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Miller CJ, Bailey HM, Abel EA, Burgess CM, Connolly SL, Franz A, Smith E, Bauer MS. Efficacy of life goals collaborative care for bipolar disorder: A systematic review. J Affect Disord 2024; 359:356-363. [PMID: 38754598 DOI: 10.1016/j.jad.2024.05.058] [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: 10/12/2023] [Revised: 04/17/2024] [Accepted: 05/12/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Bipolar disorder remains a disabling mental health condition despite the availability of effective treatments. Collaborative chronic care models (CCMs) represent an evidence-based way to structure care for conditions like bipolar disorder. Life Goals Collaborative Care (LGCC) was designed specifically for bipolar disorder, featuring psychoeducation alongside collaborative components (e.g. nurse care management or expert psychiatric consultation). Despite the use of Life Goals across health systems, a systematic review summarizing its effectiveness has never been conducted. METHODS We conducted a systematic review of randomized controlled trials (RCTs) of LGCC through December 2023 to help guide the field in treating bipolar disorder (PROSPERO: #404581). We evaluated study quality and outcomes in several symptom and quality of life domains. RESULTS Ten articles describing eight studies met inclusion criteria. All studies featured group-based LGCC; most were compared to treatment as usual (TAU). Three of eight studies found LGCC to be associated with statistically significant effects for the prevention of manic episodes. Most studies finding positive effects featured additional collaborative care components beyond psychoeducation and were conducted in capitated healthcare systems. LIMITATIONS Limitations include: several types of potential bias in included studies; exclusion of observational studies of LGCC; lack of generalizability to pediatric populations; insufficient studies to conduct subgroup analyses; and low confidence in the quality of the evidence. CONCLUSIONS In this systematic review, group-based LGCC demonstrated some positive effects for reducing mania recurrence; results for other outcome domains were equivocal. Future studies should investigate one-on-one LGCC, both in person and virtually, to enhance well-being for people with bipolar disorder.
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Affiliation(s)
- Christopher J Miller
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152M), Boston, MA, USA; Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA, USA; National Expert Consultation & Specialized Services - Mental Health (NEXCSS-MH), US Department of Veterans Affairs, Washington, DC, USA.
| | - Hannah M Bailey
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152M), Boston, MA, USA
| | - Erica A Abel
- National Expert Consultation & Specialized Services - Mental Health (NEXCSS-MH), US Department of Veterans Affairs, Washington, DC, USA; Pain Research, Informatics, Multimorbidities and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA; VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Claire M Burgess
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA, USA; National Expert Consultation & Specialized Services - Mental Health (NEXCSS-MH), US Department of Veterans Affairs, Washington, DC, USA; Department of Mental Health, VA Boston Healthcare System, Boston, MA, USA
| | - Samantha L Connolly
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152M), Boston, MA, USA; Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA, USA
| | - Aleda Franz
- National Expert Consultation & Specialized Services - Mental Health (NEXCSS-MH), US Department of Veterans Affairs, Washington, DC, USA; VA Connecticut Healthcare System, West Haven, CT, USA; Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Eric Smith
- VA Bedford Healthcare System, Bedford, MA, USA; Departments of Psychiatry and Population and Quantitative Health Sciences, U Mass Chan Medical School, Worcester, MA, USA
| | - Mark S Bauer
- Department of Psychiatry, Harvard Medical School, 401 Park Drive, Boston, MA, USA
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Reilly S, Hobson-Merrett C, Gibbons B, Jones B, Richards D, Plappert H, Gibson J, Green M, Gask L, Huxley PJ, Druss BG, Planner CL. Collaborative care approaches for people with severe mental illness. Cochrane Database Syst Rev 2024; 5:CD009531. [PMID: 38712709 PMCID: PMC11075124 DOI: 10.1002/14651858.cd009531.pub3] [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: 05/08/2024]
Abstract
BACKGROUND Collaborative care for severe mental illness (SMI) is a community-based intervention that promotes interdisciplinary working across primary and secondary care. Collaborative care interventions aim to improve the physical and/or mental health care of individuals with SMI. This is an update of a 2013 Cochrane review, based on new searches of the literature, which includes an additional seven studies. OBJECTIVES To assess the effectiveness of collaborative care approaches in comparison with standard care (or other non-collaborative care interventions) for people with diagnoses of SMI who are living in the community. SEARCH METHODS We searched the Cochrane Schizophrenia Study-Based Register of Trials (10 February 2021). We searched the Cochrane Common Mental Disorders (CCMD) controlled trials register (all available years to 6 June 2016). Subsequent searches on Ovid MEDLINE, Embase and PsycINFO together with the Cochrane Central Register of Controlled Trials (with an overlap) were run on 17 December 2021. SELECTION CRITERIA Randomised controlled trials (RCTs) where interventions described as 'collaborative care' were compared with 'standard care' for adults (18+ years) living in the community with a diagnosis of SMI. SMI was defined as schizophrenia, other types of schizophrenia-like psychosis or bipolar affective disorder. The primary outcomes of interest were: quality of life, mental state and psychiatric admissions at 12 months follow-up. DATA COLLECTION AND ANALYSIS Pairs of authors independently extracted data. We assessed the quality and certainty of the evidence using RoB 2 (for the primary outcomes) and GRADE. We compared treatment effects between collaborative care and standard care. We divided outcomes into short-term (up to six months), medium-term (seven to 12 months) and long-term (over 12 months). For dichotomous data we calculated the risk ratio (RR) and for continuous data we calculated the standardised mean difference (SMD), with 95% confidence intervals (CIs). We used random-effects meta-analyses due to substantial levels of heterogeneity across trials. We created a summary of findings table using GRADEpro. MAIN RESULTS Eight RCTs (1165 participants) are included in this review. Two met the criteria for type A collaborative care (intervention comprised of the four core components). The remaining six met the criteria for type B (described as collaborative care by the trialists, but not comprised of the four core components). The composition and purpose of the interventions varied across studies. For most outcomes there was low- or very low-certainty evidence. We found three studies that assessed the quality of life of participants at 12 months. Quality of life was measured using the SF-12 and the WHOQOL-BREF and the mean endpoint mental health component scores were reported at 12 months. Very low-certainty evidence did not show a difference in quality of life (mental health domain) between collaborative care and standard care in the medium term (at 12 months) (SMD 0.03, 95% CI -0.26 to 0.32; 3 RCTs, 227 participants). Very low-certainty evidence did not show a difference in quality of life (physical health domain) between collaborative care and standard care in the medium term (at 12 months) (SMD 0.08, 95% CI -0.18 to 0.33; 3 RCTs, 237 participants). Furthermore, in the medium term (at 12 months) low-certainty evidence did not show a difference between collaborative care and standard care in mental state (binary) (RR 0.99, 95% CI 0.77 to 1.28; 1 RCT, 253 participants) or in the risk of being admitted to a psychiatric hospital at 12 months (RR 5.15, 95% CI 0.67 to 39.57; 1 RCT, 253 participants). One study indicated an improvement in disability (proxy for social functioning) at 12 months in the collaborative care arm compared to usual care (RR 1.38, 95% CI 0.97 to 1.95; 1 RCT, 253 participants); we deemed this low-certainty evidence. Personal recovery and satisfaction/experience of care outcomes were not reported in any of the included studies. The data from one study indicated that the collaborative care treatment was more expensive than standard care (mean difference (MD) international dollars (Int$) 493.00, 95% CI 345.41 to 640.59) in the short term. Another study found the collaborative care intervention to be slightly less expensive at three years. AUTHORS' CONCLUSIONS This review does not provide evidence to indicate that collaborative care is more effective than standard care in the medium term (at 12 months) in relation to our primary outcomes (quality of life, mental state and psychiatric admissions). The evidence would be improved by better reporting, higher-quality RCTs and the assessment of underlying mechanisms of collaborative care. We advise caution in utilising the information in this review to assess the effectiveness of collaborative care.
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Affiliation(s)
- Siobhan Reilly
- Centre for Applied Dementia Studies, Faculty of Health Studies, University of Bradford, Bradford, UK
- Wolfson Centre for Applied Health Research, Bradford, UK
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Charley Hobson-Merrett
- Primary Care Plymouth, University of Plymouth, Plymouth, UK
- National Institute for Health Research Applied Research Collaboration South West Peninsula, Plymouth, UK
| | | | - Ben Jones
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Debra Richards
- Primary Care Plymouth, University of Plymouth, Plymouth, UK
| | - Humera Plappert
- Primary Care Clinical Sciences, University of Birmingham, Birmingham, UK
| | | | - Maria Green
- Pennine Health Care NHS Foundation Trust, Bury, UK
| | - Linda Gask
- Health Sciences Research Group, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Peter J Huxley
- Centre for Mental Health and Society, School of Health Sciences, Bangor University, Bangor, UK
| | - Benjamin G Druss
- Department of Health Policy and Management, Emory University, Atlanta, USA
| | - Claire L Planner
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK
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Strunz M, Jiménez NP, Gregorius L, Hewer W, Pollmanns J, Viehmann K, Jacobi F. Interventions to Promote the Utilization of Physical Health Care for People with Severe Mental Illness: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:126. [PMID: 36612457 PMCID: PMC9819522 DOI: 10.3390/ijerph20010126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The main contributor to excess mortality in severe mental illness (SMI) is poor physical health. Causes include unfavorable health behaviors among people with SMI, stigmatization phenomena, as well as limited access to and utilization of physical health care. Patient centered interventions to promote the utilization of and access to existing physical health care facilities may be a pragmatic and cost-effective approach to improve health equity in this vulnerable and often neglected patient population. OBJECTIVE/METHODS In this study, we systematically reviewed the international literature on such studies (sources: literature databases, trial-registries, grey literature). Empirical studies (quantitative, qualitative, and mixed methods) of interventions to improve the utilization of and access to medical health care for people with a SMI, were included. RESULTS We identified 38 studies, described in 51 study publications, and summarized them in terms of type, theoretical rationale, outcome measures, and study author's interpretation of the intervention success. CONCLUSIONS Useful interventions to promote the utilization of physical health care for people with a SMI exist, but still appear to be rare, or at least not supplemented by evaluation studies. The present review provides a map of the evidence and may serve as a starting point for further quantitative effectiveness evaluations of this promising type of behavioral intervention.
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Affiliation(s)
| | | | - Lisa Gregorius
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany
| | - Walter Hewer
- Klinikum Christophsbad, 73035 Göppingen, Germany
| | | | - Kerstin Viehmann
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany
| | - Frank Jacobi
- Psychologische Hochschule Berlin, 10179 Berlin, Germany
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Rocks T, Teasdale SB, Fehily C, Young C, Howland G, Kelly B, Dawson S, Jacka F, Dunbar JA, O’Neil A. Effectiveness of nutrition and dietary interventions for people with serious mental illness: systematic review and meta-analysis. Med J Aust 2022; 217 Suppl 7:S7-S21. [PMID: 36183316 PMCID: PMC9828433 DOI: 10.5694/mja2.51680] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/04/2022] [Accepted: 05/10/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To review recent published trials of nutrition and dietary interventions for people with serious mental illness; to assess their effectiveness in improving metabolic syndrome risk factors. STUDY DESIGN Systematic review and meta-analysis of randomised and non-randomised controlled trials of interventions with a nutrition/diet-related component delivered to people with serious mental illness, published 1 January 2010 - 6 September 2021. Primary outcomes were weight, body mass index (BMI), and waist circumference. Secondary outcomes were total serum cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, triglyceride, and blood glucose levels. DATA SOURCES MEDLINE, EMBASE, PsycINFO, CINAHL, and CENTRAL databases. In addition, reference lists of relevant publications were examined for further additional studies. DATA SYNTHESIS Twenty-five studies encompassing 26 intervention arms were included in our analysis. Eight studies were at low or some risk of bias, seventeen were deemed to be at high risk. Eight of seventeen intervention arms found statistically significant intervention effects on weight, ten of 24 on BMI, and seven of seventeen on waist circumference. The pooled effects of nutrition interventions on metabolic syndrome risk factors were statistically non-significant. However, we identified small size effects on weight for interventions delivered by dietitians (five studies; 262 intervention, 258 control participants; standardised mean difference [SMD], -0.28; 95% CI, -0.51 to -0.04) and interventions consisting of individual sessions only (three studies; 141 intervention, 134 control participants; SMD, -0.30; 95% CI, -0.54 to -0.06). CONCLUSIONS We found only limited evidence for nutrition interventions improving metabolic syndrome risk factors in people with serious mental illness. However, they may be more effective when delivered on an individual basis or by dietitians. PROSPERO REGISTRATION CRD42021235979 (prospective).
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Affiliation(s)
- Tetyana Rocks
- Institute for Mental and Physical Health and Clinical Translation (IMPACT)Deakin UniversityMelbourneVIC
| | - Scott B Teasdale
- University of New South WalesSydneyNSW,Mindgardens Neuroscience NetworkSydneyNSW
| | | | - Claire Young
- Institute for Mental and Physical Health and Clinical Translation (IMPACT)Deakin UniversityGeelongVIC
| | - Gina Howland
- Institute for Mental and Physical Health and Clinical Translation (IMPACT)Deakin UniversityGeelongVIC
| | | | - Samantha Dawson
- Institute for Mental and Physical Health and Clinical Translation (IMPACT)Deakin UniversityGeelongVIC
| | - Felice Jacka
- Institute for Mental and Physical Health and Clinical Translation (IMPACT)Deakin UniversityGeelongVIC,Murdoch Children’s Research InstituteMelbourneVIC
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Severe Mental Illness and Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 80:918-933. [PMID: 36007991 DOI: 10.1016/j.jacc.2022.06.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022]
Abstract
People with severe mental illness, consisting of schizophrenia, bipolar disorder, and major depression, have a high burden of modifiable cardiovascular risk behaviors and conditions and have a cardiovascular mortality rate twice that of the general population. People with acute and chronic cardiovascular disease are at a higher risk of developing mental health symptoms and disease. There is emerging evidence for shared etiological factors between severe mental illness and cardiovascular disease that includes biological, genetic, and behavioral mechanisms. This state-of-the art review will describe the relationship between severe mental illness and cardiovascular disease, explore the factors that lead to poor cardiovascular outcomes in people with severe mental illness, propose strategies to improve the cardiovascular health of people with severe mental illness, and present areas for future research focus.
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Kho A, Daumit GL, Truesdale KP, Brown A, Kilbourne AM, Ladapo J, Wali S, Cicutto L, Matthews AK, Smith JD, Davis PD, Schoenthaler A, Ogedegbe G, Islam N, Mills KT, He J, Watson KS, Winn RA, Stevens J, Huebschmann AG, Szefler SJ. The National Heart Lung and Blood Institute Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Alliance. Health Serv Res 2022; 57 Suppl 1:20-31. [PMID: 35383917 PMCID: PMC9108215 DOI: 10.1111/1475-6773.13983] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe the National Heart Lung and Blood Institute (NHLBI) sponsored Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease (DECIPHeR) Alliance to support late-stage implementation research aimed at reducing disparities in communities with high burdens of cardiovascular and/or pulmonary disease. STUDY SETTING NHBLI funded seven DECIPHeR studies and a Coordinating Center. Projects target high-risk diverse populations including racial and ethnic minorities, urban, rural, and low-income communities, disadvantaged children, and persons with serious mental illness. Two projects address multiple cardiovascular risk factors, three focus on hypertension, one on tobacco use, and one on pediatric asthma. STUDY DESIGN The initial phase supports planning activities for sustainable uptake of evidence-based interventions in targeted communities. The second phase tests late-stage evidence-based implementation strategies. DATA COLLECTION/EXTRACTION METHODS Not applicable. PRINCIPAL FINDINGS We provide an overview of the DECIPHeR Alliance and individual study designs, populations, and settings, implementation strategies, interventions, and outcomes. We describe the Alliance's organizational structure, designed to promote cross-center partnership and collaboration. CONCLUSIONS The DECIPHeR Alliance represents an ambitious national effort to develop sustainable implementation of interventions to achieve cardiovascular and pulmonary health equity.
