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Zhong M, Liu Z, Wang F, Yang J, Chen E, Lee E, Wu G, Yang J. Effects of long-term antipsychotic medication on brain instability in first-episode schizophrenia patients: a resting-state fMRI study. Front Pharmacol 2024; 15:1387123. [PMID: 38846088 PMCID: PMC11153814 DOI: 10.3389/fphar.2024.1387123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 05/02/2024] [Indexed: 06/09/2024] Open
Abstract
Early initiation of antipsychotic treatment plays a crucial role in the management of first-episode schizophrenia (FES) patients, significantly improving their prognosis. However, limited attention has been given to the long-term effects of antipsychotic drug therapy on FES patients. In this research, we examined the changes in abnormal brain regions among FES patients undergoing long-term treatment using a dynamic perspective. A total of 98 participants were included in the data analysis, comprising 48 FES patients, 50 healthy controls, 22 patients completed a follow-up period of more than 6 months with qualified data. We processed resting-state fMRI data to calculate coefficient of variation of fractional amplitude of low-frequency fluctuations (CVfALFF), which reflects the brain regional activity stability. Data analysis was performed at baseline and after long-term treatment. We observed that compared with HCs, patients at baseline showed an elevated CVfALFF in the supramarginal gyrus (SMG), parahippocampal gyrus (PHG), caudate, orbital part of inferior frontal gyrus (IOG), insula, and inferior frontal gyrus (IFG). After long-term treatment, the instability in SMG, PHG, caudate, IOG, insula and inferior IFG have ameliorated. Additionally, there was a positive correlation between the decrease in dfALFF in the SMG and the reduction in the SANS total score following long-term treatment. In conclusion, FES patients exhibit unstable regional activity in widespread brain regions at baseline, which can be ameliorated with long-term treatment. Moreover, the extent of amelioration in SMG instability is associated with the amelioration of negative symptoms.
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Affiliation(s)
- Maoxing Zhong
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhening Liu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Feiwen Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jun Yang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Eric Chen
- Department of Psychiatry, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Edwin Lee
- Department of Psychiatry, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Guowei Wu
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Jie Yang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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Healthy choices, healthy changes: A randomized trial of incentives to promote healthy eating and exercise in people with schizophrenia and other serious mental illnesses. Schizophr Res 2023; 255:1-8. [PMID: 36933290 DOI: 10.1016/j.schres.2023.03.007] [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: 02/09/2022] [Revised: 01/12/2023] [Accepted: 03/03/2023] [Indexed: 03/20/2023]
Abstract
INTRODUCTION People with schizophrenia and other serious mental illnesses (SMI) represent a concerning health disparity population, with 10-30 fewer years of life compared to the general population, mainly from high rates of cardiovascular disease (CVD). Preventing CVD is possible with exercise and diet interventions, but only 50 % of participants in clinical trials achieve reduction in CVD risk. This study assessed whether cash incentives improved weight loss, cardiovascular endurance, and/or mortality risk when added to one of four healthy lifestyle programs (gym membership, Weight Watchers membership, the InSHAPE program, InSHAPE + Weight Watchers). METHODS From 2012 to 2015, 1348 overweight or obese adults with SMI enrolled in a study using equipoise stratified randomization. Participants were randomly assigned to intervention, then to cash incentives, or not, for participation (gym and/or Weight Watchers), with baseline and quarterly assessments for 12 months. We examined effects of the interventions, key covariates, and incentives, using generalized linear models. RESULTS Main effects of randomization to receive cash incentives was not significant for any outcome; whereas total amount of incentives was significantly associated with all three primary outcomes (weight loss, cardiovascular endurance, mortality risk), mainly for participants in the InSHAPE+WW group who received additional cash incentives. CONCLUSIONS Incentives may be effective at preventing CVD and improving health outcomes for people with SMI, especially in the context of intensive support for healthy lifestyle behaviors. Policy changes are required to increase access to healthy lifestyle programming and more research is needed to establish the optimal amount of incentives for people with SMI. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02515981.
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Oh J, Oh J, Kim DW, Youn H, Kim SH, Kim SI, Chung IW, Wang KS, Kim M, Paik JW, Koh MJ, Lee Y, Choi SY, Kim JJ. Effects of Long-acting Injectable 3-Monthly Paliperidone Palmitate on the Clinical and Social Performance of Patients with Schizophrenia. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2023; 21:126-134. [PMID: 36700319 PMCID: PMC9889906 DOI: 10.9758/cpn.2023.21.1.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 01/27/2023]
Abstract
Objective To investigate the effects of long-acting injectable 3-monthly paliperidone palmitate on the clinical and social functioning of patients with schizophrenia. Methods This study enrolled patients with schizophrenia receiving long-acting injectable 1-monthly paliperidone palmitate for at least 4 months and who subsequently received 3-monthly paliperidone palmitate. Accordingly, 418 patients were followed up for 24 weeks. Their clinical symptoms and social functioning were measured using the Clinical Global Impression-Severity of Illness and Personal and Social Performance scales. Results The Personal and Social Performance total score was significantly higher after 3-monthly paliperidone palmitate treatment than at baseline (baseline vs. week 24: 54.3 ± 18.0 vs. 61.0 ± 14.5 [mean ± standard deviation]; p < 0.001; Wilcoxon signed-rank test); the proportion of patients in the mildly ill group (scores 71-100) also increased significantly (baseline vs. week 24: 16.5% vs. 20.6%; p < 0.001; McNemar-Bowker test). The mean Clinical Global Impression-Severity of Illness score decreased significantly (baseline vs. week 24: 3.7 ± 1.0 vs. 3.4 ± 0.9; p < 0.001; Wilcoxon signed-rank test), as did the proportion of patients in the severely ill group (baseline vs. week 24: 4.1% vs. 2.1%; p < 0.001; McNemar-Bowker test). Conclusion Continuous 3-monthly paliperidone palmitate treatment significantly enhances the personal and social performance of patients with schizophrenia and reduces the proportion of those with severe illness. These findings suggest that long-acting injectable antipsychotic administration at intervals longer than 1 month might improve the social functioning of and promote return to activities of daily living in patients with schizophrenia.
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Affiliation(s)
- Jihoon Oh
- Department of Psychiatry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jihye Oh
- Department of Psychiatry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | | | - HyunChul Youn
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | | | - Soo In Kim
- Department of Psychiatry, Ewha Womans University College of Medicine, Seoul, Korea
| | - In Won Chung
- Institute of Spirituality and Mental Health, St. Andrew’s Hospital, Icheon, Korea
| | - Kuan Shu Wang
- Department of Psychiatry, Maryknoll Medical Center, Busan, Korea
| | - Minah Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Korea
| | - Jong-Woo Paik
- Department of Psychiatry, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| | | | - Yoosun Lee
- Medical Affairs, Janssen Korea, Seoul, Korea
| | | | - Jung-Jin Kim
- Department of Psychiatry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea,Address for correspondence: Jung-Jin Kim Department of Psychiatry, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea, E-mail: , ORCID: https://orcid.org/0000-0003-3899-5579
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Short-term Medication Effects on Brain Functional Activity and Network Architecture in First-Episode psychosis: a longitudinal fMRI study. Brain Imaging Behav 2023; 17:137-148. [PMID: 36646973 DOI: 10.1007/s11682-022-00704-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/17/2022] [Accepted: 07/04/2022] [Indexed: 01/18/2023]
Abstract
The effect of antipsychotic medications is critical for the long-term outcome of symptoms and functions during first-episode psychosis (FEP). However, how brain functions respond to the antipsychotic treatment in the early stage of psychosis and its underlying neural mechanisms remain unclear. In this study, we explored the cross-sectional and longitudinal changes of regional homogeneity (ReHo), whole-brain functional connectivity, and network topological properties via resting-state functional magnetic resonance images. Thirty-two drug-naïve FEP patients and 30 matched healthy volunteers (HV) were included, where 23 patients were re-visited with effective responses after two months of antipsychotic treatment. Compared to HV, drug-naive patients demonstrated significantly different patterns of functional connectivity involving the right thalamus. These functional alterations mainly involved decreased ReHo, increased nodal efficiency in the right thalamus, and increased thalamic-sensorimotor-frontoparietal connectivity. In the follow-up analysis, patients after treatment showed reduced ReHo and nodal clustering in visual networks, as well as disturbances of visual-somatomotor and hippocampus-superior frontal gyrus connectivity. The longitudinal changes of ReHo in the visual cortex were associated with an improvement in general psychotic symptoms. This study provides new evidence regarding alterations in brain function linked to schizophrenia onset and affected by antipsychotic medications. Moreover, our results demonstrated that the functional alterations at baseline were not fully modulated by antipsychotic medications, suggesting that antipsychotic medications may reduce psychotic symptoms but limit the effects in regions involved in disease pathophysiology.
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Mo PKH, So GYK, Lu Z, Mak WWS. The Mediating Role of Health-Promoting Behaviors on the Association between Symptom Severity and Quality of Life among Chinese Individuals with Mental Illness: A Cross-Sectional Study. Psychopathology 2022; 56:194-205. [PMID: 35901786 DOI: 10.1159/000525495] [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: 06/25/2021] [Accepted: 05/06/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Research has shown that people with mental illnesses (PMI) are found to show poorer lifestyle than the general population. Yet, the effect of their psychiatric symptoms in the association between gender difference, health-promoting behaviors, and quality of life have received little attention. The present study examined the association between symptom severity, health-promoting behaviors, and quality of life among PMI in Hong Kong. Gender difference on the association between these variables was also examined. METHOD A cross-sectional survey was conducted among 591 individuals with DSM-IV-TR Axis 1 diagnosis recruited from the community. RESULTS Results from MANOVA showed that PMI with more severe psychiatric symptoms engaged in a significantly lower level of health-promoting behaviors and reported a lower level of quality of life. Results from structural equation modeling showed that health-promoting behaviors mediated the association between psychiatric symptoms and quality of life. Multigroup analyses showed that the association between psychiatric symptoms and health-promoting behaviors was stronger among female participants, while the association between health-promoting behaviors and quality of life was stronger among male participants. DISCUSSION/CONCLUSION Despite clear evidence suggesting symptom severity to be negatively correlated with quality of life, the underlying mechanism has been less clear. There is a need to promote health-promoting behaviors in order to improve the quality of life of PMI. Gender-specific interventions are warranted.
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Affiliation(s)
- Phoenix K H Mo
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Georgina Y K So
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Zhihui Lu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
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Rossom RC, Crain AL, O’Connor PJ, Waring SC, Hooker SA, Ohnsorg K, Taran A, Kopski KM, Sperl-Hillen JM. Effect of Clinical Decision Support on Cardiovascular Risk Among Adults With Bipolar Disorder, Schizoaffective Disorder, or Schizophrenia: A Cluster Randomized Clinical Trial. JAMA Netw Open 2022; 5:e220202. [PMID: 35254433 PMCID: PMC8902652 DOI: 10.1001/jamanetworkopen.2022.0202] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Adults with schizophrenia, schizoaffective disorder, or bipolar disorder, collectively termed serious mental illness (SMI), have shortened life spans compared with people without SMI. The leading cause of death is cardiovascular (CV) disease. OBJECTIVE To assess whether a clinical decision support (CDS) system aimed at primary care clinicians improves CV health for adult primary care patients with SMI. DESIGN, SETTING, AND PARTICIPANTS In this cluster randomized clinical trial conducted from March 2, 2016, to September 19, 2018, restricted randomization assigned 76 primary care clinics in 3 Midwestern health care systems to receive or not receive a CDS system aimed at improving CV health among patients with SMI. Eligible clinics had at least 20 patients with SMI; clinicians and their adult patients with SMI with at least 1 modifiable CV risk factor not at the goal set by the American College of Cardiology/American Heart Association guidelines were included. Statistical analysis was conducted on an intention-to-treat basis from January 10, 2019, to December 29, 2021. INTERVENTION The CDS system assessed modifiable CV risk factors and provided personalized treatment recommendations to clinicians and patients. MAIN OUTCOMES AND MEASURES Patient-level change in total modifiable CV risk over 12 months, summed from individual modifiable risk factors (smoking, body mass index, low-density lipoprotein cholesterol level, systolic blood pressure, and hemoglobin A1c level). RESULTS A total of 80 clinics were randomized; 4 clinics were excluded for having fewer than 20 eligible patients, leaving 42 intervention clinics and 34 control clinics. A total of 8937 patients with SMI (4922 women [55.1%]; mean [SD] age, 48.4 [13.5] years) were enrolled. There was a 4% lower rate of increase in total modifiable CV risk among intervention patients relative to control patients (relative rate ratio [RR], 0.96; 95% CI, 0.94-0.98). The intervention favored patients who were 18 to 29 years of age (RR, 0.89; 95% CI, 0.81-0.98) or 50 to 59 years of age (RR, 0.93; 95% CI, 0.90-0.96), Black (RR, 0.93; 95% CI, 0.88-0.98), or White (RR, 0.96; 95% CI, 0.94-0.98). Men (RR, 0.96; 95% CI, 0.94-0.99) and women (RR, 0.95; 95% CI, 0.92-0.97), as well as patients with any SMI subtype (bipolar disorder: RR, 0.96; 95% CI, 0.94-0.99; schizoaffective disorder: RR, 0.94; 95% CI, 0.90-0.98; schizophrenia: RR, 0.92; 95% CI, 0.85-0.99) also benefited from the intervention. Despite treatment effects favoring the intervention, there were no significant differences in individual modifiable risk factors. CONCLUSIONS AND RELEVANCE This CDS intervention resulted in a rate of change in total modifiable CV risk that was 4% lower among intervention patients compared with control patients. Results were driven by the cumulative effects of incremental and mostly nonsignificant changes in individual modifiable risk factors. These findings emphasize the value of using CDS to prompt early primary care intervention for adults with SMI. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02451670.
