1
|
Cohen AS, Cardenas-Turanzas M, Champagne-Langabeer T. Roles of Hospital Type and Community Setting in Rate of Screening for Metabolic Disorders Among Psychiatric Patients. Psychiatr Serv 2024; 75:763-769. [PMID: 38566560 DOI: 10.1176/appi.ps.20230472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Globally, rates of metabolic disorders continue to climb, leading to significant disease morbidity and mortality. Individuals with mental illness are particularly prone to obesity, and some medications, such as antipsychotics, may increase the risk for metabolic disorders. The American Psychiatric Association and the American Diabetes Association recommend that patients taking antipsychotic medications receive regular screening for metabolic disorders. This study examined hospital and community factors associated with screening these patients for such disorders. METHODS The authors combined Centers for Medicare and Medicaid Services (CMS) hospital-level data on screening for metabolic disorders among patients with an antipsychotic prescription with community data, including urbanization classification, social vulnerability, and metabolic disease presence and risk factors. Data were merged at the county level and evaluated with a nonparametric multivariate regression model. RESULTS The CMS data set included 1,497 U.S. hospitals with data on screening for metabolic disorders among patients with an antipsychotic prescription. Screening rates varied by type of facility; acute care and critical access hospitals outperformed freestanding psychiatric facilities (p<0.001). No other variables examined in the multivariate model were associated with screening for metabolic disorders. CONCLUSIONS Despite common resource limitations, screening for metabolic disorders may be driven more by logistics and less by time, finances, or a community's primary care network. Identifying the specific logistical challenges of freestanding psychiatric facilities could aid in the development of targeted interventions to improve the rates of screening for and treatment of not only metabolic disorders but also other common comorbid conditions.
Collapse
Affiliation(s)
- A Sarah Cohen
- Center for Behavioral Emergency and Addiction Research, D. Bradley McWilliams School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston
| | - Marylou Cardenas-Turanzas
- Center for Behavioral Emergency and Addiction Research, D. Bradley McWilliams School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston
| | - Tiffany Champagne-Langabeer
- Center for Behavioral Emergency and Addiction Research, D. Bradley McWilliams School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston
| |
Collapse
|
2
|
McIntyre RS, Kwan ATH, Rosenblat JD, Teopiz KM, Mansur RB. Psychotropic Drug-Related Weight Gain and Its Treatment. Am J Psychiatry 2024; 181:26-38. [PMID: 38161305 DOI: 10.1176/appi.ajp.20230922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Psychotropic drug-related weight gain (PDWG) is a common occurrence and is highly associated with non-initiation, discontinuation, and dissatisfaction with psychiatric drugs. Moreover, PDWG intersects with the elevated risk for obesity and associated morbidity that has been amply reported in the psychiatric population. Evidence indicates that differential liability for PDWG exists for antipsychotics, antidepressants, and anticonvulsants. During the past two decades, agents within these classes have become available with significantly lower or no liability for PDWG and as such should be prioritized. Although lithium is associated with weight gain, the overall extent of weight gain is significantly lower than previously estimated. The benefit of lifestyle and behavioral modification for obesity and/or PDWG in psychiatric populations is established, with effectiveness similar to that in the general population. Metformin is the most studied pharmacological treatment in the prevention and treatment of PDWG, and promising data are emerging for glucagon-like peptide-1 (GLP-1) receptor agonists (e.g., liraglutide, exenatide, semaglutide). Most pharmacologic antidotes for PDWG are supported with low-confidence data (e.g., topiramate, histamine-2 receptor antagonists). Future vistas for pharmacologic treatment for PDWG include large, adequately controlled studies with GLP-1 receptor agonists and possibly GLP-1/glucose-dependent insulinotropic polypeptide co-agonists (e.g., tirzepatide) as well as specific dietary modifications.
Collapse
Affiliation(s)
- Roger S McIntyre
- Department of Psychiatry (McIntyre, Rosenblat, Mansur) and Department of Pharmacology and Toxicology (McIntyre, Rosenblat, Mansur), University of Toronto, Toronto; Brain and Cognition Discovery Foundation, Toronto (McIntyre, Kwan, Teopiz); Faculty of Medicine, University of Ottawa, Ottawa (Kwan)
| | - Angela T H Kwan
- Department of Psychiatry (McIntyre, Rosenblat, Mansur) and Department of Pharmacology and Toxicology (McIntyre, Rosenblat, Mansur), University of Toronto, Toronto; Brain and Cognition Discovery Foundation, Toronto (McIntyre, Kwan, Teopiz); Faculty of Medicine, University of Ottawa, Ottawa (Kwan)
| | - Joshua D Rosenblat
- Department of Psychiatry (McIntyre, Rosenblat, Mansur) and Department of Pharmacology and Toxicology (McIntyre, Rosenblat, Mansur), University of Toronto, Toronto; Brain and Cognition Discovery Foundation, Toronto (McIntyre, Kwan, Teopiz); Faculty of Medicine, University of Ottawa, Ottawa (Kwan)
| | - Kayla M Teopiz
- Department of Psychiatry (McIntyre, Rosenblat, Mansur) and Department of Pharmacology and Toxicology (McIntyre, Rosenblat, Mansur), University of Toronto, Toronto; Brain and Cognition Discovery Foundation, Toronto (McIntyre, Kwan, Teopiz); Faculty of Medicine, University of Ottawa, Ottawa (Kwan)
| | - Rodrigo B Mansur
- Department of Psychiatry (McIntyre, Rosenblat, Mansur) and Department of Pharmacology and Toxicology (McIntyre, Rosenblat, Mansur), University of Toronto, Toronto; Brain and Cognition Discovery Foundation, Toronto (McIntyre, Kwan, Teopiz); Faculty of Medicine, University of Ottawa, Ottawa (Kwan)
| |
Collapse
|
3
|
Walburg FS, van Meijel B, Hoekstra T, Kol J, Pape LM, de Joode JW, van Tulder M, Adriaanse M. Effectiveness of a Lifestyle Intervention for People With a Severe Mental Illness in Dutch Outpatient Mental Health Care: A Randomized Clinical Trial. JAMA Psychiatry 2023; 80:886-894. [PMID: 37342055 PMCID: PMC10285675 DOI: 10.1001/jamapsychiatry.2023.1566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/22/2023] [Indexed: 06/22/2023]
Abstract
Importance People with a severe mental illness (SMI) have a life expectancy reduced by 10 to 20 years compared with the general population, primarily attributable to cardiometabolic disorders. Lifestyle interventions for people with SMI can improve health and reduce cardiometabolic risk. Objective To evaluate the effectiveness of a group-based lifestyle intervention among people with SMI in outpatient treatment settings compared with treatment as usual (TAU). Design, Setting, and Participants The Severe Mental Illness Lifestyle Evaluation (SMILE) study is a pragmatic cluster randomized clinical trial performed in 8 mental health care centers with 21 flexible assertive community treatment teams in the Netherlands. Inclusion criteria were SMI, age of 18 years or older, and body mass index (calculated as weight in kilograms divided by height in meters squared) of 27 or greater. Data were collected from January 2018 to February 2020, and data were analyzed from September 2020 to February 2023. Interventions Weekly 2-hour group sessions for 6 months followed by monthly 2-hour group sessions for another 6 months, delivered by trained mental health care workers. The intervention targeted overall lifestyle changes, emphasizing establishing a healthy diet and promoting physical activity. TAU (control) did not include structured interventions or advice on lifestyle. Main Outcomes and Measures Crude and adjusted linear mixed models and multivariable logistic regression analyses were performed. The main outcome was body weight change. Secondary outcomes included changes in body mass index, blood pressure, lipid profiles, fasting glucose level, quality of life, self-management ability, and lifestyle behaviors (physical activity and health, mental health, nutrition, and sleep). Results The study population included 11 lifestyle intervention teams (126 participants) and 10 TAU teams (98 participants). Of 224 included patients, 137 (61.2%) were female, and the mean (SD) age was 47.6 (11.1) years. From baseline to 12 months, participants in the lifestyle intervention group lost 3.3 kg (95% CI, -6.2 to -0.4) more than those in the control group. In the lifestyle intervention group, people with high attendance rates lost more weight than participants with medium and low rates (mean [SD] weight loss: high, -4.9 [8.1] kg; medium, -0.2 [7.8] kg; low, 0.8 [8.3] kg). Only small or no changes were found for secondary outcomes. Conclusions and Relevance In this trial, the lifestyle intervention significantly reduced weight from baseline to 12 months in overweight and obese adults with SMI. Tailoring lifestyle interventions and increasing attendance rates might be beneficial for people with SMI. Trial Registration Netherlands Trial Register Identifier: NTR6837.