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Affiliation(s)
- Abel Kho
- Center for Health Information Partnerships (CHiP)Northwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Gail L. Daumit
- Department of MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Kimberly P. Truesdale
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Arleen Brown
- Department of Internal MedicineUniversity of Los Angeles School of MedicineLos AngelesCAUSA
| | - Amy M. Kilbourne
- Department of Learning Health SciencesUniversity of Michigan MedicineAnn ArborMichiganUSA
- Quality Enhancement Research Initiative (QUERI)U.S. Department of Veterans AffairsWashington, D.C.USA
| | - Joseph Ladapo
- Department of MedicineUniversity of Florida College of MedicineGainesvilleFloridaUSA
| | - Soma Wali
- Department of Internal MedicineUniversity of Los Angeles School of MedicineLos AngelesCAUSA
| | - Lisa Cicutto
- Department of MedicineNational Jewish Health, Community Outreach and ResearchDenverColoradoUSA
| | | | - Justin D. Smith
- Department of Population Health SciencesUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Paris D. Davis
- Total Resource Community Development OrganizationNorthwestern UniversityChicagoIllinoisUSA
| | - Antoinette Schoenthaler
- Department of Population HealthNew York University Grossman School of MedicineNew YorkNew YorkUSA
| | - Gbenga Ogedegbe
- Department of Population HealthNew York University Grossman School of MedicineNew YorkNew YorkUSA
| | - Nadia Islam
- Department of Population HealthNew York University Grossman School of MedicineNew YorkNew YorkUSA
| | - Katherine T. Mills
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLouisianaUSA
| | - Jiang He
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLouisianaUSA
| | - Karriem S. Watson
- NIH All of Us Bethesda, MD; FormerlyUniversity of Illinois in Chicago Hospital and Health Sciences System, Mile Square Health Center ChicagoIllinoisUSA
| | - Robert A. Winn
- Massey Cancer CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - June Stevens
- Department of Nutrition, Gillings School of Global Public HealthUniversity of North CarolinaChapel HillNorth CarolinaUSA
| | - Amy G. Huebschmann
- Department of Medicine, Division of General Internal MedicineUniversity of Colorado Denver School of MedicineAuroraColoradoUSA
| | - Stanley J. Szefler
- Department of PediatricsUniversity of Colorado Denver School of MedicineDenverColoradoUSA
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Foster M, Weaver J, Shalaby R, Eboreime E, Poong K, Gusnowski A, Snaterse M, Surood S, Urichuk L, Agyapong VIO. Shared Care Practices in Community Addiction and Mental Health Services: A Qualitative Study on the Experiences and Perspectives of Stakeholders. Healthcare (Basel) 2022; 10:healthcare10050831. [PMID: 35627967 PMCID: PMC9140640 DOI: 10.3390/healthcare10050831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/23/2022] [Accepted: 04/28/2022] [Indexed: 12/04/2022] Open
Abstract
Shared care involves collaboration between primary care, secondary and tertiary care that enables the allocation of responsibilities of care according to the treatment needs of patients over the course of a mental illness. This study aims to determine stakeholders’ perspectives on the features of an ideal shared care model and barriers to practicing shared care within addiction and mental health programs in Edmonton, Canada. This is a qualitative cross-sectional study with data collected through focus group discussions. Participants included patients, general practitioners, psychiatrists, management, and therapists working in primary and secondary addiction and mental health. Responses were audio-recorded, transcribed, and analyzed thematically. Perceived barriers to the implementation of an ideal shared care model identified by participants include fragmented communication between primary and secondary healthcare providers, patient and family physician discomfort with discussing addiction and mental health, a lack of staff capacity, confidentiality issues, and practitioner buy-in. Participants also identified enablers to include implementing shared electronic medical record systems, improving communication and collaboration, physical co-location, and increasing practitioner awareness of appropriate referrals and services. This original research provides stakeholders’ perspectives on the features of an ideal shared care model and barriers to practicing shared care within addiction and mental health programs.
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Affiliation(s)
- Michele Foster
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, AB T6G 2B7, Canada; (M.F.); (R.S.); (E.E.); (L.U.)
| | - Julia Weaver
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB T5J 0G5, Canada; (J.W.); (K.P.); (A.G.); (M.S.); (S.S.)
| | - Reham Shalaby
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, AB T6G 2B7, Canada; (M.F.); (R.S.); (E.E.); (L.U.)
| | - Ejemai Eboreime
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, AB T6G 2B7, Canada; (M.F.); (R.S.); (E.E.); (L.U.)
| | - Kimberly Poong
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB T5J 0G5, Canada; (J.W.); (K.P.); (A.G.); (M.S.); (S.S.)
| | - April Gusnowski
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB T5J 0G5, Canada; (J.W.); (K.P.); (A.G.); (M.S.); (S.S.)
| | - Mark Snaterse
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB T5J 0G5, Canada; (J.W.); (K.P.); (A.G.); (M.S.); (S.S.)
| | - Shireen Surood
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB T5J 0G5, Canada; (J.W.); (K.P.); (A.G.); (M.S.); (S.S.)
| | - Liana Urichuk
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, AB T6G 2B7, Canada; (M.F.); (R.S.); (E.E.); (L.U.)
- Alberta Health Services, Addiction and Mental Health, Edmonton, AB T5J 0G5, Canada; (J.W.); (K.P.); (A.G.); (M.S.); (S.S.)
| | - Vincent I. O. Agyapong
- Department of Psychiatry, Faculty of Medicine, University of Alberta, Edmonton, AB T6G 2B7, Canada; (M.F.); (R.S.); (E.E.); (L.U.)
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 2E2, Canada
- Correspondence: ; Tel.: +1-780-215-7771; Fax: +1-902-473-4887
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8
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Rossom RC, Crain AL, O’Connor PJ, Waring SC, Hooker SA, Ohnsorg K, Taran A, Kopski KM, Sperl-Hillen JM. Effect of Clinical Decision Support on Cardiovascular Risk Among Adults With Bipolar Disorder, Schizoaffective Disorder, or Schizophrenia: A Cluster Randomized Clinical Trial. JAMA Netw Open 2022; 5:e220202. [PMID: 35254433 PMCID: PMC8902652 DOI: 10.1001/jamanetworkopen.2022.0202] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Adults with schizophrenia, schizoaffective disorder, or bipolar disorder, collectively termed serious mental illness (SMI), have shortened life spans compared with people without SMI. The leading cause of death is cardiovascular (CV) disease. OBJECTIVE To assess whether a clinical decision support (CDS) system aimed at primary care clinicians improves CV health for adult primary care patients with SMI. DESIGN, SETTING, AND PARTICIPANTS In this cluster randomized clinical trial conducted from March 2, 2016, to September 19, 2018, restricted randomization assigned 76 primary care clinics in 3 Midwestern health care systems to receive or not receive a CDS system aimed at improving CV health among patients with SMI. Eligible clinics had at least 20 patients with SMI; clinicians and their adult patients with SMI with at least 1 modifiable CV risk factor not at the goal set by the American College of Cardiology/American Heart Association guidelines were included. Statistical analysis was conducted on an intention-to-treat basis from January 10, 2019, to December 29, 2021. INTERVENTION The CDS system assessed modifiable CV risk factors and provided personalized treatment recommendations to clinicians and patients. MAIN OUTCOMES AND MEASURES Patient-level change in total modifiable CV risk over 12 months, summed from individual modifiable risk factors (smoking, body mass index, low-density lipoprotein cholesterol level, systolic blood pressure, and hemoglobin A1c level). RESULTS A total of 80 clinics were randomized; 4 clinics were excluded for having fewer than 20 eligible patients, leaving 42 intervention clinics and 34 control clinics. A total of 8937 patients with SMI (4922 women [55.1%]; mean [SD] age, 48.4 [13.5] years) were enrolled. There was a 4% lower rate of increase in total modifiable CV risk among intervention patients relative to control patients (relative rate ratio [RR], 0.96; 95% CI, 0.94-0.98). The intervention favored patients who were 18 to 29 years of age (RR, 0.89; 95% CI, 0.81-0.98) or 50 to 59 years of age (RR, 0.93; 95% CI, 0.90-0.96), Black (RR, 0.93; 95% CI, 0.88-0.98), or White (RR, 0.96; 95% CI, 0.94-0.98). Men (RR, 0.96; 95% CI, 0.94-0.99) and women (RR, 0.95; 95% CI, 0.92-0.97), as well as patients with any SMI subtype (bipolar disorder: RR, 0.96; 95% CI, 0.94-0.99; schizoaffective disorder: RR, 0.94; 95% CI, 0.90-0.98; schizophrenia: RR, 0.92; 95% CI, 0.85-0.99) also benefited from the intervention. Despite treatment effects favoring the intervention, there were no significant differences in individual modifiable risk factors. CONCLUSIONS AND RELEVANCE This CDS intervention resulted in a rate of change in total modifiable CV risk that was 4% lower among intervention patients compared with control patients. Results were driven by the cumulative effects of incremental and mostly nonsignificant changes in individual modifiable risk factors. These findings emphasize the value of using CDS to prompt early primary care intervention for adults with SMI. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02451670.
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Affiliation(s)
- Rebecca C. Rossom
- Department of Research, HealthPartners Institute, Minneapolis, Minnesota
| | - A. Lauren Crain
- Department of Research, HealthPartners Institute, Minneapolis, Minnesota
| | | | - Stephen C. Waring
- Essentia Health and Essentia Institute of Rural Health, Duluth, Minnesota
| | | | - Kris Ohnsorg
- Department of Research, HealthPartners Institute, Minneapolis, Minnesota
| | - Allise Taran
- Essentia Health and Essentia Institute of Rural Health, Duluth, Minnesota
| | - Kristen M. Kopski
- Park Nicollet Health Services, Minneapolis, Minnesota
- Now with Medica Health Plan, Minnetonka, Minnesota
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Lim CT, Caan MP, Kim CH, Chow CM, Leff HS, Tepper MC. Care Management for Serious Mental Illness: A Systematic Review and Meta-Analysis. Psychiatr Serv 2022; 73:180-187. [PMID: 34253036 DOI: 10.1176/appi.ps.202000473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Persons with serious mental illness face adverse psychiatric and medical outcomes, and their care is associated with a large burden of health care costs. Care management, in which assessment, care planning, and care coordination are provided, is a common model of support, yet the evidence supporting its use among psychiatric populations is mixed. A systematic review and a meta-analysis were undertaken to determine the impact of care management on clinical outcomes, acute care utilization, cost, and satisfaction among adults with serious mental illness. METHODS A multidatabase literature search was performed. Articles were included if they compared standard outpatient care plus care management with standard outpatient care alone for adults with serious mental illness and reported on one or more predefined outcomes. Randomized controlled trials (RCTs) and other study designs were permitted for inclusion in the systematic review. The meta-analysis included only RCTs. RESULTS For the systematic review, 34 articles representing 28 unique studies were included. Fifteen of these articles, representing 12 unique studies, were included in the meta-analysis, which indicated that care management was associated with small, statistically significant improvements in psychiatric symptoms, overall quality of life (QOL), and mental QOL (Hedges' g range 0.13-0.26). In addition, care management was associated with a small, statistically significant reduction in inpatient psychiatric hospital days (Hedges' g=0.16, p=0.02). CONCLUSIONS Care management is associated with fewer psychiatric symptoms and greater QOL for persons with serious mental illness. Further work is needed to determine which components of the intervention are associated with effectiveness.
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Affiliation(s)
- Christopher T Lim
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston
| | - Marissa P Caan
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston
| | - Clara H Kim
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston
| | - Clifton M Chow
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston
| | - H Stephen Leff
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston
| | - Miriam C Tepper
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston
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10
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Bipolar Disorder and Cardiovascular Risk in Rural versus Urban Populations in Colombia: A Comparative Clinical and Epidemiological Evaluation. Ann Glob Health 2021; 87:112. [PMID: 34824993 PMCID: PMC8603855 DOI: 10.5334/aogh.3479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Various multifactorial elements may contribute toward the urban and rural disparities in cardiovascular disease (CVD) risk, particularly among patients with psychiatric diseases. Objective: To investigate whether rural patients diagnosed and treated for Bipolar Disorder (BD) have different risk profiles and outcomes of CVD compared to urban (BD) patients. Methods: We conducted a case-control study that included 125 BD patients (cases) from rural Filadelfia, Colombia and 250 BD patients (controls) treated in Bogotá, Colombia. Cases and controls were 2:1, matched by age and sex. We applied the Framingham Heart Study (FHS) risk calculator to assess risk. Differences by rural/urban status (i.e., case-control status) were assessed by chi-square, paired t-tests, and logistic regression. Findings: Rural BD patients were found to have lower education (p = 1.0 × 10–4), alcohol consumption (p = 3.0 × 10–4), smoking (p = 0.015), psychiatric (p = 1.0 × 10–4) and CV family history (p = 0.0042) compared to urban BD patients. Rural BD patients were 81% more likely to have a more favorable CVD risk profile (OR: 0.19, 95% CI [0.06–0.62]) than urban BD patients, despite rural BD patients having increased CVD morbidity (p = 1.0 × 10–2). Conclusion: Based on increase in morbidity but lower predictive risk in the rural population, our study suggests that the FHS-CVD calculator may not be optimal to assess CVD risk in this population.
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11
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Kelly EL, Hong B, Duan L, Pancake L, Cohen H, Brekke JS. Service Use by Medicaid Recipients With Serious Mental Illness During an RCT of the Bridge Peer Health Navigator Intervention. Psychiatr Serv 2021; 72:1145-1150. [PMID: 33887952 DOI: 10.1176/appi.ps.201900615] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Integration of general medical care and mental health care is a high priority for individuals with serious mental illnesses because of their high risk of morbidity and early mortality. The Bridge is a peer-led, health navigator intervention designed to improve access to and use of health care and self-management of medical services by individuals with serious mental illnesses. This study expands on a previous study in which the authors examined participants' self-reported outcomes from a 12-month randomized controlled trial of the Bridge. In the study reported here, Medicaid data were used to assess the impact of the intervention on service use during that trial. METHODS Medicaid data on use of general medical services (emergency room, outpatient, and inpatient) for 6 months were compared for 144 individuals with serious mental illnesses-Bridge participants (N=72) and a waitlist control group (N=72). An intent-to-treat approach was used, with regression models controlling for general medical services in the 6 months before baseline. RESULTS Zero-inflated negative binomial analyses, controlling for service use 6 months before baseline, found that the intervention group used the emergency room significantly less frequently, compared with the control group (adjusted mean±SD number of visits, 0.72±0.19 versus 1.59±0.42). No between-group differences were found in use of general medical inpatient or outpatient services. CONCLUSIONS The Bridge was effective in decreasing emergency room use among individuals with serious mental illnesses.
