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Clark LL, Zagni M, While AE. 'No health without mental health': where are we now? Br J Community Nurs 2024; 29:282-287. [PMID: 38814835 DOI: 10.12968/bjcn.2024.29.6.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Mental health services are under unprecedented pressure with overwhelming referrals and a current waiting list of 1.2 million people of all ages. The cross-government White Paper 'No health without mental health' was launched 12 years ago detailing the importance of wellbeing services in the creation of mentally healthy communities through health promotion and illness prevention. While primary care, community services and psychiatry are pivotal in the treatment of mental Illness/disorder, mental health care per se is on a continuum, and a great deal of work can be undertaken in communities by wellbeing services to prevent avoidable referrals. This paper proposes a broad framework of education and training for wellbeing/positive mental health services, primary and community care, and nurses working in Community Mental Health Treatment Teams and Home Treatment Teams to ensure all those working with potentially vulnerable adults and children are regulated and meet national standards for mandatory mental health education and training.
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Affiliation(s)
| | | | - Alison E While
- Emeritus Professor of Community Nursing, Faculty of Nursing, Midwifery and Palliative Care, King's College London; Fellow of the Queen's Nursing Institute
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2
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Herinckx H, Gubrud P, Kerlinger A, Cellarius K. Identifying Competencies of the ACT Program Nurse Using the DACUM Method. Issues Ment Health Nurs 2024:1-10. [PMID: 38593458 DOI: 10.1080/01612840.2024.2328255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
The nurse role on an Assertive Community Treatment (ACT) team requires a specialized set of skills in psychiatric community-based care. While the ACT model has existed for fifty years, no nationally recognized standard curriculum to train ACT nurses has been developed. The ACT Nursing Project described in this paper aimed to create a competency-based on-board training program using the Developing a Curriculum (DACUM) method. Eight ACT nurses from three states served as the expert panel to create a DACUM chart detailing the full set of nine duties and 127 tasks required of ACT nurses. To verify the DACUM results, 57 ACT nurses from four states completed a survey and confirmed that 80% of the tasks identified by the expert panel were also performed by the validation sample of ACT nurses. This paper describes how the DACUM duties and tasks provided the framework to develop onboard training curriculum for ACT program nurses. The next step is to pilot the onboard training curriculum to newly hired ACT nurses to ensure they are equipped to meet the complex needs of people living with serious mental illness, and to increase their competency, job satisfaction and decrease the high annual turnover rate among ACT nurses.
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Affiliation(s)
- Heidi Herinckx
- Oregon Centers of Excellence, Options for Southern Oregon, Grants Pass, Oregon, USA
| | - Paula Gubrud
- Nursing Education Connections and OHSU School of Nursing, Portland, Oregon, USA
| | - Alyssa Kerlinger
- Oregon Center of Excellence for Assertive Community Treatment, Options for Southern Oregon, Grants Pass, Oregon, USA
| | - Karen Cellarius
- School of Social Work, Human Services Implementation Lab at the Portland State University Regional Research Institute, Portland, Oregon, USA
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3
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Browne J, Rudolph JL, Jiang L, Bayer TA, Kunicki ZJ, De Vito AN, Bozzay ML, McGeary JE, Kelso CM, Wu WC. Serious mental illness is associated with elevated risk of hospital readmission in veterans with heart failure. J Psychosom Res 2024; 178:111604. [PMID: 38309130 DOI: 10.1016/j.jpsychores.2024.111604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVE Adults with serious mental illness (SMI) have high rates of cardiovascular disease, particularly heart failure, which contribute to premature mortality. The aims were to examine 90- and 365-day all-cause medical or surgical hospital readmission in Veterans with SMI discharged from a heart failure hospitalization. The exploratory aim was to evaluate 180-day post-discharge engagement in cardiac rehabilitation, an effective intervention for heart failure. METHODS This study used administrative data from the Veterans Health Administration (VHA) and Centers for Medicare & Medicaid Services between 2011 and 2019. SMI status and medical comorbidity were assessed in the year prior to hospitalization. Cox proportional hazards models (competing risk of death) were used to evaluate the relationship between SMI status and outcomes. Models were adjusted for VHA hospital site, demographics, and medical characteristics. RESULTS The sample comprised 189,767 Veterans of which 23,671 (12.5%) had SMI. Compared to those without SMI, Veterans with SMI had significantly higher readmission rates at 90 (16.1% vs. 13.9%) and 365 (42.6% vs. 37.1%) days. After adjustment, risk of readmission remained significant (90 days: HR: 1.07, 95% CI: 1.03, 1.11; 365 days: HR: 1.10, 95% CI: 1.07, 1.12). SMI status was not significantly associated with 180-day cardiac rehabilitation engagement (HR: 0.98, 95% CI: 0.91, 1.07). CONCLUSIONS Veterans with SMI and heart failure have higher 90- and 365-day hospital readmission rates even after adjustment. There were no differences in cardiac rehabilitation engagement based on SMI status. Future work should consider a broader range of post-discharge interventions to understand contributors to readmission.
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Affiliation(s)
- Julia Browne
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | - James L Rudolph
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Health Services, Policy & Practice, Brown University, Providence, RI, USA
| | - Lan Jiang
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA
| | - Thomas A Bayer
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA
| | - Zachary J Kunicki
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Alyssa N De Vito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Memory and Aging Program, Butler Hospital, Providence, RI, USA
| | - Melanie L Bozzay
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - John E McGeary
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Catherine M Kelso
- Veterans Health Administration, Office of Patient Care Services, Geriatrics and Extended Care, Washington DC, USA
| | - Wen-Chih Wu
- Medical Service, VA Providence Healthcare System, Providence, RI, USA
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Liao CH, Chang CS, Kung PT, Chou WY, Tsai WC. Stroke and suicide among people with severe mental illnesses. Sci Rep 2024; 14:4991. [PMID: 38424228 PMCID: PMC10904760 DOI: 10.1038/s41598-024-55564-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 02/25/2024] [Indexed: 03/02/2024] Open
Abstract
The associations between people with severe mental illnesses (SMI) and the risks of stroke, suicide, and death remain unclear. We examined healthcare service usage among adults with and without SMI and explored the risk of stroke, suicide, and death. We divided 18-80-year-old adults with SMI into catastrophic and non-catastrophic illness groups. These groups were subjected to a 1:5:5 propensity score matching with people without SMI. Data on demographic characteristics, economic factors, environmental factors, comorbid conditions, self-injury behavior, the number of outpatients and ED visits, and hospitalization were collected. The primary outcomes were risks of stroke, suicide, and death. We included 19,570 people with catastrophic SMI, 97,850 with non-catastrophic SMI, and 97,850 controls. Patients with SMI, especially those with catastrophic illnesses, had higher stroke risk, suicide, and death than those without SMI. People with SMI used health services more frequently than those without SMI. Patients with a history of hospitalization or ED access had a higher risk of stroke, suicide, and death. Our data indicate that special attention should be given to patients with SMI, particularly those with a history of healthcare service utilization, such as through more extended hospital stays with high-intensity interventions.
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Affiliation(s)
- Chun-Hui Liao
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Chen-Shu Chang
- Department of Neurology, Vascular and Genomic Research Center, Changhua Christian Hospital, Changhua, Taiwan
- Department of Medical Laboratory Science and Biotechnology, Central-Taiwan University of Science and Technology, Taichung, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Wen-Yu Chou
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung, 406040, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist., Taichung, 406040, Taiwan.
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Shaw P, Mifsud A, Osborn D, Nahata N, Hall C, Prenelle I, Lamb D. An integrated primary care service to reduce cardiovascular disease risk in people with severe mental illness: Primrose-A - thematic analysis of its acceptability, feasibility, and implementation. BMC Health Serv Res 2024; 24:255. [PMID: 38418971 PMCID: PMC10900648 DOI: 10.1186/s12913-024-10628-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/23/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Cardiovascular disease among patients with severe mental illness in England is a major preventable contributor to premature mortality. To address this, a nurse and peer-coach delivered service (Primrose-A) was implemented in three London general practices from 2019 (implementation continued during COVID-19). This study aimed to conduct interviews with patient and staff to determine the acceptability of, and experiences with, Primrose-A. METHODS Semi-structured audio-recorded interviews with eight patients who had received Primrose-A, and 3 nurses, 1 GP, and 1 peer-coach who had delivered Primrose-A in three London-based GP surgeries were conducted. Reflexive thematic analysis was used to identify themes from the transcribed interviews. FINDINGS Overall, Primrose-A was viewed positively by patients and staff, with participants describing success in improving patients' mental health, isolation, motivation, and physical health. Therapeutic relationships between staff and patients, and long regular appointments were important facilitators of patient engagement and acceptance of the intervention. Several barriers to the implementation of Primrose-A were identified, including training, administrative and communication issues, burden of time and resources, and COVID-19. CONCLUSIONS Intervention acceptability could be enhanced by providing longer-term continuity of care paired with more peer-coaching sessions to build positive relationships and facilitate sustained health behaviour change. Future implementation of Primrose-A or similar interventions should consider: (1) training sufficiency (covering physical and mental health, including addiction), (2) adequate staffing to deliver the intervention, (3) facilitation of clear communication pathways between staff, and (4) supporting administrative processes.
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Affiliation(s)
- Philippa Shaw
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, W1T 7NF, London, United Kingdom
| | - Annabel Mifsud
- Department of Applied Health Research, UCL, 1-19 Torrington Place, WC1E 7H, London, United Kingdom
| | - David Osborn
- Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, W1T 7NF, London, United Kingdom
- Camden and Islington NHS Trust, 4 St Pancras Way, NW1 0PE, London, United Kingdom
| | - Nitisha Nahata
- Camden Health Partners LTD, St Pancras Hospital, 4 Saint Pancras Way, South Wing, NW1 0PE, London, United Kingdom
| | - Cerdic Hall
- Camden and Islington NHS Trust, 4 St Pancras Way, NW1 0PE, London, United Kingdom
| | - Ian Prenelle
- Camden and Islington NHS Trust, 4 St Pancras Way, NW1 0PE, London, United Kingdom
| | - Danielle Lamb
- Department of Applied Health Research, UCL, 1-19 Torrington Place, WC1E 7H, London, United Kingdom.
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Chu RST, Chong RCH, Chang DHH, Shan Leung AL, Chan JKN, Wong CSM, Chang WC. The risk of stroke and post-stroke mortality in people with schizophrenia: A systematic review and meta-analysis study. Psychiatry Res 2024; 332:115713. [PMID: 38183926 DOI: 10.1016/j.psychres.2024.115713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/14/2023] [Accepted: 01/01/2024] [Indexed: 01/08/2024]
Abstract
Sources of heterogeneity in risk of stroke and mortality risk following acute-stroke in schizophrenia are understudied. We systematically searched four electronic-databases until 1-November-2022, and conducted meta-analysis to synthesize estimates of stroke-risk and post-stroke mortality for schizophrenia patients relative to non-schizophrenia counterparts. Subgroup-analyses and meta-regression models stratified by sex, nature of sample (incident/prevalent), geographical region, study-period and time-frame following stroke were conducted when applicable. Fifteen and 5 studies were included for meta-analysis of stroke-risk (n=18,368,253; 129,095 schizophrenia patients) and all-cause post-stroke mortality (n=289,231; 4,477 schizophrenia patients), respectively. Schizophrenia patients exhibited elevated stroke-risk (relative-risk =1.55[95% CI:1.31-1.84]) relative to non-schizophrenia controls. Schizophrenia was associated with increased stroke-risk in both sexes, study-periods of 1990s and 2000s, and irrespective of nature of sample and geographical regions. Meta-regression revealed regional differences in relative-risk for stroke, but limited by small number of studies. After removal of an outlier study, meta-analysis demonstrated that schizophrenia was associated with increased overall (hazard-ratio=1.37[1.30-1.44]), short-term (≤90 days; 1.29[1.14-1.46]) and longer-term (≥1 year; 1.45[1.32-1.60]) post-stroke mortality rates. Raised post-stroke mortality rate for schizophrenia was observed irrespective of nature of sample, geographical regions and study-periods. Taken together, schizophrenia is associated with increased stroke-risk and post-stroke mortality. Multilevel-interventions are required to reduce these physical-health disparities.
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Affiliation(s)
- Ryan Sai Ting Chu
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Ryan Chi Hin Chong
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Don Ho Hin Chang
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Alice Lok Shan Leung
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Joe Kwun Nam Chan
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Corine Sau Man Wong
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Wing Chung Chang
- Department of Psychiatry, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pokfulam, Hong Kong.
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Reardon B, Toles M, Cuddeback G, Travers D. Perceptions of ACT Team Members on the Implementation of Physical Health Services: A Qualitative Study. J Am Psychiatr Nurses Assoc 2024; 30:108-120. [PMID: 35220783 DOI: 10.1177/10783903221079800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Adults with severe mental illnesses have mortality rates 2.5 to 3 times higher than the general population, largely due to medical illnesses. Those with the most profound mental illnesses are served by assertive community treatment (ACT) teams that provide intensive mental health care; however, there are no clearly established models to integrate physical health treatment into ACT and this is a critical gap in the literature. AIMS To describe perceptions of ACT team members regarding services provided for their clients to treat physical health, how those services can be improved, and what implementation strategies would likely be needed to promote uptake and sustainability of those services on ACT teams. METHOD Qualitative interviews were conducted via Zoom using a semistructured interview guide with 19 employees from three ACT teams in a southeastern state. Interview transcripts were analyzed, using manifest content analysis, a form of qualitative analysis, to identify key themes in the interview transcripts. RESULTS ACT team members described limited physical health services for their clients. They reported (1) system-level barriers to improving physical health care, such as inadequate tools and training; and (2) patient-level barriers, such as limited awareness of physical care needs. ACT team members reported the need for additional medical staff and strengthened relationships with primary care providers. They also recommended changes in policy, education, and quality monitoring to implement new physical health care services. CONCLUSIONS Findings suggest intervention components and implementation strategies for improving physical health care of ACT consumers.