Collapse
Affiliation(s)
- Florine Sanna Walburg
- Department Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Berno van Meijel
- Inholland University of Applied Sciences, Department of Health, Sports and Welfare, Mental Health Nursing Research Group, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam UMC (VUmc), Amsterdam, the Netherlands
- Parnassia Psychiatric Institute, Parnassia Academy, The Hague, the Netherlands
| | - Trynke Hoekstra
- Department Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Jelle Kol
- Department Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Laura Michelle Pape
- Department Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Johanna Willemina de Joode
- Department Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Maurits van Tulder
- Department of Clinical, Neuro- and Developmental Psychology, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marcel Adriaanse
- Department Health Sciences, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| |
Collapse
|
4
|
Attala A, Smith J, Lake AA, Giles E. Investigating 'treat culture' in a secure care service: a study of inpatient NHS staff on their views and opinions on weight gain and treat giving for patients in a forensic secure care service. J Hum Nutr Diet 2022; 36:729-741. [PMID: 36522842 DOI: 10.1111/jhn.13129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Obesity is a significant health inequality within forensic secure care mental health/learning disability inpatient settings. Patients may be at increased risk of developing preventable long-term conditions/premature death. This study investigated staff views on patient weight gain, how it affects patients and how to better manage patient weight in this setting. Furthermore, the research explored the culture of food being used as a 'treat' and the perceived impact of 'treats' on weight. METHODS A two-phase mixed methods approach was taken to explore staff views on patient weight gain and the 'treat' culture on adult forensic secure care inpatient wards in one NHS Mental Health Trust in the north-east of England. Phase one was an online survey, and phase two consisted of semi-structured qualitative interviews. The quantitative survey data were analysed using descriptive statistics. Thematic analysis was used for the open-ended survey questions and interview data. RESULTS The survey had 49 responses out of a possible 380 (13%). Ninety-two per cent of staff participants viewed patient weight gain as an area for concern, citing a range of reasons for weight gain. Weight gain was considered a risk to developing long-term health conditions and poor mental health. Nine participants were interviewed. Six themes were identified suggesting why patients might gain weight in forensic secure care, for example, patient history, staff behaviours, the surrounding 'treat' culture in this environment, along with suggestions of what could be improved to manage patient weight. CONCLUSIONS People detained in forensic secure care may be more at risk of weight gain due to their history, the secure care environment and the 'treat' culture adopted in these environments.
Collapse
Affiliation(s)
- Anita Attala
- Dietetics Department, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jo Smith
- The Research and Development Team, Tees, Esk and Wear Valleys NHS Foundation Trust, Middlesbrough, UK
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Amelia A Lake
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Emma Giles
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| |
Collapse
|
5
|
Batty GD, Deary IJ, Altschul D. Pre-pandemic mental and physical health as predictors of COVID-19 vaccine hesitancy: evidence from a UK-wide cohort study. Ann Med 2022; 54:274-282. [PMID: 35067149 PMCID: PMC8788379 DOI: 10.1080/07853890.2022.2027007] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 12/27/2021] [Accepted: 01/04/2022] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Although several predictors of COVID-19 vaccine hesitancy have been identified, the role of physical health and, particularly, mental health, is poorly understood. METHODS We used individual-level data from a pandemic-focused investigation (COVID Survey), a prospective cohort study nested within the UK Understanding Society (Main Survey) project. In the week immediately following the announcement of successful testing of the first efficacious inoculation (Oxford University/AstraZeneca, November/December 2020), data on vaccine intentionality were collected in 12,035 individuals aged 16-95 years. Pre-pandemic, study members had responded to enquiries about diagnoses of mental and physical health, including the completion of the 12-item General Health Questionnaire for symptoms of psychological distress (anxiety and depression). Peri-pandemic, individuals indicated whether they or someone in their household was shielding; that is, people judged by the UK National Health Service as being particularly clinically vulnerable who were therefore requested to remain at home. Intention to take up vaccination for COVID-19 was also self-reported. RESULTS In an analytical sample of 11,955 people (6741 women), 15.4% indicated that they were vaccine-hesitant. Relative to their disease-free counterparts, shielding was associated with a 24% lower risk of being hesitant (odds ratio; 95% confidence interval: 0.76; 0.59, 0.96), after adjustment for a range of covariates which included age, education, and ethnicity. Corresponding results for cardiometabolic disease were 22% (0.78; 0.64, 0.95), and for respiratory disease were 26% (0.74; 0.59, 0.93). Having a pre-pandemic diagnosis of anxiety or depression, or a high score on the distress symptom scale, were all unrelated to the willingness to vaccine-hesitancy. CONCLUSIONS People with a physical condition were more likely to take up the potential offer of a COVID-19 vaccination. These effects were not apparent for indices of mental health.Key messagesIn understanding predictors of COVID-19 vaccine hesitancy, the role of physical and mental health has not been well-examined despite both groups seemingly experiencing an elevated risk of the disease.In a large UK cohort study, people with a pre-pandemic physical condition were more likely to take up the theoretical offer of vaccination.There were no apparent effects for indices of pre-pandemic mental health.
Collapse
Affiliation(s)
- G. David Batty
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Ian J. Deary
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Drew Altschul
- Department of Psychology, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
6
|
Hay R, Cullen B, Graham N, Lyall DM, Aman A, Pell JP, Ward J, Smith DJ, Strawbridge RJ. Genetic analysis of the PCSK9 locus in psychological, psychiatric, metabolic and cardiovascular traits in UK Biobank. Eur J Hum Genet 2022; 30:1380-1390. [PMID: 35501368 PMCID: PMC9712543 DOI: 10.1038/s41431-022-01107-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/11/2022] [Accepted: 04/12/2022] [Indexed: 11/09/2022] Open
Abstract
The association between severe mental illness (SMI) and cardiovascular and metabolic disease (CMD) is poorly understood. PCSK9 is expressed in systems critical to both SMI and CMD and influences lipid homeostasis and brain function. We systematically investigated relationships between genetic variation within the PCSK9 locus and risk for both CMD and SMI. UK Biobank recruited ~500,000 volunteers and assessed a wide range of SMI and CMD phenotypes. We used genetic data from white British ancestry individuals of UK Biobank. Genetic association analyses were conducted in PLINK, with statistical significance defined by the number of independent SNPs. Conditional analyses and linkage disequilibrium assessed the independence of SNPs and the presence of multiple signals. Two genetic risk scores of lipid-lowering alleles were calculated and used as proxies for putative lipid-lowering effects of PCSK9. PCSK9 variants were associated with central adiposity, venous thrombosis embolism, systolic blood pressure, mood instability, and neuroticism (all p < 1.16 × 10-4). No secondary signals were identified. Conditional analyses and high linkage disequilibrium (r2 = 0.98) indicated that mood instability and central obesity may share a genetic signal. Genetic risk scores suggested that the lipid-lowering effects of PCSK9 may be causal for greater mood instability and higher neuroticism. This is the first study to implicate the PCSK9 locus in mood-disorder symptoms and related traits, as well as the shared pathology of SMI and CMD. PCSK9 effects on mood may occur via lipid-lowering mechanisms. Further work is needed to understand whether repurposing PCSK9-targeting therapies might improve SMI symptoms and prevent CMD.
Collapse
Affiliation(s)
- Rachel Hay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Breda Cullen
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Nicholas Graham
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Donald M Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alisha Aman
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Joey Ward
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Daniel J Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Rona J Strawbridge
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
- Health Data Research UK, Glasgow, UK.
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
| |
Collapse
|
7
|
Spanakis P, Peckham E, Young B, Heron P, Bailey D, Gilbody S. A systematic review of behavioural smoking cessation interventions for people with severe mental ill health-what works? Addiction 2022; 117:1526-1542. [PMID: 34697848 PMCID: PMC9298065 DOI: 10.1111/add.15724] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 10/08/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS People with severe mental ill health smoke more and suffer greater smoking-related morbidity and mortality. Little is known about the effectiveness of behavioural interventions for smoking cessation in this group. This review evaluated randomized controlled trial evidence to measure the effectiveness of behavioural smoking cessation interventions (both digital and non-digital) in people with severe mental ill health. DESIGN Systematic review and random-effects meta-analysis. We searched between inception and January 2020 in Medline, EMBASE, PsycINFO, CINAHL, Health Management Information Consortium and CENTRAL databases. SETTING AND PARTICIPANTS Randomized controlled trials (RCTs) assessing the effects of behavioural smoking cessation and reduction interventions in adults with severe mental ill health, conducted in any country, in either in-patient or community settings and published in English. MEASUREMENTS The primary outcome was biochemically verified smoking cessation. Smoking reduction and changes in mental health symptoms and body mass index (BMI) were included as secondary outcomes. Narrative data synthesis and meta-analysis were conducted and the quality of included studies was appraised using the risk of bias 2 (RoB2) tool. FINDINGS We included 12 individual studies (16 articles) involving 1861 participants. The first meta-analysis (three studies, 921 participants) demonstrated effectiveness of bespoke face-to-face interventions compared with usual care across all time-points [medium-term: relative risk (RR) = 2.29, 95% confidence interval (CI) = 1.38-3.81; long-term: RR = 1.58, 95% CI = 1.09-2.30]. The second (three studies, 275 participants) did not demonstrate any difference in effectiveness of bespoke digital on-line interventions compared with standard digital on-line interventions (medium-term: RR = 0.87, 95% CI = 0.17-4.46). A narrative overview revealed mixed results when comparing bespoke face-to-face interventions with other active interventions. The methodological quality of studies was mixed, with the majority having some concerns mainly around risk of selective reporting. CONCLUSIONS Face-to-face bespoke smoking cessation interventions for adults with severe mental ill health appear to be effective when compared with treatment as usual, but evidence is equivocal when compared with other active interventions. There is limited evidence comparing bespoke digital interventions with generic interventions, and we found no studies comparing them with usual treatment.