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Affiliation(s)
- Erin L Kelly
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, and Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Social Medicine and Humanities, University of California, Los Angeles (Kelly); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Hong); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Duan, Cohen, Brekke); Pacific Clinics, Arcadia, California (Pancake)
| | - Benjamin Hong
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, and Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Social Medicine and Humanities, University of California, Los Angeles (Kelly); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Hong); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Duan, Cohen, Brekke); Pacific Clinics, Arcadia, California (Pancake)
| | - Lei Duan
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, and Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Social Medicine and Humanities, University of California, Los Angeles (Kelly); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Hong); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Duan, Cohen, Brekke); Pacific Clinics, Arcadia, California (Pancake)
| | - Laura Pancake
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, and Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Social Medicine and Humanities, University of California, Los Angeles (Kelly); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Hong); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Duan, Cohen, Brekke); Pacific Clinics, Arcadia, California (Pancake)
| | - Heather Cohen
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, and Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Social Medicine and Humanities, University of California, Los Angeles (Kelly); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Hong); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Duan, Cohen, Brekke); Pacific Clinics, Arcadia, California (Pancake)
| | - John S Brekke
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, and Jane and Terry Semel Institute for Neuroscience and Human Behavior, Center for Social Medicine and Humanities, University of California, Los Angeles (Kelly); Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (Hong); Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles (Duan, Cohen, Brekke); Pacific Clinics, Arcadia, California (Pancake)
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12
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Fenger-Grøn M, Vestergaard CH, Ribe AR, Johnsen SP, Frost L, Sandbæk A, Davydow DS. Association Between Bipolar Disorder or Schizophrenia and Oral Anticoagulation Use in Danish Adults With Incident or Prevalent Atrial Fibrillation. JAMA Netw Open 2021; 4:e2110096. [PMID: 33999163 PMCID: PMC8129823 DOI: 10.1001/jamanetworkopen.2021.10096] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Individuals with bipolar disorder or schizophrenia have a higher risk of adverse outcomes from cardiovascular diseases. Oral anticoagulation therapy (OAT) for patients with atrial fibrillation (AF) is needed for stroke prevention, but whether patients with bipolar disorder or schizophrenia face disparities in receiving this therapy is unknown. OBJECTIVE To assess whether bipolar disorder or schizophrenia is associated with a lower rate of OAT initiation in patients with incident AF and lower prevalence of OAT in those with prevalent AF. DESIGN, SETTING, AND PARTICIPANTS A nationwide cohort study of Danish patients with AF was conducted from January 1, 2005, to December 31, 2016, and data were analyzed from January 1 to June 15, 2020. Data from national registries included information on all redeemed prescriptions and all hospital contacts of all patients with incident or prevalent AF (age, 18-100 years) and increased risk status, defined by a CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, stroke or transient ischemic attack, vascular disease, age 65-74 years, sex category) risk score greater than or equal to 2. EXPOSURES Hospital diagnosis of bipolar disorder or schizophrenia. MAIN OUTCOMES AND MEASURES Adjusted proportion differences for OAT initiation and OAT prevalence, comparing individuals with and without bipolar disorder or schizophrenia. RESULTS Patients included with incident AF (n = 147 810) had a mean (SD) age of 76.9 (10.1) years, 78 577 (53.2%) were women, 1208 (0.8%) had bipolar disorder, and 572 (0.4%) had schizophrenia. Accounting for age, sex, and calendar time, bipolar disorder and schizophrenia were associated with significantly lower frequency of OAT initiation within 90 days after incident AF (bipolar disorder: -12.7%; 95% CI, -15.3% to -10.0%; schizophrenia: -24.5%; 95% CI, -28.3% to -20.7%) and lower OAT prevalence in patients with prevalent AF (bipolar disorder: -11.6%; 95% CI, -13.9% to -9.3% schizophrenia: -21.6%; 95% CI, -24.8% to -18.4%). Adjusting for socioeconomic factors and other comorbid conditions attenuated these associations, particularly for patients with bipolar disorder. However, schizophrenia continued to be associated with a with a lower rate of OAT initiation (-15.5%, 95% CI, -19.3% to -11.7%) and a -12.8% (95% CI, -15.9% to -9.7%) lower OAT prevalence. These associations were also present after the introduction of non-vitamin K antagonists (adjusted proportion difference in 2013-2016: -12.4%; 95% CI, -18.7% to -6.1% for initiation and -10.1%; 95% CI, -13.8% to -6.4% for prevalence). CONCLUSIONS AND RELEVANCE In this study, patients with bipolar disorder or schizophrenia were less likely to receive OAT in the setting of AF. For patients with bipolar disorder, this deficit was largely associated with socioeconomic factors and comorbidities, especially toward the end of the study period. For patients with schizophrenia, disparities in this stroke prevention therapy persistently exceeded what could be explained by other patient characteristics.
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Affiliation(s)
- Morten Fenger-Grøn
- Research Unit for General Practice, Aarhus Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | | | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lars Frost
- Department of Clinical Medicine, Aarhus University, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Annelli Sandbæk
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center, Aarhus University Hospital, Aarhus, Denmark
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13
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Martens N, Destoop M, Dom G. Organization of Community Mental Health Services for Persons with a Severe Mental Illness and Comorbid Somatic Conditions: A Systematic Review on Somatic Outcomes and Health Related Quality of Life. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E462. [PMID: 33435525 PMCID: PMC7826863 DOI: 10.3390/ijerph18020462] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/11/2020] [Accepted: 12/30/2020] [Indexed: 12/20/2022]
Abstract
It is well established that persons with a severe mental illness (SMI) have a greater risk of physical comorbid conditions and premature mortality. Most studies in the field of community mental health care (CMHC) have only focused on improving cardiovascular health in people with a SMI using lifestyle approaches. Studies using organizational modifications are rather scarce. This systematic review aimed to synthesize and describe possible organizational strategies to improve physical health for persons with a SMI in CMHC. The primary outcome was Health-related Quality of Life (HR-QOL). Results suggested modest effects on quality of life and were inconsistent throughout all the included studies. Despite these findings, it appears that a more integrated approach had a positive effect on health outcomes, patient satisfaction and HR-QOL. The complexity of the processes involved in community care delivery makes it difficult to compare different models and organizational approaches. Mental health nurses were identified as possible key professionals in care organization, but no clear description of their role was found. This review could provide new insights into contributing factors for integrated care. Future research targeting the identification of the nurses' role and facilitating factors in integrated care, in order to improve treatment and follow-up of somatic comorbidities, is recommended.
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Affiliation(s)
- Nicolaas Martens
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, B-2000 Antwerp, Belgium; (M.D.); (G.D.)
- Multiversum Mental Health Services, B-2530 Boechout, Belgium
- Department of Health and Welfare, Karel De Grote University College, B-2018 Antwerp, Belgium
| | - Marianne Destoop
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, B-2000 Antwerp, Belgium; (M.D.); (G.D.)
- Multiversum Mental Health Services, B-2530 Boechout, Belgium
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, B-2000 Antwerp, Belgium; (M.D.); (G.D.)
- Multiversum Mental Health Services, B-2530 Boechout, Belgium
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14
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Tremain H, Fletcher K, Scott J, McEnery C, Berk M, Murray G. The influence of stage of illness on functional outcomes after psychological treatment in bipolar disorder: A systematic review. Bipolar Disord 2020; 22:666-692. [PMID: 32621794 DOI: 10.1111/bdi.12974] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The aim of this study was to advance understanding of stage of illness in bipolar disorder (BD), by interrogating the literature for evidence of an influence of stage of illness on functional (ie non-symptom) outcomes following psychosocial intervention. METHODS A systematic literature search following PRISMA guidelines was conducted to identify empirical studies of psychosocial interventions for established BD. To investigate stage as a predictor of three functional outcomes (general/social functioning, cognitive functioning and quality of life [QoL]), study samples were dichotomised into earlier and later stage using proxy measures identified in existing staging models. Findings were integrated using data-based convergent synthesis. RESULTS A total of 88 analyses from 62 studies were identified. Synthesis across studies suggested that psychosocial intervention was more likely to be effective for general functioning outcomes earlier in the course of established BD. No stage-related differences were found for cognitive or QoL outcomes. Exploratory investigations found some evidence of an interaction between specific intervention type and stage of illness in predicting outcomes. CONCLUSIONS A novel systematic review provided preliminary evidence that benefits general/social functioning may be more pronounced in earlier versus later stages of established BD. The review also generated hypotheses about a potential three-way interaction, whereby specific psychosocial interventions may be best placed to target functional outcomes in earlier versus later stage BD. The strength of conclusions is limited by the overall low-quality and significant heterogeneity of studies. Further research is urgently required to understand the impact of illness stage on the effectiveness of psychosocial interventions.
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Affiliation(s)
- Hailey Tremain
- Centre for Mental Health, Faculty of Health Arts and Design, Swinburne University, Melbourne, Vic, Australia
| | - Kathryn Fletcher
- Centre for Mental Health, Faculty of Health Arts and Design, Swinburne University, Melbourne, Vic, Australia
| | - Jan Scott
- Centre for Mental Health, Faculty of Health Arts and Design, Swinburne University, Melbourne, Vic, Australia.,Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Carla McEnery
- Centre for Mental Health, Faculty of Health Arts and Design, Swinburne University, Melbourne, Vic, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Vic, Australia
| | - Michael Berk
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Vic, Australia.,IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Vic, Australia.,The Department of Psychiatry and the Florey Institute for Neuroscience and Mental Health, the University of Melbourne, Parkville, Vic, Australia
| | - Greg Murray
- Centre for Mental Health, Faculty of Health Arts and Design, Swinburne University, Melbourne, Vic, Australia
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15
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Richardson A, Richard L, Gunter K, Cunningham R, Hamer H, Lockett H, Wyeth E, Stokes T, Burke M, Green M, Cox A, Derrett S. A systematic scoping review of interventions to integrate physical and mental healthcare for people with serious mental illness and substance use disorders. J Psychiatr Res 2020; 128:52-67. [PMID: 32521251 DOI: 10.1016/j.jpsychires.2020.05.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/20/2020] [Accepted: 05/23/2020] [Indexed: 02/07/2023]
Abstract
Integrated care approaches have been recommended to remove barriers to healthcare and improve the physical health outcomes of people living with serious mental illness (SMI) and/or substance use disorders (SUDs). The aim of this systematic scoping review was to describe empirical investigations of interventions designed to integrate physical, mental, and addiction healthcare for this population. An iterative and systematic search of five electronic databases (Medline (Ovid), PsycINFO, CINAHL, Embase (Ovid) and Scopus) was conducted to identify peer-reviewed articles published between January 2000 and April 2019. Two reviewers independently screened publications in two successive stages of title and abstract screening, followed by full-text screening of eligible publications. Data from each included publication were extracted independently by two reviewers using a standardised spreadsheet. A total of 28 eligible publications were identified, representing 25 unique studies. Over half of the included studies investigated the use of case managers to provide self-management skills or to coordinate mental and physical healthcare (n = 14). Other interventions examined the co-location of services (n = 9) and the implementation of screening and referral pathways to specialist treatment (n = 2). Less than half of the included studies described a framework, theory or model that was underpinning the intervention tested. While some aspects of integrated care have been identified and addressed by interventions, other key dimensions have not been considered, such as shared decision-making. Identification of a comprehensive model of integrated care is recommended to inform the development and evaluation of future interventions for people with SMI/SUDs.
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Affiliation(s)
- Amy Richardson
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Lauralie Richard
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Kathryn Gunter
- Chicago Center for Diabetes Translation Research, The University of Chicago Department of Medicine, Chicago, IL, 60637, USA.
| | - Ruth Cunningham
- Department of Public Health, University of Otago, Wellington, PO Box 7343, Wellington, 6242, New Zealand.
| | - Helen Hamer
- Helen Hamer & Associates Ltd, Auckland, New Zealand.
| | - Helen Lockett
- Department of Public Health, University of Otago, Wellington, PO Box 7343, Wellington, 6242, New Zealand.
| | - Emma Wyeth
- Ngāi Tahu Māori Health Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Tim Stokes
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
| | - Martin Burke
- Addictions, Supportive Accommodation, Reintegration and Palliative Care Services, Salvation Army, PO Box 6015, Wellington, 6141, New Zealand.
| | - Mel Green
- South Community Mental Health Team, Southern District Health Board, Private Bag 1921, Dunedin, 9054, New Zealand.
| | - Adell Cox
- Southern District Health Board, New Zealand.
| | - Sarah Derrett
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
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16
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Speyer H, Jakobsen AS, Westergaard C, Nørgaard HCB, Jørgensen KB, Pisinger C, Krogh J, Hjorthøj C, Nordentoft M, Gluud C, Correll CU. Lifestyle Interventions for Weight Management in People with Serious Mental Illness: A Systematic Review with Meta-Analysis, Trial Sequential Analysis, and Meta-Regression Analysis Exploring the Mediators and Moderators of Treatment Effects. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 88:350-362. [PMID: 31522170 DOI: 10.1159/000502293] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/19/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Serious mental illness (SMI) reduces life expectancy, primarily due to somatic comorbidity linked to obesity. Meta-analyses have found beneficial effects of lifestyle interventions in people with SMI and recommended their implementation to manage obesity. OBJECTIVE The objective of this systematic review was to assess the benefits and harms of individualized lifestyle interventions for weight in people diagnosed with SMI and to explore potential mediators and moderators of the effect. METHODS The protocol was registered at PROSPERO (CRD42016049093). Randomized clinical trials (RCTs) assessing the effect of individualized lifestyle interventions on weight management in people with SMI were included. Primary outcomes were differences in endpoint body mass index (BMI) and the proportion achieving clinically relevant weight loss (≥5%). Secondary outcomes included quality of life, cardiometabolic risk factors, and adverse effects. RESULTS We included 41 RCTs (n = 4,267). All trials were at high risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions. The experimental interventions reduced the mean difference in BMI by -0.63 kg/m2 (95% confidence interval [CI] = -1.02 to -0.23; p = 0.002; I2 = 70.7%) compared to the control groups. At postintervention follow-up (17 RCTs), the effect size remained similar but was no longer significant (BMI = -0.63 kg/m2; 95% CI = -1.30 to 0.04; p = 0.07; I2 = 48.8%). The risk ratio for losing ≥5% of baseline weight was 1.51 (95% CI = 1.07-2.13; p = 0.02) compared to the control groups. GRADE showed very low or low quality of evidence. CONCLUSION There is a statistically significant, but clinically insignificant, mean effect of individualized lifestyle interventions for weight reduction in people with SMI.
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Affiliation(s)
- Helene Speyer
- Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark,
| | - Ane Storch Jakobsen
- Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Casper Westergaard
- Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | | | | | - Charlotta Pisinger
- Research Center for Prevention and Health, Department 84-85, Glostrup University Hospital, Glostrup, Denmark
| | - Jesper Krogh
- Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Carsten Hjorthøj
- Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Merete Nordentoft
- Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Christian Gluud
- The Copenhagen Trial Unit, Center for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA.,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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17
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Goldstein BI, Baune BT, Bond DJ, Chen P, Eyler L, Fagiolini A, Gomes F, Hajek T, Hatch J, McElroy SL, McIntyre RS, Prieto M, Sylvia LG, Tsai S, Kcomt A, Fiedorowicz JG. Call to action regarding the vascular-bipolar link: A report from the Vascular Task Force of the International Society for Bipolar Disorders. Bipolar Disord 2020; 22:440-460. [PMID: 32356562 PMCID: PMC7522687 DOI: 10.1111/bdi.12921] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The association of bipolar disorder with early and excessive cardiovascular disease was identified over a century ago. Nonetheless, the vascular-bipolar link remains underrecognized, particularly with regard to how this link can contribute to our understanding of pathogenesis and treatment. METHODS An international group of experts completed a selective review of the literature, distilling core themes, identifying limitations and gaps in the literature, and highlighting future directions to bridge these gaps. RESULTS The association between bipolar disorder and vascular disease is large in magnitude, consistent across studies, and independent of confounding variables where assessed. The vascular-bipolar link is multifactorial and is difficult to study given the latency between the onset of bipolar disorder, often in adolescence or early adulthood, and subsequent vascular disease, which usually occurs decades later. As a result, studies have often focused on risk factors for vascular disease or intermediate phenotypes, such as structural and functional vascular imaging measures. There is interest in identifying the most relevant mediators of this relationship, including lifestyle (eg, smoking, diet, exercise), medications, and systemic biological mediators (eg, inflammation). Nonetheless, there is a paucity of treatment studies that deliberately engage these mediators, and thus far no treatment studies have focused on engaging vascular imaging targets. CONCLUSIONS Further research focused on the vascular-bipolar link holds promise for gleaning insights regarding the underlying causes of bipolar disorder, identifying novel treatment approaches, and mitigating disparities in cardiovascular outcomes for people with bipolar disorder.
