Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care

World psychiatry: official journal of the World Psychiatric Association (WPA) (Impact Factor: 14.23). 02/2011; 10(1):52-77. DOI: 10.1002/j.2051-5545.2011.tb00014.x
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The lifespan of people with severe mental illness (SMI) is shorter compared to the general population. This excess mortality is mainly due to physical illness. We report prevalence rates of different physical illnesses as well as important individual lifestyle choices, side effects of psychotropic treatment and disparities in health care access, utilization and provision that contribute to these poor physical health outcomes. We searched MEDLINE (1966 - August 2010) combining the MeSH terms of schizophrenia, bipolar disorder and major depressive disorder with the different MeSH terms of general physical disease categories to select pertinent reviews and additional relevant studies through cross-referencing to identify prevalence figures and factors contributing to the excess morbidity and mortality rates. Nutritional and metabolic diseases, cardiovascular diseases, viral diseases, respiratory tract diseases, musculoskeletal diseases, sexual dysfunction, pregnancy complications, stomatognathic diseases, and possibly obesity-related cancers are, compared to the general population, more prevalent among people with SMI. It seems that lifestyle as well as treatment specific factors account for much of the increased risk for most of these physical diseases. Moreover, there is sufficient evidence that people with SMI are less likely to receive standard levels of care for most of these diseases. Lifestyle factors, relatively easy to measure, are barely considered for screening; baseline testing of numerous important physical parameters is insufficiently performed. Besides modifiable lifestyle factors and side effects of psychotropic medications, access to and quality of health care remains to be improved for individuals with SMI.

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Available from: Marc De Hert, Oct 04, 2015
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    • "The main motor impairments described include a decreased balance and postural control, displayed by postural instability, increased postural sway area and center of pressure displacement (Agarwal & Agarwal, 2014; Kent et al., 2012; Marvel, Schwartz, & Rosse, 2004; Stensdotter, Loras, Fløvig, & Djupsjobacka, 2013); poorer gait performance, comprising shorter stride length and decreased gait velocity (Putzhammer et al., 2004; Putzhammer, Perfahl, Pfeiff, & Hajak, 2005); and higher incidence of motor neurological soft signs, with inferior performance in motor coordination and sequencing tasks (Dazzan & Murray, 2002; Zakaria, Jaafar, Baharudin, Ibrahim, & Midin, 2013). Currently, there has been a growing interest in the physical rehabilitation of patients with schizophrenia (Hert et al., 2011), with international guidelines emphasizing the role of physical activity in the treatment of this disorder (Lehman et al., 2010; "
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    ABSTRACT: Objectives To evaluate the feasibility and acceptability of an exergame intervention as a tool to promote physical activity in outpatients with schizophrenia. Design Feasibility/Acceptability Study and Quasi-Experimental Trial. Method Sixteen outpatients with schizophrenia received treatment as usual and they all completed an 8-week exergame intervention using Microsoft Kinect® (20 minute sessions, biweekly). Participants completed pre and post treatment assessments regarding functional mobility (Timed Up and Go Test), functional fitness performance (Senior Fitness Test), motor neurological soft signs (Brief Motor Scale), hand grip strength (digital dynamometer), static balance (force plate), speed of processing (Trail Making Test), schizophrenia-related symptoms (Positive and Negative Syndrome Scale) and functioning (Personal and Social Performance Scale). The EG group completed an acceptability questionnaire after the intervention. Results Attrition rate was 18.75% and 69.23% of the participants completed the intervention within the proposed schedule. Baseline clinical traits were not related to game performance indicators. Over 90% of the participants rated the intervention as satisfactory and interactive. Most participants (76.9%) agreed that this intervention promotes healthier lifestyles and is an acceptable alternative to perform physical activity. Repeated-measures MANOVA analyses found no significant multivariate effects for combined outcomes. Conclusion This study established the feasibility and acceptability of an exergame intervention for outpatients with schizophrenia. The intervention proved to be an appealing alternative to physical activity. Future trials should include larger sample sizes, explore patients’ adherence to home-based exergames and consider greater intervention dosage (length, session duration, and/or frequency) in order to achieve potential effects.
