[Drawing up guidelines for the attendance of physical health of patients with severe mental illness].
ABSTRACT Having a mental illness has been and remains even now, a strong barrier to effective medical care. Most mental illness, such as schizophrenia, bipolar disorder, and depression are associated with undue medical morbidity and mortality. It represents a major health problem, with a 15 to 30 year shorter lifetime compared with the general population.
Based these facts, a workshop was convened by a panel of specialists: psychiatrists, endocrinologists, cardiologists, internists, and pharmacologists from some French hospitals to review the information relating to the comorbidity and mortality among the patients with severe mental illness, the risks with antipsychotic treatment for the development of metabolic disorders and finally cardiovascular disease. The French experts strongly agreed on these points: that the patients with severe mental illness have a higher rate of preventable risk factors such as smoking, addiction, poor diet, lack of exercise; the recognition and management of morbidity are made more difficult by barriers related to patients, the illness, the attitudes of medical practitioners, and the structure of healthcare delivery services; and improved detection and treatment of comorbidity medical illness in people with severe mental illness will have significant benefits for their psychosocial functioning and overall quality of life. GUIDELINES FOR INITIATING ANTIPSYCHOTIC THERAPY: Based on these elements, the French experts propose guidelines for practising psychiatrists when initiating and maintaining therapy with antipsychotic compounds. The aim of the guidelines is practical and concerns the detection of medical illness at the first episode of mental illness, management of comorbidity with other specialists, family practitioner and follow-up with some key points. The guidelines are divided into two major parts. The first part provides: a review of mortality and comorbidity of patients with severe mental illness: the increased morbidity and mortality are primarily due to premature cardiovascular disease (myocardial infarction, stroke...).The cardiovascular events are strongly linked to non modifiable risk factors such as age, gender, personal and/or family history, but also to crucial modifiable risk factors, such as overweight and obesity, dyslipidemia, diabetes, hypertension and smoking. Although these classical risk factors exist in the general population, epidemiological studies suggest that patients with severe mental illness have an increased prevalence of these risk factors. The causes of increased metabolic and cardiovascular risk in this population are strongly related to poverty and limited access to medical care, but also to the use of psychotropic medication. A review of major published consensus guidelines for metabolic monitoring of patients treated with antipsychotic medication that have recommended stringent monitoring of metabolic status and cardiovascular risk factors in psychiatric patients receiving antipsychotic drugs. There have been six attempts, all published between 2004 and 2005: Mount Sinai, Australia, ADA-APA, Belgium, United Kingdom, Canada. Each guideline had specific, somewhat discordant, recommendations about which patients and drugs should be monitored. However, there was agreement on the importance of baseline monitoring and follow-up for the first three to four months of treatment, with subsequent ongoing reevaluation. There was agreement on the utility of the following tests and measures: weight and height, waist circumference, blood pressure, fasting plasma glucose, fasting lipid profile. In the second part, the French experts propose guidelines for practising psychiatrists when initiating and maintaining therapy with antipsychotic drugs: the first goal is identification of risk factors for development of metabolic and cardiovascular disorders: non modifiable risk factors: these include: increasing age, gender (increased rates of obesity, diabetes and metabolic syndrome are observed in female patients treated with antipsychotic drugs), personal and family history of obesity, diabetes, heart disease, ethnicity as we know that there are increased rates of diabetes, metabolic syndrome and coronary heart disease in patients of non European ethnicity, especially among South Asian, Hispanic, and Native American people. Modifiable risk factors: these include: obesity, visceral obesity, smoking, physical inactivity, and bad diet habits. Then the expert's panel focussed on all the components of the initial visit such as: family and medical history; baseline weight and BMI should be measured for all patients. Body mass index can be calculated by dividing weight (in kilograms) by height (in meters) squared; visceral obesity measured by waist circumference; blood pressure; fasting plasma glucose; fasting lipid profiles. These are the basic measures and laboratory examinations to do when initiating an antipsychotic treatment. ECG: several of the antipsychotic medications, typical and atypical, have been shown to prolong the QTc interval on the ECG. Prolongation of the QTc interval is of potential concern since the patient may be at risk for wave burst arrhythmia, a potentially serious ventricular arrhythmia. A QTc interval greater than 500 ms places the patient at a significantly increased risk for serious arrhythmia. QTc prolongation has been reported with varying incidence and degrees of severity. The atypical antipsychotics can also cause other cardiovascular adverse effects with, for example, orthostatic hypotension. Risk factors for cardiovascular adverse effects with antipsychotics include: known cardiovascular disease, electrolyte disorders, such as hypokaliemia, hypomagnesaemia, genetic characteristics, increasing age, female gender, autonomic dysfunction, high doses of antipsychotics, the use of interacting drugs, and psychiatric illness itself. In any patient with pre-existing cardiac disease, a pre-treatment ECG with routine follow-up is recommended.