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Affiliation(s)
- Benjamin I. Goldstein
- Centre for Youth Bipolar DisorderSunnybrook Health Sciences CentreTorontoONCanada,Departments of Psychiatry & PharmacologyFaculty of MedicineUniversity of TorontoTorontoONCanada
| | - Bernhard T. Baune
- Department of Psychiatry and PsychotherapyUniversity of MünsterMünsterGermany,Department of PsychiatryMelbourne Medical SchoolThe University of MelbourneMelbourneVICAustralia,The Florey Institute of Neuroscience and Mental HealthThe University of MelbourneParkvilleVICAustralia
| | - David J. Bond
- Department of Psychiatry and Behavioral ScienceUniversity of Minnesota Medical SchoolMinneapolisMNUSA
| | - Pao‐Huan Chen
- Department of PsychiatryTaipei Medical University HospitalTaipeiTaiwan,Department of PsychiatrySchool of MedicineCollege of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Lisa Eyler
- Department of PsychiatryUniversity of California San DiegoSan DiegoCAUSA
| | | | - Fabiano Gomes
- Department of PsychiatryQueen’s University School of MedicineKingstonONCanada
| | - Tomas Hajek
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada,National Institute of Mental HealthKlecanyCzech Republic
| | - Jessica Hatch
- Centre for Youth Bipolar DisorderSunnybrook Health Sciences CentreTorontoONCanada,Departments of Psychiatry & PharmacologyFaculty of MedicineUniversity of TorontoTorontoONCanada
| | - Susan L. McElroy
- Department of Psychiatry and Behavioral NeuroscienceUniversity of Cincinnati College of MedicineCincinnatiOHUSA,Lindner Center of HOPEMasonOHUSA
| | - Roger S. McIntyre
- Departments of Psychiatry & PharmacologyFaculty of MedicineUniversity of TorontoTorontoONCanada,Mood Disorders Psychopharmacology UnitUniversity Health NetworkTorontoONCanada
| | - Miguel Prieto
- Department of PsychiatryFaculty of MedicineUniversidad de los AndesSantiagoChile,Mental Health ServiceClínica Universidad de los AndesSantiagoChile,Department of Psychiatry and PsychologyMayo Clinic College of Medicine and ScienceRochesterMNUSA
| | - Louisa G. Sylvia
- Department of PsychiatryMassachusetts General HospitalBostonMAUSA,Department of PsychiatryHarvard Medical SchoolCambridgeMAUSA
| | - Shang‐Ying Tsai
- Department of PsychiatryTaipei Medical University HospitalTaipeiTaiwan,Department of PsychiatrySchool of MedicineCollege of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Andrew Kcomt
- Hope+Me—Mood Disorders Association of OntarioTorontoONCanada
| | - Jess G. Fiedorowicz
- Departments of Psychiatry, Internal Medicine, & EpidemiologyCarver College of MedicineUniversity of IowaIowa CityIAUSA
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18
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Voggt A, Berger M, Obermeier M, Löw A, Seemueller F, Riedel M, Moeller H, Zimmermann R, Kirchberg F, Von Schacky C, Severus E. Heart Rate Variability and Omega-3 Index in Euthymic Patients with Bipolar Disorders. Eur Psychiatry 2020; 30:228-32. [DOI: 10.1016/j.eurpsy.2014.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 11/17/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022] Open
Abstract
AbstractBackground:Affective disorders are associated with an increased risk of cardiovascular disease, which, at least partly, appears to be independent of psychopharmacological treatments used to manage these disorders. Reduced heart rate variability (SDNN) and a low Omega-3 Index have been shown to be associated with increased risk for death after myocardial infarction. Therefore, we set out to investigate heart rate variability and the Omega-3 Index in euthymic patients with bipolar disorders.Methods:We assessed heart rate variability (SDNN) and the Omega-3 Index in 90 euthymic, mostly medicated patients with bipolar disorders (Bipolar-I, Bipolar-II) on stable psychotropic medication, free of significant medical comorbidity and in 62 healthy controls. Heart rate variability was measured from electrocardiography under a standardized 30 minutes resting state condition. Age, sex, BMI, smoking, alcohol consumption and caffeine consumption as potential confounders were also assessed.Results:Heart rate variability (SDNN) was significantly lower in patients with bipolar disorders compared to healthy controls (35.4 msec versus 60.7 msec; P < 0.0001), whereas the Omega-3 Index did not differ significantly between the groups (5.2% versus 5.3%). In a linear regression model, only group membership (patients with bipolar disorders versus healthy controls) and age significantly predicted heart rate variability (SDNN).Conclusion:Heart rate variability (SDNN) may provide a useful tool to study the impact of interventions aimed at reducing the increased risk of cardiovascular disease in euthymic patients with bipolar disorders. The difference in SDNN between cases and controls cannot be explained by a difference in the Omega-3 Index.
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19
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Almeida OP, Hankey GJ, Yeap BB, Flicker L. Impact of a prudent lifestyle on the clinical outcomes of older men with bipolar disorder. Aging Ment Health 2020; 24:627-633. [PMID: 30596455 DOI: 10.1080/13607863.2018.1553233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objectives: To determine if the excess mortality associated with Bipolar disorder (BD) is independent of lifestyle.Methods: Prospective study of a community-representative sample of 12,203 men aged 65-85 years followed for 17.7 years. We used the 8-item 'prudence score' to assesses lifestyle behaviours, including the use of alcohol and smoking, physical activity, body mass and key aspects of diet. Scores of 5 or more indicate a prudent lifestyle.Results: 69 (0.6%) men had BD - a larger proportion of them than the remainder of the sample had diabetes, ischaemic heart disease, stroke, chronic respiratory diseases and dementia. The odds of a prudent lifestyle were 40% lower among participants with BD. BD was associated with increased risk of future contact with health services due to ischaemic heart disease and cancer, and respiratory, digestive and renal diseases, although such risk became comparable to that of men without BD for men with BD and a prudent lifestyle. The adjusted mortality hazard associated with the diagnosis of BD was 1.66 (95%CI = 1.20, 2.28), while the mortality hazard associated with a prudent lifestyle was 0.81 (95%CI = 0.78, 0.85). The mortality hazard for men with BD who were also prudent was 0.83 (95%CI = 0.52, 1.30). All analyses were adjusted for sociodemographic measures and prevalent morbidities.Conclusion: The excess morbidity and mortality of older men with BD seems to be mediated by non-prudent lifestyle practices. If future studies can demonstrate that this association is causal, then lifestyle interventions will need to become an integral part of the management of older adults with BD.
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Affiliation(s)
- Osvaldo P Almeida
- Medical School, University of Western Australia, Perth, Australia.,WA Centre for Health and Ageing, University of Western Australia, Perth, Australia
| | - Graeme J Hankey
- Medical School, University of Western Australia, Perth, Australia
| | - Bu B Yeap
- Medical School, University of Western Australia, Perth, Australia
| | - Leon Flicker
- Medical School, University of Western Australia, Perth, Australia.,WA Centre for Health and Ageing, University of Western Australia, Perth, Australia
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20
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Ralat SI, Barrios RI. THE MANAGEMENT OF CARDIOVASCULAR DISEASE RISK FACTORS IN BIPOLAR DISORDER PATIENTS IN PRIMARY HEALTHCARE SETTINGS. REVISTA PUERTORRIQUENA DE PSICOLOGIA 2020; 31:62-78. [PMID: 34221244 PMCID: PMC8249201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Accumulating evidence supports the association between cardiovascular disease (CVD) risk factors and bipolar disorder (BD). CVD is the leading cause of morbidity and mortality in patients with bipolar disorder. However, there is a need to study the management of the risk factors in the primary healthcare context. This narrative review aims to appraise the different approaches of care that have been used in the management of these patients to address CVD risk factors in primary care. We reviewed articles from PubMed, Science Direct and other studies cited in the articles found. The keywords used for this review included "bipolar," "bipolar disorder," "cardiovascular" or "metabolic syndrome," "screening," "primary care," and "integrative" or "integrated care model" or "collaborative care model." This review includes studies published over a period of 48 months (January 2016 through December 2019). We identified 128 articles, removing two duplicates. From them, 115 articles are excluded based on the inclusion/exclusion criteria leaving eleven relevant articles. Upon full-text review, six studies were excluded. The final studies included are five. We used the study-quality assessment tools from the National Heart, Lung, and Blood Institute to assess the quality of the articles found. CVD risk factors in patients with BD and forms of other severe mental illness (SMI) are often underdetected. Primary healthcare providers need to identify these risk factors in the management of these patients to determine and recommend appropriate strategies.
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Affiliation(s)
- Sandra I. Ralat
- Department of Psychiatry, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Rossana I. Barrios
- Conrado F. Asenjo Library, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
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21
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Mazoruk S, Meyrick J, Taousi Z, Huxley A. The effectiveness of health behavior change interventions in managing physical health in people with a psychotic illness: A systematic review. Perspect Psychiatr Care 2020; 56:121-140. [PMID: 31131451 DOI: 10.1111/ppc.12391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 04/02/2019] [Accepted: 04/14/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE People living with psychotic illness disproportionately experience more comorbidities and have a markedly shorter life expectancy compared to the general population. This review evaluates the effectiveness of health behavior change interventions in improving health outcomes in this group. DESIGN AND METHODS All studies included objective physical health measures or health behaviors as the main outcome measures and experimental design with baseline and follow-up quantitative data. Only studies of moderate and strong quality were included. Narrative synthesis was undertaken. FINDINGS Included studies utilized a range of methodological designs and outcome measures. The majority reported significant intervention effect on most outcome measures. PRACTICE IMPLICATIONS Health behavior change interventions can be effective in improving health outcomes in people with psychotic illness, with the potential benefit of improved psychiatric outcomes.
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Affiliation(s)
- Sabina Mazoruk
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Jane Meyrick
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Zohra Taousi
- Department of Community Psychiatry, Hertfordshire Partnership University NHS Foundation Trust, St Albans, Hertfordshire, UK
| | - Adam Huxley
- Change Grow Live, Department of Psychology, Hatfield, Hertfordshire, UK
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22
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Zhang C, Zheng X, Zhu R, Hou L, Yang XY, Lu J, Jiang F, Yang T. The effectiveness of the "SMG" model for health-promoting lifestyles among empty nesters: a community intervention trial. Health Qual Life Outcomes 2019; 17:168. [PMID: 31703707 PMCID: PMC6839261 DOI: 10.1186/s12955-019-1222-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 09/20/2019] [Indexed: 01/08/2023] Open
Abstract
Background With the disintegration of the extended family in recent years, the empty-nest phenomenon is increasingly common in China and the health of empty nesters is attracting more attention. Lifestyles, accounting for 53% in determining death, play a vital role in improving the health of individuals. However, it was rarely studied in promoting the health of empty nesters. In this study, we proposed a “SMG” model in empty nesters, including the self-management, mutual management, and group management, to implement health-promoting lifestyles interventions among empty nesters to provide an effective means to improve their lifestyles and health. Methods We conducted a prospective intervention on 350 empty nesters in three communities located in Taiyuan, China. One hundred sixty-seven empty nesters were randomly assigned to the intervention group with SMG-based health-promoting lifestyles interventions used for 7-months, and 183 were randomly assigned to the control group with no measures imposed. The Health-Promoting Lifestyle Profile (HPLP-C) was used to rate the lifestyles of empty nesters. Generalized estimation model was used to analyze the differences between the intervention and control groups over time, adjusted for education and employment. Results After 7 months of health-promoting lifestyles intervention, HPLP-C score and each dimension score in the intervention group all increase from baseline. There were significant differences after intervention associated with time and group interaction effects in aspects of HPLP-C (mean score = 8.838, 95%CI:6.369–11.306), self-realization (mean score = 1.443, 95%CI:0.352–2.534), Health responsibility (mean score = 1.492, 95%CI:0.477–2.508), physical activity (mean score = 1.031, 95%CI:0.572–1.491), nutrition (mean = 0.827, 95%CI:0.177–1.476), interpersonal relations (mean = 2.917, 95%CI:2.365–3.469) and stress management (mean score = 0.729, 95%CI:0.131–1.327). And education is contributing to the effect of the health-promoting lifestyle intervention (Estimate:8.833, p < 0.001). Conclusions SMG-based health-promoting lifestyles intervention in empty nesters effectively improved the lifestyles of empty nesters, and the outcome was affected by education. Lifestyle change requires ongoing intervention, and community service centres must be involved in implementing the “SMG” model to provide ongoing support and improve the effect of interventions among empty nesters. Trial registration Chinese Clinical Trial ChiCTR1800015884. Registration date: 26–04-2018. Retrospectively registered.
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Affiliation(s)
- Chichen Zhang
- School of Health Services Management, Southern Medical University, Guangzhou, Guangdong, China. .,Center for Health Management and Policy Research, Shanxi Medical University, Taiyuan, Shanxi, China. .,School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
| | - Xiao Zheng
- School of Health Services Management, Southern Medical University, Guangzhou, Guangdong, China
| | - Ruifang Zhu
- School of Nursing, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Lihong Hou
- Center for Health Management and Policy Research, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xiaozhao Yousef Yang
- Department of Political Science and Sociology, Murray State University, Murray, KY, USA
| | - Jiao Lu
- Center for Health Management and Policy Research, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Feng Jiang
- Library, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Tingzhong Yang
- School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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23
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Nielsen RE, Kugathasan P, Straszek S, Jensen SE, Licht RW. Why are somatic diseases in bipolar disorder insufficiently treated? Int J Bipolar Disord 2019; 7:12. [PMID: 31055668 PMCID: PMC6500513 DOI: 10.1186/s40345-019-0147-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/23/2019] [Indexed: 12/27/2022] Open
Abstract
Background Somatic diseases, including cardiovascular, respiratory, and cancer diseases, are the main contributors to a shortened life expectancy of 10–20 years in patients with bipolar disorder as compared to the general population. In the general population an increase in survival has been observed over the last decades, primarily due to the advances in primary prophylaxis, medical treatment and progress in early detection and monitoring of somatic diseases. In this narrative review, we discuss the existing literature on treatment and outcomes of cardiovascular, respiratory, and cancer diseases in patients with bipolar disorder, and put this in the context of findings in studies on patients diagnosed with other severe mental disorders. Main body The existing literature suggests that patients with bipolar disorder receive fewer or delayed medical interventions, when admitted with severe somatic diseases, compared to those not diagnosed with bipolar disorder. Cardiovascular disease is the most investigated disease regarding outcomes in patients with severe mental illness, and novel findings indicate that the increased mortality following cardiac events in these patients can be reduced if they are intensively treated with secondary prophylactic cardiac intervention. Elderly patients diagnosed with mental disorders and cancer experience a delay in receiving specific cancer treatment. No studies have investigated treatment outcomes in patients with severe mental disease and respiratory diseases. Conclusion It is surprising and of major concern that patients with bipolar disorder have not benefitted from the significant improvement that has taken place over time over time of somatic treatments in general, especially in countries with equal and free access to healthcare services. Therefore, no matter whether this situation is a result of a negative attitude from health care providers to patients with mental illness, the result of the patient’s lack of awareness of their physical illness or the results of other factors, further attention including research on developing strategies for improving the management of somatic diseases in patients with bipolar disorder is needed.