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Affiliation(s)
- Rebecca C. Rossom
- Department of Research, HealthPartners Institute, Minneapolis, Minnesota
| | - A. Lauren Crain
- Department of Research, HealthPartners Institute, Minneapolis, Minnesota
| | | | - Stephen C. Waring
- Essentia Health and Essentia Institute of Rural Health, Duluth, Minnesota
| | | | - Kris Ohnsorg
- Department of Research, HealthPartners Institute, Minneapolis, Minnesota
| | - Allise Taran
- Essentia Health and Essentia Institute of Rural Health, Duluth, Minnesota
| | - Kristen M. Kopski
- Park Nicollet Health Services, Minneapolis, Minnesota
- Now with Medica Health Plan, Minnetonka, Minnesota
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Johnson FR, Gonzalez JM, Yang JC, Ozdemir S, Kymes S. Who Would Pay Higher Taxes for Better Mental Health? Results of a Large-Sample National Choice Experiment. Milbank Q 2021; 99:771-793. [PMID: 34375477 PMCID: PMC8452366 DOI: 10.1111/1468-0009.12523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Policy Points Public funding for mental health programs must compete with other funding priorities in limited state budgets. Valuing state‐funded mental health programs in a policy‐relevant context requires consideration of how much benefit from other programs the public is willing to forgo to increase mental health program benefits and how much the public is willing to be taxed for such program benefits. Taxpayer resistance to increased taxes to pay for publicly funded mental health programs and perceived benefits of such programs vary with state population size. In all states, taxpayers seem to support increased public funding for mental health programs such as state Medicaid services, suggesting such programs are underfunded from the perspective of the average taxpayer.
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Ceccarelli F, Mahmoud M. Multimodal temporal machine learning for Bipolar Disorder and Depression Recognition. Pattern Anal Appl 2021. [DOI: 10.1007/s10044-021-01001-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Nguyen L, Sharma B, Newton R. Rapid response calls in inpatient psychiatric units. Australas Psychiatry 2021; 29:309-314. [PMID: 33297748 DOI: 10.1177/1039856220975590] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the rates of serious medical issues on psychiatry wards by determining the rate, indication and outcomes of rapid response calls. METHOD Using retrospective file review, information regarding rapid response calls during an 8-month period was analysed. RESULTS Seventy-two rapid response calls were recorded; 7.5% of the admissions involved a rapid response call. Of patients who required a rapid response call, 88.6% had medical comorbidities. Also, 29.2% of rapid response calls required transfer to another ward. CONCLUSIONS Patients on psychiatry wards frequently require urgent medical intervention. Improved collaboration and service planning between general medical and psychiatric service is required to improve clinical care and outcomes for this high-risk group.
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Affiliation(s)
| | | | - Richard Newton
- Monash University Central Clinical School Division of Clinical Sciences, VIC, Australia.,Peninsula Health, VIC, Australia
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Lin T, Farber BA. Trajectories of depression in psychotherapy: How client characteristics predict clinical improvement. J Clin Psychol 2021; 77:1354-1370. [PMID: 33538344 DOI: 10.1002/jclp.23119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 12/18/2020] [Accepted: 01/20/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The current study aims to ascertain the trajectories of psychotherapy clients' symptom change and identify client factors that predict treatment outcome. METHOD We conducted a latent growth mixture model (LGMM) to identify the change trajectories of 44 clients' depression scores during psychotherapy. Client characteristics were then explored to determine whether any were associated with change trajectories. We examined whether the number of physician visits and/or client self-concealment scores predict 63 clients' improvement after controlling for initial symptom severity. RESULTS Two trajectories of clients' symptom change were identified: nonimprovers (52.3%) and improvers (47.7%). Nonimprovers had higher levels of self-concealment and baseline depression than improvers. The number of physician visits was associated with higher depression scores at baseline and greater clinical improvement during psychotherapy. CONCLUSION Clients showed distinct trajectories of symptom change in psychotherapy. Early identification of clients at risk for treatment failure may increase the probability of therapeutic success.
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Affiliation(s)
- Tao Lin
- Department of Psychology, Ohio University, Athens, Ohio, USA
| | - Barry A Farber
- Teachers College, Columbia University, New York, New York, USA
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Fattahi C, Hamada K, Chiang M, Kosuru S, Polavarapu M, Sitthichai R, Fan X. A narrative review of mindfulness-based therapy for schizophrenia, co-occurring substance use and comorbid cardiometabolic problems. Psychiatry Res 2021; 296:113707. [PMID: 33421838 DOI: 10.1016/j.psychres.2021.113707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 01/01/2021] [Indexed: 10/22/2022]
Abstract
Mindfulness-based therapy (MBT) has gained attention in recent years as a promising treatment for patients with schizophrenia for whom traditional interventions are not effective. Research demonstrates improvements in psychotic symptoms, emotion regulation, and other areas including re-hospitalization rates and insight into illness following MBT interventions. Yet MBT studies have not carefully reported results in patients with schizophrenia and co-occurring substance use or comorbid medical problems, bringing into question the generalizability of these findings. This narrative review explores the literature regarding the use of mindfulness-based interventions for patients with schizophrenia as well as for patients with substance use disorder, cardiovascular disease, obesity, and diabetes. Findings suggest that MBTs can improve craving in substance use disorder, eating related behaviors in obesity, diabetes-related distress, and metabolic regulation in patients with diabetes. Increased insula and anterior cingulate cortex volumes and activities following MBTs might be associated with the potential benefit of MBTs in patients with schizophrenia. Our review provides a foundational basis in support of the need for future studies evaluating the safety and efficacy of MBTs for schizophrenia with co-occurring substance use disorder and/or comorbid cardiometabolic problems.
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Affiliation(s)
- Cameron Fattahi
- UMass Memorial Health Care/University of Massachusetts Medical School, Worcester, MA, 01605, United States
| | - Kareem Hamada
- UMass Memorial Health Care/University of Massachusetts Medical School, Worcester, MA, 01605, United States
| | - Mathew Chiang
- UMass Memorial Health Care/University of Massachusetts Medical School, Worcester, MA, 01605, United States
| | - Sindu Kosuru
- UMass Memorial Health Care/University of Massachusetts Medical School, Worcester, MA, 01605, United States
| | - Mona Polavarapu
- UMass Memorial Health Care/University of Massachusetts Medical School, Worcester, MA, 01605, United States
| | - Rangsun Sitthichai
- UMass Memorial Health Care/University of Massachusetts Medical School, Worcester, MA, 01605, United States
| | - Xiaoduo Fan
- UMass Memorial Health Care/University of Massachusetts Medical School, Worcester, MA, 01605, United States.
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Brown A, Alas H, Bortz C, Pierce KE, Vasquez-Montes D, Ihejirika RC, Segreto FA, Haskel J, Kaplan DJ, Segar AH, Diebo BG, Hockley A, Gerling MC, Passias PG. Patients with psychiatric diagnoses have increased odds of morbidity and mortality in elective orthopedic surgery. J Clin Neurosci 2020; 84:42-45. [PMID: 33485597 DOI: 10.1016/j.jocn.2020.11.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 10/28/2020] [Accepted: 11/28/2020] [Indexed: 11/29/2022]
Abstract
Psychiatric diagnoses (PD) present a significant burden on elective surgery patients and may have potentially dramatic impacts on outcomes. As ailments of the spine can be particularly debilitating, the effect of PD on outcomes was compared between elective spine surgery patients and other common elective orthopedic surgery procedures. This study included 412,777 elective orthopedic patients who were concurrently diagnosed with PD within the years 2005 to 2016. 30.2% of PD patients experienced a post-operative complication, compared to 25.1% for non-PD patients (p < 0.001). Mood Disorders (bipolar or depressive disorders) were the most commonly diagnosed PD for all elective Orthopedic procedures, followed by anxiety, then dementia (p < 0.001). Logistic regression analysis found PD to be a significant predictor of higher cost to charge ratio (CCR), length of stay (LOS), and death (all p < 0.001). Between, hand, elbow, and shoulder specialties, spine patients had the highest odds of increased CCR and unfavorable discharge, and the second highest odds of death (all p < 0.001).
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Affiliation(s)
- Avery Brown
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Haddy Alas
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Cole Bortz
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Katherine E Pierce
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Dennis Vasquez-Montes
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Rivka C Ihejirika
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Frank A Segreto
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA
| | - Jonathan Haskel
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Daniel James Kaplan
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Anand H Segar
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Aaron Hockley
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Michael C Gerling
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Peter G Passias
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, New York, NY, USA.
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Brito ME, Sampaio IM, Ferreira AC, Lorencetti PG, Celeri EHRV, Azevedo RCS, Noto CS, Gadelha A, Chaim FDM, Cazzo E, Ramos AC, Velloso LA, Chaim EA, Dalgalarrondo P, Dos Santos-Júnior A. Patients with Schizophrenia Undergoing Gastric Bypass Surgery: a Case Series Study. Obes Surg 2020; 30:3813-3821. [PMID: 32451918 DOI: 10.1007/s11695-020-04702-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE Obesity affects approximately 45-55% of persons with schizophrenia and is more difficult to manage in these individuals than in the general population, apart from being an additional factor for morbidity and premature mortality. Although bariatric surgery is considered the most effective long-term treatment for severe obesity, there are few reports on the outcomes of this procedure in persons with schizophrenia. This study aimed to evaluate weight loss and psychiatric symptoms in persons with obesity and schizophrenia after bariatric surgery. MATERIALS AND METHODS Five persons with schizophrenia and moderate to severe obesity who underwent bariatric surgery were followed up for 2 years. Anthropometric data were collected, and psychiatric symptoms were evaluated using the Positive and Negative Syndrome Scale (PANSS), which assessed the pre- and postoperative occurrence and severity of symptoms of schizophrenia. RESULTS The mean body mass index before surgery was 43.5 ± 5.2 kg/m2 and decreased to 28.1 ± 1.9 kg/m2 1 year postoperatively. The mean percentage of total postoperative weight loss was 30.7 ± 6.8% after 6 months, 34.7 ± 7.9% after 1 year, and 34.3 ± 5.5% after 2 years. Before surgery, all subjects were in remission based on the PANSS. Postoperative evaluations showed that the participants had no relapse of psychiatric symptoms (p > 0.05 for the three PANSS dimensions throughout the follow-up period). There were no considerable changes in their medication regimens. CONCLUSIONS These findings suggest that bariatric surgery may be a viable treatment option for stable patients with schizophrenia if they have a preoperative assessment and close management and involvement by mental health professionals throughout the course of treatment.
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Affiliation(s)
- Maíra E Brito
- Department of Psychiatry - Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), Campinas, SP, Brazil.
| | - Inaiah M Sampaio
- Department of Psychiatry - Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), Campinas, SP, Brazil
| | - Areta C Ferreira
- Department of Psychiatry - Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), Campinas, SP, Brazil
| | - Pedro G Lorencetti
- Department of Psychiatry - Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), Campinas, SP, Brazil
| | - Eloísa H R V Celeri
- Department of Psychiatry - Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), Campinas, SP, Brazil
| | - Renata C S Azevedo
- Department of Psychiatry - Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), Campinas, SP, Brazil
| | - Cristiano S Noto
- Early Psychosis Unit (GAPi), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Ary Gadelha
- Program of Schizophrenia, Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Felipe D M Chaim
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), Campinas, SP, Brazil
| | - Everton Cazzo
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), Campinas, SP, Brazil
| | - Almino C Ramos
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), Campinas, SP, Brazil
| | - Lício A Velloso
- Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), Campinas, SP, Brazil
| | - Elinton A Chaim
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), Campinas, SP, Brazil
| | - Paulo Dalgalarrondo
- Department of Psychiatry - Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), Campinas, SP, Brazil
| | - Amilton Dos Santos-Júnior
- Department of Psychiatry - Faculty of Medical Sciences, State University of Campinas (FCM-UNICAMP), Campinas, SP, Brazil
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Räsänen S, Meyer-Rochow VB, Moring J, Hakko H. Hospital-treated physical illnesses and mortality: An 11-year follow-up study of long-stay psychiatric patients. Eur Psychiatry 2020; 22:211-8. [PMID: 17158034 DOI: 10.1016/j.eurpsy.2006.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 09/13/2006] [Accepted: 09/14/2006] [Indexed: 11/28/2022] Open
Abstract
AbstractUnder-recognitions of somatic illnesses have frequently been suggested to explain the well-known increased risks of mortality in long-stay psychiatric patients. There are, however, no studies, in which register information on realized somatic hospitalisations and mortality from somatic illnesses in psychiatric patients are actually linked and simultaneously evaluated. In this study, 208 long-stay psychiatric patients, suffering from functional psychoses (mainly schizophrenia) in Northern Finland were followed up for 11 years, and screened for all somatic hospitalisations and subsequent causes of death. 86.5% of the patients had undergone hospital treatment due to some physical illness after their first psychiatric admission. During specialized psychiatric care the majority of the deceased patients had received some somatic treatment for illnesses that ultimately caused their deaths: 81% representing circulatory, 71% digestive, 56% neoplastic, and 36% respiratory ailments. We found no evidence for the frequently expressed view that somatic illnesses in psychiatric patients were under-recognized. Thus, the widely-documented poor physical outcome of long-stay psychiatric patients may be not attributable to neglect of care or abandon, but to difficulties in efficaciously addressing medical conditions in a population characterised by unhealthy life-style habits, psychiatric disability and isolation. The health care systems apparently offer a range of services, but the latter do not always reach the patients. Why this is so requires detailed further investigation.
