis on the use of electronic health records (EHR). While a range of encouraging initiatives exists throughout the country, technological and medico-legal challenges are providing significant barriers for the successful integration of care and EHRs for many partnering organizations. Furthermore, there is a lack of rigorous research studying the effectiveness and sustainability of these programmes. Recommendations are made for the alleviation of policy barriers and future areas of inquiry.
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Affiliation(s)
- Silke A von Esenwein
- Center for Behavioral Health Policy Studies, Rollins School of Public Health, Emory University , Atlanta, Georgia , USA
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Saloojee S, Burns JK, Motala AA. Very low rates of screening for metabolic syndrome among patients with severe mental illness in Durban, South Africa. BMC Psychiatry 2014; 14:228. [PMID: 25113131 PMCID: PMC4149236 DOI: 10.1186/s12888-014-0228-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 08/04/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Sub Saharan African is experiencing the largest increase in the prevalence of type 2 diabetes mellitus and cardiovascular disease globally. Metabolic syndrome (MetS) is a cluster of risk factors for these conditions. There is a consistently higher prevalence of cardiometabolic disease among individuals with severe mental illness (SMI) compared to the general population worldwide. However, it is known from research in high income countries that screening for MetS in patients with SMI is low. The objective of this study was to document the extent of the expected low frequency of testing for all the components of the metabolic syndrome (MetS) in patients with SMI in a low middle income country. METHODS This was a cross sectional study, undertaken from January to June 2012 on out-patients with SMI who were treated with antipsychotic medication for at least 6 months. The study measured the proportion of participants who were tested for MetS in the previous year. RESULTS The study included 331 (M: F; 167:164) participants with a mean age of 35.2 ± 11.98 years. The majority (78.8%) were black South Africans. Only 2 subjects (0.6%) were screened for all five components of MetS. Regarding the individual components, 99%, 0.6%, 3.9% and 1.8% were screened for raised blood pressure, abdominal obesity, hyperglycaemia, hypertriglyceridaemia and decreased high density lipoprotein cholesterol respectively. CONCLUSION It is unacceptable that less than one percent of our participants were adequately screened for modifiable risk factors for type 2 diabetes mellitus and cardiovascular disease which are the most common causes of mortality among patients with SMI. These results highlight the need for translating guidelines into action in low and middle income countries.
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Affiliation(s)
- Shamima Saloojee
- Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu – Natal, Private bag X3, Congella, 4013 Durban, South Africa
| | - Jonathan K Burns
- Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu – Natal, Private bag X3, Congella, 4013 Durban, South Africa
| | - Ayesha A Motala
- Department of Diabetes and Endocrinology, Nelson R Mandela School of Medicine, University of KwaZulu - Natal, Durban, South Africa
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Grover S, Nebhinani N, Chakrabarti S, Avasthi A, Basu D, Kulhara P, Mattoo SK, Malhotra S. Cardiovascular risk factors among bipolar disorder patients admitted to an inpatient unit of a tertiary care hospital in India. Asian J Psychiatr 2014; 10:51-5. [PMID: 25042952 DOI: 10.1016/j.ajp.2014.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 02/05/2014] [Accepted: 03/08/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The study aimed to examine the prevalence of cardiovascular risk factors in patients with bipolar disorder. METHODS By consecutive sampling, 93 inpatients (aged ≥20 years) diagnosed with bipolar disorder were evaluated for 10 year coronary heart disease (CHD) risk and 10-year cardiovascular mortality risk (CMR) on the Framingham (10-year all CHD events) function/risk equation and Systematic Coronary Risk Evaluation (SCORE) respectively. RESULTS Ten-year CHD risk was 3.36% and 10-year CMR was estimated to be 1.73%. One tenth (10.7%) of the sample was found to have very high/high CHD risk (≥10) and 6.45% of the sample had high CMR risk (≥5). More than half (54.88%) of patients had metabolic syndrome. Compared to females, males had higher Framingham function score (4.09±5.75 vs 1.59±1.05, U value - 634.5*, p<0.05) and had higher very high/high CHD risk (≥10) (15.1% vs 0, χ(2) 4.58, p<0.05). CONCLUSIONS Findings of the present study suggest the presence of cardiovascular risk factors and higher rate of metabolic syndrome in patients with bipolar disorder. Considering this fact, there is an urgent need for routine screening for cardiovascular risk factors in these patients. Mental health professionals should be aware of these risks; there is need to develop preventive strategies to reduce the cardiovascular risk in this population.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.
| | - Naresh Nebhinani
- Postgraduate Institute Medical Science, Rohtak, Haryana 124001, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Ajit Avasthi
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Debasish Basu
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Parmanand Kulhara
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Surendra Kumar Mattoo
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
| | - Savita Malhotra
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India
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Abstract
Audit has been defined as "a quality improvement process that seeks to improve patient care and outcome, through systematic review of care and comparison with explicit criteria, followed by the implementation of change". As of May 2011, under the Medical Practitioners Act 2007, doctors are legally obliged to join in professional competence schemes, following requirements set by the Medical Council. These include the obligation for doctors to conduct one clinical audit per year. In Ireland and elsewhere, audit provides an opportunity for services to create an "environment in which clinical care will flourish".