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Affiliation(s)
- Brandy Reardon
- Brandy Reardon, PhD, RN, University of North Carolina at Chapel Hill, NC, USA
| | - Mark Toles
- Mark Toles, PhD, RN, FAAN, University of North Carolina at Chapel Hill, NC, USA
| | - Gary Cuddeback
- Gary Cuddeback, PhD, MSW, MPH, University of North Carolina at Chapel Hill, NC, USA
| | - Debbie Travers
- Debbie Travers, PhD, RN, FAEN, Duke University, Chapel Hill, NC, USA
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Bravo C, Minano-Garrido E, Carballo-Costa L, Muñoz-Cruzado y Barba M, Solé S, Rubí-Carnacea F, Catalan-Matamoros D. Beliefs and Self-Perceptions of Spanish Mental Health Professionals about Physical Therapy in Mental Health: An Observational Survey Study. Healthcare (Basel) 2023; 11:3136. [PMID: 38132026 PMCID: PMC10742876 DOI: 10.3390/healthcare11243136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/26/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE The aim of this study is to understand the image, perception, and beliefs regarding the role of the physiotherapist in the field of mental health physiotherapy, both among the professional community and other multidisciplinary teams. METHODS An observational phenomenological qualitative study through the administration of an ad hoc survey comprising both categorical and open-ended as well as quantitative questions was conducted. RESULTS A total of 368 responses were analysed. The participants comprised 78.4% women with a mean age of 37.5, an average professional experience of 14.33 years, and 88.3% practicing physical therapists. From the qualitative analysis conducted, three categories emerged in relation to the obtained responses: (a) functions with codes of "improving quality of life" and "intervening in physical pathologies"; (b) objectives with codes of "Improving quality of life", "Intervening in physical pathologies", "Functional rehabilitation", "Health promotion", and "Intervening in mental disorders"; and (c) image with codes "unfamiliarity", "holistic vision", "necessity", and "importance". Regarding the tools, the findings highlight a strong focus on physical exercise interventions due to their well-established benefits. Cognitive strategies like therapeutic relationships and cognitive-behavioural techniques were also prominent. Additionally, embodiment techniques involving movement, relaxation, breathing, and voice usage were notable. Lastly, manual therapy and physical agents formed another distinct category. CONCLUSIONS The vision and role of this professional profile were unknown to the respondents. Despite being perceived as having a holistic view of the patient and being considered an essential need, the actual image remains vague. However, there is significant interest, indicating a promising future, although the lack of specialized training is noted. Therefore, the need for specialized education and awareness campaigns among professionals in the mental health field is highlighted.
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Affiliation(s)
- Cristina Bravo
- Group of Salut&Genesis, Campus de Salud UdL-Igualada, 08700 Barcelona, Spain;
- Department of Nursing and Physiotherapy, University of Lleida, 25006 Lleida, Spain;
- Grup d’Estudis Societat, Salut, Educació i Cultura, GESEC, Department of Nursing and Physiotherapy, University of Lleida, 25006 Lleida, Spain
- Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, 25198 Lleida, Spain
| | - Emilio Minano-Garrido
- International School of Doctoral Studies, University of Murcia, 30100 Murcia, Spain;
- Department of Physical Therapy, Hôpital Haut-Lévêque, CHU Bordeaux, F-33000 Bordeaux, France
| | - Lidia Carballo-Costa
- Grupo de investigación en Intervención psicosocial y Rehabilitación funcional, Faculty of Physiotherapy Universidade da Coruña, Campus de A Coruña, 15071 A Coruña, Spain;
| | | | - Silvia Solé
- Department of Nursing and Physiotherapy, University of Lleida, 25006 Lleida, Spain;
- Grup d’Estudis Societat, Salut, Educació i Cultura, GESEC, Department of Nursing and Physiotherapy, University of Lleida, 25006 Lleida, Spain
- Department of Physiotherapy, Faculty of Health Sciences, University of Malaga, 29016 Malaga, Spain;
| | - Francesc Rubí-Carnacea
- Department of Nursing and Physiotherapy, University of Lleida, 25006 Lleida, Spain;
- Grup d’Estudis Societat, Salut, Educació i Cultura, GESEC, Department of Nursing and Physiotherapy, University of Lleida, 25006 Lleida, Spain
- Health Care Research Group (GRECS), Lleida Institute for Biomedical Research Dr. Pifarré Foundation, IRBLleida, 25198 Lleida, Spain
| | - Daniel Catalan-Matamoros
- Research Group CTS 451 “Health Sciences”, University of Almeria, 04120 Almeria, Spain;
- Science/Health Communication, University Carlos III of Madrid, 28911 Madrid, Spain
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Howe J, MacPhee M, Duddy C, Habib H, Wong G, Jacklin S, Oduola S, Upthegrove R, Carlish M, Allen K, Patterson E, Maidment I. A realist review of medication optimisation of community dwelling service users with serious mental illness. BMJ Qual Saf 2023:bmjqs-2023-016615. [PMID: 38071586 DOI: 10.1136/bmjqs-2023-016615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/14/2023] [Indexed: 12/22/2023]
Abstract
BACKGROUND Severe mental illness (SMI) incorporates schizophrenia, bipolar disorder, non-organic psychosis, personality disorder or any other severe and enduring mental health illness. Medication, particularly antipsychotics and mood stabilisers are the main treatment options. Medication optimisation is a hallmark of medication safety, characterised by the use of collaborative, person-centred approaches. There is very little published research describing medication optimisation with people living with SMI. OBJECTIVE Published literature and two stakeholder groups were employed to answer: What works for whom and in what circumstances to optimise medication use with people living with SMI in the community? METHODS A five-stage realist review was co-conducted with a lived experience group of individuals living with SMI and a practitioner group caring for individuals with SMI. An initial programme theory was developed. A formal literature search was conducted across eight bibliographic databases, and literature were screened for relevance to programme theory refinement. In total 60 papers contributed to the review. 42 papers were from the original database search with 18 papers identified from additional database searches and citation searches conducted based on stakeholder recommendations. RESULTS Our programme theory represents a continuum from a service user's initial diagnosis of SMI to therapeutic alliance development with practitioners, followed by mutual exchange of information, shared decision-making and medication optimisation. Accompanying the programme theory are 11 context-mechanism-outcome configurations that propose evidence-informed contextual factors and mechanisms that either facilitate or impede medication optimisation. Two mid-range theories highlighted in this review are supported decision-making and trust formation. CONCLUSIONS Supported decision-making and trust are foundational to overcoming stigma and establishing 'safety' and comfort between service users and practitioners. Avenues for future research include the influence of stigma and equity across cultural and ethnic groups with individuals with SMI; and use of trained supports, such as peer support workers. PROSPERO REGISTRATION NUMBER CRD42021280980.
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Affiliation(s)
- Jo Howe
- Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Maura MacPhee
- School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Claire Duddy
- Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Hafsah Habib
- Pharmacy School, Aston University College of Health and Life Sciences, Birmingham, UK
| | - Geoff Wong
- Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Simon Jacklin
- School of Pharmacy and Bioengineering, Keele University, Keele, UK
| | - Sheri Oduola
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Birmingham, UK
- Birmingham Early Intervention Service, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Max Carlish
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Katherine Allen
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Emma Patterson
- Birmingham and Solihull Mental Health NHS Foundation Trust, Birmingham, UK
| | - Ian Maidment
- Pharmacy School, College of Health and Life Sciences, Aston University, Birmingham, UK
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Bärkås A, Kharko A, Blease C, Cajander Å, Johansen Fagerlund A, Huvila I, Johansen MA, Kane B, Kujala S, Moll J, Rexhepi H, Scandurra I, Wang B, Hägglund M. Errors, Omissions, and Offenses in the Health Record of Mental Health Care Patients: Results from a Nationwide Survey in Sweden. J Med Internet Res 2023; 25:e47841. [PMID: 37921861 PMCID: PMC10656659 DOI: 10.2196/47841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/06/2023] [Accepted: 09/28/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Previous research reports that patients with mental health conditions experience benefits, for example, increased empowerment and validation, from reading their patient-accessible electronic health records (PAEHRs). In mental health care (MHC), PAEHRs remain controversial, as health care professionals are concerned that patients may feel worried or offended by the content of the notes. Moreover, existing research has focused on specific mental health diagnoses, excluding the larger PAEHR userbase with experience in MHC. OBJECTIVE The objective of this study is to establish if and how the experiences of patients with and those without MHC differ in using their PAEHRs by (1) comparing patient characteristics and differences in using the national patient portal between the 2 groups and (2) establishing group differences in the prevalence of negative experiences, for example, rates of errors, omissions, and offenses between the 2 groups. METHODS Our analysis was performed on data from an online patient survey distributed through the Swedish national patient portal as part of our international research project, NORDeHEALTH. The respondents were patient users of the national patient portal 1177, aged 15 years or older, and categorized either as those with MHC experience or with any other health care experience (nonmental health care [non-MHC]). Patient characteristics such as gender, age, education, employment, and health status were gathered. Portal use characteristics included frequency of access, encouragement to read the record, and instances of positive and negative experiences. Negative experiences were further explored through rates of error, omission, and offense. The data were summarized through descriptive statistics. Group differences were analyzed through Pearson chi-square. RESULTS Of the total sample (N=12,334), MHC respondents (n=3131) experienced errors (1586/3131, 50.65%, and non-MHC 3311/9203, 35.98%), omissions (1089/3131, 34.78%, and non-MHC 2427/9203, 26.37%) and offenses (1183/3131, 37.78%, and non-MHC 1616/9203, 17.56%) in the electronic health record at a higher rate than non-MHC respondents (n=9203). Respondents reported that the identified error (MHC 795/3131, 50.13%, and non-MHC 1366/9203, 41.26%) and omission (MHC 622/3131, 57.12%, and non-MHC 1329/9203, 54.76%) were "very important," but most did nothing to correct them (MHC 792/3131, 41.29%, and non-MHC 1838/9203, 42.17%). Most of the respondents identified as women in both groups. CONCLUSIONS About 1 in 2 MHC patients identified an error in the record, and about 1 in 3 identified an omission, both at a much higher rate than in the non-MHC group. Patients with MHC also felt offended by the content of the notes more commonly (1 in 3 vs 1 in 6). These findings validate some of the worries expressed by health care professionals about providing patients with MHC with PAEHRs and highlight challenges with the documentation quality in the records.
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Affiliation(s)
- Annika Bärkås
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- MedTech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Anna Kharko
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- MedTech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Charlotte Blease
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- MedTech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Åsa Cajander
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | | | - Isto Huvila
- Department of ALM, Uppsala University, Uppsala, Sweden
| | - Monika Alise Johansen
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Telemedicine and E-health Research Group, Arctic University of Norway, Tromsø, Norway
| | - Bridget Kane
- Business School, Karlstad University, Karlstad, Sweden
| | - Sari Kujala
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Jonas Moll
- Centre for Empirical Research on Information Systems, School of Business, Örebro University, Örebro, Sweden
| | - Hanife Rexhepi
- School of Informatics, University of Skövde, Skövde, Sweden
| | - Isabella Scandurra
- Centre for Empirical Research on Information Systems, School of Business, Örebro University, Örebro, Sweden
| | - Bo Wang
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
| | - Maria Hägglund
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- MedTech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden
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11
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Ebert T, Hamuda N, City-Elifaz E, Kobo O, Roguin A. Trends in CV mortality among patients with known mental and behavioral disorders in the US between 1999 and 2020. Front Psychiatry 2023; 14:1255323. [PMID: 38025453 PMCID: PMC10646424 DOI: 10.3389/fpsyt.2023.1255323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Patients with mental disorders are at increased risk of cardiovascular events. We aimed to assess the cardiovascular mortality trends over the last two decades among patients with mental and behavioral co-morbidities in the US. Methods We performed a retrospective, observational study using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) Multiple Cause of Death dataset. We determined national trends in age-standardized mortality rates attributed to cardiovascular diseases in patients with and without mental and behavioral disorders, from 1999 to 2020, stratified by mental and behavioral disorders subtype [ICD10 codes F], age, gender, race, and place of residence. Results Among more than 18.7 million cardiovascular deaths in the United States (US), 13.5% [2.53 million] were patients with a concomitant mental and behavioral disorder. During the study period, among patients with mental and behavioral disorders, the age-adjusted mortality rate increased by 113.9% Vs a 44.8% decline in patients with no mental disorder (both p<0.05). In patients with mental and behavioral disorders, the age-adjusted mortality rate increased more significantly among patients whose mental and behavioral disorder was secondary to substance abuse (+532.6%, p<0.05) than among those with organic mental disorders, such as dementia or delirium (+6.2%, P- nonsignificant). Male patients (+163.6%) and residents of more rural areas (+128-162%) experienced a more prominent increase in age-adjusted cardiovascular mortality. Discussion While there was an overall reduction in cardiovascular mortality in the US in the past two decades, we demonstrated an overall increase in cardiovascular mortality among patients with mental disorders.