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Affiliation(s)
- Sami Räsänen
- Department of Psychiatry, Oulu University Hospital, PO Box 26, 90029 Oulu, Finland
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15
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Comparison of Elixhauser and Charlson Methods for Discriminative Performance in Mortality Risk in Patients with Schizophrenic Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17072450. [PMID: 32260241 PMCID: PMC7177958 DOI: 10.3390/ijerph17072450] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 01/10/2023]
Abstract
Although Charlson Comorbidity Index scores (CCIS) and Elixhauser comorbidity index scores (ECIS) have been used to assess comorbidity in patients with schizophrenia, only CCIS, not ECIS, have been used to predict mortality in this population. This nationwide retrospective study investigated discriminative performance of mortality of these two scales in patients with schizophrenia. Exploiting Taiwan's National Health Insurance Research Database (NHRID), we identified patients diagnosed with schizophrenia discharged from hospitals between Jan 1, 1996 and Dec 31, 2007. They were followed up for subsequent death. Comorbidities presented one year prior to hospital admissions were identified and adapted to the CCIS and ECIS. Discriminatory ability was evaluated using the adjusted hazard ratio and Akaike information criterion (AIC) and Harrell's C-statistic. We identified 58,771 discharged patients with schizophrenic disorders and followed them for a mean of 10.4 years, 16.6% of whom had died. Both ECIS and CCIS were significantly associated with mortality, but ECIS had superior discriminatory ability by a lower AIC and higher Harrell's C-statistic (201231 vs. 201400; 0.856 vs. 0.854, respectively). ECIS had better discriminative performance in mortality risk than CCIS in patients with schizophrenic disorders. Its use may be encouraged for risk adjustment in this population.
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16
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Rossom RC, O'Connor PJ, Crain AL, Waring S, Ohnsorg K, Taran A, Kopski K, Sperl-Hillen JM. Pragmatic trial design of an intervention to reduce cardiovascular risk in people with serious mental illness. Contemp Clin Trials 2020; 91:105964. [PMID: 32087336 PMCID: PMC7263956 DOI: 10.1016/j.cct.2020.105964] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/29/2020] [Accepted: 02/17/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cardiovascular (CV) disease is the leading cause of death for people with serious mental illness (SMI), but clinicians are often slow to address this risk. METHODS/DESIGN 78 Midwestern primary care clinics were randomized to receive or not receive access to a clinical decision support (CDS) tool. Between March 2016 and September 2018, primary care clinicians (PCPs) received CDS alerts during visits with adult patients with SMI who met minimal inclusion criteria and had at least one CV risk factor not at goal. The PCP CDS included a summary of six modifiable CV risk factors and patient-specific treatment recommendations. Psychiatrists received CDS alerts during their next visit with an eligible patient with SMI that alerted them to an elevated body mass index or recent weight gain and the presence of an obesogenic SMI medication. Study outcomes include total modifiable CV risk, six modifiable CV risk factors, and use of obesogenic SMI medications. DISCUSSION This cluster-randomized pragmatic trial allowed PCPs and psychiatrists the opportunity to improve CV risk in a timely manner for patients with SMI. Effectiveness will be assessed using an intent-to-treat analysis, and outcomes will be assessed largely through electronic health record data harvested by the CDS tool itself. In total, 10,347 patients with SMI had an index primary care visit in a randomized clinic, and 8937 patients had at least one follow-up visit. Analyses are ongoing, and trial results are expected in mid-2020. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02451670.
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Affiliation(s)
- Rebecca C Rossom
- HealthPartners Institute, Minneapolis, MN, United States of America.
| | | | - A Lauren Crain
- HealthPartners Institute, Minneapolis, MN, United States of America
| | | | - Kris Ohnsorg
- HealthPartners Institute, Minneapolis, MN, United States of America
| | - Allise Taran
- Essentia Health, Duluth, MN, United States of America
| | - Kris Kopski
- HealthPartners Medical Group, Minneapolis, MN, United States of America
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17
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Association Between Technology Use and Social Integration Among Veterans With Disabilities. J Nerv Ment Dis 2020; 208:306-311. [PMID: 32221185 DOI: 10.1097/nmd.0000000000001132] [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: 11/27/2022]
Abstract
Social connectedness has positive effects on physical and mental health. Many aspects of life, including social networks, are increasingly technology-based, influenced by access to computers. Individuals with psychiatric disabilities may experience unique barriers to computer use. The current study evaluated computer use among 199 veterans in Connecticut and Houston, Texas, with psychiatric and/or physical disabilities, and its association with social integration. Two-thirds had used a computer within the past month, most commonly for information seeking, but also for social interaction. However, computer use and social integration were not significantly associated. The study suggests a greater rate of computer use than anticipated, encouraging given society's increasing reliance on technology. Future research into experience with other modalities is needed, as is research into veterans' willingness and desire to use technology for various purposes.
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18
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Filipcic I, Simunovic Filipcic I, Ivezic E, Matic K, Tunjic Vukadinovic N, Vuk Pisk S, Bodor D, Bajic Z, Jakovljevic M, Sartorius N. Chronic physical illnesses in patients with schizophrenia spectrum disorders are independently associated with higher rates of psychiatric rehospitalization; a cross-sectional study in Croatia. Eur Psychiatry 2020; 43:73-80. [DOI: 10.1016/j.eurpsy.2017.02.484] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/29/2017] [Accepted: 02/22/2017] [Indexed: 01/10/2023] Open
Abstract
AbstractBackground:Increased physical morbidity in patients with schizophrenia spectrum disorders (SSDs) is well documented. However, much less is known about the association between somatic comorbidities and psychosis treatment outcomes.Subjects and methods:This cross-sectional study, nested within the larger frame of a prospective cohort study, was done in 2016 at Psychiatric Hospital Sveti Ivan, Zagreb, Croatia. Data were collected on a consecutive sample of 301 patients diagnosed with schizophrenia spectrum disorders who achieved a stable therapeutic dosage. Key outcome was the number of psychiatric rehospitalizations since diagnosis of the primary psychiatric illness. Predictors were number of physical and psychiatric comorbidities. By robust regression, we controlled different clinical, sociodemographic, and lifestyle confounding factors.Results:The number of chronic somatic comorbidities was statistically significantly associated with a larger number of psychiatric rehospitalizations, even after the adjustment for number of psychiatric comorbidities and large number of other clinical, sociodemographic, and lifestyle variables.Conclusions:Chronic somatic comorbidities are associated with higher rates of psychiatric rehospitalization independently of psychiatric comorbidities and other clinical, sociodemographic, and lifestyle factors. Therefore, to treat psychosis effectively, it may be necessary to treat chronic somatic comorbidities promptly and adequately. Chronic somatic comorbidities should be considered equally important as the SSD, and should be brought to the forefront of psychiatric treatment and research with the SSD as one entity. The integrative approach should be the imperative in clinical practice.
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19
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Gao N, Eissenstat SJ, Giacobbe G. Poor physical health: A major barrier to employment among individuals with serious mental illness. JOURNAL OF VOCATIONAL REHABILITATION 2020. [DOI: 10.3233/jvr-191063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ni Gao
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - SunHee J. Eissenstat
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Giovanna Giacobbe
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
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20
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Abstract
AIMS Suicide attempt is an important indicator of suicide and potential future mortality. However, the prevalence of suicide attempts has been inconsistent across studies. This meta-analysis aimed to examine the prevalence of suicide attempts in individuals with schizophrenia and associated correlates. METHODS Relevant publications in Embase, PsycINFO, PubMed, Web of science and Cochrane were systematically searched. Data on the prevalence of suicide attempts in individuals with schizophrenia were pooled using a random-effects model. RESULTS Thirty-five studies with 16 747 individuals with schizophrenia were included. The pooled lifetime prevalence of suicide attempts was 26.8% (95% CI 22.1-31.9%; I2 = 97.0%), while the 1-year prevalence, 1-month prevalence and the prevalence of suicide attempts from illness onset were 3.0% (95% CI 2.3-3.7%; I2 = 95.6%), 2.7% (95% CI 2.1-3.4%; I2 = 78.5%) and 45.9% (95% CI 42.1-49.9%; I2 = 0), respectively. Earlier age of onset (Q = 4.38, p = 0.04), high-income countries (Q = 53.29, p < 0.001), North America and Europe and Central Asia (Q = 32.83, p < 0.001) were significantly associated with a higher prevalence of suicide attempts. CONCLUSIONS Suicide attempts are common in individuals with schizophrenia, especially those with an early age of onset and living in high-income countries and regions. Regular screening and effective preventive measures should be implemented as part of the clinical care.
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21
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Pratt SI, Brunette MF, Wolfe R, Scherer EA, Xie H, Bartels S, Ferron JC, Capuchino K. Incentivizing healthy lifestyle behaviors to reduce cardiovascular risk in people with serious mental illness: An equipoise randomized controlled trial of the wellness incentives program. Contemp Clin Trials 2019; 81:1-10. [PMID: 30991110 DOI: 10.1016/j.cct.2019.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 03/01/2019] [Accepted: 04/11/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Medicaid recipients with serious mental illness die 25-30 years earlier than people in the general population due to health conditions that are modifiable through lifestyle changes. Cardiovascular diseases from excess weight, smoking, and sedentary lifestyle contribute substantially to this life expectancy disparity. The current study evaluated the impact of incentives on participation in weight management programming (for overweight and obese adults) and smoking cessation treatment (for regular smokers). METHODS Participants were Medicaid recipients with disabling mental illness receiving services at any one of 10 community mental health centers across New Hampshire. Using an equipoise stratified randomized design, n = 1348 were enrolled and assigned to one of four weight management programs (Healthy Choices Healthy Changes: HCHC) and n = 661 were enrolled and assigned to one of three smoking cessation interventions (Breathe Well Live Well: BWLW). Following assignment to an intervention, participants were randomized to receive financial incentives (to attend weight management programs, or to achieve abstinence from smoking) or not. Data were collected at baseline and every 3 months for 12 months. DISCUSSION New Hampshire's HCHC and BWLW programs were designed to address serious and preventable health disparities by providing incentivized health promotion programs to overweight/obese and/or tobacco-smoking Medicaid beneficiaries with mental illness. This study was an unprecedented opportunity to evaluate an innovative statewide implementation of incentivized health promotion targeting the most at-risk and costly beneficiaries. If proven effective, this program has the potential to serve as a national model for widespread implementation.