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Affiliation(s)
- René Ernst Nielsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. .,Department of Psychiatry, Aalborg University Hospital, Mølleparkvej 10, 9000, Aalborg, Denmark.
| | - Pirathiv Kugathasan
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Psychiatry, Aalborg University Hospital, Mølleparkvej 10, 9000, Aalborg, Denmark
| | - Sune Straszek
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Psychiatry, Aalborg University Hospital, Mølleparkvej 10, 9000, Aalborg, Denmark
| | - Svend Eggert Jensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Rasmus W Licht
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Psychiatry, Aalborg University Hospital, Mølleparkvej 10, 9000, Aalborg, Denmark
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24
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Kilbourne AM, Prenovost KM, Liebrecht C, Eisenberg D, Kim HM, Un H, Bauer MS. Randomized Controlled Trial of a Collaborative Care Intervention for Mood Disorders by a National Commercial Health Plan. Psychiatr Serv 2019; 70:219-224. [PMID: 30602344 PMCID: PMC6522242 DOI: 10.1176/appi.ps.201800336] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Few individuals with mood disorders have access to evidence-based collaborative chronic care models (CCMs) because most patients are seen in small-group practices (<20 providers) with limited capacity to deliver CCMs. In this single-blind randomized controlled trial, we determined whether a CCM delivered nationally in a U.S. health plan improved 12-month outcomes among enrollees with mood disorders compared with usual care. METHODS Aetna insurance enrollees (N=238), mostly females (66.1%) with a mean age of 41.1 years, who were recently hospitalized for unipolar major depression or bipolar disorder provided informed consent, completed baseline assessments, and were randomly assigned to usual care or CCM. The CCM included 10 sessions of the Life Goals self-management program and brief contacts by phone by a care manager to determine symptom status. Primary outcomes were changes over 12 months in depression symptoms (nine-item Patient Health Questionnaire [PHQ-9]) and mental health-related quality of life (Short Form-12). RESULTS Adjusted mean PHQ-9 scores were lower by 2.34 points (95% confidence level [CL]=-4.18 to -0.50, p=0.01), indicating improved symptoms, and adjusted mean SF-12 mental health scores were higher by 3.21 points (CL=-.97 to 7.38, p=0.10), indicating better quality of life, among participants receiving CCM versus usual care. CONCLUSIONS Individuals receiving CCM compared with usual care had improved clinical outcomes, although substantial attrition may limit the impact of health plan-level delivery of CCMs. Further research on the use of health plan-level interventions, such as CCMs, as alternatives to practice-based models is warranted.
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Affiliation(s)
- Amy M Kilbourne
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Kilbourne, Kim); Department of Psychiatry, University of Michigan Medical School, North Campus, Ann Arbor (Kilbourne, Prenovost, Liebrecht); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Eisenberg); Aetna Healthcare, Blue Bell, Pennsylvania (Un); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Bauer)
| | - Katherine M Prenovost
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Kilbourne, Kim); Department of Psychiatry, University of Michigan Medical School, North Campus, Ann Arbor (Kilbourne, Prenovost, Liebrecht); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Eisenberg); Aetna Healthcare, Blue Bell, Pennsylvania (Un); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Bauer)
| | - Celeste Liebrecht
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Kilbourne, Kim); Department of Psychiatry, University of Michigan Medical School, North Campus, Ann Arbor (Kilbourne, Prenovost, Liebrecht); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Eisenberg); Aetna Healthcare, Blue Bell, Pennsylvania (Un); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Bauer)
| | - Daniel Eisenberg
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Kilbourne, Kim); Department of Psychiatry, University of Michigan Medical School, North Campus, Ann Arbor (Kilbourne, Prenovost, Liebrecht); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Eisenberg); Aetna Healthcare, Blue Bell, Pennsylvania (Un); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Bauer)
| | - Hyungjin Myra Kim
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Kilbourne, Kim); Department of Psychiatry, University of Michigan Medical School, North Campus, Ann Arbor (Kilbourne, Prenovost, Liebrecht); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Eisenberg); Aetna Healthcare, Blue Bell, Pennsylvania (Un); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Bauer)
| | - Hyong Un
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Kilbourne, Kim); Department of Psychiatry, University of Michigan Medical School, North Campus, Ann Arbor (Kilbourne, Prenovost, Liebrecht); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Eisenberg); Aetna Healthcare, Blue Bell, Pennsylvania (Un); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Bauer)
| | - Mark S Bauer
- Center for Clinical Management Research, U.S. Department of Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan (Kilbourne, Kim); Department of Psychiatry, University of Michigan Medical School, North Campus, Ann Arbor (Kilbourne, Prenovost, Liebrecht); Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Eisenberg); Aetna Healthcare, Blue Bell, Pennsylvania (Un); Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, and Department of Psychiatry, Harvard Medical School, Boston (Bauer)
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25
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Cuomo A, Maina G, Bolognesi S, Rosso G, Beccarini Crescenzi B, Zanobini F, Goracci A, Facchi E, Favaretto E, Baldini I, Santucci A, Fagiolini A. Prevalence and Correlates of Vitamin D Deficiency in a Sample of 290 Inpatients With Mental Illness. Front Psychiatry 2019; 10:167. [PMID: 31001150 PMCID: PMC6455075 DOI: 10.3389/fpsyt.2019.00167] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 03/07/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Vitamin D inadequacy or deficiency (VDID) has been reported in a high percentage of otherwise healthy individuals. Factors that may contribute to the high prevalence of VDID in people with mental disorders include diet low in vitamin D, poor sunlight exposure, decrease in cutaneous vitamin D synthesis, intake of certain medications, poor mobility, excessive alcohol intake, and tobacco smoking. VDID has been correlated to a host of adverse conditions, including rickets, osteoporosis, osteomalacia, muscle diseases, depression, cognitive dysfunction, and even certain cancers. Objectives: The purpose of this study was to report the prevalence and correlates of vitamin D inadequacy in a sample of 290 psychiatric patients admitted to inpatient or day hospital treatment at the University of Siena Medical Center. Methods: We retrospectively evaluated the prevalence of VDID in 290 psychiatric inpatients' medical records during the year 2017 and evaluated the correlates of VDID in patients with mental illness. Results: Two hundred and seventy two out of two hundred and ninety patients (94%) showed VDID. Physical activity and regular diet were positively correlated with vitamin D levels whereas age, tobacco smoking, PTH, alkaline phosphatase levels were negatively correlated. Statistically significant differences were found among smokers and non-smokers in all study groups. Conclusions: VDID was highly prevalent in our sample. In addition to vitamin D supplementation, psychosocial intervention able to promote and help sustain physical activity, appropriate diet, quitting smoking and sensible sun exposure to prevent and treat VDID in patients with mental health should be implemented, tested, and introduced in our clinical practice.
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Affiliation(s)
- Alessandro Cuomo
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Giuseppe Maina
- Department of Neuroscience, University of Torino, Turin, Italy
| | - Simone Bolognesi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Gianluca Rosso
- Department of Neuroscience, University of Torino, Turin, Italy
| | | | - Francesco Zanobini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Arianna Goracci
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | | | | | - Irene Baldini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Aurora Santucci
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Andrea Fagiolini
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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26
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Reilly-Harrington NA, Feig EH, Huffman JC. Bipolar Disorder and Obesity: Contributing Factors, Impact on Clinical Course, and the Role of Bariatric Surgery. Curr Obes Rep 2018; 7:294-300. [PMID: 30368736 DOI: 10.1007/s13679-018-0322-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW Bipolar disorder (BD) is a severe, common, and chronic affective disorder. This review highlights the BD and obesity connection and the role of treatments for obesity in this population. RECENT FINDINGS Patients with BD are at a significantly increased risk for obesity, as compared to those without BD, with obesity serving as a proxy for severity and predictor of poorer outcome. BD is characterized by substantial medical burden, with obesity-related conditions contributing to premature mortality. Pharmacotherapy for BD can cause weight gain and may be moderated by binge eating behavior. Bariatric surgery may be the most robust intervention for weight loss in patients with stable BD, but access may be limited. There is a greater need for interventions to prevent weight gain in BD, the development weight-neutral medications for BD, and more research into the role of bariatric surgery for patients with BD.
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Affiliation(s)
- Noreen A Reilly-Harrington
- Massachusetts General Hospital and Harvard Medical School, 50 Staniford Street, 4th Floor, Boston, MA, 02114, USA.
| | - Emily H Feig
- Massachusetts General Hospital and Harvard Medical School, 50 Staniford Street, 4th Floor, Boston, MA, 02114, USA
| | - Jeff C Huffman
- Massachusetts General Hospital and Harvard Medical School, 50 Staniford Street, 4th Floor, Boston, MA, 02114, USA
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27
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Bauer IE, Kiropoulos LA, Crist NP, Hamilton JE, Soares JC, Meyer TD. A qualitative study investigating bipolar patients' expectations of a lifestyle intervention: A self-management program. Arch Psychiatr Nurs 2018; 32:555-560. [PMID: 30029747 DOI: 10.1016/j.apnu.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/17/2018] [Accepted: 03/06/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND There is some evidence supporting the efficacy of lifestyle interventions in changing unhealthy habits and reduce the risk of developing comorbid conditions in Bipolar Disorder (BD). AIMS This qualitative study aimed to identify what an optimal lifestyle intervention would look like for individuals with BD. METHODS The current findings are based on one focus group and two paired interviews including a total of 10 individuals with BD (44.20 ± 11.11 years; 6 females). Groups' transcripts were analyzed using a narrative approach. Primary themes included facilitating factors and barriers, general content, outcomes, format of the intervention, and background factors. RESULTS Participants were in favor of a group-based lifestyle intervention as part of their usual treatment. The optimal group format would include 4 to 10 individuals, and comprise of 12 to 18 sessions lasting 1 to 1.5 h each. Accountability, motivation, interaction, and group activities were identified as contributing to the success of a lifestyle intervention. CONCLUSIONS This qualitative study provides important information regarding aspects of lifestyle intervention format and delivery for individuals with BD. We identified barriers and facilitating factors that should be addressed in health promotion interventions delivered within community mental health settings.
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Affiliation(s)
- Isabelle E Bauer
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA.
| | - Litza A Kiropoulos
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Nicholas P Crist
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Jane E Hamilton
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Jair C Soares
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - Thomas D Meyer
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
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Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, Sharma V, Goldstein BI, Rej S, Beaulieu S, Alda M, MacQueen G, Milev RV, Ravindran A, O'Donovan C, McIntosh D, Lam RW, Vazquez G, Kapczinski F, McIntyre RS, Kozicky J, Kanba S, Lafer B, Suppes T, Calabrese JR, Vieta E, Malhi G, Post RM, Berk M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord 2018; 20:97-170. [PMID: 29536616 PMCID: PMC5947163 DOI: 10.1111/bdi.12609] [Citation(s) in RCA: 937] [Impact Index Per Article: 156.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 12/21/2017] [Indexed: 12/14/2022]
Abstract
The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third- line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment-emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second- line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence-based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first-line treatments for acute mania. First-line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first-line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.
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Affiliation(s)
- Lakshmi N Yatham
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | | | - Sagar V Parikh
- Department of PsychiatryUniversity of MichiganAnn ArborMIUSA
| | - Ayal Schaffer
- Department of PsychiatryUniversity of TorontoTorontoONCanada
| | - David J Bond
- Department of PsychiatryUniversity of MinnesotaMinneapolisMNUSA
| | - Benicio N Frey
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | - Verinder Sharma
- Departments of Psychiatry and Obstetrics & GynaecologyWestern UniversityLondonONCanada
| | | | - Soham Rej
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Serge Beaulieu
- Department of PsychiatryMcGill UniversityMontrealQCCanada
| | - Martin Alda
- Department of PsychiatryDalhousie UniversityHalifaxNSCanada
| | - Glenda MacQueen
- Department of PsychiatryUniversity of CalgaryCalgaryABCanada
| | - Roumen V Milev
- Departments of Psychiatry and PsychologyQueen's UniversityKingstonONCanada
| | - Arun Ravindran
- Department of PsychiatryUniversity of TorontoTorontoONCanada
| | | | - Diane McIntosh
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Raymond W Lam
- Department of PsychiatryUniversity of British ColumbiaVancouverBCCanada
| | - Gustavo Vazquez
- Departments of Psychiatry and PsychologyQueen's UniversityKingstonONCanada
| | - Flavio Kapczinski
- Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonONCanada
| | | | - Jan Kozicky
- School of Population and Public HealthUniversity of British ColumbiaVancouverBCCanada
| | | | - Beny Lafer
- Department of PsychiatryUniversity of Sao PauloSao PauloBrazil
| | - Trisha Suppes
- Bipolar and Depression Research ProgramVA Palo AltoDepartment of Psychiatry & Behavioral Sciences Stanford UniversityStanfordCAUSA
| | - Joseph R Calabrese
- Department of PsychiatryUniversity Hospitals Case Medical CenterCase Western Reserve UniversityClevelandOHUSA
| | - Eduard Vieta
- Bipolar UnitInstitute of NeuroscienceHospital ClinicUniversity of BarcelonaIDIBAPS, CIBERSAMBarcelonaCataloniaSpain
| | - Gin Malhi
- Department of PsychiatryUniversity of SydneySydneyNSWAustralia
| | - Robert M Post
- Department of PsychiatryGeorge Washington UniversityWashingtonDCUSA
| | - Michael Berk
- Deakin UniveristyIMPACT Strategic Research CentreSchool of Medicine, Barwon HealthGeelongVic.Australia
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Rodgers M, Dalton J, Harden M, Street A, Parker G, Eastwood A. Integrated Care to Address the Physical Health Needs of People with Severe Mental Illness: A Mapping Review of the Recent Evidence on Barriers, Facilitators and Evaluations. Int J Integr Care 2018; 18:9. [PMID: 29588643 PMCID: PMC5854169 DOI: 10.5334/ijic.2605] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 11/28/2017] [Indexed: 11/20/2022] Open
Abstract
People with mental health conditions have a lower life expectancy and poorer physical health outcomes than the general population. Evidence suggests this is due to a combination of clinical risk factors, socioeconomic factors, and health system factors, notably a lack of integration when care is required across service settings. Several recent reports have looked at ways to better integrate physical and mental health care for people with severe mental illness (SMI). We built on these by conducting a mapping review that looked for the most recent evidence and service models in this area. This involved searching the published literature and speaking to people involved in providing or using current services. Few of the identified service models were described adequately and fewer still were evaluated, raising questions about the replicability and generalisability of much of the existing evidence. However, some common themes did emerge. Efforts to improve the physical health care of people with SMI should empower staff and service users and help remove everyday barriers to delivering and accessing integrated care. In particular, there is a need for improved communication among professionals and better information technology to support them, greater clarity about who is responsible and accountable for physical health care, and greater awareness of the effects of stigmatisation on the wider culture and environment in which services are delivered.