Collapse
Affiliation(s)
- Panagiotis Spanakis
- Department of Health Sciences and Closing the Gap NetworkUniversity of YorkYorkUK
| | - Emily Peckham
- Department of Health Sciences and Closing the Gap NetworkUniversity of YorkYorkUK
| | - Ben Young
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Paul Heron
- Department of Health Sciences and Closing the Gap NetworkUniversity of YorkYorkUK
| | - Della Bailey
- Department of Health Sciences and Closing the Gap NetworkUniversity of YorkYorkUK
| | - Simon Gilbody
- Department of Health Sciences and Closing the Gap NetworkUniversity of YorkYorkUK,York Hull Medical SchoolUniversity of York, HeslingtonYorkUK
| |
Collapse
|
8
|
Maidment ID, Wong G, Duddy C, Upthegrove R, Oduola S, Robotham D, Higgs S, Ahern A, Birdi G. REalist Synthesis Of non-pharmacologicaL interVEntions for antipsychotic-induced weight gain (RESOLVE) in people living with severe mental illness (SMI). Syst Rev 2022; 11:42. [PMID: 35264212 PMCID: PMC8906356 DOI: 10.1186/s13643-022-01912-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with severe mental illnesses (SMI) such as schizophrenia die on average 15 to 20 years earlier than everyone else. Two thirds of these deaths are from preventable physical illnesses such as hypertension, cardiovascular disease, and diabetes, which are worsened by weight gain. Antipsychotics are associated with significant weight gain. In REalist Synthesis Of non-pharmacologicaL interVEntions (RESOLVE), a realist synthesis, combining primary and secondary data, will be used to understand and explain how, why, for whom, and in what contexts non-pharmacological interventions can help service users to manage antipsychotic-induced weight gain. METHODS A five-step approach will be used to develop guidance: 1. Developing the initial programme theory An initial (candidate) programme theory, which sets out how and why outcomes occur within an intervention, will be developed. 2. Developing the search The initial programme theory will be refined using academic and grey literature. The proposed initial sampling frame are as follows: Context: people living with SMI, taking antipsychotics, different types of SMI. INTERVENTION non-pharmacological interventions. MECHANISMS triggered by the intervention. Outcomes e.g. weight, metabolic adverse events, quality of life, adherence, burden, economic. Searching for relevant documents will continue until sufficient data is found to conclude that the refined programme theory is coherent and plausible. Lived experience (service users) and stakeholder (practitioners) groups will provide feedback. 3. Selection, appraisal and data extraction Documents will be screened against inclusion and exclusion criteria. The text extracted from these documents will be coded as contexts, mechanisms and their relationships to outcomes. 4. Primary data collection Realist interviews with up to 30 service users and informal carers, and 20 practitioners will gather data to support, refute or refine the programme theory. 5. Data analysis A realist logic of analysis will be used to develop and refine the programme theory from secondary and primary data. The analysis will aim to identify practical intervention strategies to change contexts so that key mechanisms are triggered to produce desired outcomes. Guidance will be produced based on these strategies. DISCUSSION This realist synthesis aims to develop guidance for service users and practitioners on the most appropriate interventional strategies to manage and limit antipsychotic weight gain. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42021268697.
Collapse
Affiliation(s)
- Ian D Maidment
- College of Health and Life Sciences, Aston University, Birmingham, B4 7ET, UK.
| | - Geoffrey Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Claire Duddy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Rachel Upthegrove
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Sheri Oduola
- School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
| | - Dan Robotham
- The McPin Foundation, 7-14 Great Dover St, London, SE1 4YR, UK
| | - Suzanne Higgs
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Amy Ahern
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Gurkiran Birdi
- College of Health and Life Sciences, Aston University, Birmingham, B4 7ET, UK
| |
Collapse
|
9
|
Dietary Habits and Obesity in Patients with Psychotic Disorders in Rural Areas in Northwestern Greece. PSYCH 2021. [DOI: 10.3390/psych4010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
People suffering from psychotic disorders display high rates of physical morbidity and mortality in comparison to the general population. The present study explores the relation between the dietary habits, the prevalence of obesity and the occurrence of physical morbidity in patients who suffer from psychotic disorders in rural regions of northwest Greece. Two scales were applied to evaluate the quality of life (Quality of Life Questionnaire II, Moorehead–Ardelt) and the dietary habits (Dietary Instrument for Nutrition Education (DINE) Questionnaire) of these patients. The study sample used in this study consisted of 55 patients who suffered from a psychotic disorder. Most (75%) were male, with a mean age of 51.5 years and an average duration of disease of 25.1 years. Of these, 38.2% (21 patients) were obese with a BMI < 30 Kg/m2, 32.7% (16 patients) were overweight and 29.1% had a normal body weight. The majority of the sample, 80%, was treated with second-generation medications. With regards to their dietary habits, 94.5% (52/55) of the sample showed a low intake of fiber content, 67.3% (37/55) showed a high intake of saturated fats and 100% (55/55) a low intake of unsaturated fats. The rates of physical morbidity in the present sample were 21.8% with at least one disease and 14.5% with two diseases, whereas 5.5% met the criteria for metabolic syndrome (MS). The average BMI of the women was statistically significantly higher compared to the men. The majority of the sample (69.1%) exhibited acceptable levels of quality of life. No co-relations of quality of life with BMI were found. In addition, no co-relations of BMI with dietary habits were revealed.
Collapse
|
10
|
Afzal M, Siddiqi N, Ahmad B, Afsheen N, Aslam F, Ali A, Ayesha R, Bryant M, Holt R, Khalid H, Ishaq K, Koly KN, Rajan S, Saba J, Tirbhowan N, Zavala GA. Prevalence of Overweight and Obesity in People With Severe Mental Illness: Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2021; 12:769309. [PMID: 34899604 PMCID: PMC8656226 DOI: 10.3389/fendo.2021.769309] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/21/2021] [Indexed: 11/23/2022] Open
Abstract
Aims 1) To determine the pooled prevalence of overweight and obesity in people with severe mental illness (SMI), overall and by type of SMI, geographical region, and year of data collection; and 2) to assess the likelihood of overweight and obesity, in people with SMI compared with the general population. Methods PubMed, Medline, EMBASE, and PsycINFO databases were searched to identify observational studies assessing the prevalence of obesity in adults with SMI. Screening, data extraction and risk of bias assessments were performed independently by two co-authors. Random effect estimates for the pooled prevalence of overweight and obesity and the pooled odds of obesity in people with SMI compared with the general population were calculated. Subgroup analyses were conducted for types of SMI, setting, antipsychotic medication, region of the world, country income classification, date of data collection and sex. We assessed publication bias and performed a series of sensitivity analyses, excluding studies with high risk of bias, with low sample size and those not reporting obesity according to WHO classification. Result 120 studies from 43 countries were included, the majority were from high income countries. The pooled prevalence of obesity in people with SMI was 25.9% (95% C.I. = 23.3-29.1) and the combined pooled prevalence of overweight and obesity was 60.1% (95% C.I. = 55.8-63.1). Sub-Saharan Africa (13.0%, 95%C.I. = 6.7-25.1) and South Asia (17.7%, 95%C.I. = 10.5-28.5) had the lowest prevalence of obesity whilst North Africa and the Middle East (35.8%, 95%C.I. = 23.8-44.8) reported the highest prevalence. People with SMI were 3.04 more likely (95% C.I. = 2.42-3.82) to have obesity than the general population, but there was no difference in the prevalence of overweight. Women with schizophrenia were 1.44 (95% C.I. = 1.25-1.67) times more likely than men with schizophrenia to live with obesity; however, no gender differences were found among those with bipolar disorder. Conclusion People with SMI have a markedly high prevalence and higher odds of obesity than the general population. This may contribute to the very high prevalence of physical health conditions and mortality in this group. People with SMI around the world would likely benefit from interventions to reduce and prevent obesity.