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Affiliation(s)
- Sarah I Pratt
- Department of Psychiatry, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America.
| | - Mary F Brunette
- Department of Psychiatry, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Rosemarie Wolfe
- Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Emily A Scherer
- Department of Biomedical Data Sciences, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Haiyi Xie
- Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America; Department of Biomedical Data Sciences, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Stephen Bartels
- Department of Psychiatry, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America; Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Joelle C Ferron
- Department of Psychiatry, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Kelley Capuchino
- Division of Behavioral Health, New Hampshire Department of Health and Human Services, Concord, NH, United States of America
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22
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Chen WY, Hung YN, Huang SJ, Pan CH, Su SS, Yang TW, Kuo CJ. Nationwide analysis of medical utilization in people with severe mental illness receiving home care case management. Schizophr Res 2019; 208:60-66. [PMID: 31076263 DOI: 10.1016/j.schres.2019.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 02/20/2019] [Accepted: 04/29/2019] [Indexed: 01/14/2023]
Abstract
AIM This nationwide study investigated the change in medical utilization of psychiatric home care case management (CM). METHODS This nationwide study enrolled patients receiving CM (N = 10,274) from January 1, 1999 to December 31, 2010, from Taiwan's National Health Insurance Research Database. Through a 2-year mirror-image comparison weighted by the contributed person-time for each subject, we evaluated changes in medical utilization. Furthermore, a case-crossover analysis was used to verify the independent effect of CM in changing medical utilization by adjusting the time-variant variables between the pre-2-year (within 2 years before receiving CM) and post-2-year (within years after receiving CM) periods. The same methodology was applied for the subsequent 2-year comparison to assess the maintenance effect. RESULTS Of the 10,274 patients receiving CM, 69.7% had schizophrenia. The results showed a chronological trend for the intervention of CM. The adjusted mirror-image analysis revealed a significant decrement of psychiatric and involuntary admissions after the intervention, and the utilization shifted toward psychiatric outpatient service. The case-crossover analysis with the adjustment of time-variant covariates confirmed the independent effect of CM on the changes of medical utilization. The comparable effect persisted after the next 2 years of intervention. However, CM showed no impact on lowering the admission rate for comorbid physical illnesses after the intervention. CONCLUSIONS The CM model can effectively reduce psychiatric hospitalization and involuntary admission frequency but has no effect on comorbid physical illnesses. Care models aimed at ameliorating physical problems in such patients are needed.
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Affiliation(s)
- Wen-Yin Chen
- Songde Branch (Taipei City Psychiatric Center), Taipei City Hospital, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Yen-Ni Hung
- School of Gerontology Health Management and Master Program in Long-term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Sheng-Jean Huang
- Taipei City Hospital, Taipei, Taiwan; Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Hung Pan
- Songde Branch (Taipei City Psychiatric Center), Taipei City Hospital, Taipei, Taiwan
| | - Sheng-Shiang Su
- Computer Center, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tien-Wei Yang
- Songde Branch (Taipei City Psychiatric Center), Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chian-Jue Kuo
- Songde Branch (Taipei City Psychiatric Center), Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department and Graduate Institute of Forensic Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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23
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Houben N, Janssen EPCJ, Hendriks MRC, van der Kellen D, van Alphen BPJ, van Meijel B. Physical health status of older adults with severe mental illness: The PHiSMI-E cohort study. Int J Ment Health Nurs 2019; 28:457-467. [PMID: 30294958 DOI: 10.1111/inm.12547] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/03/2018] [Indexed: 12/26/2022]
Abstract
The objective was to use various somatic parameters as basis for investigating the physical health of older adults with severe mental illnesses (SMI). A cross-sectional study design is performed by using baseline data from the Physical Health in SMI-elderly (PHiSMI-E) study. Data were collected using the Nursing Monitoring of Somatic Status and Lifestyle - Mental Health instrument in adults aged over 60 with SMI in a large Dutch mental health institute. Ninety-nine elderly SMI patients were included. Somatic comorbidity (84.8%), use of somatic medication (77.7%) and polypharmacy (67.7%) were prevalent. Extrapyramidal symptoms were experienced by 51% of patients, mainly in the subgroup with psychotic disorders (75.6%). Unhealthy diet was reported in 16.2%, obesity in 27.3%, and physical inactivity in 57.6%. Fatigue (67.7%) and dry mouth (66.6%) were the commonest reported physical symptoms. Mean VAS score (scale 0-10) indicating participants' self-perceived physical health was 6.7 (SD ± 1.6). After division of the total patient group into tertiles based on the VAS scores, the lowest tertile was characterized by less physical activity, unhealthier diet, more use of medication, more fatigue, somnolence, and inner agitation. In conclusion, impaired physical health status was common in these older patients with SMI. Although they had more psychiatric and somatic comorbidity than adult SMI patients described in the literature, they had a healthier lifestyle. To reduce morbidity and premature mortality in these frail patients, it is essential that healthcare providers are aware of the high prevalence of somatic comorbidity and symptoms, and of their interactions with the psychiatric disorders. This study improves our understanding of differences in vulnerability factors of older patients with SMI. The (early) detection of somatic comorbidities may improve long-term health outcomes of these patients.
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Affiliation(s)
- Noortje Houben
- Department of Old Age Psychiatry, Mondriaan, Heerlen, The Netherlands.,Department of Advanced Nursing Practice, School for Nursing, Zuyd University, Heerlen, The Netherlands
| | - Eveline P C J Janssen
- Department of Old Age Psychiatry, Mondriaan, Heerlen, The Netherlands.,Department of Psychiatry and Neuropsychology, MHeNs School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marike R C Hendriks
- Department of Advanced Nursing Practice, School for Nursing, Zuyd University, Heerlen, The Netherlands
| | - Digna van der Kellen
- Department of Mental Health, Indigo Rijnmond, Rotterdam, The Netherlands.,uTOPiGGZ, Training and Coaching, Spijkenisse, The Netherlands
| | - Bas P J van Alphen
- Department of Old Age Psychiatry, Mondriaan, Heerlen, The Netherlands.,Department of Clinical and Lifespan Psychology, Vrije universiteit Brussel (VUB), Brussels, Belgium.,Department of Medical and Clinical Psychology, School of Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands
| | - Berno van Meijel
- Inholland University of Applied Sciences, Research Group Mental Health Nursing, Amsterdam, The Netherlands.,Department of Psychiatry, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Parnassia Psychiatric Institute, The Hague, The Netherlands.,GGZ-VS, Academy for Masters in Advanced Nursing Practice, Utrecht, The Netherlands
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24
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Collins C, O’Shea MT, Cunniffe J, Finegan P. Health system changes needed to support people consulting general practice out of hours services in Ireland. Int J Ment Health Syst 2018; 12:56. [PMID: 30344620 PMCID: PMC6186104 DOI: 10.1186/s13033-018-0235-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental illness acts as a barrier to accessing and obtaining effective medical care. It has been shown that out of hours services are an important first stop for emergency care for people experiencing mental health difficulties. However, little is in fact known about the use of out of hours general practice services by people experiencing mental health difficulties. AIM To establish the number and range of consultations that have a primary or related mental health issue attending general practitioner (GP) out of hours and to document adherence to their follow-up care referral. DESIGN AND SETTING Descriptive study in one large out of hours primary care service in the South East of Ireland (Caredoc). METHODS An anonymous extraction of retrospective data from 1 year of the out of hours' electronic database was undertaken. Patients who attended the out of hours with a possible mental health issue and were referred to the psychiatric services or back to their own GP, were tracked via phone follow-up with hospitals and GPs over 6 months to establish if they attended for the recommend follow-up care. RESULTS Over a 1 year period, there were 3844 out of hours presentations with a mental health component. Overall, 9.3% were referred by the out of hours GP for follow-up to a hospital emergency department (ED) or were advised to attend their own GP. A total of 104 patients who were advised to attend their GP or ED following their consultation with the out of hours GP were tracked. Twenty-seven patients were referred back to their GP of which the follow-up call to the GP revealed that 44.5% did not attend. Seventy-seven patients were referred to the hospital services, of whom 37.7% did not attend. CONCLUSIONS There are significant challenges at the interface of primary care and secondary mental health services in Ireland. As expounded by the WHO and WONCA, in order to be effective and efficient, care for mental health must be coordinated with services at different levels of care complemented by the broader health system.
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Affiliation(s)
- C. Collins
- Irish College of General Practitioners, 4-5 Lincoln Place, Dublin 2, Ireland
| | - M. T. O’Shea
- Irish College of General Practitioners, 4-5 Lincoln Place, Dublin 2, Ireland
| | | | - P. Finegan
- Irish College of General Practitioners, 4-5 Lincoln Place, Dublin 2, Ireland
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25
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Abu Rahal Z, Vadas L, Manor I, Bloch B, Avital A. Use of information and communication technologies among individuals with and without serious mental illness. Psychiatry Res 2018; 266:160-167. [PMID: 29864616 DOI: 10.1016/j.psychres.2018.05.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/08/2018] [Accepted: 05/10/2018] [Indexed: 11/29/2022]
Abstract
Growing interest surrounds the use ofinformation and communication technologies (ICTs) for mental-health-related purposes, yet little is known about rates of ICT use among the psychiatric population and those with severe mental illness. This study examines ICT accessibility among the psychiatric population, focusing on serious and non-serious mental illness (SMI and non-SMI). Patients (N = 427) from all service branches of the Psychiatry Department at Emek Medical Centerwere recruited orally or through advertisement. Responders completed a self-report survey regarding accessibility and use of ICTs (i.e., computer, internet, Facebook, mobile phone, smartphone). Results revealed that 59.3% of respondents used computers, 77.3% used the internet, 92.7% owned a mobile phone, 67.9% owned a smartphone, and 63% used Facebook. Over half of participants who used ICTs reported doing so at least once per day. SMI and non-SMI respondents differed significantly in their use and access to a computer, the internet, Facebook, and smartphones. Results suggest that mental illness is not a barrier to using and accessing technology; however, when differentiating between SMI and non-SMI, illness severity is a barrier to potential ICT utilization. These results may encourage policy makers to design ICTs that suit the needs of individuals with SMI.
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Affiliation(s)
- Ziyad Abu Rahal
- Psychiatry Department, Emek Medical Center, Afula, Israel; Clalit Health Services, Northern District, Israel
| | - Limor Vadas
- Psychiatry Department, Emek Medical Center, Afula, Israel
| | - Iris Manor
- Attention Deficit Hyperactivity Disorder Clinic, Geha Medical Center, Petah Tikva, Israel
| | - Boaz Bloch
- Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Psychiatry Department, Emek Medical Center, Afula, Israel
| | - Avi Avital
- Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Psychiatry Department, Emek Medical Center, Afula, Israel.
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MacEwan JP, Silverstein AR, Shafrin J, Lakdawalla DN, Hatch A, Forma FM. Medication Adherence Patterns Among Patients with Multiple Serious Mental and Physical Illnesses. Adv Ther 2018; 35:671-685. [PMID: 29725982 PMCID: PMC5960492 DOI: 10.1007/s12325-018-0700-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Patients with mental and physical health conditions are complex to treat and often use multiple medications. It is unclear how adherence to one medication predicts adherence to others. A predictive relationship could permit less expensive adherence monitoring if overall adherence could be predicted through tracking a single medication. METHODS To test this hypothesis, we examined whether patients with multiple mental and physical illnesses have similar adherence trajectories across medications. Specifically, we conducted a retrospective cohort analysis using health insurance claims data for enrollees who were diagnosed with a serious mental illness, initiated an atypical antipsychotic, as well as an SSRI (to treat serious mental illness), biguanides (to treat type 2 diabetes), or an ACE inhibitor (to treat hypertension). Using group-based trajectory modeling, we estimated adherence patterns based on monthly estimates of the proportion of days covered with each medication. We measured the predictive value of the atypical antipsychotic trajectories to adherence predictions based on patient characteristics and assessed their relative strength with the R-squared goodness of fit metric. RESULTS Within our sample of 431,591 patients, four trajectory groups were observed: non-adherent, gradual discontinuation, stop-start, and adherent. The accuracy of atypical antipsychotic adherence for predicting adherence to ACE inhibitors, biguanides, and SSRIs was 44.5, 44.5, and 49.6%, respectively (all p < 0.001 vs. random). We also found that information on patient adherence patterns to atypical antipsychotics was a better predictor of patient adherence to these three medications than would be the case using patient demographic and clinical characteristics alone. CONCLUSION Among patients with multiple chronic mental and physical illnesses, patterns of atypical antipsychotic adherence were useful predictors of adherence patterns to a patient's adherence to ACE inhibitors, biguanides, and SSRIs. FUNDING Otsuka Pharmaceutical Development & Commercialization, Inc.