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Affiliation(s)
- Mark Rodgers
- Centre for Reviews and Dissemination, University of York, Heslington, YO10 5DD, York, UK
| | - Jane Dalton
- Centre for Reviews and Dissemination, University of York, Heslington, YO10 5DD, York, UK
| | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, Heslington, YO10 5DD, York, UK
| | - Andrew Street
- Department of Health Policy, London School of Economics and Political Science, WC2A 2AE, London, GB
| | - Gillian Parker
- Social Policy Research Unit, University of York, Heslington, YO10 5DD, York, UK
| | - Alison Eastwood
- Centre for Reviews and Dissemination, University of York, Heslington, YO10 5DD, York, UK
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Mitchell AJ, Hardy S, Shiers D. Parity of esteem: Addressing the inequalities between mental and physical healthcare. BJPSYCH ADVANCES 2018. [DOI: 10.1192/apt.bp.114.014266] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryParity of esteem means valuing mental health as much as physical health in order to close inequalities in mortality, morbidity or delivery of care. There is clear evidence that patients with mental illness receive inferior medical, surgical and preventive care. This further exacerbated by low help-seeking, high stigma, medication side-effects and relatively low resources in mental healthcare. As a result, patients with severe mental illness die 10–20 years prematurely and have a high rate of cardiometabolic complications and other physical illnesses. Many physical healthcare guidelines and policy recommendations address parity of esteem, but their implementation to date has been poor. All clinicians should be aware that inequalities in care are adversely influencing mental health outcomes, and managers, healthcare organisations and politicians should provide resources and education to address this gap.Learning Objectives• Understand the concept of parity of esteem• Be aware of the current inequalities in mental healthcare• Appreciate how parity of esteem may be improved
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Goldstein BI. Bipolar Disorder and the Vascular System: Mechanisms and New Prevention Opportunities. Can J Cardiol 2017; 33:1565-1576. [DOI: 10.1016/j.cjca.2017.10.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 10/01/2017] [Accepted: 10/02/2017] [Indexed: 12/19/2022] Open
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Development and validation of the ASPIRE-VA coaching fidelity checklist (ACFC): a tool to help ensure delivery of high-quality weight management interventions. Transl Behav Med 2017; 6:369-85. [PMID: 27528526 DOI: 10.1007/s13142-015-0336-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Practical and valid instruments are needed to assess fidelity of coaching for weight loss. The purpose of this study was to develop and validate the ASPIRE Coaching Fidelity Checklist (ACFC). Classical test theory guided ACFC development. Principal component analyses were used to determine item groupings. Psychometric properties, internal consistency, and inter-rater reliability were evaluated for each subscale. Criterion validity was tested by predicting weight loss as a function of coaching fidelity. The final 19-item ACFC consists of two domains (session process and session structure) and five subscales (sets goals and monitor progress, assess and personalize self-regulatory content, manages the session, creates a supportive and empathetic climate, and stays on track). Four of five subscales showed high internal consistency (Cronbach alphas > 0.70) for group-based coaching; only two of five subscales had high internal reliability for phone-based coaching. All five sub-scales were positively and significantly associated with weight loss for group- but not for phone-based coaching. The ACFC is a reliable and valid instrument that can be used to assess fidelity and guide skill-building for weight management interventionists.
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Marshe VS, Pira S, Mantere O, Bosche B, Looper KJ, Herrmann N, Müller DJ, Rej S. C-reactive protein and cardiovascular risk in bipolar disorder patients: A systematic review. Prog Neuropsychopharmacol Biol Psychiatry 2017; 79:442-451. [PMID: 28764912 DOI: 10.1016/j.pnpbp.2017.07.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/09/2017] [Accepted: 07/28/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVES New research is revealing a strong association between inflammatory markers with bipolar disorder (BD), potentially due to the high prevalence of cardiovascular disease and cardiovascular risk factors in BD. We aimed to synthesize the literature examining the association between the clinically most relevant inflammatory marker, C-reactive protein (CRP) and cardiovascular disease and cardiovascular risk factors in patients with BD. METHODS MEDLINE, Embase and PsychInfo were systematically searched for all relevant English language articles published prior to April 2017. Articles were included if they examined the association between CRP and cardiovascular risk factors/disease in BD. RESULTS Fifteen relevant articles were retrieved. Studies were mostly cross-sectional and heterogeneous in the cardiovascular risk factors investigated. Overall, elevated CRP was associated with increased risk of metabolic syndrome, elevated body mass index, higher waist circumference, and obesity. CRP was inconsistently associated with elevated fasting glucose, insulin levels, serum triglycerides, total cholesterol levels, and low high density lipoprotein (HDL) levels. Atypical antipsychotic use may mediate some of these effects. No study examined CRP's association with actual cardiovascular disease (e.g. coronary artery disease) in BD. CONCLUSIONS In BD, CRP is associated with increases in several cardiovascular risk factors, suggesting that systemic inflammation could be a shared driving force for both outcomes of BD and cardiovascular risk. Further longitudinal research is needed in this area to verify causality, including an examination of actual cardiovascular disease. Non-pharmacological and pharmacological treatments with anti-inflammatory effects should also be investigated, particularly in patients with increased CRP, for their potential to reduce cardiovascular risk in BD.
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Affiliation(s)
- Victoria S Marshe
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Pharmacogenetics Research Clinic, Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Shamira Pira
- Geri-PARTy Research Group, Jewish General Hospital, Montréal, Quebec, Canada
| | - Outi Mantere
- Department of Psychiatry, McGill University, Montréal, Quebec, Canada; Bipolar Disorders Clinic, Douglas Mental Health University Institute, Montréal, Quebec, Canada
| | - Bert Bosche
- Division of Neurosurgery, St Michael's Hospital, Toronto, Ontario, Canada; Neuroscience Research Program, Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Department of Neurology, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Karl J Looper
- Geri-PARTy Research Group, Jewish General Hospital, Montréal, Quebec, Canada; Department of Psychiatry, McGill University, Montréal, Quebec, Canada
| | - Nathan Herrmann
- Neuropsychopharmacology Research Group, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Daniel J Müller
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Pharmacogenetics Research Clinic, Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Soham Rej
- Geri-PARTy Research Group, Jewish General Hospital, Montréal, Quebec, Canada; Department of Psychiatry, McGill University, Montréal, Quebec, Canada.
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Ward MC, Druss BG. Reverse Integration Initiatives for Individuals With Serious Mental Illness. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2017; 15:271-278. [PMID: 31975857 PMCID: PMC6519558 DOI: 10.1176/appi.focus.20170011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Medical progress has greatly extended the life span of individuals living in the United States, yet certain groups have lagged behind in achieving wellness and longevity. Prominent among these are individuals with serious mental illness. Because of this, various initiatives have been launched at the community, state, and national level to improve the medical care of those with serious mental illness. Many of these initiatives promote "reverse integration," or the provision of collaborative care services in behavioral health locations. Despite significant barriers to implementation, these initiatives have shown moderate success in improving medical outcomes for those with serious mental illness, in both research and "real-life" settings. Additionally, the role of psychiatrists in addressing physical health has been explored, and there is a need for educational opportunities to optimize competency in this area. Overall, work still needs to be done before the mortality gap for those with serious mental illness dissipates.
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Affiliation(s)
- Martha C Ward
- Dr. Ward is with the Department of Psychiatry and Behavioral Sciences and the Department of Medicine, Emory University School of Medicine, Atlanta. Dr. Druss is the Rosalynn Carter Chair in Mental Health, Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
| | - Benjamin G Druss
- Dr. Ward is with the Department of Psychiatry and Behavioral Sciences and the Department of Medicine, Emory University School of Medicine, Atlanta. Dr. Druss is the Rosalynn Carter Chair in Mental Health, Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta
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DiNapoli EA, Bramoweth AD, Whiteman KL, Hanusa BH, Kasckow J. Mood Disorders in Middle-Aged and Older Veterans With Multimorbidity. J Aging Health 2017; 29:657-668. [PMID: 27020938 PMCID: PMC5435543 DOI: 10.1177/0898264316641082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study identified the prevalence of and relationship between mood disorders and multimorbidity in middle-aged and older veterans. METHOD Cross-sectional data were obtained from veterans who received primary care services at VA Pittsburgh Healthcare System from January 2007 to December 2011 ( n = 34,786). RESULTS Most veterans had three or more organ systems with chronic disease (95.3%), of which 4.1% had a depressive disorder, 2.5% had an anxiety disorder, and 0.7% had co-occurring depression and anxiety. The odds of having a mood disorder increased with each additional organ system with chronic disease, with odds being the greatest in those with 10 to 13 organ systems with chronic disease. Younger age, female gender, non-married marital status, and having a service connected disability were also significant predictors of having a mood disorder. DISCUSSION These findings suggest a need to integrate mental health assessment and treatment in chronic health care management for veterans.
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Affiliation(s)
- Elizabeth A. DiNapoli
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Adam D. Bramoweth
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Karen L. Whiteman
- Dartmouth Centers for Health and Aging, Lebanon, NH, USA
- The Dartmouth Institute, Lebanon, NH, USA
| | - Barbara H. Hanusa
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - John Kasckow
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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De Rosa C, Sampogna G, Luciano M, Del Vecchio V, Pocai B, Borriello G, Giallonardo V, Savorani M, Pinna F, Pompili M, Fiorillo A. Improving physical health of patients with severe mental disorders: a critical review of lifestyle psychosocial interventions. Expert Rev Neurother 2017; 17:667-681. [PMID: 28468528 DOI: 10.1080/14737175.2017.1325321] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION People with severe mental disorders have a mortality rate that is more than two times higher than the general population, with at least a decade of potential years of life lost. People with mental disorders have a significantly higher risk of obesity, hyperglycemia and metabolic syndrome, which are related to modifiable risk factors, such as heavy smoking, poor physical activities, and inappropriate unhealthy diet, which can be improved through lifestyle changes. Areas covered: Lifestyle behaviours are amenable to change through the adoption of specific psychosocial interventions, and several approaches have been promoted. In the present review, the authors aim to: 1) critically analyze studies involving multimodal lifestyle interventions; 2) discuss the way forward to integrate these interventions in clinical routine care. Expert commentary: The psychoeducational approaches developed for the improvement of healthy lifestyle behaviours differ for several aspects: 1) the format (individual vs. group); 2) the setting (outpatient vs. inpatient vs. home-based); 3) the professional characteristics of the staff running the intervention (psychiatrists or nurses or dietitians or psychologists); 4) the active ingredients of the intervention (education only or inclusion of motivational interview or of problem solving); 5) the duration of treatment (ranging from 3 months to 2 years).
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Affiliation(s)
- Corrado De Rosa
- a Department of Psychiatry , University of Naples SUN , Naples , Italy
| | - Gaia Sampogna
- a Department of Psychiatry , University of Naples SUN , Naples , Italy
| | - Mario Luciano
- a Department of Psychiatry , University of Naples SUN , Naples , Italy
| | | | - Benedetta Pocai
- a Department of Psychiatry , University of Naples SUN , Naples , Italy
| | | | | | - Micaela Savorani
- a Department of Psychiatry , University of Naples SUN , Naples , Italy
| | - Federica Pinna
- b Department of Public Health, Clinical and Molecular Medicine, Section of Psychiatry , University of Cagliari , Cagliari , Italy
| | - Maurizio Pompili
- c Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre , Sapienza University of Rome , Rome , Italy
| | - Andrea Fiorillo
- a Department of Psychiatry , University of Naples SUN , Naples , Italy
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Kilbourne AM, Barbaresso MM, Lai Z, Nord KM, Bramlet M, Goodrich DE, Post EP, Almirall D, Bauer MS. Improving Physical Health in Patients With Chronic Mental Disorders: Twelve-Month Results From a Randomized Controlled Collaborative Care Trial. J Clin Psychiatry 2017; 78:129-137. [PMID: 27780336 PMCID: PMC5272777 DOI: 10.4088/jcp.15m10301] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/09/2015] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Persons with chronic mental disorders are disproportionately burdened with physical health conditions. We determined whether Life Goals Collaborative Care compared to usual care improves physical health in patients with mental disorders within 12 months. METHODS This single-blind randomized controlled effectiveness study of a collaborative care model was conducted at a midwestern Veterans Affairs urban outpatient mental health clinic. Patients (N = 293 out of 474 eligible approached) with an ICD-9-CM diagnosis of schizophrenia, bipolar disorder, or major depressive disorder and at least 1 cardiovascular disease risk factor provided informed consent and were randomized (February 24, 2010, to April 29, 2015) to Life Goals (n = 146) or usual care (n = 147). A total of 287 completed baseline assessments, and 245 completed 12-month follow-up assessments. Life Goals included 5 weekly sessions that provided semistructured guidance on managing physical and mental health symptoms through healthy behavior changes, augmented by ongoing care coordination. The primary outcome was change in physical health-related quality of life score (Veterans RAND 12-item Short Form Health Survey [VR-12] physical health component score). Secondary outcomes included control of cardiovascular risk factors from baseline to 12 months (blood pressure, lipids, weight), mental health-related quality of life, and mental health symptoms. RESULTS Among patients completing baseline and 12-month outcomes assessments (N = 245), the mean age was 55.3 years (SD = 10.8; range, 25-78 years), and 15.4% were female. Intent-to-treat analysis revealed that compared to those in usual care, patients randomized to Life Goals had slightly increased VR-12 physical health scores (coefficient = 3.21; P = .01). CONCLUSIONS Patients with chronic mental disorders and cardiovascular disease risk who received Life Goals had improved physical health-related quality of life. TRIAL REGISTRATION ClinicalTrials.gov identifiers: NCT01487668 and NCT01244854.
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Affiliation(s)
- Amy M. Kilbourne
- VA Center for Clinical Management Research, Ann Arbor, MI, USA, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA,Author for correspondence: Amy M. Kilbourne, PhD, MPH, VA Center for Clinical Management Research, 2215 Fuller Road, Mailstop 152, Ann Arbor, MI, 48105. Voice: 734-845-3452; fax: 734-222-7503,
| | | | - Zongshan Lai
- VA Center for Clinical Management Research, Ann Arbor, MI, USA, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Kristina M. Nord
- VA Center for Clinical Management Research, Ann Arbor, MI, USA, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - David E. Goodrich
- VA Center for Clinical Management Research, Ann Arbor, MI, USA, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Edward P. Post
- VA Center for Clinical Management Research, Ann Arbor, MI, USA, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Daniel Almirall
- Institute for Social Research, University of Michigan, Ann Arbor, USA
| | - Mark S. Bauer
- VA Center for Healthcare Organization and Implementation Research, Boston, MA, USA, Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Whiteman KL, Naslund JA, DiNapoli EA, Bruce ML, Bartels SJ. Systematic Review of Integrated General Medical and Psychiatric Self-Management Interventions for Adults With Serious Mental Illness. Psychiatr Serv 2016; 67:1213-1225. [PMID: 27301767 PMCID: PMC5089924 DOI: 10.1176/appi.ps.201500521] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Adults with serious mental illness are disproportionately affected by general medical comorbidity, earlier onset of disease, and premature mortality. Integrated self-management interventions have been developed to address both general medical and psychiatric illnesses. This systematic review examined evidence about the effect of self-management interventions that target both general medical and psychiatric illnesses and evaluated the potential for implementation. METHODS Databases, including CINAHL, Cochrane Central, Ovid MEDLINE, PsycINFO, and Web of Science, were searched for articles published between 1946 and July 2015. Studies evaluating integrated general medical and psychiatric self-management interventions for adults with schizophrenia spectrum or mood disorders and general medical comorbidity were included. RESULTS Fifteen studies (nine randomized controlled trials and six pre-post designs) reported on nine interventions: automated telehealth, Health and Recovery Peer program, Helping Older People Experience Success, Integrated Illness Management and Recovery, Life Goals Collaborative Care, Living Well, Norlunga Chronic Disease Self-Management program, Paxton House, and Targeted Training in Illness Management. Most studies demonstrated feasibility, acceptability, and preliminary effectiveness; however, clinical effectiveness could not be established in most studies because of methodological limitations. Factors identified that may deter implementation included operating costs, impractical length, and workforce requirements. CONCLUSIONS Integrated general medical and psychiatric illness self-management interventions appear feasible and acceptable, with high potential for clinical effectiveness. However, implementation factors were rarely considered in intervention development, which may contribute to limited uptake and reach in real-world settings.