Collapse
Affiliation(s)
- Medhia Afzal
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, York, United Kingdom
- Health and Care of Older People, East Kent Hospitals University National Health Service (NHS Foundation), Kent, United Kingdom
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, York, United Kingdom
| | - Bilal Ahmad
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Nida Afsheen
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Faiza Aslam
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Ayaz Ali
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Rubab Ayesha
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Maria Bryant
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, York, United Kingdom
| | - Richard Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- Southampton National Institute for Health Research Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Humaira Khalid
- Health and Care of Older People, East Kent Hospitals University National Health Service (NHS Foundation), Kent, United Kingdom
| | - Kousar Ishaq
- Health and Care of Older People, East Kent Hospitals University National Health Service (NHS Foundation), Kent, United Kingdom
| | - Kamrun Nahar Koly
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Sukanya Rajan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Bangalore, India
| | - Jobaida Saba
- Health System and Population Studies Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Gerardo A. Zavala
- Department of Health Sciences, University of York, York, United Kingdom
| |
Collapse
|
11
|
Abstract
Many psychiatric disorders are associated with obesity and include mood disorders, anxiety disorders, personality disorders, attention deficit hyperactivity disorder, binge eating disorders, trauma, bipolar disorder, and schizophrenia. According to National Obesity Observatory, there is evidence that both obesity and mental health disorders take up a significant portion of the global burden of disease. The bidirectional nature of obesity and mental illness indicates the importance of screening all persons being treated for either obesity or mental illnesses be screened for the other. Failure to do so may decrease the effectiveness of treatment for each one individually.
Collapse
Affiliation(s)
- Christy Perry
- Southeastern Louisiana University, School of Nursing, 4849 Essen Lane, Baton Rouge, LA 70809, USA
| | | | - Sattaria S Dilks
- Graduate Nursing McNeese State University, 550 Sale Road, Lake Charles, LA 70605, USA.
| |
Collapse
|
12
|
Lavallee KL, Zhang XC, Schneider S, Margraf J. Obesity and Mental Health: A Longitudinal, Cross-Cultural Examination in Germany and China. Front Psychol 2021; 12:712567. [PMID: 34646201 PMCID: PMC8504480 DOI: 10.3389/fpsyg.2021.712567] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/16/2021] [Indexed: 01/07/2023] Open
Abstract
The present study examines the relationship between obesity and mental health using longitudinal data. Participants with data at baseline and one-year follow-up were included from two countries: Germany (364) and China (9007). A series of structural equation models with three mediators and one moderator were conducted separately for female and male students in Germany and China. Zero-order correlations indicated that overweight/obesity was significantly related to later depression and anxiety in Chinese males. Additional effects of obesity on later mental health flowed through effects on attractiveness (Chinese and German females, and Chinese males), physical health (Chinese males), and life satisfaction (German females). Though overweight/obesity is related to mental health across many other studies, results in this study yield total effects between overweight/obesity and follow-up mental health only in Chinese males. The relationship between overweight/obesity and follow-up mental health was significantly mediated by follow-up attractiveness, or health state, or life satisfaction in German females, Chinese females, and Chinese male students, with no significant indirect effects found in German male students. This highlights the possible importance of culture in examining these effects.
Collapse
Affiliation(s)
- Kristen L Lavallee
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Xiao Chi Zhang
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Silvia Schneider
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| |
Collapse
|
13
|
Al-Rawi S, Zolezzi M, Eltorki Y. Evaluation of cardiovascular risk in adult psychiatric outpatients in Qatar using two risk assessment tools. Qatar Med J 2021; 2021:27. [PMID: 34604012 PMCID: PMC8475158 DOI: 10.5339/qmj.2021.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/13/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction: Individuals with serious mental illness (SMI) experience premature death, likely due to increased rates of obesity and cardiovascular disease (CVD). This study was conducted to estimate the CVD risk in a cohort of individuals with SMI receiving outpatient psychiatric services in Qatar and to assess contributory CVD risk factors. Methods: This is a retrospective review of the electronic medical records of a cohort of outpatients with SMI attending a mental health clinic in Doha, Qatar. The CVD risk was estimated using two risk prediction tools: the American Heart Association and the American College of Cardiology (AHA/ACC) risk calculator and the World Health Organization/International Society of Hypertension (WHO/ISH) CVD risk prediction charts for the Eastern Mediterranean region. Descriptive and inferential statistics were used to analyze the demographic and clinical data. Data were analyzed using Statistical Package for the Social Sciences. Results: Of the 346 eligible patients, 28% (n = 97) had obtainable data for the estimation of their CVD risk using both tools. Approximately one-third of the cohort (33%) were classified as high risk using the AHA/ACC risk calculator, and 13.3% were classified as intermediate to high risk using the WHO/ISH CVD risk prediction charts. Based on the AHA/ACC risk scores, among those with a high CVD risk, almost two-thirds had CVD modifiable risk factors (i.e., smoking, diabetes, dyslipidemia, and hypertension). No statistically significant difference in the CVD risk estimates was observed among individuals with a body mass index of more or lower than 30 kg/m2 (p = 0.815). Conclusion: Based on the AHA/ACC risk calculator, approximately one-third of the study cohort had high CVD risk estimates. The WHO/ISH CVD risk prediction charts appeared to underestimate CVD risk, particularly for those identified as high risk using the AHA/ACC risk calculator. A closer alliance between psychiatrists and primary healthcare professionals to control modifiable cardiovascular risk factors among patients with SMI is necessary.
Collapse
Affiliation(s)
- Safa Al-Rawi
- Al Wakrah Hospital, Hamad Medical Corporation, Doha, Qatar E-mail:
| | - Monica Zolezzi
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Yassin Eltorki
- Mental Health Hospital, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
14
|
Aschbrenner KA, Naslund JA, Reed JD, Fetter JC. Renewed call for lifestyle interventions to address obesity among individuals with serious mental illness in the COVID-19 era and beyond. Transl Behav Med 2021; 11:1359-1364. [PMID: 34160055 DOI: 10.1093/tbm/ibab076] [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: 01/01/2023] Open
Abstract
Behavioral health has the opportunity to lead the way in using lifestyle interventions to address obesity and health disparities in people with serious mental illness (SMI) in the COVID-19 era. Evidence-based interventions for weight loss in individuals with SMI exist, and the field has developed strategies for implementing these interventions in real-world mental health care settings. In addition to promoting weight loss, lifestyle interventions have the potential to address social isolation and loneliness and other patient-centered outcomes among individuals with SMI, which will be especially valuable for mitigating the growing concerns about loneliness attributed to the COVID-19 pandemic restrictions on in-person encounters. In this commentary, we discuss practice, policy, and research implications related to using evidence-based lifestyle interventions for individuals with SMI during the COVID-19 pandemic and sustaining these programs in the long-term.
Collapse
Affiliation(s)
- Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Jeffrey D Reed
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| | - Jeffrey C Fetter
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, Lebanon, NH, USA
| |
Collapse
|
15
|
Batty GD, Deary IJ, Altschul D. Pre-pandemic mental and physical health as predictors of COVID-19 vaccine hesitancy: evidence from a UK-wide cohort study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.04.27.21256185. [PMID: 34013297 PMCID: PMC8132272 DOI: 10.1101/2021.04.27.21256185] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
IMPORTANCE Although several predictors of COVID-19 vaccine hesitancy have been identified, the role of physical health has not been well-examined, and the association with mental health is unknown. OBJECTIVE To examine the association of pre-pandemic mental health, physical health, and shielding with vaccine hesitancy after the announcement of the successful testing of the Oxford University/AstraZeneca vaccine. DESIGN SETTING AND PARTICIPANTS We used individual-level data from a pandemic-focused investigation (COVID Survey), a prospective cohort study nested within the UK Understanding Society (Main Survey) project. In the week immediately following the announcement of successful testing of the first efficacious inoculation (November/December 2020), data on vaccine intentionality were collected in 12,035 individuals aged 16-95 years. Pre-pandemic, study members had responded to enquiries about diagnoses of mental and physical health, completed the 12-item General Health Questionnaire for symptoms of psychological distress (anxiety and depression), and indicated whether they or someone in their household was shielding. MAIN OUTCOME MEASURES Self-reported intention to take up a vaccination for COVID-19. To summarise our results, we computed odds ratios with accompanying 95% confidence intervals for indices of health and shielding adjusted for selected covariates. RESULTS In an analytical sample of 11,955 people (6741 women), 15.4% indicated that they were vaccine hesitant. Relative to their disease-free counterparts, shielding was associated with a 24% lower risk of being hesitant (odds ratio; 95% confidence interval: 0.76; 0.59, 0.96), after adjustment for a range of covariates which included age, education, and ethnicity. Corresponding results for cardiometabolic disease were 22% (0.78; 0.64, 0.95), and for respiratory disease were 26% (0.74; 0.59, 0.93). Having a pre-pandemic diagnosis of anxiety or depression, or a high score on the distress symptom scale, were all unrelated to the willingness to take up a vaccine. CONCLUSIONS AND RELEVANCE People who have been prioritised for COVID-19 vaccination owing to a physical condition are more likely to take it up. These effects were not apparent for indices of mental health.