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Affiliation(s)
- Joanna P MacEwan
- Precision Health Economics, 11100 Santa Monica Blvd, Suite 500, Los Angeles, CA, 90025, USA.
| | - Alison R Silverstein
- Precision Health Economics, 11100 Santa Monica Blvd, Suite 500, Los Angeles, CA, 90025, USA
| | - Jason Shafrin
- Precision Health Economics, 11100 Santa Monica Blvd, Suite 500, Los Angeles, CA, 90025, USA
| | - Darius N Lakdawalla
- Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, 90089, USA
| | - Ainslie Hatch
- Otsuka America Pharmaceutical, Inc., 508 Carnegie Center Drive, Princeton, NJ, 08540, USA
| | - Felicia M Forma
- Otsuka Pharmaceutical Development & Commercialization, Inc., 508 Carnegie Center Drive, Princeton, NJ, 08540, USA
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Hanlon P, Yeoman L, Gibson L, Esiovwa R, Williamson AE, Mair FS, Lowrie R. A systematic review of interventions by healthcare professionals to improve management of non-communicable diseases and communicable diseases requiring long-term care in adults who are homeless. BMJ Open 2018; 8:e020161. [PMID: 29627814 PMCID: PMC5892758 DOI: 10.1136/bmjopen-2017-020161] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Identify, describe and appraise trials of interventions delivered by healthcare professionals to manage non-communicable diseases (NCDs) and communicable diseases that require long-term care or treatment (LT-CDs), excluding mental health and substance use disorders, in homeless adults. DESIGN Systematic review of randomised controlled trials (RCTs), non-RCTs and controlled before-after studies. Interventions characterised using Effective Practice and Organisation of Care (EPOC) taxonomy. Quality assessed using EPOC risk of bias criteria. DATA SOURCES Database searches (MEDLINE, Embase, PsycINFO, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Applied Social Sciences Index and Abstracts (ASSIA) and Cochrane Central Register of Controlled Trials), hand searching reference lists, citation searches, grey literature and contact with study authors. SETTING Community. PARTICIPANTS Adults (≥18 years) fulfilling European Typology of Homelessness criteria. INTERVENTION Delivered by healthcare professionals managing NCD and LT-CDs. OUTCOMES Primary outcome: unscheduled healthcare utilisation. SECONDARY OUTCOMES mortality, biological markers of disease control, adherence to treatment, engagement in care, patient satisfaction, knowledge, self-efficacy, quality of life and cost-effectiveness. RESULTS 11 studies were included (8 RCTs, 2 quasi-experimental and 1 feasibility) involving 9-520 participants (67%-94% male, median age 37-49 years). Ten from USA and one from UK. Studies included various NCDs (n=3); or focused on latent tuberculosis (n=4); HIV (n=2); hepatitis C (n=1) or type 2 diabetes (n=1). All interventions were complex with multiple components. Four described theories underpinning intervention. Three assessed unscheduled healthcare utilisation: none showed consistent reduction in hospitalisation or emergency department attendance. Six assessed adherence to specific treatments, of which four showed improved adherence to latent tuberculosis therapy. Three concerned education case management, all of which improved disease-specific knowledge. No improvements in biological markers of disease (two studies) and none assessed mortality. CONCLUSIONS Evidence for management of NCD and LT-CDs in homeless adults is sparse. Educational case-management interventions may improve knowledge and medication adherence. Large trials of theory-based interventions are needed, assessing healthcare utilisation and outcomes as well as assessment of biological outcomes and cost-effectiveness.
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Affiliation(s)
- Peter Hanlon
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lynsey Yeoman
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lauren Gibson
- Pharmacy and Prescribing Support Unit, NHS Greater Glasgow and Clyde, West Glasgow Ambulatory Care Unit, Glasgow, UK
| | - Regina Esiovwa
- Pharmacy and Prescribing Support Unit, NHS Greater Glasgow and Clyde, West Glasgow Ambulatory Care Unit, Glasgow, UK
| | - Andrea E Williamson
- General Practice and Primary Care, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Richard Lowrie
- Pharmacy and Prescribing Support Unit, NHS Greater Glasgow and Clyde, West Glasgow Ambulatory Care Unit, Glasgow, UK
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Wästberg BA, Sandström B, Gunnarsson AB. New way of working: Professionals' expectations and experiences of the Culture and Health Project for clients with psychiatric disabilities: A focus group study. Int J Ment Health Nurs 2018; 27:329-340. [PMID: 28247475 DOI: 10.1111/inm.12324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2017] [Indexed: 12/01/2022]
Abstract
UNLABELLED There is a need for various types of interventions when meeting needs of clients with psychiatric disabilities and complementary interventions may also influence their well-being. The Culture and Health project, based on complementary interventions with 270 clients, was created in a county in Sweden for clients with psychiatric disabilities and for professionals to carry out the interventions. The aim of this study was to investigate the professionals' expectations regarding the project and their clients' possibilities for participating, and to investigate the professionals' experiences of the project after its completion. Focus group data with a total of 30 professionals participating were collected. A qualitative content analysis revealed four categories of the professionals' expectations before entering the project: "Clients' own possibilities and limitations for their development and independence", "Professionals' possibilities for supporting the clients", "Societal prerequisites", and "Expectations of a new way of working". Furthermore, the analysis regarding professionals' experiences after working with the project revealed three categories: "Adopting the challenges", "Having ways of working that function - prerequisites and possibilities", and "Meeting the future - an ambition to continue". CONCLUSION Working in the Culture and Health project together with the clients in group-based activities was perceived as beneficial, although challenges arose. When implementing cultural activities, support from stakeholder organisations is needed.
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Affiliation(s)
- Birgitta A Wästberg
- Skane University Hospital, Lund, Sweden.,Blekinge Centre of Competence, Karlskrona, Sweden
| | - Boel Sandström
- Blekinge Centre of Competence, Karlskrona, Sweden.,Department of Care Science, Malmö University, Malmö, Sweden
| | - Anna Birgitta Gunnarsson
- Department of Research and Development, Region Kronoberg, Växjö, Sweden.,Department of Clinical Neuroscience and Rehabilitation, the Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
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Evaluation of the long-term safety and tolerability of cariprazine in patients with schizophrenia: results from a 1-year open-label study. CNS Spectr 2018; 23:39-50. [PMID: 28478771 DOI: 10.1017/s1092852917000220] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Cariprazine, a dopamine D3/D2 partial agonist atypical antipsychotic with preferential binding to D3 receptors, is approved for the treatment of schizophrenia and manic or mixed episodes associated with bipolar I disorder. The efficacy and safety of cariprazine was established in three randomized, double-blind, placebo-controlled, 6-week trials in patients with acute exacerbation of schizophrenia. This 53-week study evaluated the long-term safety and tolerability of cariprazine in patients with schizophrenia. METHODS This was a multicenter, open-label, flexible-dose study of cariprazine 3-9 mg/d in adults with schizophrenia. Participants included new patients and patients who had completed one of two phase III lead-in studies (NCT01104766, NCT01104779). Eligible patients entered a no-drug screening period of up to 1 week followed by 48 weeks of flexibly dosed, open-label cariprazine treatment (3-9 mg/d) and 4 weeks of safety follow-up. RESULTS A total of 586 patients received open-label cariprazine treatment, ~39% of whom completed the study. No unexpected safety issues or deaths were reported. The most common (≥10%) adverse events (AEs) observed were akathisia (16%), headache (13%), insomnia (13%), and weight gain (10%). Serious AEs occurred in 59 (10.1%) patients, and 73 (12.5%) patients discontinued the study due to AEs during open-label treatment. Mean changes in metabolic, hepatic, and cardiovascular parameters were not considered clinically relevant. Mean body weight increased by 1.5 kg during the study, prolactin levels decreased slightly, and measures of efficacy remained stable. CONCLUSIONS Long-term cariprazine treatment at doses up to 9 mg/d appeared to be generally safe and well tolerated in patients with schizophrenia.
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Abstract
People with schizophrenia die prematurely. Their illness, its treatment and their lifestyle all contribute to the excess morbidity and mortality. Lifestyle ‘choices' (e.g. poor diet, low rates of physical activity and increased likelihood to smoke cigarettes) predispose them to poor physical health and comorbid medical diseases. In addition, weight gain and obesity are a consequence of most antipsychotics, particularly the atypicals. Excessive body weight increases the risk of morbidity and mortality, and is the biggest risk factor for type II diabetes in schizophrenia. Much of the excess mortality of schizophrenia is preventable through lifestyle and risk factor modification and the treatment of common diseases, but the potential for improving outcomes in this area is only starting to be addressed.
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Chen L, Selvendra A, Stewart A, Castle D. Risk factors in early and late onset schizophrenia. Compr Psychiatry 2018; 80:155-162. [PMID: 29096206 DOI: 10.1016/j.comppsych.2017.09.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 09/11/2017] [Accepted: 09/17/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND This study looks at key risk factors in patients with schizophrenia to identify trends according to age of onset, comparing presentations prior to 26years (youth onset), between 26 and 40years (middle onset), and after 40years of age (late onset). METHODS The early psychosis program at St Vincent's Hospital Melbourne treats patients presenting in the early stages of psychosis between 16 and 65years of age. A database was developed to capture key risk factors in all patients with an eventual diagnosis of schizophrenia (n=225). Risk factor profiles were then generated and compared for patients based on age of onset. RESULTS Older age of onset was associated with weaker family history of schizophrenia, lower rates of substance use, better early psychosocial functioning and higher educational achievement. Female preponderance and comorbid physical health problems were particularly notable in the late onset cohort. Later life schizophrenia also showed a relatively greater association with psychosocial factors proximal to psychosis onset, such as unemployment. DISCUSSION Clear trends are noticeable with age. Older patients have characteristic differences in their background risk factors compared to youth onset patients, including less hereditary influence and relatively more emphasis on later life risk factors. Identifying the roles of specific risk factors in these distinct age-onset groups can enhance our understanding of underlying aetiology and facilitate service development to meet the needs of each specific age group.
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Affiliation(s)
- Laura Chen
- Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Ajit Selvendra
- Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia; Mental Health Service, St. Vincent's Hospital, Fitzroy, Victoria, Australia.
| | - Anne Stewart
- Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - David Castle
- Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia; Mental Health Service, St. Vincent's Hospital, Fitzroy, Victoria, Australia
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Hanlon P, Yeoman L, Esiovwa R, Gibson L, Williamson AE, Mair FS, Lowrie R. Interventions by healthcare professionals to improve management of physical long-term conditions in adults who are homeless: a systematic review protocol. BMJ Open 2017; 7:e016756. [PMID: 28827259 PMCID: PMC5629632 DOI: 10.1136/bmjopen-2017-016756] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION People experiencing homelessness are at increased risk of, and have poorer outcomes from, a range of physical long-term conditions (LTCs). It is increasingly recognised that interventions targeting people who are homeless should be tailored to the specific needs of this population. This systematic review aims to identify, describe and appraise trials of interventions that aim to manage physical LTCs in homeless adults and are delivered by healthcare professionals. METHODS AND ANALYSIS Seven electronic databases (Medline, EMBASE, Cochrane Central Register of Controlled Trials, Assia, Scopus, PsycINFO and CINAHL) will be searched from 1960 (or inception) to October 2016 and supplemented by forward citation searching, handsearching of reference lists and searching grey literature. Two reviewers will independently review titles, abstract and full-texts using DistillerSR software. Inclusion criteria include (1) homeless adults with any physical LTC, (2) interventions delivered by a healthcare professional (any professional trained to provide any form of healthcare, but excluding social workers and professionals without health-related training), (3) comparison with usual care or an alternative intervention, (4) report outcomes such as healthcare usage, physical and psychological health or well-being or cost-effectiveness, (5) randomised controlled trials, non-randomised controlled trials, controlled before-after studies. Quality will be assessed using the Cochrane EPOC Risk of Bias Tool. A meta-analysis will be performed if sufficient data are identified; however, we anticipate a narrative synthesis will be performed. ETHICS AND DISSEMINATION This review will synthesise existing evidence for interventions delivered by healthcare professionals to manage physical LTCs in adults who are homeless. The findings will inform the development of future interventions and research aiming to improve the management of LTCs for people experiencing homelessness. Ethical approval will not be required for this systematic review as it does not contain individual patient data. We will disseminate the results of this systematic review via conference presentations, healthcare professional networks, social media and peer-reviewed publication. TRIAL REGISTRATION NUMBER PROSPERO registration number: CRD42016046183.
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Affiliation(s)
- Peter Hanlon
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glassgow, UK
| | - Lynsey Yeoman
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glassgow, UK
| | - Regina Esiovwa
- Pharmacy Prescribing and Support Unit, West Glasgow Ambulatory Care Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Lauren Gibson
- Pharmacy Prescribing and Support Unit, West Glasgow Ambulatory Care Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Andrea E Williamson
- General Practice and Primary Care, School of Medicine, Dentistry and Nursing, University of Glasgow, Glassgow, UK
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glassgow, UK
| | - Richard Lowrie
- Pharmacy Prescribing and Support Unit, West Glasgow Ambulatory Care Centre, NHS Greater Glasgow and Clyde, Glasgow, UK
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Lasebikan VO, Azegbeobor J. Medical Co-morbidities Among Patients with Severe Mental Illnesses in a Community Health Facility in Nigeria. Community Ment Health J 2017; 53:736-746. [PMID: 27888379 DOI: 10.1007/s10597-016-0063-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 11/22/2016] [Indexed: 01/05/2023]
Abstract
To examine prevalence of medical comorbidity (MCM) in schizophrenia (n = 1310) and in bipolar disorder (n = 1307) and the association of high burden of MCM (≥3 MCM) with duration of untreated illness, number of episodes, functioning, poly-medication and lifetime hospitalization for the mental disorder. Participants were recruited from a private psychiatric facility in Ibadan, Nigeria between 2004 and 2013 and enquiry made about the lifetime occurrence of 20 common chronic diseases including common tropical diseases. Psychiatric diagnosis was made using the Structured Clinical Interview for DSM IV Axis I disorder (SCID). Except for nutritional anemia, dermatitis and intestinal Helminthiasis, patients with schizophrenia were not at higher odds of reporting MCM than those with bipolar disorder. DUI ≥2 years, episodes of illness ≥3, being on multiple neuroleptics and history of previous hospitalization were significantly associated with high burden of MCM in schizophrenia and episodes of illness ≥3, reduced functioning and history of previous hospitalization with bipolar disorder. Schizophrenia and bipolar disorder are associated with high rates of medical comorbidity. Treatment of this medical comorbidity is essential in order to improve the outcomes for patients with bipolar disorder and schizophrenia.