Patients on antipsychotic drugs should undergo regular testing of blood sugar, lipid profile, as well as body weight, waist circumference and blood pressure, with recommended time intervals between measures. Clinicians should track the effects of treatment on physical and biological parameters, and should facilitate access to appropriate medical care. In order to prevent or limit possible side effects, information must be given to the patient and his family on the cardiovascular and metabolic risks. The cost-effectiveness of implementing these recommendations is considerable: the costs of laboratory tests and additional equipment costs (such as scales, tape measures, and blood pressure devices) are modest. The issue of responsibility for monitoring for metabolic abnormalities is much debated. However, with the prescription of antipsychotic drugs comes the responsibility for monitoring potential drug-induced metabolic abnormalities. The onset of metabolic disorders will imply specific treatments. A coordinated action of psychiatrists, general practitioners, endocrinologists, cardiologists, nurses, dieticians, and of the family is certainly a key determinant to ensure the optimal care of these patients.
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ABSTRACT: Citazione. Lucii C, Simonetta A, Buselli S et al. Valutare gli esiti dei ricoveri nei servizi psichiatrici di diagnosi e cura: uno studio osservazionale. Evidence 2014;6(4): e1000075. Ricevuto 11 novembre 2013 | Accettato 30 gennaio 2014 | Pubblicato 28 aprile 2014 Copyright. 2014 Lucii. Questo è un articolo open-access, distribuito con licenza Creative Commons Attribution, che ne consente l'utilizzo, la di-stribuzione e la riproduzione su qualsiasi supporto esclusivamente per fini non commerciali, a condizione di riportare sempre autore e citazione originale. Fonti di finanziamento. Nessuna. Conflitti d'interesse. Nessuno dichiarato. Provenienza. Non commissionato; sottoposto a peer-review. ABSTRACT Background. Vi è la necessità di migliorare il ricovero nei Servizi Psichiatrici di Diagnosi e Cura (SPDC), sia in termini di appropriatezza che in termini della qualità delle cure erogate durante il ricovero. In Italia solo il 45 % dei posti letto si trova in strutture pubbliche (SPDC e Cliniche Psi-chiatriche Universitarie), il resto in case di cura private sia convenzionate che non. Il Dipartimento Interaziendale di Siena ha predisposto un protocollo di valutazione degli esiti dei ricoveri in SPDC per migliorare la qualità del rico-vero nell'ambito dell'assistenza sanitaria pubblica. Obiettivi. Valutare se il ricovero ospedaliero produce un miglioramento psicopatologico e di funzionamento so-ciale e relazionale dei pazienti, utilizzando dei semplici strumenti clinici adatti alla pratica clinica quotidiana: la scala HoNOS-Roma in una versione modificata a 13 item, la scala BPRS 4.0 e una scheda Buona Salute, apposita-mente predisposta per valutare parametri clinici di sa-lute. Tali strumenti fanno parte del protocollo operativo per la valutazione degli esiti adottato dal Dipartimento. Metodi. Le schede di valutazione sono state sommini-strate a tutti i pazienti ricoverati nei SPDC della provincia e nella Clinica Psichiatrica e dimessi dal 01.01.2012 al 30.04.2013 per un totale di 406 ricoveri. Viene conside-rata la diagnosi principale di dimissione utilizzando ICD-9-CM 24 a
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ABSTRACT: The use of antipsychotic medication in the United States and throughout the world has greatly increased over the last fifteen years. These drugs have significant side effect burdens, many of them relating to cardiovascular health.Journal of Multidisciplinary Healthcare 01/2014; 7:489-501. DOI:10.2147/JMDH.S49817
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ABSTRACT: The present study was conducted to investigate depression among addictive patients and if there is a possible association between general characteristics of participants including demographic variable and depression. The methodology of the present study included case control study design, study sample included 36 addictive patients who received treatment at Governmental Center for Treatment and Rehabilitation of Addiction. Study instrument was a questionnaire constructed for data collection from participants in addition to measuring depression using the Beck Depression Inventory (BDI). Study findings revealed medium to severe depression among addictive group, while control group had no depression. None of the general characteristics of participants showed significant variation between the addictive group and the control group (P>0.05). There was in the present study not found an association between demographical data and depression.Indian Research Journal of Pharmacy and Science 11/2014; 1(3):10-18.