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Vancampfort D, Wampers M, Mitchell AJ, Correll CU, De Herdt A, Probst M, De Hert M. A meta-analysis of cardio-metabolic abnormalities in drug naïve, first-episode and multi-episode patients with schizophrenia versus general population controls. World Psychiatry 2013; 12:240-50. [PMID: 24096790 PMCID: PMC3799255 DOI: 10.1002/wps.20069] [Citation(s) in RCA: 197] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A meta-analysis was conducted to explore the risk for cardio-metabolic abnormalities in drug naïve, first-episode and multi-episode patients with schizophrenia and age- and gender- or cohort-matched general population controls. Our literature search generated 203 relevant studies, of which 136 were included. The final dataset comprised 185,606 unique patients with schizophrenia, and 28 studies provided data for age- and gender-matched or cohort-matched general population controls (n=3,898,739). We found that multi-episode patients with schizophrenia were at increased risk for abdominal obesity (OR=4.43; CI=2.52-7.82; p<0.001), hypertension (OR=1.36; CI=1.21-1.53; p<0.001), low high-density lipoprotein cholesterol (OR=2.35; CI=1.78-3.10; p<0.001), hypertriglyceridemia (OR=2.73; CI=1.95-3.83; p<0.001), metabolic syndrome (OR=2.35; CI=1.68-3.29; p<0.001), and diabetes (OR=1.99; CI=1.55-2.54; p<0.001), compared to controls. Multi-episode patients with schizophrenia were also at increased risk, compared to first-episode (p<0.001) and drug-naïve (p<0.001) patients, for the above abnormalities, with the exception of hypertension and diabetes. Our data provide further evidence supporting WPA recommendations on screening, follow-up, health education and lifestyle changes in people with schizophrenia.
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Affiliation(s)
- Davy Vancampfort
- University Psychiatric Centre KU Leuven, Campus Kortenberg, Leuvensesteenweg 517, 3070 Kortenberg, Belgium; KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
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Bipolar Disorder and Metabolic Syndrome: A Systematic Review. BRAZILIAN JOURNAL OF PSYCHIATRY 2013; 35:88-93. [DOI: 10.1016/j.rbp.2012.07.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Accepted: 07/09/2012] [Indexed: 02/07/2023]
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Parrinello MC. Prevention of Metabolic Syndrome from Atypical Antipsychotic Medications: Applying Rogers’ Diffusion of Innovations Model in Clinical Practice. J Psychosoc Nurs Ment Health Serv 2012; 50:36-44. [DOI: 10.3928/02793695-20121107-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Tsan JY, Stock EM, Gonzalez JM, Greenawalt DS, Zeber JE, Rouf E, Copeland LA. Mortality and guideline-concordant care for older patients with schizophrenia: a retrospective longitudinal study. BMC Med 2012. [PMID: 23181341 PMCID: PMC3523058 DOI: 10.1186/1741-7015-10-147] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Schizophrenia is associated with excess mortality and multimorbidity, which is possibly associated with difficulty in coordinating care for multiple mental and physical comorbidities. We analyzed the receipt by patients with schizophrenia of 11 types of guideline-concordant care and the association of such care with survival. METHODS Guideline-concordant care over an 8-year period (financial years 2002 to 2009) was examined in a nationwide sample of 49,173 male veterans with schizophrenia, who were aged 50 years or older. Administrative databases from the electronic medical record system of the Veterans Health Administration (VA) provided comprehensive measures of patient demographics and medical information. Relying on the 2004 American Psychiatric Association guidelines, patterns in 11 types of care were identified and cluster-analyzed. Care types included cardiovascular, metabolic, weight management, nicotine dependence, infectious diseases, vision, and mental health counseling (individual, family, drugs/alcohol, psychiatric medication, and compensated work therapy). Survival analysis estimated association of care patterns with survival, adjusting for clinical and demographic covariates. RESULTS There was an average of four chronic diseases in addition to schizophrenia in the cohort, notably hypertension (43%) and dyslipidemia (29%). Three longitudinal trajectories (clusters) were identified: 'high-consistent' (averaging 5.4 types of care annually), 'moderate-consistent' (averaging 3.8), and 'poor-decreasing' (averaging 1.9). Most veterans were receiving cardiovascular care (67 to 76%), hepatic and renal function assays (79 to 84%), individual counseling (72 to 85%) and psychiatry consults (66 to 82%), with the proportion receiving care varying by cluster group. After adjustment for age, baseline comorbidity, and other covariates, there was a greater survival rate for those with poor-decreasing care compared with high-consistent care, and for high-consistent compared with moderate-consistent care. CONCLUSIONS Relatively low levels of guideline-concordant care were seen for older VA patients with schizophrenia, and trajectories of care over time were associated with survival in a non-intuitive pattern. The group with the lowest and decreasing levels of care was also the oldest, but nonetheless had the best age-adjusted and other covariate-adjusted survival rates, possibly because they were requiring less care relative to younger, sicker veterans, and thus their comorbidity burden was markedly lower. Notably, in the group with the sickest individuals (that is those with the highest comorbidity scores, who were very disabled), receiving guideline-concordant care was associated with improved survival in adjusted models compared with those patients receiving only moderate levels of care.