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Affiliation(s)
- Victor Olufolahan Lasebikan
- Consultation Liaison Unit, Department of Psychiatry, University College Hospital, PMB 5116, Ibadan, Nigeria.
| | - Joachim Azegbeobor
- Department of Psychiatry, University College Hospital, Ibadan, PMB 5116, Ibadan, Nigeria
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Rodrigues-Silva N, Ribeiro L. Impact of medical comorbidity in psychiatric inpatient length of stay. J Ment Health 2017; 29:701-705. [PMID: 28686478 DOI: 10.1080/09638237.2017.1340605] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Background: Medical comorbidity is associated with worse psychiatric outcomes, reduced functioning and higher services use, including inpatient psychiatric care.Aim: We explored the relation between medical comorbidity and length of stay, adjusting for potential confounders.Methods: We retrospectively analyzed an administrative database comprising all inpatient admissions between 2005 and 2014 at the Department of Psychiatry and Mental Health at Vila Nova de Gaia/Espinho Healthcare Center, Vila Nova de Gaia - Portugal. Psychiatric diagnosis and medical comorbidity were coded according to single-level and multi-level classification schemes, respectively, as proposed by the Clinical Classification Software.Results: We included a total of 4613 psychiatric inpatient admissions. The prevalence of medical comorbidity was 25.4% and it was associated with an average increase of 3.5 days (p < 0.001) in length of stay, comparing to patients without medical comorbidity. After adjusting for potential confounders, such as age, sex and year of discharge, medical comorbidity was associated with a 13% increase in length of stay.Conclusions: Medical comorbidity has measurable effects in inpatient outcomes, such as the length of stay and should be a major focus for intervention, in ambulatory care but also during psychiatric hospitalization.
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Affiliation(s)
- Nuno Rodrigues-Silva
- Department of Psychiatry and Mental Health, Vila Nova de Gaia/Espinho Healthcare Center, Vila Nova de Gaia, Portugal
| | - Lúcia Ribeiro
- Department of Psychiatry and Mental Health, Vila Nova de Gaia/Espinho Healthcare Center, Vila Nova de Gaia, Portugal
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Chinman M, Daniels K, Smith J, McCarthy S, Medoff D, Peeples A, Goldberg R. Provision of peer specialist services in VA patient aligned care teams: protocol for testing a cluster randomized implementation trial. Implement Sci 2017; 12:57. [PMID: 28464935 PMCID: PMC5414325 DOI: 10.1186/s13012-017-0587-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/22/2017] [Indexed: 11/10/2022] Open
Abstract
Background Over 1100 Veterans work in the Veterans Health Administration (VHA) as peer specialists (PSs). PSs are Veterans with formal training who provide support to other Veterans with similar diagnoses, primarily in mental health settings. A White House Executive Action mandated the pilot reassignment of VHA PSs from mental health to 25 primary care Patient Aligned Care Teams (PACT) in order to broaden the provision of wellness services that can address many chronic illnesses. An evaluation of this initiative was undertaken to assess the impact of outside assistance on the deployment of PS in PACT, as implementation support is often needed to prevent challenges commonly experienced when first deploying PSs in VHA settings. We present the protocol for this cluster-randomized hybrid type II trial to test the impact of standard implementation (receive minimal assistance) vs. facilitated implementation (receive outside assistance) on the deployment of VHA PSs in PACT. Methods A VHA Office of Mental Health Services work group is recruiting 25 Veterans Affairs Medical Centers to reassign a mental health PSs to provide wellness-oriented care in PACT. Sites in three successive cohorts (n = 8, 8, 9) beginning over 6-month blocks will be matched and randomized to either standard or facilitated implementation. In facilitated implementation, an outside expert works with site stakeholders through a site visit, regular calls, and performance data to guide the planning and address challenges. Standard implementation sites will receive a webinar and access the Office of Mental Health Services work group. The two conditions will be compared on PS workload data, fidelity to the PS model of service delivery, team functioning, and Veteran measures of activation, satisfaction, and functioning. Qualitative interviews will collect information on implementation barriers and facilitators. Discussion This evaluation will provide critical data to guide administrators and VHA policy makers on future deployment of PSs, as their role has been expanding beyond mental health. In addition, development of novel implementation strategies (facilitation tailored to PSs) and the use of new tools (peer fidelity) can be models for monitoring and supporting deployment of PSs throughout VHA. Trial registration ClinicalTrials.gov, NCT02732600 (URL:https://clinicaltrials.gov/ct2/show/NCT02732600)
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Affiliation(s)
- Matthew Chinman
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh, Pittsburgh, PA, USA. .,Center for Health Equity Research and Promotion, VA Pittsburgh, Pittsburgh, PA, USA. .,RAND Corporation, Pittsburgh, PA, USA. .,VA Pittsburgh Healthcare System, Research Office Building (151R), University Drive C, Pittsburgh, PA, 15240, USA.
| | - Karin Daniels
- Center for Health Equity Research and Promotion, VA Pittsburgh, Pittsburgh, PA, USA
| | - Jeff Smith
- Central Arkansas Veterans Healthcare System, HSR&D and Mental Health Quality Enhancement Research Initiative (QUERI), Little Rock, AR, USA
| | - Sharon McCarthy
- VISN 4 Mental Illness Research, Education and Clinical Center, VA Pittsburgh, Pittsburgh, PA, USA.,Center for Health Equity Research and Promotion, VA Pittsburgh, Pittsburgh, PA, USA
| | - Deborah Medoff
- VISN 5 Mental Illness Research, Education and Clinical Center (MIRECC), Baltimore, MD, USA.,Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Amanda Peeples
- VISN 5 Mental Illness Research, Education and Clinical Center (MIRECC), Baltimore, MD, USA.,Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland, School of Medicine, Baltimore, MD, USA
| | - Richard Goldberg
- VISN 5 Mental Illness Research, Education and Clinical Center (MIRECC), Baltimore, MD, USA.,Division of Psychiatric Services Research, Department of Psychiatry, University of Maryland, School of Medicine, Baltimore, MD, USA
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Medeiros-Ferreira L, Navarro-Pastor JB, Zúñiga-Lagares A, Romaní R, Muray E, Obiols JE. Perceived needs and health-related quality of life in people with schizophrenia and metabolic syndrome: a "real-world" study. BMC Psychiatry 2016; 16:414. [PMID: 27871263 PMCID: PMC5117524 DOI: 10.1186/s12888-016-1005-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 08/16/2016] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The complexity of schizophrenia lies in the combination of psychiatric, somatic and social needs requiring care. The aim of the study was to compare perceived needs between groups with absence/presence of metabolic syndrome (MetS) and to analyze the relationship between needs, health-related quality of life (HRQoL) and MetS in people with schizophrenia or schizoaffective disorder. METHODS A "real-world" cross-sectional study was set up with a comprehensive framework including the following, needs for care (Camberwell Assessment of Need Interview [CAN]), HRQoL (Euro Qol-5D Questionnaire), sociodemographic data, lifestyle habits, psychopathology (Positive And Negative Syndrome Scale [PANSS]), global functioning (Global Assessment of Functioning Scale [GAF]), anthropometric measurements and blood test results were assessed for an outpatient sample (n = 60). RESULTS The mean number of needs (given by CAN) was identified for both groups. Patients with MetS rated a higher number of needs compared to the group without this condition. Mobility problems (given by EQ-5D) were negatively associated with the number of total and unmet needs. For participants with MetS, HRQoL was related to the number of needs and unmet needs. For people with MetS, positive symptomatology score (given by PANSS) was related to the number of needs and met needs and general symptomatology was associated with total, met and unmet needs. For individuals without MetS, the global functioning score (given by GAF) was significantly inversely related with total, met and unmet needs. CONCLUSIONS Needs and HRQoL, as well as general symptomatology, were related only in patients with MetS. This has implications for treatment planning at the individual and organizational levels. An analysis of both physical and mental needs could provide a starting point for the extension of facilities in the health care system in order to reach the goal of improving quality of life.
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Affiliation(s)
- Leticia Medeiros-Ferreira
- Department of Clinical and Health Psychology, Faculty of Psychology, Universitat Autònoma de Barcelona/Nou Barris Nord Mental Health Center, Paseo Valldaura 214- bajos, 08042, Barcelona, Spain. .,Nou Barris Nord Mental Health Center, Paseo Valldaura 214- bajos, 08042, Barcelona, Spain.
| | - José Blas Navarro-Pastor
- Department of Psychobiology and Methodology of Health Sciences, Faculty of Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Antonio Zúñiga-Lagares
- Nou Barris Nord Mental Health Center, Paseo Valldaura 214- bajos, 08042 Barcelona, Spain
| | - Rosanna Romaní
- Nou Barris Nord Mental Health Center, Paseo Valldaura 214- bajos, 08042 Barcelona, Spain
| | - Elisenda Muray
- Nou Barris Nord Mental Health Center, Paseo Valldaura 214- bajos, 08042 Barcelona, Spain
| | - Jordi E. Obiols
- Department of Clinical and Health Psychology, Faculty of Psychology, Universitat Autònoma de Barcelona/Nou Barris Nord Mental Health Center, Paseo Valldaura 214- bajos, 08042 Barcelona, Spain
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Naslund JA, Aschbrenner KA, Scherer EA, McHugo GJ, Marsch LA, Bartels SJ. Wearable devices and mobile technologies for supporting behavioral weight loss among people with serious mental illness. Psychiatry Res 2016; 244:139-44. [PMID: 27479104 PMCID: PMC5026936 DOI: 10.1016/j.psychres.2016.06.056] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 06/29/2016] [Accepted: 06/29/2016] [Indexed: 12/27/2022]
Abstract
Promoting physical activity is essential for addressing elevated cardiovascular risk and high obesity rates affecting people with serious mental illness. Numerous challenges interfere with exercise participation in this high-risk group including mental health symptoms, low motivation, and limited access to safe and affordable options for physical activity. Wearable devices and mobile health technologies may afford new opportunities for promoting physical activity and supporting behavioral weight loss efforts. This exploratory study examined whether daily step count measured using Fitbit wearable devices was associated with weight loss and improved fitness among individuals with serious mental illness enrolled in a 6-month lifestyle program. Participants (n=34) had a schizophrenia spectrum disorder (23.5%), major depression (50.0%), or bipolar disorder (26.5%), and wore Fitbits most of the days (M=86.2%; SD=18.4%) they were enrolled in the study. At 6-months, higher average daily step count was associated with greater weight loss (F=5.07; df=1,32; p=0.0314), but not improved fitness (F=1.92; df=1,31; p=0.176). These findings demonstrate that encouraging participants with serious mental illness enrolled in lifestyle interventions to collect more steps may contribute to greater weight loss. This suggests that wearable devices may offer a feasible and potentially effective strategy for supporting behavioral weight loss in community mental health settings.
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Affiliation(s)
- John A Naslund
- Health Promotion Research Center at Dartmouth, 46 Centerra Parkway, Lebanon, NH 03766, United States; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States.
| | - Kelly A Aschbrenner
- Health Promotion Research Center at Dartmouth, 46 Centerra Parkway, Lebanon, NH 03766, United States; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Emily A Scherer
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Gregory J McHugo
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Lisa A Marsch
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
| | - Stephen J Bartels
- Health Promotion Research Center at Dartmouth, 46 Centerra Parkway, Lebanon, NH 03766, United States; The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, United States; Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
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Wright N, Akhtar A, Tosh GE, Clifton AV. HIV prevention advice for people with serious mental illness. Cochrane Database Syst Rev 2016; 9:CD009639. [PMID: 27609030 PMCID: PMC6457823 DOI: 10.1002/14651858.cd009639.pub3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND People with serious mental illness have rates of Human Immuno-deficiency Virus (HIV) infection higher than expected in the general population for the same demographic area. Despite this elevated prevalence, UK national strategies around sexual health and HIV prevention do not state that people with serious mental illness are a high risk group. However, a significant proportion in this group are sexually active and engage in HIV-risk behaviours including having multiple sexual partners, infrequent use of condoms and trading sex for money or drugs. Therefore we propose the provision of HIV prevention advice could enhance the physical and social well being of this population. OBJECTIVES To assess the effects of HIV prevention advice in reducing morbidity, mortality and preserving the quality of life in people with serious mental illness. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Trials Register (24 January 2012; 4 July 2016). SELECTION CRITERIA We planned to include all randomised controlled trials focusing on HIV prevention advice versus standard care or comparing HIV prevention advice with other more focused methods of delivering care or information for people with serious mental illness. DATA COLLECTION AND ANALYSIS Review authors (NW, AC, AA, GT) independently screened search results and did not identify any studies that fulfilled the review's criteria. MAIN RESULTS We did not identify any randomised studies that evaluated advice regarding HIV for people with serious mental illness. The excluded studies illustrate that randomisation of packages of care relevant to both people with serious mental illness and HIV risk are possible. AUTHORS' CONCLUSIONS Policy makers, clinicians, researchers and service users need to collaborate to produce guidance on how best to provide advice for people with serious mental illness in preventing the spread of HIV infection. It is entirely feasible that this could be within the context of a well-designed simple large randomised study.