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Affiliation(s)
- Karen L Whiteman
- Dr. Whiteman and Dr. Bartels are with the Dartmouth Centers for Health and Aging and the CDC Health Promotion Research Center at Dartmouth, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Mr. Naslund is with the CDC Health Promotion Research Center at Dartmouth and the Dartmouth Institute, Lebanon, New Hampshire. Dr. DiNapoli is with the Mental Illness Research, Education and Clinical Center, VISN 4, Department of Veterans Affairs Pittsburgh Healthcare System, and with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh. Dr. Bruce is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - John A Naslund
- Dr. Whiteman and Dr. Bartels are with the Dartmouth Centers for Health and Aging and the CDC Health Promotion Research Center at Dartmouth, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Mr. Naslund is with the CDC Health Promotion Research Center at Dartmouth and the Dartmouth Institute, Lebanon, New Hampshire. Dr. DiNapoli is with the Mental Illness Research, Education and Clinical Center, VISN 4, Department of Veterans Affairs Pittsburgh Healthcare System, and with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh. Dr. Bruce is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - Elizabeth A DiNapoli
- Dr. Whiteman and Dr. Bartels are with the Dartmouth Centers for Health and Aging and the CDC Health Promotion Research Center at Dartmouth, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Mr. Naslund is with the CDC Health Promotion Research Center at Dartmouth and the Dartmouth Institute, Lebanon, New Hampshire. Dr. DiNapoli is with the Mental Illness Research, Education and Clinical Center, VISN 4, Department of Veterans Affairs Pittsburgh Healthcare System, and with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh. Dr. Bruce is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - Martha L Bruce
- Dr. Whiteman and Dr. Bartels are with the Dartmouth Centers for Health and Aging and the CDC Health Promotion Research Center at Dartmouth, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Mr. Naslund is with the CDC Health Promotion Research Center at Dartmouth and the Dartmouth Institute, Lebanon, New Hampshire. Dr. DiNapoli is with the Mental Illness Research, Education and Clinical Center, VISN 4, Department of Veterans Affairs Pittsburgh Healthcare System, and with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh. Dr. Bruce is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
| | - Stephen J Bartels
- Dr. Whiteman and Dr. Bartels are with the Dartmouth Centers for Health and Aging and the CDC Health Promotion Research Center at Dartmouth, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire (e-mail: ). Mr. Naslund is with the CDC Health Promotion Research Center at Dartmouth and the Dartmouth Institute, Lebanon, New Hampshire. Dr. DiNapoli is with the Mental Illness Research, Education and Clinical Center, VISN 4, Department of Veterans Affairs Pittsburgh Healthcare System, and with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh. Dr. Bruce is with the Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire
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DiNapoli EA, Cinna C, Whiteman KL, Fox L, Appelt CJ, Kasckow J. Mental health treatment preferences and challenges of living with multimorbidity from the veteran perspective. Int J Geriatr Psychiatry 2016; 31:1097-104. [PMID: 27442187 PMCID: PMC5839102 DOI: 10.1002/gps.4550] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 06/14/2016] [Accepted: 06/15/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To explore middle-aged and older veterans' current disease-management practices, mental health treatment preferences, and challenges of living with multiple chronic health conditions (i.e., multimorbidity). METHODS Semi-structured qualitative interviews and self-report measures were collected from 28 middle-aged and older (50 years of age or older) veterans with multimorbidity. RESULTS Our sample of veterans with multimorbidity was, on average, mildly depressed and anxious with elevated stress and disability. Veterans acknowledged the interaction of physical and emotional symptoms, which caused greater difficulty with health care management and daily functioning. Veterans had many concerns regarding their physical and emotional health conditions, such as continued disease progression and the addition of other emotional and physical health complications. Veterans also identified specific self-care approaches for disease management (e.g., medication, healthy lifestyle practices, and psychological stress management techniques), as well as barriers to engaging in care (e.g., money, transportation, and stigma). Participants preferred a combination of medication, psychotherapy, and healthy lifestyle practices for mental health treatment. The majority of participants (88.5%) agreed that these mental health treatments would be beneficial to integrate into disease management for older veterans with multimorbidity. Lastly, veterans provided an array of recommendations for improving Veteran's Administration services and reducing mental health stigma. CONCLUSIONS These findings provide support for patient-centered approaches and integrated mental and physical health self-management in the Veteran's Administration for middle-aged and older veterans with multiple chronic conditions. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Elizabeth A DiNapoli
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Christopher Cinna
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Graduate Center for Social and Public Policy, Duquesne University, Pittsburgh, PA, USA
| | - Karen L Whiteman
- Dartmouth Centers for Health and Aging, Lebanon, NH, USA
- CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Pittsburgh, PA, USA
| | - Lauren Fox
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Cathleen J Appelt
- VISN 4 Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Graduate Center for Social and Public Policy, Duquesne University, Pittsburgh, PA, USA
- Department of Sociology, Duquesne University, Pittsburgh, PA, USA
| | - John Kasckow
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- MIRECC and Behavioral Health, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- VA Pittsburgh Center for Health and Equity Promotion, Pittsburgh, PA, USA
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Olfson M. The Rise of Primary Care Physicians in the Provision of US Mental Health Care. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2016; 41:559-583. [PMID: 27127264 DOI: 10.1215/03616878-3620821] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Primary care physicians have assumed an increasingly important role in US outpatient mental health care. They are providing an increasing volume of outpatient mental health services, prescribing a growing number and variety of psychotropic medications, and treating patients with a broader array of mental health conditions. These trends, which run counter to a general trend toward specialization and subspecialization within US health care, place new strains on the clinical competencies of primary care physicians. They also underscore the importance of implementing more effective models of collaboration between primary care physicians and mental health specialists. Several elements of the Affordable Care Act provide options for financing and organizing the delivery of integrated general medical and behavioral services. Such integrated services have the potential to improve access and quality of outpatient mental health care for a range of psychiatric disorders. Because people with severe and persisting mental disorders commonly require a higher-level medical expertise than is readily available within primary care as well as a complex array of social services, separate specialized mental health will likely continue to play a vitally important role in caring for this population.
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Kay-Lambkin FJ, Thornton L, Lappin JM, Hanstock T, Sylvia L, Jacka F, Baker AL, Berk M, Mitchell PB, Callister R, Rogers N, Webster S, Dennis S, Oldmeadow C, MacKinnon A, Doran C, Turner A, Hunt S. Study protocol for a systematic review of evidence for lifestyle interventions targeting smoking, sleep, alcohol/other drug use, physical activity, and healthy diet in people with bipolar disorder. Syst Rev 2016; 5:106. [PMID: 27381332 PMCID: PMC4932766 DOI: 10.1186/s13643-016-0282-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Accepted: 06/16/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND People with bipolar disorder (BD) have a mortality gap of up to 20 years compared to the general population. Physical conditions, such as cardiovascular disease (CVD) and cancer, cause the majority of excess deaths in psychiatric populations and are the leading causes of mortality in people with BD. However, comparatively little attention has been paid to reducing the risk of physical conditions in psychiatric populations. Unhealthy lifestyle behaviors are among the potentially modifiable risk factors for a range of commonly comorbid chronic medical conditions, including CVD, diabetes, and obesity. This systematic review will identify and evaluate the available evidence for effective interventions to reduce risk and promote healthy lifestyle behaviors in BD. METHODS/DESIGN We will search MEDLINE, Embase, PsychINFO, Cochrane Database of Systematic Reviews, and CINAHL for published research studies (with at least an abstract published in English) that evaluate behavioral or psychosocial interventions to address the following lifestyle factors in people with BD: tobacco use, physical inactivity, unhealthy diet, overweight or obesity, sleep-wake disturbance, and alcohol/other drug use. Primary outcomes for the review will be changes in tobacco use, level of physical activity, diet quality, sleep quality, alcohol use, and illicit drug use. Data on each primary outcome will be synthesized across available studies in that lifestyle area (e.g., tobacco abstinence, cigarettes smoked per day), and panel of research and clinical experts in each of the target lifestyle behaviors and those experienced with clinical and research with individuals with BD will determine how best to represent data related to that primary outcome. Seven members of the systematic review team will extract data, synthesize the evidence, and rate it for quality. Evidence will be synthesized via a narrative description of the behavioral interventions and their effectiveness in improving the healthy lifestyle behaviors in people with BD. DISCUSSION The planned review will synthesize and evaluate the available evidence regarding the behavioral or psychosocial treatment of lifestyle-related behaviors in people with BD. From this review, we will identify gaps in our existing knowledge and research evidence about the management of unhealthy lifestyle behaviors in people with BD. We will also identify potential opportunities to address lifestyle behaviors in BD, with a view to reducing the burden of physical ill-health in this population. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015019993.
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Affiliation(s)
- Frances J. Kay-Lambkin
- />National Health and Medical Research Council Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
- />Priority Research Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Newcastle, Australia
| | - Louise Thornton
- />National Health and Medical Research Council Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Julia M. Lappin
- />Black Dog Institute, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Tanya Hanstock
- />Priority Research Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Newcastle, Australia
- />School of Psychology, University of Newcastle, Newcastle, Australia
| | - Louisa Sylvia
- />Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Felice Jacka
- />IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment), Deakin University, Waurn Ponds, Australia
| | - Amanda L. Baker
- />Priority Research Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Newcastle, Australia
| | - Michal Berk
- />IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment), Deakin University, Waurn Ponds, Australia
| | - Phillip B. Mitchell
- />Black Dog Institute, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Robin Callister
- />School of Biomedical Sciences and Pharmacy, Faculty of Medicine, The University of Newcastle, Newcastle, Australia
| | - Naomi Rogers
- />Brain and Mind Institute, University of Sydney, Sydney, Australia
| | - Stephanie Webster
- />National Health and Medical Research Council Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
| | - Simon Dennis
- />School of Psychology, University of Newcastle, Newcastle, Australia
| | | | | | | | - Alyna Turner
- />Priority Research Centre for Translational Neuroscience and Mental Health, The University of Newcastle, Newcastle, Australia
- />IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment), Deakin University, Waurn Ponds, Australia
| | - Sally Hunt
- />National Health and Medical Research Council Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Goodwin GM, Haddad PM, Ferrier IN, Aronson JK, Barnes T, Cipriani A, Coghill DR, Fazel S, Geddes JR, Grunze H, Holmes EA, Howes O, Hudson S, Hunt N, Jones I, Macmillan IC, McAllister-Williams H, Miklowitz DR, Morriss R, Munafò M, Paton C, Saharkian BJ, Saunders K, Sinclair J, Taylor D, Vieta E, Young AH. Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2016; 30:495-553. [PMID: 26979387 PMCID: PMC4922419 DOI: 10.1177/0269881116636545] [Citation(s) in RCA: 468] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The British Association for Psychopharmacology guidelines specify the scope and targets of treatment for bipolar disorder. The third version is based explicitly on the available evidence and presented, like previous Clinical Practice Guidelines, as recommendations to aid clinical decision making for practitioners: it may also serve as a source of information for patients and carers, and assist audit. The recommendations are presented together with a more detailed review of the corresponding evidence. A consensus meeting, involving experts in bipolar disorder and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from these participants. The best evidence from randomized controlled trials and, where available, observational studies employing quasi-experimental designs was used to evaluate treatment options. The strength of recommendations has been described using the GRADE approach. The guidelines cover the diagnosis of bipolar disorder, clinical management, and strategies for the use of medicines in short-term treatment of episodes, relapse prevention and stopping treatment. The use of medication is integrated with a coherent approach to psychoeducation and behaviour change.
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Affiliation(s)
- G M Goodwin
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - P M Haddad
- Greater Manchester West Mental Health NHS Foundation Trust, Eccles, Manchester, UK
| | - I N Ferrier
- Institute of Neuroscience, Newcastle University, UK and Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - J K Aronson
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, UK
| | - Trh Barnes
- The Centre for Mental Health, Imperial College London, Du Cane Road, London, UK
| | - A Cipriani
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - D R Coghill
- MACHS 2, Ninewells' Hospital and Medical School, Dundee, UK; now Departments of Paediatrics and Psychiatry, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, VIC, Australia
| | - S Fazel
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - J R Geddes
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - H Grunze
- Univ. Klinik f. Psychiatrie u. Psychotherapie, Christian Doppler Klinik, Universitätsklinik der Paracelsus Medizinischen Privatuniversität (PMU), Salzburg, Christian Doppler Klinik Salzburg, Austria
| | - E A Holmes
- MRC Cognition & Brain Sciences Unit, Cambridge, UK
| | - O Howes
- Institute of Psychiatry (Box 67), London, UK
| | | | - N Hunt
- Fulbourn Hospital, Cambridge, UK
| | - I Jones
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff, UK
| | - I C Macmillan
- Northumberland, Tyne and Wear NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK
| | - H McAllister-Williams
- Institute of Neuroscience, Newcastle University, UK and Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - D R Miklowitz
- UCLA Semel Institute for Neuroscience and Human Behavior, Division of Child and Adolescent Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - R Morriss
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham Innovation Park, Nottingham, UK
| | - M Munafò
- MRC Integrative Epidemiology Unit, UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, Bristol, UK
| | - C Paton
- Oxleas NHS Foundation Trust, Dartford, UK
| | - B J Saharkian
- Department of Psychiatry (Box 189), University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Kea Saunders
- University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Jma Sinclair
- University Department of Psychiatry, Southampton, UK
| | - D Taylor
- South London and Maudsley NHS Foundation Trust, Pharmacy Department, Maudsley Hospital, London, UK
| | - E Vieta
- Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - A H Young
- Centre for Affective Disorders, King's College London, London, UK
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Prieto ML, Schenck LA, Kruse JL, Klaas JP, Chamberlain AM, Bobo WV, Bellivier F, Leboyer M, Roger VL, Brown RD, Rocca WA, Frye MA. Long-term risk of myocardial infarction and stroke in bipolar I disorder: A population-based Cohort Study. J Affect Disord 2016; 194:120-7. [PMID: 26820761 PMCID: PMC4909505 DOI: 10.1016/j.jad.2016.01.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 01/08/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To estimate the risk of fatal and non-fatal myocardial infarction (MI) and stroke in patients with bipolar I disorder compared to people without bipolar I disorder. METHOD Utilizing a records-linkage system spanning 30 years (1966-1996), a population-based cohort of 334 subjects with bipolar I disorder and 334 age and sex-matched referents from Olmsted County, Minnesota, U.S. was identified. Longitudinal follow-up continued until incident MI or stroke (confirmed by board-certified cardiologist/neurologist), death, or study end date (December 31, 2013). Cox proportional hazards models assessed the hazard ratio (HR) for MI or stroke, adjusting for potential confounders. RESULTS There was an increased risk of fatal or non-fatal MI or stroke (as a composite outcome) in patients with bipolar I disorder [HR 1.54, 95% confidence interval (CI) 1.02, 2.33; p=0.04]. However, after adjusting for baseline cardiovascular risk factors (alcoholism, hypertension, diabetes, and smoking), the risk was no longer significantly increased (HR 1.19, 95% CI 0.76, 1.86; p=0.46). LIMITATIONS Small sample size for the study design. Findings were not retained after adjustment for cardiovascular disease risk factors. Psychotropic medication use during the follow-up was not ascertained and was not included in the analyses. CONCLUSION This study in a geographically defined region in the U.S. demonstrated a significant increased risk of MI or stroke in bipolar I disorder, which was no longer significant after adjustment for cardiovascular risk factors.