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Affiliation(s)
- Jack Y Tsan
- VISN 17 Center of Excellence for Research on Returning War Veterans, Department of Veterans Affairs, 4800 Memorial Drive (151C), Waco, TX 76711, USA.
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Galletly CA, Foley DL, Waterreus A, Watts GF, Castle DJ, McGrath JJ, Mackinnon A, Morgan VA. Cardiometabolic risk factors in people with psychotic disorders: the second Australian national survey of psychosis. Aust N Z J Psychiatry 2012; 46:753-61. [PMID: 22761397 DOI: 10.1177/0004867412453089] [Citation(s) in RCA: 144] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine the prevalence of cardiometabolic risk factors in Australian adults with a psychotic disorder. METHOD Data were collected during the interview phase of the second Australian survey of psychosis, a population-based survey of Australians aged 18 to 64 years with a psychotic disorder. Body mass index, waist circumference and blood pressure were measured. Participants were asked about diagnoses of relevant medical conditions, medications, smoking and physical activity. Fasting blood samples were analysed for glucose, high-density lipoprotein cholesterol, total cholesterol and triglycerides. The prevalence of metabolic syndrome was determined using the harmonized criteria developed by the International Diabetes Federation and other bodies. RESULTS A total of 1087 men (60%) and 738 women (40%) participated. Their mean age was 38.36 (SD 11.16) years; 773 (42%) were aged 18-34 years and 1052 (58%) 35-64 years. Three-quarters were overweight or obese and 82% had abdominal obesity. Almost half were hypertensive. Two-thirds were current smokers and 81% had a lifetime history of smoking. Levels of physical activity were very low. About 30% reported a diagnosis of hypertension or high cholesterol, 20% knew they had diabetes or high blood sugar and 18% had cardiovascular disease. Half of those with self-reported hypertension were taking antihypertensive drugs, and about 40% with hypercholesterolemia or hyperglycaemia were receiving medication for these conditions. Seventy per cent (N = 1286) of participants provided fasting blood samples. Abnormal levels of high-density lipoprotein cholesterol and triglycerides were each found in almost half of participants and almost one-third had elevated fasting glucose. More than half of participants (54.8%) met criteria for metabolic syndrome. CONCLUSIONS Australians living with psychosis have high rates of cardiometabolic risk factors. There are a number of obvious targets for prevention and treatment, including obesity (especially in women), smoking (more prevalent in men), hypertension, hyperlipidaemia and sedentary lifestyle.
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Affiliation(s)
- Cherrie A Galletly
- Discipline of Psychiatry, School of Medicine, University of Adelaide, Australia.