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Affiliation(s)
- Tanya Ebert
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
- Department of Psychiatry, Hillel Yaffe Medical Center, Hadera, Israel
| | - Nashed Hamuda
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Efrat City-Elifaz
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
- Department of Psychiatry, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ofer Kobo
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ariel Roguin
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
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12
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Browne J, Elbogen EB, Mueser KT, Rudolph JL, Wu WC, Philip NS, Mills WL, Sloane R, Hall KS. Physical Function Assessment of Older Veterans With Serious Mental Illness. Am J Geriatr Psychiatry 2023; 31:657-666. [PMID: 36941144 PMCID: PMC10474249 DOI: 10.1016/j.jagp.2023.02.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To characterize the physical function of older veterans with serious mental illness (SMI) across endurance, strength, and mobility domains. DESIGN Retrospective analysis of clinical performance data. SETTING Gerofit program, a national outpatient supervised exercise program for older veterans, delivered in Veterans Health Administration sites. PARTICIPANTS Older veterans aged 60 and older (n = 166 with SMI, n = 1,441 without SMI) enrolled across eight national Gerofit sites between 2010 and 2019. MEASUREMENTS Performance measures of physical function covering endurance (6-minute walk test), strength (chair stands, arm curls), and mobility (10-m walk, 8-foot-up-and-go), were administered at Gerofit enrollment. Baseline data from these measures were analyzed to characterize the functional profiles of older veterans with SMI. One sample t tests were examined to compare functional performance of older veterans with SMI to age- and sex-based reference scores. Propensity score matching (1:3) and linear mixed effects models were used to evaluate differences in function between veterans with and without SMI. RESULTS Older veterans with SMI performed worse on all measures of function (chair stands, arm curls, 10-m walk, 6-minute walk test, 8-foot-up-and-go) compared to age- and sex-based reference scores with statistically significant differences present in the male sample. Functional performance of those with SMI was also worse compared to propensity-score matched older veterans without SMI with statistically significant differences on chair stands, 6-minute walk test, and 10-m walk. CONCLUSION Older veterans with SMI have compromised strength, mobility, and endurance. Physical function should be a core component of screening and treatment for this population.
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Affiliation(s)
- Julia Browne
- Research Service, VA Providence Healthcare System, Providence, RI; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI; Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC.
| | - Eric B Elbogen
- Durham VA Health Care System, Durham, NC; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation and Departments of Occupational Therapy, Psychology, and Psychiatry, Boston University, Boston, MA
| | - James L Rudolph
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI
| | - Wen-Chih Wu
- Medical Service, VA Providence Healthcare System, Providence, RI
| | - Noah S Philip
- VA RR&D Center for Neurorestoration and Neurotechnology, VA Providence Healthcare System, Providence, RI
| | - Whitney L Mills
- Center of Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, RI; Department of Health Services, Policy & Practice, Brown University, Providence, RI
| | - Richard Sloane
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC
| | - Katherine S Hall
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC; Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, NC
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13
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McCarter R, Rosato M, Thampi A, Barr R, Leavey G. Physical health disparities and severe mental illness: A longitudinal comparative cohort study using hospital data in Northern Ireland. Eur Psychiatry 2023; 66:e70. [PMID: 37578131 PMCID: PMC10594365 DOI: 10.1192/j.eurpsy.2023.2441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND People with severe mental illness (SMI) die prematurely, mostly due to preventable causes. OBJECTIVE To examine multimorbidity and mortality in people living with SMI using linked administrative datasets. METHOD Analysis of linked electronically captured routine hospital administrative data from Northern Ireland (2010-2021). We derived sex-specific age-standardised rates for seven chronic life-limiting physical conditions (chronic kidney disease, malignant neoplasms, diabetes mellitus, chronic obstructive pulmonary disease, chronic heart failure, myocardial infarction, and stroke) and used logistic regression to examine the relationship between SMI, socio-demographic indicators, and comorbid conditions; survival models quantified the relationship between all-cause mortality and SMI. RESULTS Analysis was based on 929,412 hospital patients aged 20 years and above, of whom 10,965 (1.3%) recorded a diagnosis of SMI. Higher likelihoods of an SMI diagnosis were associated with living in socially deprived circumstances, urbanicity. SMI patients were more likely to have more comorbid physical conditions than non-SMI patients, and younger at referral to hospital for each condition, than non-SMI patients. Finally, in fully adjusted models, SMI patients had a twofold excess all-cause mortality. CONCLUSION Multiple morbidities associated with SMI can drive excess mortality. While SMI patients are younger at referral to treatment for these life-limiting conditions, their relatively premature death suggests that these conditions are also quite advanced. There is a need for a more aggressive approach to improving the physical health of this population.
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Affiliation(s)
- Rachel McCarter
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Coleraine, UK
- Administrative Data Research – Northern Ireland (ADR-NI), Ulster University, Coleraine, UK
| | - Michael Rosato
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Coleraine, UK
- Administrative Data Research – Northern Ireland (ADR-NI), Ulster University, Coleraine, UK
| | | | | | - Gerard Leavey
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Coleraine, UK
- Administrative Data Research – Northern Ireland (ADR-NI), Ulster University, Coleraine, UK
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14
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Crapanzano KA, Deweese S, Pham D, Le T, Hammarlund R. The Role of Bias in Clinical Decision-Making of People with Serious Mental Illness and Medical Co-morbidities: a Scoping Review. J Behav Health Serv Res 2023; 50:236-262. [PMID: 36720760 PMCID: PMC10016362 DOI: 10.1007/s11414-022-09829-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 02/02/2023]
Abstract
The aim of this review was to examine the evidence for the impact of explicit and implicit biases against mental illness on the clinical decision-making of primary care physicians, medical students, and nurses when they are providing care to individuals with serious mental illness for cardiovascular disease, diabetes, and cancer. Studies were identified by searching MEDLINE, EBSCO host, and PsychINFO. A total of 18 studies published between 1996 and 2020 were reviewed and summarized. The studies were divided into two groups-studies that used a simulation or vignette methodology and those with a qualitative approach (interviews and focus groups). Of the simulation/vignette studies that allowed participants to report what they would have done in various clinical scenarios, there were roughly equal numbers of neutral or negative clinical decisions that represented 80% of the relevant behavioral results. Only 21% of the findings demonstrated a clinical decision that was favorable towards people with mental illness. Of the qualitative studies, all of the studies reported behaviors (either self-reported or observed) that were likely to be biased against people with mental illness, while 3 of the studies reported mixed results. Healthcare provider bias against individuals with mental illness does exist and impacts clinical decisions negatively. Much more empirical work needs to be done to determine the full extent and impact of the problem, including how these decisions affect the lives of individuals with mental illness.
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Affiliation(s)
- Kathleen A Crapanzano
- Department of Psychiatry, LSU School of Medicine, 5246 Brittany Drive, Rm 340, Baton Rouge, Baton Rouge, LA, 70808, USA.
| | - Stephen Deweese
- Department of Psychiatry, LSU School of Medicine, 5246 Brittany Drive, Rm 340, Baton Rouge, Baton Rouge, LA, 70808, USA
| | - Diem Pham
- Department of Psychiatry, LSU School of Medicine, 5246 Brittany Drive, Rm 340, Baton Rouge, Baton Rouge, LA, 70808, USA
| | - Thanh Le
- Department of Psychiatry, LSU School of Medicine, 5246 Brittany Drive, Rm 340, Baton Rouge, Baton Rouge, LA, 70808, USA
| | - Rebecca Hammarlund
- Department of Psychiatry, LSU School of Medicine, 5246 Brittany Drive, Rm 340, Baton Rouge, Baton Rouge, LA, 70808, USA
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15
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Dobbins S, Hubbard E, Leutwyler H. Education Mediates Racial Disparities in Cognitive Impairment Among Older Adults With Schizophrenia. Clin Gerontol 2023; 46:66-79. [PMID: 33579181 PMCID: PMC8610378 DOI: 10.1080/07317115.2021.1882021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES In the general population, the construct of race is associated with disparities in cognitive aging. There are notable racial group disparities and inequities among people living with schizophrenia (PLWSz). Despite the salience of the construct of race in schizophrenia, there remains a knowledge gap about racial disparities in cognitive impairment among older adults in this vulnerable population. Our study uses mediation analysis to examine racial disparities in cognitive impairment among older adults with schizophrenia. METHODS We assess global cognition in PLWSz over age 55 with the Measurement and Treatment Research to Improve Cognition in Schizophrenia cognitive test battery in our "all-comer" sample (N = 64). The primary exposure is self-reported racial group. We examine mediation of cognitive impairment through educational attainment, adjusting for psychiatric illness severity, history of substance use, and vascular risk factors. RESULTS There was a Black/non-Black group racial disparity in global cognitive score (-2.8, 95% CI: -4.4, -1.3) after adjusting for confounding and interaction. This disparity was significantly mediated by years of education. CONCLUSIONS There are notable racial disparities in cognitive impairment among older adults with schizophrenia; however, differences in cognitive scores between racial groups are mediated by level of education. CLINICAL IMPLICATIONS Social determinants of health, particularly educational attainment, are important risk factors for cognitive impairment in PLWSz and should be considered by clinicians. Early screening and assessment of cognitive symptoms is essential to addressing health disparities/inequalities among older adults living with schizophrenia. ABBREVIATIONS CDE Controlled Direct EffectsHIV: Human Immunodeficiency VirusMATRICS: Measurement and Treatment Research to Improve Cognition in SchizophreniaMCCB: MATRICS Consensus Cognitive BatteryMTE: Marginal Total EffectsNDE: Natural Direct EffectsPANSS: Positive and Negative Symptom ScalePLWSz: People with schizophrenia.
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Affiliation(s)
- Sarah Dobbins
- University of California, San Francisco School of Nursing, 2 Koret Way, San Francisco, CA 94143, USA
| | - Erin Hubbard
- University of California, San Francisco School of Nursing, 2 Koret Way, San Francisco, CA 94143, USA
| | - Heather Leutwyler
- University of California, San Francisco School of Nursing, 2 Koret Way, San Francisco, CA 94143, USA
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16
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Nanjundaswamy MH, Gowda SM, Ganjekar S, Thippeswamy H, Desai G, Chandra PS. Women with mental illness seeking conception counselling at a specialist perinatal psychiatry service in India. Asian J Psychiatr 2022; 78:103313. [PMID: 36356427 DOI: 10.1016/j.ajp.2022.103313] [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: 09/26/2022] [Accepted: 10/30/2022] [Indexed: 11/09/2022]
Abstract
AIMS To study the clinical and sociodemographic profile of women with mental illness seeking conception counselling at perinatal psychiatry service. To compare women seeking preconception counselling (PCC) to that of those who sought help after unplanned pregnancy with exposure (UPE) to psychotropics. MATERIAL AND METHODS Data was extracted from the clinical records of women between the year 2014-2017 who attended perinatal outpatient services. The details collected included sociodemographic details, illness details, contraception, infertility treatment and detailed treatment history. RESULTS Of the 766 women who consulted perinatal psychiatry services (2014-17), 179 (23.37%) had consulted for conception counselling. Out of that 104 (58.1%) sought PCC, and 75 (41.9%) had UPE to psychotropics. PCC was sought by women with higher education, those having a severe mental illness, and a longer duration of illness. Women with medical comorbidities and receiving infertility treatment also sought PCC. Also, women who had earlier undergone PCC been more likely to seek PCC for further pregnancies. CONCLUSIONS Women with mental illness should be counselled regarding planned pregnancies, contraception, and the impact of psychotropics on pregnancy and foetus. Also, liaison with other specialities like obstetricians, sonologist and paediatricians is essential.
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Affiliation(s)
- Madhuri H Nanjundaswamy
- Dept of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | | | - Sundarnag Ganjekar
- Dept of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India.
| | - Harish Thippeswamy
- Dept of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Geetha Desai
- Dept of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Prabha S Chandra
- Dept of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru 560029, India
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17
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Sahin-Bayindir G, Buzlu S. The effect of two simulations on students' knowledge and skills regarding physical health problems of psychiatric patients: A mixed-method study. NURSE EDUCATION TODAY 2022; 119:105537. [PMID: 36155209 DOI: 10.1016/j.nedt.2022.105537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/18/2022] [Accepted: 09/04/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Simulation-based training can help nursing students improve their mental and physical healthcare knowledge and skills. OBJECTIVES This study focused on two different simulation modalities and investigated whether they helped nursing students acquire knowledge and develop skills necessary to address the physical health problems of people with mental disorders. DESIGN This is a mixed-method study. SETTINGS This study was conducted in Turkey. PARTICIPANTS The sample consisted of 61 students divided into two experimental groups and one control group. METHODS One experimental group participated in a clinical simulation scenario involving a standardized patient modality, while the other participated in a hybrid simulation modality (standardized patient and high-fidelity model simulator). The control group participated in conventional training. The researchers evaluate the effect of the modalities and conventional training on clinical practice one month after the interventions. Focus group interviews were conducted with all participants one month after the evaluation. Knowledge test was administered to all participants before the intervention, after the intervention, at the third and sixth months after the intervention. RESULTS AND CONCLUSION The clinical simulation was statistically effective for students' skill development about physical health problems of psychiatric patients. Also, in the qualitative findings, the clinical simulation increased the knowledge level of the students and improved their physical health assessment skills. Standardized patient simulation and hybrid simulation modalities should be used to help nursing students develop their assessment skills regarding the physical health problems of psychiatric patients.