Collapse
Affiliation(s)
- G David Batty
- Department of Epidemiology and Public Health, University College London, UK
| | - Ian J Deary
- Lothian Birth Cohorts, Department of Psychology, University of Edinburgh, UK
| | - Drew Altschul
- Department of Psychology, University of Edinburgh, UK
| |
Collapse
|
16
|
von Philipsborn P, Geffert K. Prävention der Adipositas. PSYCHOTHERAPEUT 2020. [DOI: 10.1007/s00278-020-00473-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
17
|
Morris J, Leung SSY, Bailey ME, Cullen B, Ferguson A, Graham N, Johnston KJA, Lyall DM, Lyall LM, Ward J, Smith DJ, Strawbridge RJ. Exploring the Role of Contactins across Psychological, Psychiatric and Cardiometabolic Traits within UK Biobank. Genes (Basel) 2020; 11:E1326. [PMID: 33182605 PMCID: PMC7697406 DOI: 10.3390/genes11111326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/05/2020] [Accepted: 11/07/2020] [Indexed: 12/17/2022] Open
Abstract
Individuals with severe mental illness have an increased risk of cardiometabolic diseases compared to the general population. Shared risk factors and medication effects explain part of this excess risk; however, there is growing evidence to suggest that shared biology (including genetic variation) is likely to contribute to comorbidity between mental and physical illness. Contactins are a family of genes involved in development of the nervous system and implicated, though genome-wide association studies, in a wide range of psychological, psychiatric and cardiometabolic conditions. Contactins are plausible candidates for shared pathology between mental and physical health. We used data from UK Biobank to systematically assess how genetic variation in contactin genes was associated with a wide range of psychological, psychiatric and cardiometabolic conditions. We also investigated whether associations for cardiometabolic and psychological traits represented the same or distinct signals and how the genetic variation might influence the measured traits. We identified: A novel genetic association between variation in CNTN1 and current smoking; two independent signals in CNTN4 for BMI; and demonstrated that associations between CNTN5 and neuroticism were distinct from those between CNTN5 and blood pressure/HbA1c. There was no evidence that the contactin genes contributed to shared aetiology between physical and mental illness.
Collapse
Affiliation(s)
- Julia Morris
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; (J.M.); (S.S.Y.L.); (B.C.); (A.F.); (N.G.); (K.J.A.J.); (D.M.L.); (L.M.L.); (J.W.); (D.J.S.)
| | - Soddy Sau Yu Leung
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; (J.M.); (S.S.Y.L.); (B.C.); (A.F.); (N.G.); (K.J.A.J.); (D.M.L.); (L.M.L.); (J.W.); (D.J.S.)
| | - Mark E.S. Bailey
- School of Life Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK;
| | - Breda Cullen
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; (J.M.); (S.S.Y.L.); (B.C.); (A.F.); (N.G.); (K.J.A.J.); (D.M.L.); (L.M.L.); (J.W.); (D.J.S.)
| | - Amy Ferguson
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; (J.M.); (S.S.Y.L.); (B.C.); (A.F.); (N.G.); (K.J.A.J.); (D.M.L.); (L.M.L.); (J.W.); (D.J.S.)
| | - Nicholas Graham
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; (J.M.); (S.S.Y.L.); (B.C.); (A.F.); (N.G.); (K.J.A.J.); (D.M.L.); (L.M.L.); (J.W.); (D.J.S.)
| | - Keira J. A. Johnston
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; (J.M.); (S.S.Y.L.); (B.C.); (A.F.); (N.G.); (K.J.A.J.); (D.M.L.); (L.M.L.); (J.W.); (D.J.S.)
- School of Life Sciences, College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow G12 8QQ, UK;
- Deanery of Molecular, Genetic and Population Health Sciences, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh EH8 9AG, UK
| | - Donald M. Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; (J.M.); (S.S.Y.L.); (B.C.); (A.F.); (N.G.); (K.J.A.J.); (D.M.L.); (L.M.L.); (J.W.); (D.J.S.)
| | - Laura M. Lyall
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; (J.M.); (S.S.Y.L.); (B.C.); (A.F.); (N.G.); (K.J.A.J.); (D.M.L.); (L.M.L.); (J.W.); (D.J.S.)
| | - Joey Ward
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; (J.M.); (S.S.Y.L.); (B.C.); (A.F.); (N.G.); (K.J.A.J.); (D.M.L.); (L.M.L.); (J.W.); (D.J.S.)
| | - Daniel J. Smith
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; (J.M.); (S.S.Y.L.); (B.C.); (A.F.); (N.G.); (K.J.A.J.); (D.M.L.); (L.M.L.); (J.W.); (D.J.S.)
| | - Rona J. Strawbridge
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8RZ, UK; (J.M.); (S.S.Y.L.); (B.C.); (A.F.); (N.G.); (K.J.A.J.); (D.M.L.); (L.M.L.); (J.W.); (D.J.S.)
- Health Data Research UK, Glasgow G12 8RZ, UK
- Cardiovascular Medicine Unit, Department of Medicine Solna, Karolinska Institutet, 171 77 Stockholm, Sweden
| |
Collapse
|
18
|
Abd El-Hameed AM, Eskandrani AA, Elroby FA. Assessment of the ameliorative effect of Hypericum perforatum on olanzapine-induced hepatic oxidative stress and metabolic abnormalities in experimental male albino rats. JOURNAL OF TAIBAH UNIVERSITY FOR SCIENCE 2020. [DOI: 10.1080/16583655.2020.1834757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Abeer M. Abd El-Hameed
- Faculty of Science, Chemistry Department, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia
| | - Areej A. Eskandrani
- Faculty of Science, Chemistry Department, Taibah University, Al-Madinah Al-Munawara, Saudi Arabia
| | - Fadwa A. Elroby
- Faculty of Medicine, Forensic Medicine &Toxicology Department, Beni-Suef University, Egypt
| |
Collapse
|
19
|
Lee H, Kane I, Sereika S. Portion-control intervention for people with serious mental illness: A feasibility study. Perspect Psychiatr Care 2020; 56:858-863. [PMID: 32207158 DOI: 10.1111/ppc.12502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/03/2020] [Accepted: 03/07/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Portion control can be an effective weight-loss strategy for people with serious mental illnesses (SMI). This study aimed to examine the feasibility of portion-control intervention (PCI) for people with SMI. DESIGN AND METHODS A randomized experimental design was used. The PCI group received weekly, telephone-delivered behavioral counseling over 12 weeks. Newsletter group received monthly newsletters regarding healthy eating. Descriptive statistics were used to analyze data collected at baseline and at 12 weeks. FINDINGS The acceptability of the PCI and significant decreases in waist circumference among the participants of the PCI group were reported. PRACTICE IMPLICATIONS Simple and structured guidelines to manage portion size, akin to those featured in our PCI, can benefit those with SMI.