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Affiliation(s)
- Miguel L. Prieto
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA,Universidad de los Andes, Facultad de Medicina, Departamento de Psiquiatría, Santiago, Chile
| | - Louis A. Schenck
- Division of Biomedical Statistics, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA
| | - Jennifer L. Kruse
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA,Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - James P. Klaas
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA
| | - Alanna M. Chamberlain
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA
| | - William V. Bobo
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA
| | - Frank Bellivier
- AP-HP, GH Saint-Louis – Lariboisière – F. Widal, Département de Psychiatrie et de Médecine Addictologique, 75475 Paris cedex 10, France,Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1144, Paris, F-75013, France,Fondation FondaMental, Créteil, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France,Université Paris Est, Faculté de Médecine, Créteil, France,INSERM, U955, Psychiatrie Génétique, Créteil, France,Hôpital H. Mondor-A. Chenevier, Département de Psychiatrie, Créteil, France
| | - Véronique L. Roger
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA,Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA
| | - Robert D. Brown
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA
| | - Walter A. Rocca
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA,Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA
| | - Mark A. Frye
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, 55905, USA
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Rodgers M, Dalton J, Harden M, Street A, Parker G, Eastwood A. Integrated care to address the physical health needs of people with severe mental illness: a rapid review. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04130] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BackgroundPeople with mental health conditions have a lower life expectancy and poorer physical health outcomes than the general population. Evidence suggests that this discrepancy is driven by a combination of clinical risk factors, socioeconomic factors and health system factors.Objective(s)To explore current service provision and map the recent evidence on models of integrated care addressing the physical health needs of people with severe mental illness (SMI) primarily within the mental health service setting. The research was designed as a rapid review of published evidence from 2013–15, including an update of a comprehensive 2013 review, together with further grey literature and insights from an expert advisory group.SynthesisWe conducted a narrative synthesis, using a guiding framework based on nine previously identified factors considered to be facilitators of good integrated care for people with mental health problems, supplemented by additional issues emerging from the evidence. Descriptive data were used to identify existing models, perceived facilitators and barriers to their implementation, and any areas for further research.Findings and discussionThe synthesis incorporated 45 publications describing 36 separate approaches to integrated care, along with further information from the advisory group. Most service models were multicomponent programmes incorporating two or more of the nine factors: (1) information sharing systems; (2) shared protocols; (3) joint funding/commissioning; (4) colocated services; (5) multidisciplinary teams; (6) liaison services; (7) navigators; (8) research; and (9) reduction of stigma. Few of the identified examples were described in detail and fewer still were evaluated, raising questions about the replicability and generalisability of much of the existing evidence. However, some common themes did emerge from the evidence. Efforts to improve the physical health care of people with SMI should empower people (staff and service users) and help remove everyday barriers to delivering and accessing integrated care. In particular, there is a need for improved communication between professionals and better information technology to support them, greater clarity about who is responsible and accountable for physical health care, and awareness of the effects of stigmatisation on the wider culture and environment in which services are delivered.Limitations and future workThe literature identified in the rapid review was limited in volume and often lacked the depth of description necessary to acquire new insights. All members of our advisory group were based in England, so this report has limited information on the NHS contexts specific to Scotland, Wales and Northern Ireland. A conventional systematic review of this topic would not appear to be appropriate in the immediate future, although a more interpretivist approach to exploring this literature might be feasible. Wherever possible, future evaluations should involve service users and be clear about which outcomes, facilitators and barriers are likely to be context-specific and which might be generalisable.FundingThe research reported here was commissioned and funded by the Health Services and Delivery Research programme as part of a series of evidence syntheses under project number 13/05/11. For more information visitwww.nets.nihr.ac.uk/projects/hsdr/130511.
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Affiliation(s)
- Mark Rodgers
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Jane Dalton
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Andrew Street
- Centre for Health Economics, University of York, York, UK
| | - Gillian Parker
- Social Policy Research Unit, University of York, York, UK
| | - Alison Eastwood
- Centre for Reviews and Dissemination, University of York, York, UK
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BAUER ISABELLEE, GÁLVEZ JUANF, HAMILTON JANEE, BALANZÁ-MARTÍNEZ VICENT, ZUNTA-SOARES GIOVANA, SOARES JAIRC, MEYER THOMASD. Lifestyle interventions targeting dietary habits and exercise in bipolar disorder: A systematic review. J Psychiatr Res 2016; 74:1-7. [PMID: 26724541 PMCID: PMC4744495 DOI: 10.1016/j.jpsychires.2015.12.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/19/2015] [Accepted: 12/07/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is a serious mental illness associated with a high risk of medical comorbidities, long-term disability and premature death. This systematic review examined the current literature on therapeutic interventions targeting nutrition, physical activity and wellness in BD and collecting health-related measures such as mood and course of illness. METHODS Scopus (all databases), Pubmed and Ovid Medline were systematically searched with no language or year restrictions, up to June 2015, for studies focusing on lifestyle interventions in BD. Search terms were related to bipolar disorder, nutrition, physical activity, wellbeing, psychosocial interventions and course of illness. We hand searched content pages of Bipolar Disorders and Journal of Affective Disorders and checked references of relevant reviews and dissertations to identify additional papers. RESULTS After applying inclusion and exclusion criteria to identified hits, this literature search retrieved six papers. Overall findings point towards a beneficial role of lifestyle interventions on mood, weight, blood pressure, lipid profile, physical activity and overall wellbeing. Methodological limitations include small sample size, gender ratio imbalance, inconsistencies in terms of laboratory measures, and lack of randomized controlled trials and absence of follow-up and longitudinal studies to determine the benefits of these factors on clinical and functional outcomes over time CONCLUSIONS Lifestyle interventions in BD targeting nutrition, exercise, wellbeing alongside beliefs, coping strategies and attitudes towards health show promise in reducing the risk of comorbid ailments in BD. There is still a strong need for studies a) developing interventions which are informed by the patient's input and b) examining the effectiveness of such interventions targeting general wellness using well-controlled trials.
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Affiliation(s)
- ISABELLE E. BAUER
- Department of Psychiatry and Behavioral Sciences. University of Texas Health Science Center. Houston, TX. USA,Corresponding author: Thomas D. Meyer, Ph.D., University of Texas HSC at Houston, UT Center of Excellence on Mood Disorders, Biomedical and Behavioral Sciences Building (BBSB), 1941 East Rd Suite 3118 Houston, TX 77054, USA.
| | - JUAN F. GÁLVEZ
- Department of Psychiatry and Behavioral Sciences. University of Texas Health Science Center. Houston, TX. USA,Department of Psychiatry. Pontificia Universidad Javeriana School of Medicine. Bogotá, Colombia,Corresponding author: Thomas D. Meyer, Ph.D., University of Texas HSC at Houston, UT Center of Excellence on Mood Disorders, Biomedical and Behavioral Sciences Building (BBSB), 1941 East Rd Suite 3118 Houston, TX 77054, USA.
| | - JANE E. HAMILTON
- Department of Psychiatry and Behavioral Sciences. University of Texas Health Science Center. Houston, TX. USA
| | - VICENT BALANZÁ-MARTÍNEZ
- Teaching Unit of Psychiatry, Department of Medicine, La Fe University and Polytechnic Hospital, University of Valencia, CIBERSAM, ISNPR, Valencia, Spain
| | - GIOVANA ZUNTA-SOARES
- Department of Psychiatry and Behavioral Sciences. University of Texas Health Science Center. Houston, TX. USA
| | - JAIR C. SOARES
- Department of Psychiatry and Behavioral Sciences. University of Texas Health Science Center. Houston, TX. USA
| | - THOMAS D. MEYER
- Department of Psychiatry and Behavioral Sciences. University of Texas Health Science Center. Houston, TX. USA,Corresponding author: Thomas D. Meyer, Ph.D., University of Texas HSC at Houston, UT Center of Excellence on Mood Disorders, Biomedical and Behavioral Sciences Building (BBSB), 1941 East Rd Suite 3118 Houston, TX 77054, USA.
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Preventative strategies may reduce the risk of chronic kidney disease in elderly patients receiving lithium. DRUGS & THERAPY PERSPECTIVES 2015. [DOI: 10.1007/s40267-015-0250-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Medical comorbidity, acute medical care use in late-life bipolar disorder: a comparison of lithium, valproate, and other pharmacotherapies. Gen Hosp Psychiatry 2015; 37:528-32. [PMID: 26254672 DOI: 10.1016/j.genhosppsych.2015.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/03/2015] [Accepted: 07/06/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Bipolar disorder is associated with high rates of medical comorbidity, particularly in late life. Little is known about medical health service utilization and potential effects of bipolar pharmacotherapy. We hypothesized that lithium use would not be associated with higher rates of medical hospitalization. METHODS Population-based retrospective cohort study of 1388 bipolar disorder patients aged ≥66years discharged from a psychiatric hospitalization in Ontario, Canada, between 2006 and 2012. Patients were divided into lithium users, valproate users, and non-lithium/non-valproate users. The main outcome was acute non-psychiatric, medical/surgical hospitalization during 1-year follow-up. RESULTS The rate of medical hospitalizations was 0.22 per patient-year. Time-to-medical hospitalization did not differ among lithium, valproate, and non-lithium/non-valproate users after adjusting for age, sex, past medical hospitalization, and antipsychotic use. Lithium, valproate, and non-lithium/non-valproate users did not differ markedly in terms of reason for medical hospitalization, 1-year acute medical health utilization outcomes, and medical comorbidity rates. CONCLUSION There were high rates of health service use for medical conditions among older adults with bipolar disorder, but this did not appear to be associated with lithium use, compared to valproate and other medication use (e.g., antipsychotics). A proactive collaborative care approach may prevent medical service utilization in severe late-life bipolar disorder.
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Kilbourne AM, Goodrich DE, Nord KM, Van Poppelen C, Kyle J, Bauer MS, Waxmonsky JA, Lai Z, Kim HM, Eisenberg D, Thomas MR. Long-Term Clinical Outcomes from a Randomized Controlled Trial of Two Implementation Strategies to Promote Collaborative Care Attendance in Community Practices. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2015; 42:642-53. [PMID: 25315181 PMCID: PMC4400210 DOI: 10.1007/s10488-014-0598-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
This randomized controlled implementation study compared the effectiveness of a standard versus enhanced version of the replicating effective programs (REP) implementation strategy to improve the uptake of the life goals-collaborative care model (LG-CC) for bipolar disorder. Seven community-based practices (384 patient participants) were randomized to standard (manual/training) or enhanced REP (customized manual/training/facilitation) to promote LG-CC implementation. Participants from enhanced REP sites had no significant changes in primary outcomes (improved quality of life, reduced functioning or mood symptoms) by 24 months. Further research is needed to determine whether implementation strategies can lead to sustained, improved participant outcomes in addition to program uptake.
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Affiliation(s)
- Amy M Kilbourne
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA,
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van der Voort TYG, van Meijel B, Goossens PJJ, Hoogendoorn AW, Draisma S, Beekman A, Kupka RW. Collaborative care for patients with bipolar disorder: randomised controlled trial. Br J Psychiatry 2015; 206:393-400. [PMID: 25792695 DOI: 10.1192/bjp.bp.114.152520] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 09/10/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND A substantial number of people with bipolar disorder show a suboptimal response to treatment. AIMS To study the effectiveness of a collaborative care programme on symptoms and medication adherence in patients with bipolar disorder, compared with care as usual. METHOD A two-armed, cluster randomised clinical trial was carried out in 16 out-patient mental health clinics in The Netherlands, in which 138 patients were randomised. Patient outcomes included duration and severity of symptoms and medication adherence, and were measured at baseline, 6 months and 12 months. Collaborative care comprised contracting, psychoeducation, problem-solving treatment, systematic relapse prevention and monitoring of outcomes. Mental health nurses functioned as care managers in this programme. The trial was registered with The Netherlands Trial Registry (NTR2600). RESULTS Collaborative care had a significant and clinically relevant effect on number of months with depressive symptoms, both at 6 months (z = -2.6, P = 0.01, d = 0.5) and at 12 months (z = -3.1, P = 0.002, d = 0.7), as well as on severity of depressive symptoms at 12 months (z = -2.9, P = 0.004, d = 0.4). There was no effect on symptoms of mania or on treatment adherence. CONCLUSIONS When compared with treatment as usual, collaborative care substantially reduced the time participants with bipolar disorder experienced depressive symptoms. Also, depressive symptom severity decreased significantly. As persistent depressive symptoms are difficult to treat and contribute to both disability and impaired quality of life in bipolar disorder, collaborative care may be an important form of treatment for people with this disorder.
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Affiliation(s)
- Trijntje Y G van der Voort
- Trijntje Y. G. van der Voort, RN, Msc, VU University, Amsterdam; Berno van Meijel, PhD, Inholland University of Applied Sciences, Amsterdam; Peter J. J. Goossens, MANP, PhD, Dimence, Deventer; Adriaan W. Hoogendoorn, PhD, GGZ inGeest, Amsterdam; Stasja Draisma, PhD, VU University, Amsterdam; Aartjan Beekman, MD, PhD, VU University Medical Centre, Amsterdam; Ralph W. Kupka, MD, PhD, VU University, Amsterdam, The Netherlands
| | - Berno van Meijel
- Trijntje Y. G. van der Voort, RN, Msc, VU University, Amsterdam; Berno van Meijel, PhD, Inholland University of Applied Sciences, Amsterdam; Peter J. J. Goossens, MANP, PhD, Dimence, Deventer; Adriaan W. Hoogendoorn, PhD, GGZ inGeest, Amsterdam; Stasja Draisma, PhD, VU University, Amsterdam; Aartjan Beekman, MD, PhD, VU University Medical Centre, Amsterdam; Ralph W. Kupka, MD, PhD, VU University, Amsterdam, The Netherlands
| | - Peter J J Goossens
- Trijntje Y. G. van der Voort, RN, Msc, VU University, Amsterdam; Berno van Meijel, PhD, Inholland University of Applied Sciences, Amsterdam; Peter J. J. Goossens, MANP, PhD, Dimence, Deventer; Adriaan W. Hoogendoorn, PhD, GGZ inGeest, Amsterdam; Stasja Draisma, PhD, VU University, Amsterdam; Aartjan Beekman, MD, PhD, VU University Medical Centre, Amsterdam; Ralph W. Kupka, MD, PhD, VU University, Amsterdam, The Netherlands
| | - Adriaan W Hoogendoorn
- Trijntje Y. G. van der Voort, RN, Msc, VU University, Amsterdam; Berno van Meijel, PhD, Inholland University of Applied Sciences, Amsterdam; Peter J. J. Goossens, MANP, PhD, Dimence, Deventer; Adriaan W. Hoogendoorn, PhD, GGZ inGeest, Amsterdam; Stasja Draisma, PhD, VU University, Amsterdam; Aartjan Beekman, MD, PhD, VU University Medical Centre, Amsterdam; Ralph W. Kupka, MD, PhD, VU University, Amsterdam, The Netherlands
| | - Stasja Draisma
- Trijntje Y. G. van der Voort, RN, Msc, VU University, Amsterdam; Berno van Meijel, PhD, Inholland University of Applied Sciences, Amsterdam; Peter J. J. Goossens, MANP, PhD, Dimence, Deventer; Adriaan W. Hoogendoorn, PhD, GGZ inGeest, Amsterdam; Stasja Draisma, PhD, VU University, Amsterdam; Aartjan Beekman, MD, PhD, VU University Medical Centre, Amsterdam; Ralph W. Kupka, MD, PhD, VU University, Amsterdam, The Netherlands
| | - Aartjan Beekman
- Trijntje Y. G. van der Voort, RN, Msc, VU University, Amsterdam; Berno van Meijel, PhD, Inholland University of Applied Sciences, Amsterdam; Peter J. J. Goossens, MANP, PhD, Dimence, Deventer; Adriaan W. Hoogendoorn, PhD, GGZ inGeest, Amsterdam; Stasja Draisma, PhD, VU University, Amsterdam; Aartjan Beekman, MD, PhD, VU University Medical Centre, Amsterdam; Ralph W. Kupka, MD, PhD, VU University, Amsterdam, The Netherlands
| | - Ralph W Kupka
- Trijntje Y. G. van der Voort, RN, Msc, VU University, Amsterdam; Berno van Meijel, PhD, Inholland University of Applied Sciences, Amsterdam; Peter J. J. Goossens, MANP, PhD, Dimence, Deventer; Adriaan W. Hoogendoorn, PhD, GGZ inGeest, Amsterdam; Stasja Draisma, PhD, VU University, Amsterdam; Aartjan Beekman, MD, PhD, VU University Medical Centre, Amsterdam; Ralph W. Kupka, MD, PhD, VU University, Amsterdam, The Netherlands
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Chronic Kidney Disease in Lithium-Treated Older Adults: A Review of Epidemiology, Mechanisms, and Implications for the Treatment of Late-Life Mood Disorders. Drugs Aging 2014; 32:31-42. [DOI: 10.1007/s40266-014-0234-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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