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Affiliation(s)
- Gizem Sahin-Bayindir
- Istanbul University - Cerrahpasa, Institute of Graduate Studies, Department of Mental Health and Psychiatric Nursing, Baglarici St., Avcilar, Istanbul, Turkey.
| | - Sevim Buzlu
- Istanbul University - Cerrahpasa, Florence Nightingale Faculty of Nursing, Department of Mental Health and Psychiatric Nursing, Sisli, Istanbul, Turkey
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Heron PN, Henderson LM, Crosland S, Gilbody SM, Johnston GA, Moriarty AS, Newbronner E, Paterson A, Spanakis P, Wadman R, Walker L, Peckham E. Sleep health among people with severe mental ill health during the COVID-19 pandemic: Results from a linked UK population cohort study. Front Psychiatry 2022; 13:975593. [PMID: 36299533 PMCID: PMC9589097 DOI: 10.3389/fpsyt.2022.975593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/22/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Sleep problems are a transdiagnostic feature of nearly all psychiatric conditions, and a strong risk factor for initial and recurrent episodes. However, people with severe mental ill health (SMI) are often excluded from general population surveys, and as such the extent and associates of poor sleep in this population are less well understood. This study explores sleep health in an SMI sample during the COVID-19 pandemic, using multiple regression to identify risk factors, including daily routine, wellbeing and demographics. Methods An existing cohort of people with an SMI diagnosis were sampled. Participants were invited to complete a self-report survey about their health and the impacts of COVID-19 and associated public health measures. Sleep duration, efficiency, and quality were measured using items from the Pittsburgh Sleep Quality Index (PSQI). Results Two hundred forty-nine adults (aged 21-84 years) completed the survey. Mean sleep duration and efficiency were similar to general population estimates, at 7 h 19 min and 78%, respectively. However, 43% reported "bad" sleep quality that was associated with being younger in age as well as disturbed routine and declined wellbeing. Indeed, 37% reported a disturbed routine during the pandemic. Conclusions High estimates of perceived poor sleep quality in the SMI population align with previous findings. Supporting people with SMI to maintain routine regularity may work to protect sleep quality and wellbeing. Future research should more closely examine sleep health in people with SMI, using accessible and scalable measures of objective and subjective sleep, examining longitudinal trends.
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Affiliation(s)
- Paul N. Heron
- Mental Health and Addictions Research Group, Department of Health Science, University of York, York, United Kingdom
| | | | - Suzanne Crosland
- Mental Health and Addictions Research Group, Department of Health Science, University of York, York, United Kingdom
| | - Simon M. Gilbody
- Mental Health and Addictions Research Group, Department of Health Science, University of York, York, United Kingdom
- Hull York Medical School, York, United Kingdom
| | | | - Andrew S. Moriarty
- Mental Health and Addictions Research Group, Department of Health Science, University of York, York, United Kingdom
- Hull York Medical School, York, United Kingdom
| | - Elizabeth Newbronner
- Mental Health and Addictions Research Group, Department of Health Science, University of York, York, United Kingdom
| | - Alastair Paterson
- Faculty of Medical and Human Sciences, Manchester University, Manchester, United Kingdom
| | - Panagiotis Spanakis
- Mental Health and Addictions Research Group, Department of Health Science, University of York, York, United Kingdom
- Department of Psychology, University of Crete, Rethymmon, Greece
- School of Psychology, Mediterranean College, Athens, Greece
| | - Ruth Wadman
- Mental Health and Addictions Research Group, Department of Health Science, University of York, York, United Kingdom
| | - Lauren Walker
- Mental Health and Addictions Research Group, Department of Health Science, University of York, York, United Kingdom
| | - Emily Peckham
- Mental Health and Addictions Research Group, Department of Health Science, University of York, York, United Kingdom
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Launders N, Dotsikas K, Marston L, Price G, Osborn DPJ, Hayes JF. The impact of comorbid severe mental illness and common chronic physical health conditions on hospitalisation: A systematic review and meta-analysis. PLoS One 2022; 17:e0272498. [PMID: 35980891 PMCID: PMC9387848 DOI: 10.1371/journal.pone.0272498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 07/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background People with severe mental illness (SMI) are at higher risk of physical health conditions compared to the general population, however, the impact of specific underlying health conditions on the use of secondary care by people with SMI is unknown. We investigated hospital use in people managed in the community with SMI and five common physical long-term conditions: cardiovascular diseases, COPD, cancers, diabetes and liver disease. Methods We performed a systematic review and meta-analysis (Prospero: CRD42020176251) using terms for SMI, physical health conditions and hospitalisation. We included observational studies in adults under the age of 75 with a diagnosis of SMI who were managed in the community and had one of the physical conditions of interest. The primary outcomes were hospital use for all causes, physical health causes and related to the physical condition under study. We performed random-effects meta-analyses, stratified by physical condition. Results We identified 5,129 studies, of which 50 were included: focusing on diabetes (n = 21), cardiovascular disease (n = 19), COPD (n = 4), cancer (n = 3), liver disease (n = 1), and multiple physical health conditions (n = 2). The pooled odds ratio (pOR) of any hospital use in patients with diabetes and SMI was 1.28 (95%CI:1.15–1.44) compared to patients with diabetes alone and pooled hazard ratio was 1.19 (95%CI:1.08–1.31). The risk of 30-day readmissions was raised in patients with SMI and diabetes (pOR: 1.18, 95%CI:1.08–1.29), SMI and cardiovascular disease (pOR: 1.27, 95%CI:1.06–1.53) and SMI and COPD (pOR:1.18, 95%CI: 1.14–1.22) compared to patients with those conditions but no SMI. Conclusion People with SMI and five physical conditions are at higher risk of hospitalisation compared to people with that physical condition alone. Further research is warranted into the combined effects of SMI and physical conditions on longer-term hospital use to better target interventions aimed at reducing inappropriate hospital use and improving disease management and outcomes.
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Affiliation(s)
- Naomi Launders
- Division of Psychiatry, UCL, London, United Kingdom
- * E-mail:
| | | | - Louise Marston
- Department of Primary Care and Population Health, UCL, London, United Kingdom
| | - Gabriele Price
- Health Improvement Directorate, Public Health England, London, United Kingdom
| | - David P. J. Osborn
- Division of Psychiatry, UCL, London, United Kingdom
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, United Kingdom
| | - Joseph F. Hayes
- Division of Psychiatry, UCL, London, United Kingdom
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, United Kingdom
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20
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Geils H, Riley A, Lavelle TA. Incentivizing drug development in serious mental illness. Clin Ther 2022; 44:1258-1267. [DOI: 10.1016/j.clinthera.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/22/2022] [Accepted: 08/07/2022] [Indexed: 11/03/2022]
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21
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Fendrich SJ, Koralnik LR, Bonner M, Goetz D, Joe P, Lee J, Mueller B, Robinson-Papp J, Gonen O, Clemente JC, Malaspina D. Patient-reported exposures and outcomes link the gut-brain axis and inflammatory pathways to specific symptoms of severe mental illness. Psychiatry Res 2022; 312:114526. [PMID: 35462090 DOI: 10.1016/j.psychres.2022.114526] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 03/16/2022] [Accepted: 03/20/2022] [Indexed: 02/08/2023]
Abstract
UNLABELLED We developed a "gut-brain-axis questionnaire" (GBAQ) to obtain standardized person-specific "review of systems" data for microbiome-gut-brain-axis studies. Individual items were compared to PANSS symptom measures using dimensional, transdiagnostic and traditional categorical approaches. METHOD Forty psychotic participants, independent of diagnoses, and 42 without psychosis (18 nonpsychotic affective disorders, 24 healthy controls) completed the GBAQ and underwent research diagnostic and symptom assessments. The PANSS scales and its dysphoric mood, autistic preoccupation and activation factors were computed. RESULTS Transdiagnostic analyses robustly linked psychosis severity to constipation (p<.001), and Negative (p=.045) and General Psychopathology scores (p=.016) with bowel hypomotility. Activation factor scores predicted numbers of psychiatric (p=.009) and medical conditions (p=.003), BMI (p=.003), skin (p<.001) and other conditions. Categorical analyses comparing psychotic, nonpsychotic and control groups revealed behavioral differences: cigarette smoking (p=.013), alcohol use (p=.007), diet (p's <.05), exercise (p<.001). All subjects accurately self-reported their diagnosis. CONCLUSIONS The GBAQ is a promising tool. Transdiagnostic analyses associated psychotic symptoms to gut hypomotility, indicative of low gut vagal tone, consistent with reduced cardiovagal activity in psychosis. Activation, similar to delirium symptoms, predicted medical comorbidity and systemic inflammatory conditions. Group level comparisons only showed behavioral differences. Underpinnings of psychiatric disorders may include reduced gut vagal function, producing psychosis, and systemic inflammation, impacting risks for psychotic and nonpsychotic conditions.
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Affiliation(s)
- Sarah J Fendrich
- Departments of Psychiatry, Neuroscience, and Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Medical Ethics and Health Policy, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lauren R Koralnik
- Department of Psychology, Barnard College of Columbia University, New York, New York, USA
| | - Mharisi Bonner
- Departments of Psychiatry, Neuroscience, and Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Deborah Goetz
- Departments of Psychiatry, Neuroscience, and Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Peter Joe
- Departments of Psychiatry, Neuroscience, and Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jakleen Lee
- Departments of Psychiatry, Neuroscience, and Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bridget Mueller
- Departments of Psychiatry, Neuroscience, and Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jessica Robinson-Papp
- Departments of Psychiatry, Neuroscience, and Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Oded Gonen
- Center for Advanced Imaging Innovation and Research (CAI2R), Department of Radiology, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Jose C Clemente
- Department of Genetics and Genomic Sciences, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dolores Malaspina
- Departments of Psychiatry, Neuroscience, and Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Martens N, Destoop M, Dom G. Physical Healthcare, Health-Related Quality of Life and Global Functioning of Persons with a Severe Mental Illness in Belgian Long-Term Mental Health Assertive Outreach Teams: A Cross-Sectional Self-Reported Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5522. [PMID: 35564916 PMCID: PMC9100211 DOI: 10.3390/ijerph19095522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/22/2022] [Accepted: 04/27/2022] [Indexed: 02/01/2023]
Abstract
Research shows that care delivery regarding somatic health problems for patients with a severe mental illness (SMI) in community and mental health is difficult to establish. During the last decade, long term mental health outreach teams in Belgium were implemented to provide treatment and follow-up at home. This study aimed to map physical health status, care professionals, health related quality of life and global functioning in persons with SMI in Belgian long term outreach teams for mental health. Using a self-administered questionnaire, 173 persons, 58.1% female with a mean age of 48.3, were questioned. Our findings suggest an undertreatment of somatic comorbid conditions, with only half of physical health complaints being addressed. Although treatment rates for hypertension, when detected were high, treatment of respiratory complaints, pain and fatigue was lacking. Although the majority of respondents responded to have a GP or psychiatrist, contact rates were rather limited. Other disciplines, such as primary care nurses, when present, tend to have more contact with people with SMI. Notably, having regular contacts with GPs seems to improve physical health complaints and/or treatment. Being treated by an outreach team did not show significant correlations with physical health complaints and/or treatment suggesting a more proactive approach by outreach teams or primary care providers is desirable.
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Affiliation(s)
- Nicolaas Martens
- Multiversum Psychiatric Hospital, Brothers of Charity Belgium, 2530 Boechout, Belgium; (M.D.); (G.D.)
- Collaborative Antwerp Psychiatry Research Institute (CAPRI), University of Antwerp, 2610 Antwerp, Belgium
- Department of Nursing, Karel de Grote University of Applied Sciences, 2018 Antwerp, Belgium
| | - Marianne Destoop
- Multiversum Psychiatric Hospital, Brothers of Charity Belgium, 2530 Boechout, Belgium; (M.D.); (G.D.)
- Collaborative Antwerp Psychiatry Research Institute (CAPRI), University of Antwerp, 2610 Antwerp, Belgium
| | - Geert Dom
- Multiversum Psychiatric Hospital, Brothers of Charity Belgium, 2530 Boechout, Belgium; (M.D.); (G.D.)
- Collaborative Antwerp Psychiatry Research Institute (CAPRI), University of Antwerp, 2610 Antwerp, Belgium
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23
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Scientific and Clinical Abstracts From WOCNext® 2022: Fort Worth, Texas ♦ June 5-8, 2022. J Wound Ostomy Continence Nurs 2022; 49:S1-S99. [PMID: 35639023 DOI: 10.1097/won.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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Mehta G, Lo B, Memarpour M, Chan A. Impact of Diabetes on Inpatient Length of Stay in Adult Mental Health Services in a Community Hospital Setting: A Retrospective Cohort Study. Can J Diabetes 2022; 46:S1499-2671(22)00075-2. [PMID: 35933315 DOI: 10.1016/j.jcjd.2022.03.012] [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: 11/20/2021] [Revised: 03/05/2022] [Accepted: 03/29/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Our aim in this study was to characterise the relationship between comorbid mental health diagnosis and diabetes type on inpatient length of stay (LOS). METHODS This retrospective, chart review study was conducted at a community hospital in Ontario, Canada. Individuals admitted to the inpatient mental health unit with a reported diagnosis of type 1 or type 2 diabetes were included in the analysis. Relevant data related to mental health conditions at admission and LOS were collected from the electronic health record. Analyses of variance and coviariance were used to determine the impact on LOS. RESULTS A total of 249 encounters were included in the analyses. Overall, individuals with type 2 diabetes (mean, 14.70 days; standard deviation, 15.75 days) had a significantly longer LOS than individuals with type 1 diabetes (mean, 8.01 days; standard deviation, 7.27 days). Upon including sociodemographic factors, individuals older in age and with a most recent admission of <1 year also had a longer LOS. There was no significant relationship between the most responsible mental health diagnosis and LOS. CONCLUSIONS Individuals with type 2 diabetes may be more likely to have a longer LOS in inpatient mental health settings than those with type 1 diabetes. More dedicated support would be beneficial for this population. Future work should focus on in-depth exploration of the challenges that lead to the observed LOS.