    Psychology of Sport and Exercise 07/2015; 19. DOI:10.1016/j.psychsport.2015.02.005 · 1.90 Impact Factor
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    • "Of particular concern is the increased risk for cardiovascular diseases (CVD), with research demonstrating that people with bipolar disorder have a nearly five times increased age-, race-, and gender-adjusted CVD risk (Goldstein et al., 2009). The underlying mechanisms for this increased CVD-risk are multifactorial and include adverse effects of pharmacological treatments (Vancampfort et al., 2013a), poorer access to and quality of physical health care (Mitchell et al., 2009; De Hert et al., 2011) and an unhealthy, sedentary lifestyle exacerbated by psychiatric symptoms (Killbourne et al., 2009; Vancampfort et al., 2013b). "
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    ABSTRACT: The physical health of people with bipolar disorder is poorer in comparison to the general population, with an increased prevalence of cardiovascular and metabolic diseases. Due to the established beneficial effects, there is growing interest in the promotion of physical activity and in particular the accurate measurement of physical fitness in this population. Currently, no existing measures of physical fitness used in the general population have been tested for validity and reliability among people with bipolar disorder. Therefore, we examined the reproducibility, feasibility and correlates of the Eurofit test battery in people with bipolar disorder. From 24 men (43.0±13.0 years) and 22 women (43.9±10.2 years) with bipolar disorder two trials of the Eurofit test, administered within three days, were analyzed. All Eurofit items showed good reproducibility with intraclass correlation coefficients ranging from 0.71 for the whole body balance test to 0.98 for the handgrip force test. Significant correlations with Eurofit test items were found with age, illness duration, body mass index, smoking behavior, mean daily lithium dosage, and depressive and lifetime hypomanic symptoms. The current study demonstrates that the Eurofit test can be recommended for evaluating the physical fitness of inpatients with bipolar disorder. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Psychiatry Research 06/2015; 228(3). DOI:10.1016/j.psychres.2015.05.042 · 2.47 Impact Factor
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    • "Clustering of cardiometabolic risk factors is termed the metabolic syndrome (MetS) (Alberti et al. 2005). Individuals with the MetS have a 3-to 6-fold increased risk of developing type 2 diabetes mellitus (Hanley et al. 2005; De Hert et al. 2011) and a 2-to 6-fold risk of mortality due to cardiovascular disease (CVD) (Hanley et al. 2005). On meta-analysis, a third of patients with schizophrenia have the MetS, with this proportion increasing with duration of illness (Mitchell et al. 2013). "
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    ABSTRACT: The aims of the study were to determine the prevalence of cardiometabolic risk factors and establish the proportion of people with psychosis meeting criteria for the metabolic syndrome (MetS). The study also aimed to identify the key lifestyle behaviours associated with increased risk of the MetS and to investigate whether the MetS is associated with illness severity and degree of functional impairment. Method Baseline data were collected as part of a large randomized controlled trial (IMPaCT RCT). The study took place within community mental health teams in five Mental Health NHS Trusts in urban and rural locations across England. A total of 450 randomly selected out-patients, aged 18���65 years, with an established psychotic illness were recruited. We ascertained the prevalence rates of cardiometabolic risk factors, illness severity and functional impairment and calculated rates of the MetS, using International Diabetes Federation (IDF) and National Cholesterol Education Program Third Adult Treatment Panel criteria. High rates of cardiometabolic risk factors were found. Nearly all women and most men had waist circumference exceeding the IDF threshold for central obesity. Half the sample was obese (body mass index ��� 30 kg/m2) and a fifth met the criteria for type 2 diabetes mellitus. Females were more likely to be obese than males (61% v. 42%, p < 0.001). Of the 308 patients with complete laboratory measures, 57% (n = 175) met the IDF criteria for the MetS. In the UK, the prevalence of cardiometabolic risk factors in individuals with psychotic illnesses is much higher than that observed in national general population studies as well as in most international studies of patients with psychosis.
    Psychological Medicine 05/2015; -1(12):1-11. DOI:10.1017/S0033291715000562 · 5.94 Impact Factor
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