Collapse
Affiliation(s)
- Heeyoung Lee
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
| | - Irene Kane
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
| | - Susan Sereika
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania
| |
Collapse
|
20
|
Ronaldson A, Elton L, Jayakumar S, Jieman A, Halvorsrud K, Bhui K. Severe mental illness and health service utilisation for nonpsychiatric medical disorders: A systematic review and meta-analysis. PLoS Med 2020; 17:e1003284. [PMID: 32925912 PMCID: PMC7489517 DOI: 10.1371/journal.pmed.1003284] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 08/10/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Psychiatric comorbidity is known to impact upon use of nonpsychiatric health services. The aim of this systematic review and meta-analysis was to assess the specific impact of severe mental illness (SMI) on the use of inpatient, emergency, and primary care services for nonpsychiatric medical disorders. METHODS AND FINDINGS PubMed, Web of Science, PsychINFO, EMBASE, and The Cochrane Library were searched for relevant studies up to October 2018. An updated search was carried out up to the end of February 2020. Studies were included if they assessed the impact of SMI on nonpsychiatric inpatient, emergency, and primary care service use in adults. Study designs eligible for review included observational cohort and case-control studies and randomised controlled trials. Random-effects meta-analyses of the effect of SMI on inpatient admissions, length of hospital stay, 30-day hospital readmission rates, and emergency department use were performed. This review protocol is registered in PROSPERO (CRD42019119516). Seventy-four studies were eligible for review. All were observational cohort or case-control studies carried out in high-income countries. Sample sizes ranged from 27 to 10,777,210. Study quality was assessed using the Newcastle-Ottawa Scale for observational studies. The majority of studies (n = 45) were deemed to be of good quality. Narrative analysis showed that SMI led to increases in use of inpatient, emergency, and primary care services. Meta-analyses revealed that patients with SMI were more likely to be admitted as nonpsychiatric inpatients (pooled odds ratio [OR] = 1.84, 95% confidence interval [CI] 1.21-2.80, p = 0.005, I2 = 100%), had hospital stays that were increased by 0.59 days (pooled standardised mean difference = 0.59 days, 95% CI 0.36-0.83, p < 0.001, I2 = 100%), were more likely to be readmitted to hospital within 30 days (pooled OR = 1.37, 95% CI 1.28-1.47, p < 0.001, I2 = 83%), and were more likely to attend the emergency department (pooled OR = 1.97, 95% CI 1.41-2.76, p < 0.001, I2 = 99%) compared to patients without SMI. Study limitations include considerable heterogeneity across studies, meaning that results of meta-analyses should be interpreted with caution, and the fact that it was not always possible to determine whether service use outcomes definitively excluded mental health treatment. CONCLUSIONS In this study, we found that SMI impacts significantly upon the use of nonpsychiatric health services. Illustrating and quantifying this helps to build a case for and guide the delivery of system-wide integration of mental and physical health services.
Collapse
Affiliation(s)
- Amy Ronaldson
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Lotte Elton
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Simone Jayakumar
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Anna Jieman
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Kristoffer Halvorsrud
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Kamaldeep Bhui
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine, Queen Mary University of London, London, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
21
|
Factors influencing subjective recovery of people with recent-onset psychosis: A cross-sectional study in a low-income sub-Saharan country. Psychiatry Res 2020; 287:112282. [PMID: 30853117 DOI: 10.1016/j.psychres.2019.01.107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 12/11/2018] [Accepted: 01/21/2019] [Indexed: 01/23/2023]
Abstract
People with psychosis were traditionally believed to have a chronic deteriorating condition with no hope of recovery. Recent studies have shown varied levels of recovery across countries. However, evidence from low-income, particularly African countries is scant. This study aimed to investigate levels of subjective recovery of people with recent-onset psychosis and identify its influencing factors. A cross-sectional study was conducted among 263 outpatients with recent-onset psychosis in a low-income country, Ethiopia. Psychiatric outpatients were randomly selected, and assessed by a set of questionnaires measuring their psychosocial, clinical and physical health conditions. Hierarchical multiple regression tests were used to identify factors influencing subjective recovery. The level of subjective recovery was found to be high, with a mean Questionnaire about the Process of Recovery score of 44.17. Individuals with higher quality of life were found to have significantly better subjective recovery level. Hopeless and centrally obese individuals were found to have significantly lower level of subjective recovery. Despite the limitations associated with a cross sectional study design, the results suggest that individuals with recent-onset psychosis in Ethiopia may have a better level of subjective recovery than those in high-income countries and their recovery is influenced by quality of life, hopelessness and central obesity.
Collapse
|
22
|
Bailey JM, Clinton-McHarg TL, Wye PM, Wiggers JH, Bartlem KM, Bowman JA. Preventive care for physical activity and fruit and vegetable consumption: a survey of family carer expectations of health service delivery for people with a mental health condition. BMC Health Serv Res 2020; 20:201. [PMID: 32164730 PMCID: PMC7068924 DOI: 10.1186/s12913-020-5059-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 02/28/2020] [Indexed: 11/07/2022] Open
Abstract
Background Chronic disease is a leading cause of death globally, where inadequate fruit and vegetable consumption and inadequate physical activity are consistently implicated as key contributing risk factors for such diseases. People with a mental health condition are reported to experience a higher prevalence of such risks and experience an increased morbidity and mortality from resultant chronic disease. Despite guidelines identifying a need for services accessed by people with a mental health condition to provide care to address such health risk behaviours, sub-optimal care is frequently reported suggesting a need for innovative strategies to increase the provision of physical health care. An exploratory study was conducted to examine: 1) family carers’ expectations of care provision regarding fruit and vegetable consumption and physical activity by health and community services for people with a mental health condition; 2) carer’s own health risk behaviour status and perceptions of the influence of the health risk behaviours on mental health; and 3) possible associations of socio-demographic, clinical and attitudinal factors with carer expectations of care provision for fruit and vegetable consumption and physical activity. Methods Family carers (n = 144) of a person with a mental health condition completed a cross-sectional survey. Participants were members of a mental health carer support organisation operating in New South Wales, Australia. Results A high proportion of participants considered care for fruit and vegetable consumption and physical activity respectively should be provided by: mental health hospitals (78.5, 82.7%); community mental health services (76.7, 85.9%); general practice (81.1, 79.2%); and non-government organisations (56.2, 65.4%). Most participants perceived adequate fruit and vegetable consumption (55.9%), and physical activity (71.3%) would have a very positive impact on mental health. Carers who perceived adequate fruit and vegetable consumption and physical activity would have a positive impact on mental health were more likely to expect care for such behaviours from some services. Conclusions The majority of participants expected care for fruit and vegetable consumption and physical activity be provided by all services catering for people with a mental health condition, reinforcing the appropriateness for such services to provide physical health care for clients in a systematic manner.
Collapse
Affiliation(s)
- Jacqueline M Bailey
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.
| | - Tara L Clinton-McHarg
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Paula M Wye
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - John H Wiggers
- Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Population Health, Hunter New England Local Health District, Booth Building, Wallsend Health Services, Longworth Avenue, Wallsend, Wallsend, NSW, 2287, Australia.,School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia
| | - Kate M Bartlem
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Jennifer A Bowman
- School of Psychology, Faculty of Science and Information Technology, The University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Clinical Research Centre, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| |
Collapse
|
23
|
Sfera A, Osorio C, Diaz EL, Maguire G, Cummings M. The Other Obesity Epidemic-Of Drugs and Bugs. Front Endocrinol (Lausanne) 2020; 11:488. [PMID: 32849279 PMCID: PMC7411001 DOI: 10.3389/fendo.2020.00488] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 06/22/2020] [Indexed: 12/13/2022] Open
Abstract
Chronic psychiatric patients with schizophrenia and related disorders are frequently treatment-resistant and may require higher doses of psychotropic drugs to remain stable. Prolonged exposure to these agents increases the risk of weight gain and cardiometabolic disorders, leading to poorer outcomes and higher medical cost. It is well-established that obesity has reached epidemic proportions throughout the world, however it is less known that its rates are two to three times higher in mentally ill patients compared to the general population. Psychotropic drugs have emerged as a major cause of weight gain, pointing to an urgent need for novel interventions to attenuate this unintended consequence. Recently, the gut microbial community has been linked to psychotropic drugs-induced obesity as these agents were found to possess antimicrobial properties and trigger intestinal dysbiosis, depleting Bacteroidetes phylum. Since germ-free animals exposed to psychotropics have not demonstrated weight gain, altered commensal flora composition is believed to be necessary and sufficient to induce dysmetabolism. Conversely, not only do psychotropics disrupt the composition of gut microbiota but the later alter the metabolism of the former. Here we review the role of gut bacterial community in psychotropic drugs metabolism and dysbiosis. We discuss potential biomarkers reflecting the status of Bacteroidetes phylum and take a closer look at nutritional interventions, fecal microbiota transplantation, and transcranial magnetic stimulation, strategies that may lower obesity rates in chronic psychiatric patients.
Collapse
Affiliation(s)
- Adonis Sfera
- Psychiatry, Loma Linda University, Loma Linda, CA, United States
- Department of Psychiatry, Patton State Hospital, San Bernardino, CA, United States
- *Correspondence: Adonis Sfera
| | - Carolina Osorio
- Department of Psychiatry, Loma Linda University, Loma Linda, CA, United States
| | - Eddie Lee Diaz
- Department of Psychiatry, Patton State Hospital, San Bernardino, CA, United States
| | - Gerald Maguire
- Department of Psychiatry, University of California, Riverside, Riverside, CA, United States
| | - Michael Cummings
- Department of Psychiatry, Patton State Hospital, San Bernardino, CA, United States
| |
Collapse
|
24
|
Seeman MV. Men and women respond differently to antipsychotic drugs. Neuropharmacology 2019; 163:107631. [PMID: 31077728 DOI: 10.1016/j.neuropharm.2019.05.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 04/19/2019] [Accepted: 05/07/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Because women are often perceived as having better outcomes than men in psychotic illnesses such as schizophrenia - women are less often in hospital, have a lower suicide rate, are less often involved with the law, enjoy better relationships with family and friends - the question arises as to whether or not this apparent advantage is attributable to a gender difference in antipsychotic response. OBJECTIVE The aim of this paper is to critically review the quantitative and qualitative literature on gender difference in antipsychotic response sourced mainly from medical databases of the last ten years. FINDINGS There are theoretical reasons why women's effective doses of antipsychotics might need to be lower than guidelines recommend for men, especially as regards olanzapine and clozapine, but, because there are so many variables that impinge on antipsychotic response, it is difficult to provide definitive guidance. What is evident is that some antipsychotic side effects, weight gain for instance, are more worrisome for women than for men. It is also evident that, after menopause, women need an increase in their antipsychotic dose; other reproductive stages in women's lives require special prescribing considerations as well. CONCLUSION There is a science, and an art, to prescribing antipsychotics, which needs to take gender into account. This article is part of the issue entitled 'Special Issue on Antipsychotics'.