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Affiliation(s)
- Gaurav Mehta
- Southlake Regional Health Centre, Newmarket, Ontario, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Brian Lo
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Mahdi Memarpour
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
| | - Angela Chan
- Southlake Regional Health Centre, Newmarket, Ontario, Canada
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25
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van Schijndel M, Jansen L, Busschbach J, van Waarde J, Wierdsma A, Tiemeier H. Hospital healthcare utilizers with medical and psychiatric claims in the Netherlands: a nationwide study. BMC Health Serv Res 2022; 22:480. [PMID: 35410295 PMCID: PMC9004012 DOI: 10.1186/s12913-022-07798-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 03/16/2022] [Indexed: 11/22/2022] Open
Abstract
Background Psychiatric and medical multimorbidity is associated with low quality of life, poor functioning and excess mortality. Differences in healthcare utilization between those receiving co-occurring medical and psychiatric healthcare (HUMPCs) and those only receiving medical (HUMCs) or only psychiatric healthcare (HUPCs) may indicate differences in care accessibility, help-seeking behavior and the risk patterns of medical illness. We aimed to assess the occurrence of psychiatric diagnostic groups in HUMPCs compared to HUPCs and to compare their medical and psychiatric claims expenditures. Methods Using Dutch claims data covering psychiatric and medical hospital care in 2010–2011, healthcare utilization differences between HUMPCs and HUPCs were expressed as differences and ratios, accounting for differences in age and sex between groups. Median claims expenditures were then compared between HUMPCs and HUPCs. Results HUMPCs had 40% higher median medical cost of claims compared to HUMCs and a 10% increased number of psychiatric claims compared to HUPCs. HUMPCs were more often diagnosed with: organic disorders; behavioral syndromes associated with physiological disturbances and physical factors; mood [affective] disorders; neurotic, stress related and somatoform disorders; and disorders of adult personality and behavior. By contrast, disorders of psychological development, schizophrenia, schizotypal and delusional disorders, behavioral and emotional disorders with usual onset occurring in childhood, and mental and behavioral disorders due to psychoactive substance abuse were less often diagnosed in this group. Conclusions Both medical and psychiatric disease become more costly where both are present. For HUMPCs the costs of both medical and psychiatric claims for almost all diagnostic groups were higher than for HUPCs and HUMCs.
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Affiliation(s)
- Maarten van Schijndel
- Department of Psychiatry, Rijnstate Hospital, Arnhem, the Netherlands.,Department of Psychiatry, Erasmus Medical Centre, Epidemiological and Social Psychiatric Research Institute, Rotterdam, the Netherlands
| | - Luc Jansen
- Department of Psychiatry, Erasmus Medical Centre, Epidemiological and Social Psychiatric Research Institute, Rotterdam, the Netherlands.
| | - Jan Busschbach
- Department of Psychiatry, Section Medical Psychology and Psychotherapy, Erasmus MC, Rotterdam, the Netherlands
| | - Jeroen van Waarde
- Department of Psychiatry, Rijnstate Hospital, Arnhem, the Netherlands
| | - Andre Wierdsma
- Department of Psychiatry, Erasmus Medical Centre, Epidemiological and Social Psychiatric Research Institute, Rotterdam, the Netherlands
| | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Social and Behavioural Science, Harvard TH Chan School of Public Health, Boston, MA, USA
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26
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Happell B, Warner T, Waks S, O'Donovan A, Manning F, Doody R, Greaney S, Goodwin J, Hals E, Griffin M, Scholz B, Granerud A, Platania-Phung C, Russell S, MacGabhann L, Pulli J, Vatula A, van der Vaart KJ, Allon J, Bjornsson E, Ellilä H, Lahti M, Biering P. Something special, something unique: Perspectives of experts by experience in mental health nursing education on their contribution. J Psychiatr Ment Health Nurs 2022; 29:346-358. [PMID: 34032356 DOI: 10.1111/jpm.12773] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 02/01/2021] [Accepted: 05/13/2021] [Indexed: 12/17/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT ●Expert by Experience participation in mental health services is embedded in mental health policy in many countries. The negative attitudes of nurses and other health professionals to consumer participation poses a significant obstacle to this policy goal. ●Involving mental health Experts by Experience in the education of nursing students demonstrates positive attitudinal change. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE ●The paper presents perspectives from Experts by Experience about the unique knowledge and expertise they derive from their lived experience of mental distress and mental health service use. As a result, they can make a unique and essential contribution to mental health nursing education. They utilize this knowledge to create an interactive learning environment and encourage critical thinking. ●The international focus of this research enriches understandings about how Experts by Experience might be perceived in a broader range of countries. WHAT ARE THE IMPLICATIONS FOR PRACTICE ●Mental health policy articulates the importance of service user involvement in all aspects of mental health service delivery. This goal will not be fully achieved without nurses having positive attitudes towards experts by experience as colleagues. ●Positive attitudes are more likely to develop when nurses understand and value the contribution experts by experience bring by virtue of their unique knowledge and expertise. This paper provides some important insights to achieving this end. ABSTRACT Introduction Embedding lived experience in mental health nursing education is increasing, with research findings suggesting the impact is positive. To date, research has primarily targeted the perspectives of nursing students and academics from the health professions. Aim To enhance understanding of the unique knowledge and expertise experts by experience contribute to mental health nursing education. Methods Qualitative exploratory research methods were employed. In-depth individual interviews were conducted with experts by experience who delivered a coproduced learning module to nursing students in Europe and Australia. Results Participants described their unique and essential contribution to mental health nursing education under four main themes: critical thinking, beyond textbooks; interactive and open communication; understanding personal recovery; and mental health is health. Conclusions These findings present an understanding of the unique knowledge and expertise Experts by Experience contribute to mental health education not previously addressed in the literature. Appreciating and respecting this, unique contribute is necessary as Expert by Experience contributions continue to develop. Implications for Practice Mental health services purport to value service user involvement. Identifying and respecting and valuing the unique contribution they bring to services is essential. Without this understanding, tokenistic involvement may become a major barrier.
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Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, Hunter Institute of Medical Research, Priority Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Terri Warner
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia.,ACT Mental Health Consumer Network, Canberra, ACT, Australia
| | - Shifra Waks
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan, NSW, Australia
| | - Aine O'Donovan
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Rory Doody
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Sonya Greaney
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Woden, Canberra, ACT, Australia
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Jarmo Pulli
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | - Annaliina Vatula
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | | | - Jerry Allon
- University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Heikki Ellilä
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | - Mari Lahti
- Department of Nursing Science, Faculty of Medicine, Turku University of Applied Sciences, Turku University, Turku, Finland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
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Comorbidity combinations in schizophrenia inpatients and their associations with service utilization: A medical record-based analysis using association rule mining. Asian J Psychiatr 2022; 67:102927. [PMID: 34847493 DOI: 10.1016/j.ajp.2021.102927] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/29/2021] [Accepted: 11/16/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Comorbidities are common among patients with schizophrenia yet the prevalence of comorbidity combinations and their associations with inpatient service utilization and readmission have been scarcely explored. METHODS Data were extracted from discharge summaries of patients whose primary diagnosis was schizophrenia spectrum disorders (ICD-10: F20-F29). We identified 30 most frequent comorbidities in patients' secondary diagnoses and then used the association rule mining (ARM) method to derive comorbidity combinations associated with length of stay (LOS), daily expense and one-year readmission. RESULTS The study included data from 8252 patients. The top five most common comorbidities were extrapyramidal syndrome (EPS, 44.58%), constipation (31.63%), common cold (21.80%), hyperlipidemia (20.99%) and tachycardia (19.13%). Most comorbidity combinations identified by ARM were significantly associated with longer LOS (≥70 days), few were associated with higher daily expenses, and fewer with readmission. The 3-way combination of common cold, hyperlipidemia and fatty liver had the strongest association with longer LOS (adjusted OR (aOR): 3.38, 95% CI: 2.12-5.38). The combination of EPS and mild cognitive disorder was associated with higher daily expense (≥700 RMB) (aOR: 1.67, 95% CI: 1.20-2.31). The combination of constipation, tachycardia and fatty liver were associated with higher 1-year readmission (aOR: 2.05, 95% CI: 1.03-4.09). CONCLUSION EPS, constipation, and tachycardia were among the most commonly reported comorbidities in schizophrenia patients in Beijing, China. Specific groups of comorbidities may contribute to higher inpatient psychiatric service utilization and readmission. The mechanism behind the associations and potential interventions to optimize service use warrant further investigation.
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28
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Gee S, Almeida V, Hughes A, McMullen I, Taylor D. Reasons for admission to a general medical hospital for patients taking clozapine. Ther Adv Psychopharmacol 2022; 12:20451253221136753. [PMID: 36582490 PMCID: PMC9793060 DOI: 10.1177/20451253221136753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/12/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Clozapine is associated with a diverse range of side effects. In addition, patients prescribed clozapine commonly suffer with medical comorbidities. OBJECTIVES This study aimed to characterise patients prescribed clozapine who required medical admission, understand reasons for admission, identify areas for interventions to prevent future admission and describe clozapine management during the inpatient stay. DESIGN We conducted a retrospective analysis of patients prescribed clozapine who were admitted to a general medical hospital in a 12-month period. METHOD Data were collected using electronic drug charts and notes. RESULTS In total, 114 clozapine patients were hospitalised. Twenty-eight patients (25%) were admitted because of infection, 12 (11%) were elective admissions and 12 (11%) had gastrointestinal problems. Most patients admitted were Black (54%) and half were female. Few changes were made to clozapine dosing on admission or during the inpatient stay. Most patients had been taking clozapine for many years at the point of admission, the majority were able to continue taking it for the duration of their medical treatment and were discharged on the same dose they were taking prior to admission. Clozapine plasma concentrations were not consistently measured with only 18 (16%) patients having one or more plasma concentrations determined during their admission. The median clozapine plasma concentration on admission was 0.48 mg/L (nor-clozapine 0.21 mg/L), with a range of 0.09 to 3.9 mg/L. Three patients were admitted to the intensive care unit during their admission; all were discharged on clozapine. Four patients died; one from lung adenocarcinoma, one bowel obstruction, one cardiac arrest and one chest sepsis. In total, 27 patients (23%) had their clozapine stopped on admission, 6 (22% of this group) unintentionally. CONCLUSIONS Our study found that the most common reason for admission for patients taking clozapine was infection. Plasma concentrations were not measured routinely despite clozapine having a narrow therapeutic index and enhanced potential for toxicity in the medically unwell patient.
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Affiliation(s)
- Siobhan Gee
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK.,Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Vasco Almeida
- Department of Psychological Medicine, King's College Hospital, London, UK
| | - Adam Hughes
- Department of Psychological Medicine, King's College Hospital, London, UK
| | - Isabel McMullen
- Department of Psychological Medicine, King's College Hospital, London, UK
| | - David Taylor
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK.,Faculty of Life Sciences & Medicine, King's College London, London, UK
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29
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Schizophrenia Outside the Brain. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1400:53-63. [DOI: 10.1007/978-3-030-97182-3_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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30
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Heinbach M, Block AJ, Hubbard EM, Cataldo JK, Cooper BA, Leutwyler H. Impact of exergames on psychiatric symptoms in older adults with serious mental illness. Aging Ment Health 2021; 25:2229-2234. [PMID: 33081505 PMCID: PMC8459700 DOI: 10.1080/13607863.2020.1832442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Older adults with serious mental illness (SMI) are more likely to have high body mass index (BMI) and chronic conditions such as cardiovascular disease and diabetes. A sedentary lifestyle, which may be attributed to pharmacologic side effects and the symptoms of mental illness, has been difficult to treat. Patients experiencing negative symptoms (e.g. apathy, anhedonia) may be more likely to exercise in a group setting with activities that are designed to stimulate the mind and encourage engagement. "Exergames," or exercise-based videogames, are an interactive and stimulating method to provide aerobic activities. Exercise has also been shown to reduce the symptoms of depression. The purpose of this study is to evaluate the impact of a 10-week exergame program on depressive and negative symptoms in older adults with SMI. MATERIALS AND METHODS A single-group pretest posttest study was conducted with 52 older adults diagnosed with SMI. Participants engaged in group exergame activities for 50-minute sessions three times a week for 10 weeks. The Patient Reported Outcome Measurement Information System (PROMIS) and the Scale for the Assessment of Negative Symptoms (SANS) were conducted at enrollment, 5 weeks, and 10 weeks. RESULTS Participants achieved statistically significant reductions in self-reported depressive symptoms (-0.83, LL -1.46, UL -0.12) and observed negative symptoms (-5.29, LL -7.67, UL -3.14) over a 10-week period. CONCLUSIONS Our results suggest utilization of exergames as an adjunct treatment can be an effective, engaging, and cost-efficient method to reducing depressive and negative symptoms in older adults with SMI.
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Affiliation(s)
| | - Astrid J. Block
- UCSF School of Nursing, Department of Physiological Nursing, 2 Koret Way, Room N611C, 6th Floor, Campus Box 0610, San Francisco, CA 94143-0610
| | - Erin M. Hubbard
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA 94143-0610
| | - Janine K Cataldo
- UCSF Department of Physiological Nursing, 2 Koret Way, N611Q, San Francisco, CA 94143-0610
| | - Bruce A. Cooper
- UCSF Dept. of Physiological Nursing, Room N631, 2 Koret Way
- San Francisco, CA 94143-0610
| | - Heather Leutwyler
- Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way, N631A, Box 0610, San Francisco, California, 94143-0610
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Caldirola D, Daccò S, Cuniberti F, Grassi M, Lorusso S, Diaferia G, Perna G. Elevated C-reactive protein levels across diagnoses: The first comparison among inpatients with major depressive disorder, bipolar disorder, or obsessive-compulsive disorder. J Psychosom Res 2021; 150:110604. [PMID: 34521061 DOI: 10.1016/j.jpsychores.2021.110604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/14/2021] [Accepted: 08/30/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE We addressed elevated C-reactive protein level (eCRP) specificity comparing, for the first time, eCRP (i.e., serum CRP > 3 and ≤10 mg/L) in patients with major depressive disorder (MDD), bipolar disorder (BD), or obsessive-compulsive disorder (OCD). We also assessed to what extent multiple variables that can potentially increase inflammation may have influenced eCRP in our sample. METHODS We performed a retrospective, observational, cross-sectional study using information documented in the electronic medical records (EMRs) of patients hospitalized for a 4-week psychiatric rehabilitation program. We collected all information according to the standardized procedures of the hospital's clinical practice and applied a logistic regression model (α = 0.05). RESULTS We included 388 inpatients, that is, 156 (40.2%) with MDD, 135 (34.8%) with BD, and 97 (25.0%) with OCD, and found considerable eCRP rates among them (36.5%, 47.4%, and 29.9% in MDD, BD, and OCD, respectively) but without significant differences across groups. In the whole sample, eCRP variations were only partially attributable (approximately for one-third) to potential confounders. All groups presented considerable rates of cardiovascular risk factors, and we classified most patients as having medium or high CRP-based cardiovascular risk. CONCLUSION This first study comparing eCRP in MDD, BD, and OCD suggests that eCRP may be a transdiagnostic feature of different psychiatric disorders, and other mechanisms beyond the effects of multiple confounders may explain the presence of eCRP in a substantial portion of psychiatric patients. Therefore, we encourage the routine measurement of CRP in psychiatric clinical practice.