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Affiliation(s)
- Nicola Wright
- University of NottinghamSchool of Health SciencesInstitute of Mental HealthTriumph RoadNottinghamUKNG7 2TU
| | - Athfah Akhtar
- University of NottinghamSchool of Sociology and Social PolicyInstitute of Mental HealthTriumph RoadNottinghamUKNG7 2TU
| | - Graeme E Tosh
- Rotherham, Doncaster and South Humber NHS Foundation Trust (RDASH)General Adult DivisionFerham ClinicKimberworth RoadRotherhamSouth YorkshireUKS61 1AD
| | - Andrew V Clifton
- De Montfort UniversityFaculty of Health and Life Sciences3.10 Edith Murphy HouseThe GatewayLeicesterUKLE1 9BH
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Khokhar MA, Khokhar WA, Clifton AV, Tosh GE. Oral health education (advice and training) for people with serious mental illness. Cochrane Database Syst Rev 2016; 9:CD008802. [PMID: 27606629 PMCID: PMC6457656 DOI: 10.1002/14651858.cd008802.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND People with serious mental illness not only experience an erosion of functioning in day-to-day life over a protracted period of time, but evidence also suggests that they have a greater risk of experiencing oral disease and greater oral treatment needs than the general population. Poor oral hygiene has been linked to coronary heart disease, diabetes, and respiratory disease and impacts on quality of life, affecting everyday functioning such as eating, comfort, appearance, social acceptance, and self esteem. Oral health, however, is often not seen as a priority in people suffering with serious mental illness. OBJECTIVES To review the effects of oral health education (advice and training) with or without monitoring for people with serious mental illness. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Trials Register (5 November 2015), which is based on regular searches of MEDLINE, EMBASE, CINAHL, BIOSIS, AMED, PubMed, PsycINFO, and clinical trials registries. There are no language, date, document type, or publication status limitations for inclusion of records in the register. SELECTION CRITERIA All randomised clinical trials focusing on oral health education (advice and training) with or without monitoring for people with serious mental illness. DATA COLLECTION AND ANALYSIS We extracted data independently. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated the mean difference (MD) between groups and its 95% CI. We employed a fixed-effect model for analyses. We assessed risk of bias for included studies and created 'Summary of findings' tables using GRADE. MAIN RESULTS We included three randomised controlled trials (RCTs) involving 1358 participants. None of the studies provided useable data for the key outcomes of not having seen a dentist in the past year, not brushing teeth twice a day, chronic pain, clinically important adverse events, and service use. Data for leaving the study early and change in plaque index scores were provided. Oral health education compared with standard careWhen 'oral health education' was compared with 'standard care', there was no clear difference between the groups for numbers leaving the study early (1 RCT, n = 50, RR 1.67, 95% CI 0.45 to 6.24, moderate-quality evidence), while for dental state: no clinically important change in plaque index, an effect was found. Although this was statistically significant and favoured the intervention group, it is unclear if it was clinically important (1 RCT, n = 40, MD - 0.50 95% CI - 0.62 to - 0.38, very low quality evidence).These limited data may have implications regarding improvement in oral hygiene. Motivational interview + oral health education compared with oral health educationSimilarly, when 'motivational interview + oral health education' was compared with 'oral health education', there was no clear difference for the outcome of leaving the study early (1 RCT, n = 60 RR 3.00, 95% CI 0.33 to 27.23, moderate-quality evidence), while for dental state: no clinically important change in plaque index, an effect favouring the intervention group was found (1 RCT, n = 56, MD - 0.60 95% CI - 1.02 to - 0.18 very low-quality evidence). These limited, clinically opaque data may or may not have implications regarding improvement in oral hygiene. Monitoring compared with no monitoringFor this comparison, only data for leaving the study early were available. We found a difference in numbers leaving early, favouring the 'no monitoring' group (1 RCT, n = 1682, RR 1.07, 95% CI 1.00 to 1.14, moderate-quality evidence). However, these data are problematic. The control denominator is implied and not clear, and follow-up did not depend only on individual participants, but also on professional caregivers and organisations - the latter changing frequently resulting in poor follow-up, but not a good reflection of the acceptability of the monitoring to patients. For this comparison, no data were available for 'no clinically important change in plaque index'. AUTHORS' CONCLUSIONS We found no evidence from trials that oral health advice helps people with serious mental illness in terms of clinically meaningful outcomes. It makes sense to follow guidelines and recommendations such as those put forward by the British Society for Disability and Oral Health working group until better evidence is generated. Pioneering trialists have shown that evaluative studies relevant to oral health advice for people with serious mental illness are possible.
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Affiliation(s)
- Mariam A Khokhar
- University of SheffieldOral Health and Development15 Askham CourtGamston Radcliffe RoadNottinghamUKNG2 6NR
| | - Waqqas Ahmad Khokhar
- Leicestershire Partnership NHS TrustDepartment of PsychiatryLeicesterLeicestershireUK
| | - Andrew V Clifton
- De Montfort UniversityFaculty of Health and Life Sciences3.10 Edith Murphy HouseThe GatewayLeicesterUKLE1 9BH
| | - Graeme E Tosh
- Rotherham, Doncaster and South Humber NHS Foundation Trust (RDASH)General Adult DivisionFerham ClinicKimberworth RoadRotherhamSouth YorkshireUKS61 1AD
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Penkunas MJ, Hahn-Smith S. Risk Factors for Psychiatric Hospital Admission for Participants in California's Full-Service Partnership Program. Community Ment Health J 2016; 52:651-7. [PMID: 25527223 DOI: 10.1007/s10597-014-9789-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 12/05/2014] [Indexed: 10/24/2022]
Abstract
This study investigated the demographic and clinical predictors of psychiatric hospitalization during the first 2 years of treatment for adults participating in the full-service partnership (FSP) program, based on Assertive Community Treatment, in a large county in northern California. Clinical and demographic characteristics, data on prior hospitalizations, length of enrollment, and living situation for 328 FSP participants were collected from the county's internal billing system and the California Department of Health Care Services. In univariate models, the probability of hospitalization varied by diagnosis, age, and hospitalization history. In the multivariate model, younger age and frequent hospitalization prior to enrollment predicted hospitalization during enrollment. Findings support prior research on hospital recidivism and may be beneficial in refining future strategies for meeting the needs of adults with serious mental illness.
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Affiliation(s)
- Michael J Penkunas
- Research and Evaluation Unit, Contra Costa Behavioral Health Services, 1340 Arnold Drive, Suite 200, Martinez, CA, 94553, USA.
| | - Stephen Hahn-Smith
- Research and Evaluation Unit, Contra Costa Behavioral Health Services, 1340 Arnold Drive, Suite 200, Martinez, CA, 94553, USA
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McDevitt J, Wilbur J, Kogan J, Briller J. A Walking Program for Outpatients in Psychiatric Rehabilitation: Pilot Study. Biol Res Nurs 2016; 7:87-97. [PMID: 16267370 DOI: 10.1177/1099800405278116] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purposes of this quasi-experimental pilot study were to determine adherence to a 12-week group-based moderate-intensity walking program for sedentary adult outpatients with serious and persistent mental illness and to examine change from baseline to after the walking program in health status (mental and physical health, mood, and psychosocial functioning) and exercise motivation (exercise outcomes expectancies, exercise decisional balance). The 15 volunteers in this study were aged 21 to 65 years and enrolled in psychosocial rehabilitation; they participated in a 12-week walking program meeting three times per week for 1 hr, supplemented with four health information workshops delivered at the beginning of the study. Participants received individual exercise prescriptions determined by preprogram fitness testing and used heart rate monitors during walking sessions. Thirteen participants (87%) completed the study and attended 76% of the walking sessions. Overall, they walked at lower intensity than prescribed, with pulses within target heart rate ranges 35% of the time during Weeks 1 through 4, 26% of the time during Weeks 5 through 8, and 22% of the time during Weeks 9 through 12. However, mood improved (Profile of Mood States, t = -2.51, two-tailed, df = 12, p = .02), as did psychosocial functioning (Multnomah Community Ability Scale, two-tailed, df = 12, t = 2.49, p = .02). The findings indicate a walking group may be feasible for rehabilitation programs. In addition to the known cardiovascular risk-reduction benefits of regular walking, walking may improve mood and psychosocial functioning in adults with serious and persistent mental illness.
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Affiliation(s)
- Judith McDevitt
- Department of Public Health, Mental Health, and Administrative Nursing, University of Illinois at Chicago College of Nursing, Chicago, IL 60612, USA.
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Fabrazzo M, Monteleone P, Prisco V, Perris F, Catapano F, Tortorella A, Monteleone AM, Steardo L, Maj M. Olanzapine Is Faster than Haloperidol in Inducing Metabolic Abnormalities in Schizophrenic and Bipolar Patients. Neuropsychobiology 2016; 72:29-36. [PMID: 26337616 DOI: 10.1159/000437430] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 07/06/2015] [Indexed: 11/19/2022]
Abstract
The effects of olanzapine and haloperidol on metabolic parameters in bipolar patients have been evaluated much less comprehensively than in schizophrenic patients. Therefore, in this study, medical records of 343 schizophrenic and bipolar patients treated with haloperidol or olanzapine for 1 year were retrospectively reviewed and metabolic outcomes were evaluated. After 12 months of follow-up, 25.9% of patients showed ≥3 metabolic abnormalities with a point prevalence of 27.2% in the bipolar and 24.9% in the schizophrenic group: 22.0% of the schizophrenic patients treated with haloperidol and 29.8% of those treated with olanzapine achieved ≥3 metabolic alterations; in bipolar patients, these percentages were 15.8% of those treated with haloperidol and 37.8% of those treated with olanzapine (p < 0.0001). Significant changes were reported over time in fasting glucose, triglycerides and cholesterol blood levels, systolic and diastolic blood pressure, body weight, and BMI. Overall, a significant number of schizophrenic and bipolar patients treated with olanzapine showed ≥3 metabolic alterations in the first month of treatment when compared to those treated with haloperidol. Moreover, the number of olanzapine-treated patients developing metabolic changes in the first month was significantly higher in both diagnostic groups when compared to those who reached metabolic abnormal values in the subsequent 11 months. These data suggest that both antipsychotics could increase the metabolic risk in schizophrenic and bipolar patients with a higher prevalence in olanzapine-treated patients. On the other hand, olanzapine-treated patients seem to achieve metabolic abnormalities faster than haloperidol-treated subjects in both diagnostic groups.
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Abstract
Individuals with serious mental illnesses such as psychosis still experience higher mortality rates than the general population, decades after data have linked the gap to increased rates of physical illness, delayed diagnosis, low treatment rates and worse outcomes from treatment received. The nature of the relationship between psychosis and comorbid physical illness is complex. Multiple strategies directed at different levels of disease process, health care systems and stakeholder culture are likely required to make sustained progress in reducing the mortality gap. Evidence for strategies that effectively reduce the burden of physical co-morbidity and lead to improved health outcomes are still in their infancy but growing at a reassuringly fast rate. This editorial considers the existing evidence base and makes suggestions for the development and future direction of this urgent research agenda and how this knowledge can be implemented in clinical practice.
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Affiliation(s)
- M. Docherty
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK
| | - B. Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK
| | - F. Gaughran
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, UK
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London SE5 8AF, UK
- Collaborative Leadership in Applied Heath Research Centre and Care, South London, UK
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Improvements in Somatic Complaints Among Individuals With Serious Mental Illness Receiving Treatment in a Psychiatric Hospital. Psychosom Med 2016; 78:271-80. [PMID: 26867074 DOI: 10.1097/psy.0000000000000298] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Individuals with serious mental illness (SMI) experience significant comorbid somatic complaints. Little is known about response to integrated inpatient care that addresses psychiatric and general medical needs among individuals with SMI. METHODS Latent growth curve analyses were used to model somatic symptom trajectories across adult inpatients with SMI (n = 989). The Patient Health Questionnaire-15 (PHQ-15) was administered at admission, every 14 days, and at discharge. RESULTS Patients evidenced substantial reduction in somatization from admission (mean [standard deviation] = 9.0 [5.2]) to discharge (mean [standard deviation] = 5.2 [4.4]), with large effects (d = 0.83, 95% confidence interval = 0.76-0.90). Results indicate nonlinear improvement in somatic symptoms for 8 weeks of treatment, with greatest symptom reduction occurring during the first weeks of treatment with continued, albeit slowed, improvement until discharge. Initial PHQ-15 scores were lower among men and those who reported regular exercise in the 30 days preceding this hospitalization. In addition, presence of an anxiety disorder or personality disorder at admission; history of trauma, a gastrointestinal disorder, or major medical illness (within the past 3 months); and significant sleep disturbance independently contribute to higher PHQ-15 scores at admission. A substance use disorder and sleep disturbance were associated with greater immediate symptom reduction. CONCLUSIONS Somatic complaints can be managed in the context of inpatient psychiatric care integrated with 24-hour nursing and internal medicine specialists. Addressing psychiatric impairments, improving sleep, and ensuring abstinence from drugs and alcohol are associated with significant improvement in somatic complaints.