Collapse
Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, 260 Heath St. West, Toronto, Ontario, M5P 3L6, Canada.
| |
Collapse
|
25
|
Factors influencing subjective recovery of people with recent-onset psychosis: A cross-sectional study in a low-income Sub-Saharan country. Psychiatry Res 2019; 274:421-429. [PMID: 30875619 DOI: 10.1016/j.psychres.2019.02.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
People with psychosis were traditionally believed to have a chronic deteriorating condition with no hope of recovery. Recent studies have shown varied levels of recovery across countries. However, evidence from low-income, particularly African countries is scant. This study aimed to investigate levels of subjective recovery of people with recent-onset psychosis and identify its influencing factors. A cross-sectional study was conducted among 263 outpatients with recent-onset psychosis in a low-income country, Ethiopia. Psychiatric outpatients were randomly selected, and assessed by a set of questionnaires measuring their psychosocial, clinical and physical health conditions. Hierarchical multiple regression tests were used to identify factors influencing subjective recovery. The level of subjective recovery was found to be high, with a mean Questionnaire about the Process of Recovery score of 44.17. Individuals with higher quality of life were found to have significantly better subjective recovery level. Hopeless and centrally obese individuals were found to have significantly lower level of subjective recovery. Despite the limitations associated with a cross sectional study design, the results suggest that individuals with recent-onset psychosis in Ethiopia may have a better level of subjective recovery than those in high-income countries and their recovery is influenced by quality of life, hopelessness and central obesity.
Collapse
|
26
|
Wong-Anuchit C, Chantamit-O-Pas C, Schneider JK, Mills AC. Motivational Interviewing-Based Compliance/Adherence Therapy Interventions to Improve Psychiatric Symptoms of People With Severe Mental Illness: Meta-Analysis. J Am Psychiatr Nurses Assoc 2019; 25:122-133. [PMID: 29504450 DOI: 10.1177/1078390318761790] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Nonadherence is the leading cause of relapse in mental illness. No quantitative synthesis of multiple studies has been conducted to determine the effect of motivational interviewing (MI)-based compliance/adherence therapy (CAT) interventions on people with severe mental illness. OBJECTIVE To synthesize the studies that examined the effectiveness of MI-based CAT interventions to improve psychiatric symptoms. DESIGN Quantitative meta-analysis. RESULTS Sixteen primary studies were retrieved ( N =1267 participants). MI-based CAT interventions significantly improved psychiatric symptoms with a moderate effect size (ES) of .45. Longer sessions and higher intervention doses showed significantly greater ESs than shorter sessions and lower doses. ESs were significantly lower when participants were older and when there was a longer period between the intervention and outcome measurement. CONCLUSIONS These findings support the effectiveness of MI-based CAT interventions. Session length and dose effect should be considered when tailoring MI to clients.
Collapse
Affiliation(s)
| | | | | | - Andrew C Mills
- 4 Andrew C. Mills, PhD, RN, Mahasarakham University, Mahasarakham, Thailand
| |
Collapse
|
27
|
Lawn S, Zabeen S, Rowlands N, Picot S. Hidden care: Revelations of a case-note audit of physical health care in a community mental health service. Int J Ment Health Nurs 2018; 27:1742-1755. [PMID: 29797643 DOI: 10.1111/inm.12479] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/22/2018] [Indexed: 12/30/2022]
Abstract
People with severe mental illness (SMI) are widely reported to be at an increased risk of morbidity and premature death due to physical health conditions. Mental health nurses are ideally placed to address physical and mental health comorbidity as part of their day-to-day practice. This study involved an audit of hardcopy and electronic clinical case-notes of a random sample of 100 people with SMI case managed by community mental health service in metropolitan South Australia, to determine how well physical health conditions and risk factors, screening, and follow-up are recorded within their service records. Every contact between 1 July 2015 and 30 June 2016 was read. One-way ANOVA, Scheffe's test, and Fisher's exact test determined any significant associations across audit variables, which included gender, age, income, living arrangement, diagnosis, lifestyle factors, recording of physical health measures, and carer status. A focus on physical health care was evident from everyday case-note records; however, because this information was 'buried' within the plethora of entries and not brought to the fore with other key information about the person's psychiatric needs, it remained difficult to gain a full picture of potential gaps in physical health care for this population. Under-reporting, gaps and inconsistencies in the systematic recording of physical health information for this population are likely to undermine the quality of care they receive from mental health services, the ability of mental health service providers to respond in a timely way to their physical healthcare needs, and their communication with other healthcare providers.
Collapse
Affiliation(s)
- Sharon Lawn
- Flinders Human Behaviour and Health Research Unit, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Sara Zabeen
- Flinders Human Behaviour and Health Research Unit, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Nikki Rowlands
- Flinders Human Behaviour and Health Research Unit, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.,Southern Mental Health, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Sharon Picot
- Southern Mental Health, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| |
Collapse
|
28
|
Gidugu V, Jacobs ML. Empowering individuals with mental illness to develop healthy eating habits through mindful eating: results of a program evaluation. PSYCHOL HEALTH MED 2018; 24:177-186. [PMID: 30165751 DOI: 10.1080/13548506.2018.1516295] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Lifestyle factors like unhealthy eating habits contribute significantly to high rates of obesity and cardiovascular disease, and premature mortality among individuals with serious mental illness (SMI). Approaches focusing only on nutritional education and portion control do not address underlying challenges, e.g. effects of medication, mood, stress and anxiety on eating behaviors. We developed a program to enhance self-efficacy and self-regulation based on mindful eating. Mindful eating has been effective in reducing obesity related eating patterns in other populations, but these studies have not included individuals with SMI. METHODS Forty six individuals participated over four rounds of the 14-week mindful eating and nutrition education program, responded to questionnaires about eating behaviors and provided qualitative feedback between January 2013 and December 2016. RESULTS Pre-post analysis of the Mindful Eating Questionnaire and the Three Factor Eating Questionnaire showed that participants ate with significantly greater awareness, less distraction, greater cognitive restraint, and engaged less in over eating and emotional eating at the end of the program. The program was well-received by participants. CONCLUSIONS Mindful eating could improve the long term success of interventions to address unhealthy eating among individuals with SMI. More research is needed with rigorous experimental design, larger samples, and different settings.
Collapse
Affiliation(s)
- Vasudha Gidugu
- a Center for Psychiatric Rehabilitation , Boston University , Boston , USA
| | - Marjorie L Jacobs
- a Center for Psychiatric Rehabilitation , Boston University , Boston , USA
| |
Collapse
|
29
|
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).
Collapse
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
| |
Collapse
|
30
|
Hollins L. The NICE 10 minute physical restraint rule: A discussion of the relative risks. J Psychiatr Ment Health Nurs 2017; 24:719-726. [PMID: 28766829 DOI: 10.1111/jpm.12414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 11/26/2022]
Affiliation(s)
- L Hollins
- Risk Assessor/Researcher, Epping, Essex, UK
| |
Collapse
|
31
|
Küçükerdönmez Ö, Urhan M, Altın M, Hacıraifoğlu Ö, Yıldız B. Assessment of the relationship between food addiction and nutritional status in schizophrenic patients. Nutr Neurosci 2017; 22:392-400. [PMID: 29078744 DOI: 10.1080/1028415x.2017.1392429] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Obesity is one of today's most important public health problems. It is suggested that overeating and substance addiction show similarities, and addiction to food may be an important factor in the obesity epidemic. This study aimed to determine the prevalence of food addiction among schizophrenic patients and to examine the relationship between food addiction and anthropometric measurements and dietary nutrient intake. METHODS Study participants included a total of 104 schizophrenic outpatients, 62 females and 42 males. Food addiction was assessed by using the Yale Food Addiction Scale, and the anthropometric measurements of participants and their three-day food consumption were recorded. RESULTS This study found that more than half of the schizophrenic patients (60.6%) had food addiction, and that female schizophrenic patients had a higher prevalence (62.9%) of food addiction than male patients (57.1%). More than one-third of the schizophrenic patients with food addiction (41.3%) were found to be obese and their BMI, body weight, waist circumference, and body-fat ratio were higher than those of schizophrenic patients who did not have food addiction (P > 0.05). Moreover, the schizophrenic patients with food addiction were found to take significantly more energy, carbohydrate, and fat in their diet (P < 0.05). CONCLUSION It was observed that the development of food addiction in schizophrenic patients increased the risk of obesity and cardiovascular diseases, which were found to be at higher levels in these patients. Educational programs should be planned for these patients to acquire health dietary habits and to increase their physical activity levels, and an additional psychosocial support should be provided for patients with food addiction.