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Affiliation(s)
- Daniela Caldirola
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Via Roma 16, Albese con Cassano, 22032 Como, Italy.
| | - Silvia Daccò
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Via Roma 16, Albese con Cassano, 22032 Como, Italy
| | - Francesco Cuniberti
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Via Roma 16, Albese con Cassano, 22032 Como, Italy
| | - Massimiliano Grassi
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Via Roma 16, Albese con Cassano, 22032 Como, Italy
| | - Simona Lorusso
- Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Via Roma 16, Albese con Cassano, 22032 Como, Italy.
| | - Giuseppina Diaferia
- Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Via Roma 16, Albese con Cassano, 22032 Como, Italy.
| | - Giampaolo Perna
- Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy; Department of Clinical Neurosciences, Villa San Benedetto Menni Hospital, Hermanas Hospitalarias, Via Roma 16, Albese con Cassano, 22032 Como, Italy
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Updates in Geriatric Psychiatry. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:338-339. [PMID: 34690603 PMCID: PMC8475930 DOI: 10.1176/appi.focus.19301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Hua CL, Cornell PY, Zimmerman S, Winfree J, Thomas KS. Trends in Serious Mental Illness in US Assisted Living Compared to Nursing Homes and the Community: 2007-2017. Am J Geriatr Psychiatry 2021; 29:434-444. [PMID: 33032928 PMCID: PMC7972995 DOI: 10.1016/j.jagp.2020.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Little is known about the prevalence of serious mental illness (SMI) in assisted living (AL) communities in the United States. Trends in the prevalence of SMI in AL communities were examined over time and in relationship to characteristics such as dual eligibility and health conditions. Within- and between-state variability of SMI in AL was also examined. DESIGN Samples of Medicare beneficiaries who lived in the 48 contiguous states were created: individuals who resided in the community, in a nursing home (NH), and in an AL community on December 31st of each year (2007-2017). We conducted univariate analysis to display the trends in SMI over time in AL compared with NHs and the community. To demonstrate intrastate variability, we examined the prevalence of SMI for each state. We described within-nation and within-state variability using a Lorenz curve and GINI coefficients, respectively. RESULTS The prevalence of SMI in AL increased by 54%, rising from 7.4% in 2007 to 11.4% in 2017. Residents with SMI were more likely to be dually eligible for Medicare and Medicaid than residents without SMI. The prevalence of SMI in AL ranged from to 3.2% in Wyoming to 33.1% in New York. Approximately 10% of AL communities had over half of the sample's AL residents with SMI. CONCLUSION Given the increased proportion of residents with SMI in AL, research is needed into the mental health and social care needs of this population. Analysis is needed to uncover reasons for variations among states.
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Affiliation(s)
- Cassandra L Hua
- School of Public Health, Brown University (CLH, PYC, KST), Providence, RI.
| | - Portia Y Cornell
- School of Public Health, Brown University (CLH, PYC, KST), Providence, RI; Providence VA Medical Center (PYC, KST), Providence, RI
| | - Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research and the School of Social Work and Gillings School of Global Public Health, University of North Carolina at Chapel Hill (SZ), Chapel Hill, NC
| | - Jaclyn Winfree
- Institute on Aging, College of Urban and Public Affairs (JW), Portland State University, Portland, OR
| | - Kali S Thomas
- School of Public Health, Brown University (CLH, PYC, KST), Providence, RI; Providence VA Medical Center (PYC, KST), Providence, RI
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Horgan A, O Donovan M, Manning F, Doody R, Savage E, Dorrity C, O'Sullivan H, Goodwin J, Greaney S, Biering P, Bjornsson E, Bocking J, Russell S, Griffin M, MacGabhann L, van der Vaart KJ, Allon J, Granerud A, Hals E, Pulli J, Vatula A, Ellilä H, Lahti M, Happell B. 'Meet Me Where I Am': Mental health service users' perspectives on the desirable qualities of a mental health nurse. Int J Ment Health Nurs 2021; 30:136-147. [PMID: 32808438 DOI: 10.1111/inm.12768] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 12/15/2022]
Abstract
Nurses play a central role in the delivery of quality mental health services. Desired qualities of a mental health nurse, in particular therapeutic relationships, have been described in the literature, primarily reflecting the nursing paradigm. Service users' perspectives must be more fully understood to reflect contemporary mental health policy and to recognize their position at the centre of mental health service delivery and to directly influence and contribute their perspectives and experiences to mental health nursing education. A qualitative exploratory research project was undertaken to inform and enhance understanding of what service users see as the desired qualities of a mental health nurse. The project was co-produced by service users as experts by experience, and mental health nurse academics to ensure the service user perspective was privileged. This international project conducted in Europe and Australia included a series of focus groups with service users (n = 50). Data were analysed thematically. Being with me was a major theme identified and reflected the sub-themes: respect towards service users as persons; empathy, compassion and effective communication; understanding service users; knowledge of services; and fostering hope and believing that recovery is possible. These qualities specifically reflecting the service user perspective must be central to mental health nursing curricula to facilitate the development of holistic care and recovery-oriented practice. These findings were utilized to directly inform development of a co-produced mental health nursing learning module, to maximize genuine service user involvement, and to fully realize the benefits of service user led education for undergraduate nursing students.
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Affiliation(s)
- Aine Horgan
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Moira O Donovan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Rory Doody
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Eileen Savage
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Claire Dorrity
- School of Applied Social Sciences, University College Cork, Cork, Ireland
| | - Hazel O'Sullivan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, ENGAGE: Interdisciplinary Clinical Mental health Research Network, University College Cork, Cork, Ireland
| | - Sonya Greaney
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Pall Biering
- School of Applied Social Sciences, University College Cork, Cork, Ireland
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Julia Bocking
- ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Jarmo Pulli
- Turku University of Applied Sciences, Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Heikki Ellilä
- Turku University of Applied Sciences, Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Mari Lahti
- Turku University of Applied Sciences, Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Brenda Happell
- School of Nursing and Midwifery, Faculty of Health and Medicine, Health and Medical Research Institute, Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
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Abstract
PURPOSE OF REVIEW With more individuals reaching older ages, bipolar disorder is no longer a rare illness in the elderly. Despite the growing number of the older individuals with the illness, there are few studies that focus on bipolar disorder in the geriatric population leading to gaps in clinical knowledge and treatment. The aim of this study is therefore to increase understanding by summarizing the available literature on the epidemiology, symptomatology, comorbidities, and treatment recommendations in this cohort, as well as to suggest areas for future clinical and research focus. RECENT FINDINGS The prevalence of bipolar disorder is underestimated in the geriatric population. The illness maintains the main features observed in the other cohorts but it also has some specific characteristics in the older individuals. In this cohort, psychiatric and medical comorbidities tend to be the rule rather than the exception. Higher rates of cognitive impairments than age- and education-matched groups present across all of the illness phases. Treatment is more challenging in the elderly individuals due to higher rates of comorbidities and susceptibility to medication side effects. Two cohorts of older individuals with bipolar disorder can be recognized, those with symptoms that start earlier in life and those with late-life onset. Although the knowledge about elderly bipolar disorder is only slowly growing, it is increasingly recognized as an illness with unique features. More work is needed to improve diagnosis and to establish treatment guidelines.
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Affiliation(s)
- Ahmad Shobassy
- Department of Psychiatry, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA.
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Davidsen AS, Davidsen J, Jønsson ABR, Nielsen MH, Kjellberg PK, Reventlow S. Experiences of barriers to trans-sectoral treatment of patients with severe mental illness. A qualitative study. Int J Ment Health Syst 2020; 14:87. [PMID: 33292415 PMCID: PMC7706214 DOI: 10.1186/s13033-020-00419-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 11/19/2020] [Indexed: 01/11/2023] Open
Abstract
Background Patients with severe mental illness (SMI) have shorter life expectancy than people without SMI, mainly due to overmortality from physical diseases. They are treated by professionals in three different health and social care sectors with sparse collaboration between them, hampering coherent treatment. Previous studies have shown difficulties involved in establishing such collaboration. As the preparatory phase of an intervention to improve physical health of people with SMI and increase collaboration across sector borders, we explored different actors’ experiences of barriers for collaboration. Method We collected qualitative data from patients, professionals in general practice, psychiatry and social psychiatry involved in the treatment of these patients. Data consisted of notes from meetings and observations, interviews, focus groups and workshops. Analysis was by Interpretative Phenomenological Analysis. Results The study revealed many obstacles to collaboration and coherent treatment, including the consultation structures in general practice, sectors being subject to different legislation, and incompatible IT systems. Professionals in general practice and social psychiatry felt that they were left with the responsibility for actions taken by hospital psychiatry without opportunity to discuss their concerns with psychiatrists. There were also cultural differences between health care and social psychiatry, expressed in ideology and language. Social psychiatry had an existential approach to recovery, whereas the views of health professionals were linked to symptom control and based on outcomes. Meanwhile, patients were left in limbo between these separate ideologies with no leadership in place to promote dialogue and integrate treatments between the sectors. Conclusion Many obstacles to integrated trans-sectoral treatment of patients with SMI seem related to a lack of an overriding leadership and organizational support to establish collaboration and remove barriers related to legislation and IT. However, professional and ideological barriers also contribute. Psychiatry does not consider general practice to be part of the treatment team although general practitioners are left with responsibility for decisions taken in psychiatry; and different ideologies and treatment principles in psychiatry and municipal social psychiatry hamper the dialogue between them. There is a need to rethink the organization to avoid that the three sectors live autonomous lives with different cultures and lack of collaboration.
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Affiliation(s)
- Annette Sofie Davidsen
- Department of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Oester Farimagsgade 5, 1014, Copenhagen K, Denmark.
| | - Johan Davidsen
- Department of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Oester Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Alexandra Brandt Ryborg Jønsson
- Department of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Oester Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Maria Haahr Nielsen
- Department of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Oester Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Pia Kürstein Kjellberg
- Department of Health, VIVE-the Danish Center for Social Science Research, Herluf Trollesgade 11, 1052, Copenhagen K, Denmark
| | - Susanne Reventlow
- Department of Public Health, Section of General Practice and Research Unit for General Practice, University of Copenhagen, Oester Farimagsgade 5, 1014, Copenhagen K, Denmark
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Role of Occupational Therapy in Primary Care. Am J Occup Ther 2020; 74:7413410040p1-7413410040p16. [DOI: 10.5014/ajot.2020.74s3001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
The American Occupational Therapy Association (AOTA) affirms that occupational therapy practitioners1 are well prepared to contribute to interprofessional collaborative care teams addressing the primary care needs of individuals across the life course. Because of an increased focus on preventive population health and social determinants of health by health care organizations, synergy between primary care and occupational therapy is growing, with support for client-centered,2 comprehensive whole-person care, health promotion and prevention, disease self-management, and quality of life (Halle et al., 2018). Occupational therapy practitioners’ distinct knowledge of the significant impact that roles, habits, and routines have on health and wellness makes their contribution to primary care valuable (AOTA, 2020b). Occupational therapy’s focus on meaningful engagement in occupations is relevant and vital to participation in individual, family, and community life (AOTA, 2020c). In addition, occupational therapy practitioners’ holistic and population perspectives allow them to be effective both as interprofessional health care team members and as direct care providers to support client, family, and community needs in primary care delivery models (Leland et al., 2017). The purposes of this position paper are to define primary care and to describe occupational therapy’s evolving and advancing role in primary care, including expansion of services into specialty primary care areas such as pediatric primary care and obstetrics and gynecology (AOTA, 2018).
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Reuss CF, Hasselstrøm JB, Linnet K, Christoffersen DJ, Leth PM, Boel LWT, Banner J. Increased risk of fatal intoxication and polypharmacy among psychiatric patients at death. J Forensic Sci 2020; 66:255-264. [PMID: 33017048 DOI: 10.1111/1556-4029.14586] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 01/30/2023]
Abstract
Patients suffering from psychiatric disorders have an excess mortality and a shorter life span expectancy compared to the general population. Furthermore, they are treated with multiple drugs and are known to have an increased risk of drug abuse. In this study, we aimed at investigating the pharmaceutical drug and drug of abuse profiles of the deceased included in the Danish prospective autopsy-based forensic study on psychiatric patients, SURVIVE. Using the postmortem systematic toxicological analysis results, we identified 129 different consumed compounds in our population (n = 443). Polypharmacy (≥5 compounds) was detected in 39.5% of the deceased. Deceased with a psychiatric diagnosis or who died from a fatal intoxication had significantly more compounds at the time of their death compared to having either no psychiatric diagnosis or another cause of death, respectively. Evidence of drug abuse was present, as 29.8% of our total population had consumed either methadone or illicit drugs of abuse, excluding tetrahydrocannabinol. Of those deceased with a psychiatric diagnosis, 33.6% had either consumed methadone or illicit drugs of abuse, a greater number than those without a psychiatric diagnosis. Fatal intoxication was the most frequent cause of death (40.6%) with methadone as the major intoxicant. Here, we found that those without a psychiatric diagnosis had fewer fatal pharmaceutical drug intoxications compared to the psychiatric diagnosis groups. Our findings add further context to understanding the excess mortality of psychiatric patents, since there is an increased occurrence of fatal intoxication, polypharmacy, and drug abuse in this population.