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Abstract
To review the data with respect to prevalence and risk factors of metabolic syndrome (MetS) in bipolar disorder patients. Electronic searches were done in PUBMED, Google Scholar and Science direct. From 2004 to June 2011, 34 articles were found which reported on the prevalence of MetS. The sample size of these studies varied from 15 to 822 patients, and the rates of MetS vary widely from 16.7% to 67% across different studies. None of the sociodemographic variable has emerged as a consistent risk factor for MetS. Among the clinical variables longer duration of illness, bipolar disorder- I, with greater number of lifetime depressive and manic episodes, and with more severe and difficult-to-treat index affective episode, with depression at onset and during acute episodes, lower in severity of mania during the index episode, later age of onset at first manic episode, later age at first treatment for the first treatment for both phases, less healthy diet as rated by patients themselves, absence of physical activity and family history of diabetes mellitus have been reported as clinical risk factors of MetS. Data suggests that metabolic syndrome is fairly prevalent in bipolar disorder patients.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, Punjab, India
| | - Nidhi Malhotra
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, Punjab, India
| | - Subho Chakrabarti
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, Punjab, India
| | - Parmanand Kulhara
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh, Punjab, India
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Grover S, Aggarwal M, Chakrabarti S, Dutt A, Avasthi A, Kulhara P, Malhotra N, Somaiya M, Chauhan N. Prevalence of metabolic syndrome in bipolar disorder: an exploratory study from North India. Prog Neuropsychopharmacol Biol Psychiatry 2012; 36:141-6. [PMID: 22056292 DOI: 10.1016/j.pnpbp.2011.10.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/02/2011] [Accepted: 10/20/2011] [Indexed: 02/05/2023]
Abstract
PURPOSE To study the prevalence of metabolic syndrome in patients with bipolar disorder. MATERIAL AND METHOD By using purposive random sampling 200 patients with bipolar disorder receiving treatment were evaluated for presence of metabolic syndrome using International Diabetes Federation (IDF) and modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) criteria. RESULTS Eighty patients fulfilled IDF criteria and 82 patients met NCEP ATP-III criteria for metabolic syndrome. There was significant concordance between these two criteria sets for metabolic syndrome (Kappa value 0.979, p<0.015). Among the individual parameters studied--increased waist circumference (70.1%) was the most common abnormality, followed by increased blood pressure (44.5%) and increased triglycerides levels (42%). Compared to patients without metabolic syndrome, patients with metabolic syndrome had significantly higher body mass index and higher percentage of them (74.4% vs 51.7%) were more than 35 years of age. Logistic regression analysis revealed that these two variables significantly predicted metabolic syndrome. CONCLUSION Findings of the present study suggest that abdominal obesity is the most common abnormality and metabolic syndrome is best predicted in patients with bipolar disorder by higher age and higher body mass index.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India.
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Mitchell AJ, Delaffon V, Vancampfort D, Correll CU, De Hert M. Guideline concordant monitoring of metabolic risk in people treated with antipsychotic medication: systematic review and meta-analysis of screening practices. Psychol Med 2012; 42:125-147. [PMID: 21846426 DOI: 10.1017/s003329171100105x] [Citation(s) in RCA: 220] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite increased cardiometabolic risk in individuals with mental illness taking antipsychotic medication, metabolic screening practices are often incomplete or inconsistent. METHOD We undertook a systematic search and a PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) meta-analysis of studies examining routine metabolic screening practices in those taking antipsychotics both for patients in psychiatric care before and following implementation of monitoring guidelines. RESULTS We identified 48 studies (n=290 534) conducted between 2000 and 2011 in five countries; 25 studies examined predominantly schizophrenia-spectrum disorder populations; 39 studies (n=218 940) examined routine monitoring prior to explicit guidelines; and nine studies (n=71 594) reported post-guideline monitoring. Across 39 studies, routine baseline screening was generally low and above 50% only for blood pressure [69.8%, 95% confidence interval (CI) 50.9-85.8] and triglycerides (59.9%, 95% CI 36.6-81.1). Cholesterol was measured in 41.5% (95% CI 18.0-67.3), glucose in 44.3% (95% CI 36.3-52.4) and weight in 47.9% (95% CI 32.4-63.7). Lipids and glycosylated haemoglobin (HbA1c) were monitored in less than 25%. Rates were similar for schizophrenia patients, in US and UK studies, for in-patients and out-patients. Monitoring was non-significantly higher in case-record versus database studies and in fasting samples. Following local/national guideline implementation, monitoring improved for weight (75.9%, CI 37.3-98.7), blood pressure (75.2%, 95% CI 45.6-95.5), glucose (56.1%, 95% CI 43.4-68.3) and lipids (28.9%, 95% CI 20.3-38.4). Direct head-to-head pre-post-guideline comparison showed a modest but significant (15.4%) increase in glucose testing (p=0.0045). CONCLUSIONS In routine clinical practice, metabolic monitoring is concerningly low in people prescribed antipsychotic medication. Although guidelines can increase monitoring, most patients still do not receive adequate testing.
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Affiliation(s)
- A J Mitchell
- Psycho-oncology, Leicester General Hospital, Leicestershire Partnership Trust, Leicester, UK.
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