Collapse
Affiliation(s)
- Özge Küçükerdönmez
- a Faculty of Health Sciences, Department of Nutrition and Dietetics , Ege University , İzmir , Turkey
| | - Murat Urhan
- b Mental Health and Diseases Hospital , Manisa , Turkey
| | - Merve Altın
- c Izmir Atatürk School of Health, Department of Nutrition and Dietetics , Ege University , Izmir , Turkey
| | - Özge Hacıraifoğlu
- c Izmir Atatürk School of Health, Department of Nutrition and Dietetics , Ege University , Izmir , Turkey
| | - Burak Yıldız
- c Izmir Atatürk School of Health, Department of Nutrition and Dietetics , Ege University , Izmir , Turkey
| |
Collapse
|
32
|
Hunt K, Stiller K. Dietetic and educational interventions improve clinical outcomes of diabetic and obese clients with mental impairment. Nutr Diet 2017; 74:236-242. [PMID: 28731608 DOI: 10.1111/1747-0080.12340] [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: 09/14/2016] [Revised: 11/27/2016] [Accepted: 12/03/2016] [Indexed: 12/13/2022]
Abstract
AIM The aim of this study was to evaluate the effect of dietetic and educational interventions provided to clients with type 2 diabetes (with or without obesity) or obesity-only residing in supported residential facilities and characterised by mental impairment. METHODS A retrospective audit involving the retrieval of information from medical records and databases was undertaken to evaluate the effect of dietetic and educational interventions. Clinical outcomes were weight, body mass index and glycosylated haemoglobin (HbA1c) levels. RESULTS A total of 91 clients were included, 47 with type 2 diabetes (with or without obesity) and 44 with obesity-only. All but one had schizophrenia, an intellectual disability or another psychological condition. After interventions, the diabetic subgroup demonstrated significant decreases in weight (mean [SD] initial = 101.5 [20.7], final = 97.8 [20.6] kg, P = 0.001) and body mass index (mean [SD] initial = 35.8 [8.1], final = 34.4 [7.8] kg/m2 , P = 0.001) and a non-significant decrease in HbA1c over time. The obesity-only subgroup showed no significant change in outcomes. Factors significantly negatively impacting at least one outcome included the presence of schizophrenia (P ≤ 0.017) and refusal of intervention(s) (P ≤ 0.048), whereas a significant positive impact was seen for a greater total number of visits to a dietitian or diabetes educator (P ≤ 0.024). CONCLUSIONS These results provide evidence to support the effectiveness of dietetic and educational interventions for this vulnerable client group.
Collapse
Affiliation(s)
- Kerri Hunt
- Supported Residential Facilities Health Access Team, Sefton Park Primary Health Care Services, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Kathy Stiller
- Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| |
Collapse
|
33
|
Peckham E, Bradshaw TJ, Brabyn S, Knowles S, Gilbody S. Exploring why people with SMI smoke and why they may want to quit: baseline data from the SCIMITAR RCT. J Psychiatr Ment Health Nurs 2016; 23:282-9. [PMID: 26147943 DOI: 10.1111/jpm.12241] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2015] [Indexed: 11/28/2022]
Abstract
ACCESSIBLE SUMMARY People with severe mental ill health are up to three times more likely to smoke than other members of the general population. Life expectancy in this client group is reduced by up to 30 years, and smoking is the single most important cause of premature death. The aim of this study was to explore why people with severe mental ill health smoked and why they might want to stop smoking or cut down on the amount of cigarettes that they smoked. The study found that people with severe mental ill health are motivated to cut down or stop smoking, and this is mainly due to concerns about their own health. The reasons people gave for smoking were to relieve stress, to help relax and for something to do when they are bored. Health professionals should offer evidence supported smoking cessation therapy to people with severe mental ill health. In addition to standard National Health Service smoking cessation treatments such as pharmacotherapy and behavioural support. Practitioners should help people with serious mental ill health to identify meaningful activities to relieve boredom and challenge any incorrect beliefs they hold that smoking helps relaxation and relieves stress. ABSTRACT Smoking is the single most preventable cause of premature mortality for people with serious mental ill health (SMI). Yet little is known about the reasons why service users smoke or what their motivations for quitting might be. The aim of this paper is to explore smoking behaviours, reasons for smoking and motivations for cutting down/stopping smoking in individuals with SMI who expressed an interest in cutting down or stopping smoking. Prior to randomization, the smoking behaviours and motivations for wanting to cut down or stop smoking of participants in a randomized trial were systematically assessed. Participant's primary reasons for continuing to smoke were that they believed it helped them to cope with stress, to relax and relieve boredom. Participant's main motivations for wanting to cut down or stop smoking were related to concerns for their own health. Previous attempts to stop smoking had often been made alone without access to evidence supported smoking cessation therapy. Future recommendations include helping people with SMI to increase their activity levels to relieve boredom and inspire confidence in their ability to stop smoking and challenging beliefs that smoking aids relaxation and relieves stress.
Collapse
Affiliation(s)
| | | | | | - S Knowles
- University of Manchester, Manchester, UK
| | | |
Collapse
|
34
|
Jonikas JA, Cook JA, Razzano LA, Steigman PJ, Hamilton MM, Swarbrick MA, Santos A. Associations Between Gender and Obesity Among Adults with Mental Illnesses in a Community Health Screening Study. Community Ment Health J 2016; 52:406-15. [PMID: 26711093 PMCID: PMC4833836 DOI: 10.1007/s10597-015-9965-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 11/08/2015] [Indexed: 12/20/2022]
Abstract
The prevalence of obesity and its associations with gender, clinical factors, and medical co-morbidities were examined among 457 adults attending public mental health programs in 4 U.S. states. BMI was measured directly and other information was gathered by interview. Over half (59%, n = 270) were obese including 18% (n = 83) who were morbidly obese. In hierarchical ordinary least squares regression analysis controlling for demographic, psychiatric, medical, smoking, and health insurance statuses, women were significantly more likely to be obese than men. Obesity also was more likely among those who were younger and not high school graduates, those with diabetes or hypertension, and those who did not smoke tobacco. Interaction effects were found between gender and diabetes, hypertension, tobacco smoking, education, race, and age. The high prevalence of obesity among women, coupled with interactions between gender and other factors, suggest that targeted approaches are needed to promote optimal physical health in this population.
Collapse
Affiliation(s)
- Jessica A Jonikas
- Department of Psychiatry, Center on Mental Health Services Research and Policy, University of Illinois at Chicago, 1601 West Taylor Street, M/C 912, Chicago, IL, 60612, USA.
| | - Judith A Cook
- Department of Psychiatry, Center on Mental Health Services Research and Policy, University of Illinois at Chicago, 1601 West Taylor Street, M/C 912, Chicago, IL, 60612, USA
| | - Lisa A Razzano
- Department of Psychiatry, Center on Mental Health Services Research and Policy, University of Illinois at Chicago, 1601 West Taylor Street, M/C 912, Chicago, IL, 60612, USA
| | - Pamela J Steigman
- Department of Psychiatry, Center on Mental Health Services Research and Policy, University of Illinois at Chicago, 1601 West Taylor Street, M/C 912, Chicago, IL, 60612, USA
| | - Marie M Hamilton
- Department of Psychiatry, Center on Mental Health Services Research and Policy, University of Illinois at Chicago, 1601 West Taylor Street, M/C 912, Chicago, IL, 60612, USA
| | - Margaret A Swarbrick
- Collaborative Support Programs of New Jersey, Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, The State University of New Jersey, 8 Spring Street, Freehold, NJ, 07728, USA
| | - Alberto Santos
- Department of Psychiatry and Health Behavior, Georgia Regents University, 1120 15th Street, Augusta, GA, 30912, USA
| |
Collapse
|
35
|
Affiliation(s)
- Susanne H Stanley
- Community, Culture and Mental Health Unit, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Fremantle, Australia
| | - Jonathan D E Laugharne
- Community, Culture and Mental Health Unit, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Fremantle, Australia
| |
Collapse
|