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Affiliation(s)
- Christian Fyhn Reuss
- Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health, Aarhus University, Aarhus N, Denmark
| | - Jørgen Bo Hasselstrøm
- Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health, Aarhus University, Aarhus N, Denmark
| | - Kristian Linnet
- Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health and Medicial Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Dorte Jensen Christoffersen
- Section of Forensic Chemistry, Department of Forensic Medicine, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
| | - Peter Mygind Leth
- Section of Forensic Pathology, Department of Forensic Medicine, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark
| | - Lene Warner Thorup Boel
- Section of Forensic Pathology, Department of Forensic Medicine, Faculty of Health, Aarhus University, Aarhus N, Denmark
| | - Jytte Banner
- Section of Forensic Pathology, Department of Forensic Medicine, Faculty of Health and Medicial Sciences, University of Copenhagen, Copenhagen, Denmark
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Cook JA, Jonikas JA, Burke-Miller JK, Hamilton M, Powell IG, Tucker SJ, Wolfgang JB, Fricks L, Weidenaar J, Morris E, Powers DL. Whole Health Action Management: A Randomized Controlled Trial of a Peer-Led Health Promotion Intervention. Psychiatr Serv 2020; 71:1039-1046. [PMID: 32838676 DOI: 10.1176/appi.ps.202000012] [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: 11/30/2022]
Abstract
OBJECTIVE Adults with serious mental illness have high rates of general medical comorbidity and encounter challenges in dealing with multiple health conditions. Chronic illness self-management programs may help them more effectively cope with comorbid illnesses, especially when instructors are certified peer specialists. This study assessed the longitudinal effectiveness of a peer-delivered health promotion program. METHODS Community mental health program clients in Georgia and Illinois with serious mental illness and health impairments were randomly assigned to receive either Whole Health Action Management (WHAM), a medical illness self-management program led by peer specialists, or care as usual, resulting in a sample of N=139 (WHAM N=68, control N=71). Assessments were conducted at study baseline and at 3 and 6 months. Generalized estimating equations were used to examine change over time in the primary outcome of patient activation and secondary outcomes of general health, hope, and employment. RESULTS Longitudinal analysis indicated that compared with control participants, WHAM participants demonstrated significantly greater improvement over time in patient activation for health care. Intervention participants also demonstrated greater improvement in their self-assessed general health, overall hopefulness, and paid employment. Reactions to the WHAM program were positive, with 97% reporting being very or somewhat satisfied, and almost two-thirds (63%) reporting that their health was better than before they joined the program. CONCLUSIONS The WHAM program improved patient activation, perceived general medical health, hopefulness, and likelihood of paid employment among people with serious mental illness and co-occurring medical conditions. Results suggest that peer-delivered health self-management education is effective and well received by participants.
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Affiliation(s)
- Judith A Cook
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Wolfgang); Appalachian Consulting Group, Cleveland, Georgia (Powell, Fricks); Georgia Mental Health Consumer Network, Atlanta (Tucker); Blue Cross Blue Shield of Illinois, Chicago (Weidenaar); Howard Brown Health, Chicago (Morris); Women's Treatment Center, Chicago (Powers)
| | - Jessica A Jonikas
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Wolfgang); Appalachian Consulting Group, Cleveland, Georgia (Powell, Fricks); Georgia Mental Health Consumer Network, Atlanta (Tucker); Blue Cross Blue Shield of Illinois, Chicago (Weidenaar); Howard Brown Health, Chicago (Morris); Women's Treatment Center, Chicago (Powers)
| | - Jane K Burke-Miller
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Wolfgang); Appalachian Consulting Group, Cleveland, Georgia (Powell, Fricks); Georgia Mental Health Consumer Network, Atlanta (Tucker); Blue Cross Blue Shield of Illinois, Chicago (Weidenaar); Howard Brown Health, Chicago (Morris); Women's Treatment Center, Chicago (Powers)
| | - Marie Hamilton
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Wolfgang); Appalachian Consulting Group, Cleveland, Georgia (Powell, Fricks); Georgia Mental Health Consumer Network, Atlanta (Tucker); Blue Cross Blue Shield of Illinois, Chicago (Weidenaar); Howard Brown Health, Chicago (Morris); Women's Treatment Center, Chicago (Powers)
| | - Ike G Powell
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Wolfgang); Appalachian Consulting Group, Cleveland, Georgia (Powell, Fricks); Georgia Mental Health Consumer Network, Atlanta (Tucker); Blue Cross Blue Shield of Illinois, Chicago (Weidenaar); Howard Brown Health, Chicago (Morris); Women's Treatment Center, Chicago (Powers)
| | - Sherry Jenkins Tucker
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Wolfgang); Appalachian Consulting Group, Cleveland, Georgia (Powell, Fricks); Georgia Mental Health Consumer Network, Atlanta (Tucker); Blue Cross Blue Shield of Illinois, Chicago (Weidenaar); Howard Brown Health, Chicago (Morris); Women's Treatment Center, Chicago (Powers)
| | - Jacqueline B Wolfgang
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Wolfgang); Appalachian Consulting Group, Cleveland, Georgia (Powell, Fricks); Georgia Mental Health Consumer Network, Atlanta (Tucker); Blue Cross Blue Shield of Illinois, Chicago (Weidenaar); Howard Brown Health, Chicago (Morris); Women's Treatment Center, Chicago (Powers)
| | - Larry Fricks
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Wolfgang); Appalachian Consulting Group, Cleveland, Georgia (Powell, Fricks); Georgia Mental Health Consumer Network, Atlanta (Tucker); Blue Cross Blue Shield of Illinois, Chicago (Weidenaar); Howard Brown Health, Chicago (Morris); Women's Treatment Center, Chicago (Powers)
| | - Joni Weidenaar
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Wolfgang); Appalachian Consulting Group, Cleveland, Georgia (Powell, Fricks); Georgia Mental Health Consumer Network, Atlanta (Tucker); Blue Cross Blue Shield of Illinois, Chicago (Weidenaar); Howard Brown Health, Chicago (Morris); Women's Treatment Center, Chicago (Powers)
| | - Elliott Morris
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Wolfgang); Appalachian Consulting Group, Cleveland, Georgia (Powell, Fricks); Georgia Mental Health Consumer Network, Atlanta (Tucker); Blue Cross Blue Shield of Illinois, Chicago (Weidenaar); Howard Brown Health, Chicago (Morris); Women's Treatment Center, Chicago (Powers)
| | - Destiny L Powers
- Center on Mental Health Services Research and Policy, Department of Psychiatry, University of Illinois at Chicago, Chicago (Cook, Jonikas, Burke-Miller, Hamilton, Wolfgang); Appalachian Consulting Group, Cleveland, Georgia (Powell, Fricks); Georgia Mental Health Consumer Network, Atlanta (Tucker); Blue Cross Blue Shield of Illinois, Chicago (Weidenaar); Howard Brown Health, Chicago (Morris); Women's Treatment Center, Chicago (Powers)
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Hagen JM, Sutterland AL, Edrisy S, Tan HL, de Haan L. Accumulation rate of advanced glycation end products in recent onset psychosis: A longitudinal study. Psychiatry Res 2020; 291:113192. [PMID: 32574898 DOI: 10.1016/j.psychres.2020.113192] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/26/2022]
Abstract
Schizophrenia is associated with excessive oxidative stress. Production of advanced glycation end products (AGEs) in the skin is strongly associated with oxidative stress. Increased skin AGE-levels have been demonstrated at cross-sectional level in recent onset psychosis and chronic schizophrenia, indicating increased cardiovascular risk. We aimed to investigate factors underlying AGE-accumulation and accumulation rate of AGEs in recent onset psychosis. From December 2016 through May 2017, 66 patients and 160 (highly educated) healthy controls from a previous case-control study of AGE-levels were assessed for a follow-up measurement 12-24 months after baseline. Possible determinants of AGE-accumulation were analyzed. AGE-accumulation rates in patients and controls were compared adjusted for relevant confounders. In healthy controls, a significant association of AGE-accumulation with ethnicity and tobacco exposure was found. An indication of a markedly higher AGE-accumulation rate was found in patients suffering from recent onset psychosis compared to healthy controls, independent of ethnicity and tobacco smoking, but not independent of cannabis use (more prevalent in patients than controls), although results were not significant.
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Affiliation(s)
- Julia M Hagen
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Early Psychosis Section, Meibergdreef 5, 1105AZ Amsterdam, the Netherlands.
| | - Arjen L Sutterland
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Early Psychosis Section, Meibergdreef 5, 1105AZ Amsterdam, the Netherlands.
| | - Sarah Edrisy
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Early Psychosis Section, Meibergdreef 5, 1105AZ Amsterdam, the Netherlands
| | - Hanno L Tan
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Heart Center, Meibergdreef 9, 1105AZ Amsterdam, the Netherlands; Netherlands Heart Institute, Moreelsepark 1, 3511 EP Utrecht, the Netherlands.
| | - Lieuwe de Haan
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Early Psychosis Section, Meibergdreef 5, 1105AZ Amsterdam, the Netherlands.
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Angels and their demons. Palliat Support Care 2020; 19:123-124. [PMID: 32729448 DOI: 10.1017/s1478951520000553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Shields MC, Ritter G, Busch AB. Electronic Health Information Exchange At Discharge From Inpatient Psychiatric Care In Acute Care Hospitals. Health Aff (Millwood) 2020; 39:958-967. [PMID: 32479237 DOI: 10.1377/hlthaff.2019.00985] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
To address the complex health care needs of patients with mental illness-who commonly have co-occurring medical conditions and substance use disorders-it is critically important for providers to use electronic health records (EHRs) for health information exchange (HIE) when patients are transferred from inpatient psychiatric units in acute care hospitals. Efficient and timely HIE is necessary to ensure that patients receive adequate and informed follow-up care. This study examined the percentage of inpatient psychiatric units that reported using EHRs for HIE at transfers of care and hospital characteristics associated with that use. We linked national data from the Inpatient Psychiatric Facility Quality Reporting Program of the Centers for Medicare and Medicaid Services, the American Hospital Association Annual Survey, and state mental health privacy laws. In 2016 the use of electronic HIE upon transfer from psychiatric units lagged behind the corresponding overall use rates from acute care hospitals (56.3 percent versus 88 percent), with wide variation across states. Hospital size and accountable care organization participation were associated with electronic HIE, but a state's having mental health privacy laws more stringent than the Health Insurance Portability and Accountability Act did not. Given these results, policy efforts to incentivize the use of electronic HIE in psychiatric settings should be strengthened.
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Affiliation(s)
- Morgan C Shields
- Morgan C. Shields is a PhD candidate and NIAAA fellow at the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, in Waltham, Massachusetts, and a research assistant in the Department of Health Care Policy, Harvard Medical School, in Boston, Massachusetts
| | - Grant Ritter
- Grant Ritter is an associate research professor at the Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University
| | - Alisa B Busch
- Alisa B. Busch is an associate professor of psychiatry and health care policy at McLean Hospital and the Department of Health Care Policy, Harvard Medical School. She is also the chief medical information officer at McLean Hospital
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Ward L, Carter M. Learning how to SMILE. Improving physical and mental health through nurse education and creative practice. Nurse Educ Pract 2020; 43:102712. [PMID: 32007743 DOI: 10.1016/j.nepr.2020.102712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/29/2019] [Accepted: 01/20/2020] [Indexed: 12/13/2022]
Abstract
The purpose of this pilot study was to explore how best to prepare and support nursing undergraduate students learning in a community/primary care setting through a Student Managed Initiatives in Lifestyle Education (SMILE) project. Further to this our intention was to evaluate the ways in which students were able to apply nursing theory to the practice of identifying and responding to the health needs of vulnerable people. Using a collaborative approach and a qualitative method, this pilot study used focus group discussions to explore both the experiences of community participants and undergraduate nursing students. This project found that students were able to draw on theoretical understandings and their simulated learning experiences to support their learning in a complex, non-clinical practice setting. It also illustrates the way in which community centres and other naturalistic environments where individuals and groups meet, can provide spontaneous and rewarding opportunities for nursing students to develop and apply health promoting knowledge and skills. Shaping nursing curricula with this in mind, creates the potential for nurses to make a significant contribution to improved health outcomes for vulnerable and/or marginalised people.
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Affiliation(s)
- Louise Ward
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, 3086, Australia.
| | - Melody Carter
- Three Counties School of Nursing and Midwifery, University of Worcester, St John's Campus, Henwick Grove, Worcester, WR26AJ, UK.
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Doane MJ, Sajatovic M, Weiden PJ, O’Sullivan AK, Maher S, Bjorner JB, Sikora Kessler A, Carpenter-Conlin J, Bessonova L, Velligan DI. Antipsychotic Treatment Experiences of People with Schizophrenia: Patient Perspectives from an Online Survey. Patient Prefer Adherence 2020; 14:2043-2054. [PMID: 33149559 PMCID: PMC7604247 DOI: 10.2147/ppa.s270020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/06/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND This survey examined the experiences of people living with schizophrenia who have used oral antipsychotics (APs). METHODS Adults with self-reported physician-diagnosed schizophrenia (N=200), who were members of an online research participation panel and reported taking one or more oral APs within the last year, completed a cross-sectional online survey that focused on direct report of their experiences regarding APs (eg, symptoms, side effects, adherence). Descriptive analyses were conducted for the total survey sample and for subgroups defined a priori by experience with specific, prevalent side effects. RESULTS The mean age of the sample was 41.9 (SD=11.0) years, 50% of participants were female, and 32% were nonwhite. Overall ratings were positive for medication effectiveness and convenience but negative for side effects. While most participants reported that APs improved schizophrenia symptoms (92%), 27% reported APs as having done "more harm than good." Almost all participants (98%) reported experiencing side effects of APs, with the most common being anxiety (88%), feeling drowsy/tired (86%), and trouble concentrating (85%). Side effects frequently cited as either "extremely" or "very" bothersome were weight gain (56%), sexual dysfunction (55%), and trouble concentrating (54%). Over 80% reported that side effects had negatively impacted their work and social functioning (eg, social activities or family/romantic relationships). Since initiating treatment, 56% of respondents had stopped taking APs at some point (65% of these due to side effects). Side effects commonly reported as having led to stopping AP treatment were "feeling like a 'zombie'" (22%), feeling drowsy/tired (21%), and weight gain (20%). CONCLUSION Most participants reported improvements in schizophrenia symptoms associated with the use of APs. However, most participants also reported experiencing numerous bothersome side effects that negatively impacted their work, social functioning, and treatment adherence. Results highlight the unmet need for new APs with favorable benefit-risk profiles.