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Tsoutsoulas C, Mulsant BH, Kalache SM, Kumar S, Ghazala Z, Voineskos AN, Butters MA, Menon M, Rajji TK. The influence of medical burden severity and cognition on functional competence in older community-dwelling individuals with schizophrenia. Schizophr Res 2016; 170:330-5. [PMID: 26724896 DOI: 10.1016/j.schres.2015.12.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 12/08/2015] [Accepted: 12/12/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Cognition predicts functional competence among individuals with schizophrenia across the lifespan. However, as these individuals age, increasing levels of medical burden may also contribute to functional deficits both directly and indirectly through cognition. Thus, we assessed the relationship among, cognition, medical burden, and functional competence in older individuals with schizophrenia. METHODS We analyzed data obtained from 60 community-dwelling participants with schizophrenia and 30 control participants aged 50 or above. Cognition was assessed using the MATRICS Consensus Cognitive Battery (MCCB), functional competence was assessed using the USCD Performance-Based Skills Assessment (UPSA), and medical burden was assessed using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). Group differences were assessed using independent samples t-tests or chi-square tests. Mediation analyses using bootstrapping techniques were used to assess whether cognition mediated the effects of medical burden on functional competence. RESULTS Participants with schizophrenia had higher levels of medical burden, cognitive deficits, and functional impairments. In participants with schizophrenia, cognition, but not medical burden, predicted functional competence after adjusting for age, education, gender, clinical symptoms, and anticholinergic burden of medications. In control participants, cognition and medical burden both predicted functional competence after adjusting for age, education, and gender. Further, cognition was found to fully mediate the association between medical burden and functional competence in control participants. CONCLUSION Cognition is a robust predictor of functional competence among older individuals with schizophrenia, regardless of medical burden. Cognitive deficits associated with schizophrenia may mask any further cognitive impairment associated with medical burden and its impact on function.
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Affiliation(s)
- Christopher Tsoutsoulas
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Benoit H Mulsant
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Sawsan M Kalache
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Sanjeev Kumar
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Zaid Ghazala
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Aristotle N Voineskos
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Mahesh Menon
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Tarek K Rajji
- Division of Geriatric Psychiatry, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
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Abstract
BACKGROUND People with a serious mental illness are more likely to smoke more and to be more dependent smokers than the general population. This may be due to a wide range of factors that could include a common aetiology to both smoking and the illness, self medication, smoking to alleviate adverse effects of medications, boredom in the existing environment, or a combination of these factors. It is important to undertake this review to facilitate improvements in both the health and safety of people with serious mental illness who smoke, and to reduce the overall burden of costs (both financial and health) to the smoker and, eventually, to the taxpayer. OBJECTIVES To review the effects of smoking cessation advice for people with serious mental illness. SEARCH METHODS We searched the Cochrane Schizophrenia Group Specialized Trials Register up to 2 April 2015, which is based on regular searches of CENTRAL, BIOSIS, PubMed, MEDLINE, EMBASE, CINAHL, PsycINFO, and trial registries. We also undertook unsystematic searches of a sample of the component databases (BNI, CINHAL, EMBASE, MEDLINE, and PsycINFO), up to 2 April 2015, and searched references of all identified studies SELECTION CRITERIA We planned to include all randomised controlled trials (RCTs) that focussed on smoking cessation advice versus standard care or comparing smoking cessation advice with other more focussed methods of delivering care or information. DATA COLLECTION AND ANALYSIS The review authors (PK, AC, and DB) independently screened search results but did not identify any trials that fulfilled the inclusion criteria of this review. MAIN RESULTS We did not identify any RCTs that evaluated advice regarding smoking cessation for people with serious mental illness. The excluded studies illustrate that randomisation of packages of care relevant to smokers with serious mental illness is possible. AUTHORS' CONCLUSIONS People with serious mental illness are more likely to smoke than the general population. Yet we could not find any high quality evidence to guide the smoking cessation advice healthcare professionals pass onto service users. This is an area where trials are possible and needed.
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Affiliation(s)
- Priya Khanna
- Northumberland, Tyne and Wear NHS Foundation TrustRehabilitation and Recovery, Adult PsychiatryNewcastleUK
| | - Andrew V Clifton
- University of HuddersfieldSchool of Human and Health SciencesQueensgateHuddersfieldSouth West YorkshireUKHD1 3DH
| | - David Banks
- Queen Margaret UniversitySchool of Health SciencesQueen Margaret DriveMusselburghEdinburghUKEH21 6UU
| | - Graeme E Tosh
- Rotherham, Doncaster and South Humber NHS Foundation Trust (RDASH)General Adult DivisionFerham ClinicKimberworth RoadRotherhamSouth YorkshireUKS61 1AD
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Iredale C, Fornells-Ambrojo M, Jolley S. Psychological interventions for housebound people with psychosis: service user and therapist perspectives in South East London. J Ment Health 2015; 25:204-11. [PMID: 26472054 DOI: 10.3109/09638237.2015.1078882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND People with psychosis often have difficulty leaving their homes to perform tasks of daily living, which also limits their access to clinic-based interventions to support recovery. Home-based psychological therapy may offer a solution. AIM To examine service user and therapist perspectives on (i) houseboundness in psychosis and (ii) the value of home-based psychological interventions, as a first step towards a systematic evaluation. METHOD Semistructured interviews with 10 service users and 12 therapists from a large inner city mental health NHS Foundation Trust were thematically analysed. RESULTS Houseboundness most commonly resulted from anxiety, paranoia and amotivation, indicating the potential usefulness of targeted psychological therapies. Home-based therapy was offered unsystematically, with variable goals. Although beneficial for engagement and assessment, little gain was reported from undertaking a full course of therapy at home. CONCLUSION Home visits could be offered by psychological therapists to engage and assess housebound service users, but home-based therapy may be best offered on a short-term basis, targeting paranoia, anxiety and amotivation to increase access to other resources. Given the increased cost associated with home-based psychological interventions, a systematic evaluation of their impact is warranted.
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Affiliation(s)
- Catherine Iredale
- a Department of Psychology , King's College London, Institute of Psychiatry, Psychology and Neuroscience , London , UK .,b South London and Maudsley NHS Foundation Trust , London , UK , and
| | - Miriam Fornells-Ambrojo
- a Department of Psychology , King's College London, Institute of Psychiatry, Psychology and Neuroscience , London , UK .,b South London and Maudsley NHS Foundation Trust , London , UK , and.,c Department of Clinical , Educational and Health Psychology, University College London , London , UK
| | - Suzanne Jolley
- a Department of Psychology , King's College London, Institute of Psychiatry, Psychology and Neuroscience , London , UK
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Abdullah-Koolmees H, Gardarsdottir H, Yazir D, Stoker LJ, Vuyk J, Egberts TCG, Heerdink ER. Medication Discontinuation in Patients After Discharge From a Psychiatric Hospital. Ann Pharmacother 2015; 49:1085-95. [PMID: 26160969 DOI: 10.1177/1060028015593763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Patients discharged from psychiatric hospitals may be at risk for intentional or unintentional discontinuation of their medication. OBJECTIVE To describe and assess the discontinuation of, and changes to, psychiatric and/or somatic medication in patients after discharge from psychiatric hospitals. METHODS A retrospective follow-up study was conducted in patients discharged from 4 psychiatric hospitals in The Netherlands between 2006 and 2009. Patients' medication use during the last 2 days of hospitalization was compared with medication dispensed during the 3 months following discharge. Changes in psychiatric and somatic medication were investigated and defined as medication discontinuation, start, or switch. Patients were classified as continuing users, when there were no changes to the medication after discharge. Relative risks with 95% confidence intervals to measure differences in discontinuation were estimated using Cox regression analysis. RESULTS This study included 1324 patients, 69.8% of whom discontinued medication, and 9.7% switched one or more medications. Nearly half (47.4%) of all patients started a medication other than that dispensed during the last 2 days of hospitalization, and 13.7% of all patients experienced no changes to their medication regimen. Approximately 40% of the patients discontinued one or more medications for chronic conditions. From these, 68% discontinued psychiatric medications and 49.4% discontinued somatic medications. A quarter (25.2%) of the 644 patients discontinued using antipsychotics. More than a quarter (28.4%) of the 292 patients using medications for cardiovascular problems discontinued. Patients using as-needed medication prior to discharge were more likely to discontinue their medication (relative risk = 1.85; 95% confidence interval = 1.55-2.20). CONCLUSIONS Discharge from a psychiatric hospital led to medication discontinuation in approximately 70% of all patients. Approximately 40% of the patients discontinued medications for chronic conditions. Discontinuation of somatic medication was more frequent than discontinuation of psychiatric medication, and risk of discontinuation was lower for patients with depressive and anxiety disorders. Although medication discontinuation can be deliberate it is alarming that a quarter of our patients using antipsychotics and cardiovascular medications discontinued their use, both of which are meant for chronic conditions.
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Affiliation(s)
- Heshu Abdullah-Koolmees
- Utrecht University, Utrecht, The Netherlands Brocacef Ziekenhuisfarmacie, Den Dolder, The Netherlands Diakonessenhuis, Utrecht, The Netherlands
| | - Helga Gardarsdottir
- Utrecht University, Utrecht, The Netherlands University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dilek Yazir
- Utrecht University, Utrecht, The Netherlands
| | | | - Judith Vuyk
- Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
| | - Toine C G Egberts
- Utrecht University, Utrecht, The Netherlands University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eibert R Heerdink
- Utrecht University, Utrecht, The Netherlands University Medical Center Utrecht, Utrecht, The Netherlands Altrecht Institute for Mental Health Care, Utrecht, The Netherlands
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49
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Slade EP, Goldman HH, Dixon LB, Gibbons B, Stuart EA. Assessing the Representativeness of Medical Expenditure Panel Survey Inpatient Utilization Data for Individuals With Psychiatric and Nonpsychiatric Conditions. Med Care Res Rev 2015; 72:736-55. [PMID: 26149973 DOI: 10.1177/1077558715592745] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 05/28/2015] [Indexed: 11/17/2022]
Abstract
Sampling and reporting biases in the Medical Expenditure Panel Survey (MEPS) survey could render data on inpatient utilization that are not representative for individuals with severe psychiatric conditions. The authors assessed the representativeness of MEPS data on psychiatric inpatient utilization, by comparing MEPS estimates of total annual psychiatric and nonpsychiatric inpatient admissions and bed days, and mean length of stay, for nonelderly U.S. adults in calendar years 2005 to 2010 (N = 9,288) to estimates from the Nationwide Inpatient Sample (NIS), a nationally representative inpatient care database derived from hospitals' administrative records (N = 21,934,378). Compared with the NIS, the MEPS indicated 34% as many psychiatric admissions and 86% as many nonpsychiatric admissions, while mean psychiatric length of stay was greater in MEPS than in NIS. In MEPS data, underrepresentation of psychiatric inpatient utilization at community hospitals may result in measurement distortions for commonly used statistics on psychiatric inpatient utilization and costs.
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Affiliation(s)
- Eric P Slade
- U.S. Department of Veterans Affairs, Baltimore, MD, USA University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Lisa B Dixon
- Columbia University College of Physicians and Surgeons, New York, NY, USA New York State Psychiatric Institute, New York, NY, USA
| | - Brent Gibbons
- University of Maryland-Baltimore County, Baltimore, MD, USA
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50
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Penkunas MJ, Friedman A, Hahn-Smith S. Characteristics of Older Adults With Serious Mental Illness Enrolled in a Publicly Funded In-Home Mental Health Treatment Program. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2015. [DOI: 10.1177/1084822315571531] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In-home mental health services for older adults will likely become increasingly utilized as the population ages. Little is known about older adults with serious mental illness who receive in-home services through the public mental health system. This study examined the demographic and clinical characteristics of this population. A total of 148 clients were included. Mood disorders were present in 75.7% and schizophrenia spectrum disorders were present in 23.6%. A history of problematic substance use was documented in 47.3% of clients and 31.8% reported suicidal ideation prior to enrollment. A total of 25% of clients utilized psychiatric emergency services during the year prior to enrollment and 15.5% of clients were hospitalized for psychiatric treatment. Older adults who receive in-home mental health services are vulnerable and have complex treatment needs.
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Affiliation(s)
| | - Anne Friedman
- Contra Costa Behavioral Health Services, Martinez, CA, USA
- University of California, Berkeley, USA
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