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Affiliation(s)
| | - Martha Sajatovic
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | | | | | | | | | | | - Leona Bessonova
- Alkermes, Inc, Waltham, MA, USA
- Correspondence: Leona Bessonova Alkermes, Inc, 852 Winter Street, Waltham, MA, USATel +1 781 609 6439 Email
| | - Dawn I Velligan
- The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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45
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Outcomes in Trauma Patients With Behavioral Health Disorders. J Surg Res 2019; 244:425-429. [DOI: 10.1016/j.jss.2019.06.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/07/2019] [Accepted: 06/14/2019] [Indexed: 11/20/2022]
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Happell B, Waks S, Bocking J, Horgan A, Manning F, Greaney S, Goodwin J, Scholz B, van der Vaart KJ, Allon J, Hals E, Granerud A, Doody R, MacGabhann L, Russell S, Griffin M, Lahti M, Ellilä H, Pulli J, Vatula A, Platania-Phung C, Bjornsson E, Biering P. "I felt some prejudice in the back of my head": Nursing students' perspectives on learning about mental health from "Experts by Experience". J Psychiatr Ment Health Nurs 2019; 26:233-243. [PMID: 31220380 DOI: 10.1111/jpm.12540] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/26/2019] [Accepted: 06/18/2019] [Indexed: 01/10/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Consumer participation in mental health services is embedded in mental health policy in many countries. The negative attitudes of nurses and other health professionals to consumer participation poses a significant obstacle to this policy goal Involving mental health "Experts by Experience" in the education of nursing students demonstrates positive attitudinal change WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: More detailed understanding of nursing students' experiences and perspectives about being taught mental health nursing by "Experts by Experience" An international focus, extending understandings about how Experts by Experience might be perceived in a broader range of countries WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Positive attitudes towards people labelled with mental illness are essential for quality nursing practice Nurses have an important leadership role in facilitating consumer participation within health services. It is critical that their attitudes are professional and optimistic. ABSTRACT: Introduction Consumer participation is central to mental health policy. Negative attitudes of health professionals are barriers to realizing policy goals. Evidence suggests consumers (Experts by Experience) can influence positive attitudes in nursing students. Research in this area to date is limited and primarily from Australia and New Zealand. Aim To enhance understanding of nursing students' perspectives and experiences of being taught mental health by an Expert by Experience. Method A qualitative exploratory approach was used. Focus groups were conducted with nursing students from seven universities in Australia and Europe. Data were analysed thematically. Results Student participants described how exposure to Experts by Experience challenged their views and attitudes and provided a mechanism for reflection, critique and change. The main theme "changing mindset" includes two subthemes: exposing stereotypes and reflection. Discussion This unique international study demonstrates the capacity for Experts by Experience to contribute to positive attitudinal change towards mental illness in nursing students. This changed mindset must occur for policy goals to be realized. Implications for practice Nurses in all areas of practice will work with people labelled with mental illness and experiencing mental distress. Overcoming stereotypes and adopting more positive attitudes is essential to deliver quality mental health care.
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Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Shifra Waks
- The University of Melbourne, Parkville, Victoria, Australia
| | - Julia Bocking
- Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Aine Horgan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sonya Greaney
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Canberra, Australian Capital Territory, Australia
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Rory Doody
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Liam MacGabhann
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Heikki Ellilä
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Jarmo Pulli
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Turku, Finland.,Department of Nursing Science, Faculty of Medicine, Turku University, Turku, Finland
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
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47
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Happell B, Waks S, Bocking J, Horgan A, Manning F, Greaney S, Goodwin J, Scholz B, van der Vaart KJ, Allon J, Granerud A, Hals E, Doody R, Russell S, Griffin M, MacGabhann L, Lahti M, Ellilä H, Pulli J, Vatula A, Platania-Phung C, Bjornsson E, Biering P. 'There's more to a person than what's in front of you': Nursing students' experiences of consumer taught mental health education. Int J Ment Health Nurs 2019; 28:950-959. [PMID: 30953420 DOI: 10.1111/inm.12596] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2019] [Indexed: 10/27/2022]
Abstract
Holistic and person-centred nursing care is commonly regarded as fundamental to nursing practice. These approaches are complementary to recovery which is rapidly becoming the preferred mode of practice within mental health. The willingness and ability of nurses to adopt recovery-oriented practice is essential to services realizing recovery goals. Involving consumers (referred herein as Experts by Experience) in mental health nursing education has demonstrated positive impact on the skills and attitudes of nursing students. A qualitative exploratory research project was undertaken to examine the perspectives of undergraduate nursing students to Expert by Experience-led teaching as part of a co-produced learning module developed through an international study. Focus groups were held with students at each site. Data were analysed thematically. Understanding the person behind the diagnosis was a major theme, including subthemes: person-centred care/seeing the whole person; getting to know the person, understanding, listening; and challenging the medical model, embracing recovery. Participants described recognizing consumers as far more than their psychiatric diagnoses, and the importance of person-centred care and recovery-oriented practice. Understanding the individuality of consumers, their needs and goals, is crucial in mental health and all areas of nursing practice. These findings suggest that recovery, taught by Experts by Experience, is effective and impactful on students' approach to practice. Further research addressing the impact of Experts by Experience is crucial to enhance our understanding of ways to facilitate the development of recovery-oriented practice in mental health and holistic and person-centred practice in all areas of health care.
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Affiliation(s)
- Brenda Happell
- School of Nursing and Midwifery, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Shifra Waks
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Julia Bocking
- Medical School, Australian National University, Acton, Canberra, Australian Capital Territory, Australia.,Faculty of Health, University of Canberra, University Drive, Bruce, Australian Capital Territory, Australia
| | - Aine Horgan
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Fionnuala Manning
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sonya Greaney
- Southern Area Mental Health Services, School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Goodwin
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Brett Scholz
- ANU Medical School, College of Health and Medicine, The Australian National University, Woden, Canberra, Australia
| | | | - Jerry Allon
- Institute for Nursing Studies, University of Applied Sciences Utrecht, Utrecht, The Netherlands
| | - Arild Granerud
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Elisabeth Hals
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Hedmark, Norway
| | - Rory Doody
- Area Lead for Mental Health Engagement, Southern Area Health Service Executive, School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Siobhan Russell
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Martha Griffin
- School of Nursing & Human Sciences, Dublin City University, Dublin, Ireland
| | - Liam MacGabhann
- Mental Health Practice, Healthy Living Centre, Dublin City University, Dublin, Ireland
| | - Mari Lahti
- Turku University of Applied Sciences, Turku, Finland.,Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Heikki Ellilä
- Turku University of Applied Sciences, Turku, Finland.,Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Jarmo Pulli
- Turku University of Applied Sciences, Turku, Finland.,Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Annaliina Vatula
- Turku University of Applied Sciences, Turku, Finland.,Faculty of Medicine, Department of Nursing Science, Turku University, Turku, Finland
| | - Chris Platania-Phung
- School of Nursing and Midwifery, University of Newcastle, University Drive, Callaghan, New South Wales, Australia
| | - Einar Bjornsson
- Department of Nursing, University of Iceland, Reykjavik, Iceland
| | - Pall Biering
- Department of Nursing, University of Iceland, Reykjavik, Iceland
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Mohamed MO, Rashid M, Farooq S, Siddiqui N, Parwani P, Shiers D, Thamman R, Gulati M, Shoaib A, Chew-Graham C, Mamas MA. Acute Myocardial Infarction in Severe Mental Illness: Prevalence, Clinical Outcomes, and Process of Care in U.S. Hospitalizations. Can J Cardiol 2019; 35:821-830. [PMID: 31292080 DOI: 10.1016/j.cjca.2019.04.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/25/2019] [Accepted: 04/25/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Severe mental illness (SMI) is associated with increased cardiovascular mortality. We sought to examine the prevalence, clinical outcomes, and management strategy of patients with SMI presenting with acute myocardial infarction (AMI). METHODS All AMI hospitalizations from the National Inpatient Sample were included, stratified by mental health status into 5 groups: no SMI, schizophrenia, other non-organic psychoses (ONOP), bipolar disorder, and major depression. Regression analyses were performed to assess the association (adjusted odds ratios [ORs], P ≤ 0.001 for all outcomes) between SMI subtypes and clinical outcomes. RESULTS Of 6,968,777 AMI hospitalizations between 2004 and 2014, 439,544 patients (6.5%) had an SMI diagnosis. Although patients with schizophrenia and ONOP experienced higher crude rates of in-hospital mortality and stroke compared with those without SMI, only schizophrenic patients were at increased odds of mortality (OR, 1.10; 95% confidence interval [CI], 1.04-1.16), whereas ONOP was the only group at increased odds of stroke (OR, 1.53; 95% CI, 1.42-1.65) after multivariate adjustment. Patients with ONOP were the only group associated with increased odds of in-hospital bleeding compared with those without SMI (OR, 1.11; 95% CI, 1.04-1.17). All those with SMI subtypes were less likely to receive coronary angiography and percutaneous coronary intervention, with the schizophrenia group being at least odds of either procedure (OR, 0.46; 95% CI, 0.45-0.48 and OR, 0.57; 95% CI, 0.55-0.59, respectively). CONCLUSION Schizophrenia and ONOP are the only SMI subtypes associated with adverse clinical outcomes after AMI. However, all patients with SMI were less likely to receive invasive management for AMI, with female gender and schizophrenia diagnosis being the strongest predictors of conservative management. A multidisciplinary approach between psychiatrists and cardiologists could improve the outcomes of this high-risk population.
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Affiliation(s)
- Mohamed Osama Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Saeed Farooq
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom; Midlands Partnership NHS Foundation Trust, Staffordshire, United Kingdom
| | - Nishat Siddiqui
- Nevill Hall Hospital, Aneurin Bevan University Health Board, Wales, United Kingdom
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, California, USA
| | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Ritu Thamman
- Department of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Martha Gulati
- Division of Cardiology, University of Arizona, Phoenix, Arizona, USA
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Carolyn Chew-Graham
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom; Midlands Partnership NHS Foundation Trust, Staffordshire, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom.
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Abstract
Schizophrenia is often accompanied by somatic comorbidities, which make the management challenge of such patients more difficult. In this study, we proposed to identify the sociodemographic and clinical factors correlating with somatic comorbidities in patients with schizophrenia to facilitate screening and prevention. It was a retrospective descriptive study of 78 schizophrenia patients in clinical remission and followed in outpatient psychiatry. In addition to the acquired records, other data were provided by the clinical and biological examinations performed for each patient. The evaluation of the therapeutic adherence was carried out using the Drug Attitude Inventory (DAI).Seventy-six patients (97.4%) had somatic comorbidities with a mean of 3.83 (± 1.81). This number increased significantly in males, older patients, couples, urban patients, and those receiving a combination therapy. According to a multivariate study, the four predictors of an increased risk of comorbidities were age, use of psychoactive substances, waist size and therapeutic adherence.Our findings focus on somatic comorbidities risk in schizophrenia patients, requiring particular vigilance in their follow-up, and suggest some modifiable clinical factors that might be a preferred target for reducing or preventing the occurrence of such disorders.
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50
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Happell B, Scholz B, Bocking J, Platania-Phung C. Promoting the Value of Mental Health Nursing: The Contribution of a Consumer Academic. Issues Ment Health Nurs 2019; 40:140-147. [PMID: 30763139 DOI: 10.1080/01612840.2018.1490834] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Mental illness is known to occur frequently in the general population and is more common within the general health care system. High-quality health care requires nurses to have the skills, knowledge and attitudes to provide care for people experiencing mental illness or mental distress. Research suggests health professionals, including nurses, tend to share similar negative attitudes to mental illness as the general population, and consequently, mental health nursing is not a popular career path. These two factors signify a need to influence more positive attitudes toward mental illness and mental health nursing among nursing students. A qualitative exploratory research study was undertaken to examine the experiences, opinions and attitudes of an academic and research team to the introduction of a consumer academic within an undergraduate mental health nursing subject. In-depth interviews were conducted with teaching and research team members. The importance of mental health skills emerged as a major theme and included sub-themes: mental health across the health care system; contribution of consumer academic to nursing skills; addressing fear and stigma, and inspiring passion in mental health nursing. Findings suggest academic input from people with lived experience of recovery from mental illness can influence the development of mental health nursing skills and enhance the popularity of mental health nursing as a career.
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Affiliation(s)
- Brenda Happell
- a School of Nursing and Midwifery, University of Newcastle , Newcastle , New South Wales , Australia
| | - Brett Scholz
- b ANU Medical School, College of Health and Medicine, The Australian National University , Woden , Canberra , Australia
| | - Julia Bocking
- c Consumer Academic , University of Canberra, Faculty of Health, and ACT Health , Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Chris Platania-Phung
- a School of Nursing and Midwifery, University of Newcastle , Newcastle , New South Wales , Australia
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