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,
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    • "Despite the recognition that bipolar disorder imposes a tremendous health burden, lifestyle interventions designed to address medical co-morbidities are scarce. Also only a limited number of screening, monitoring and treatment guidelines refer to the role of physical activity and exercise in people with severe mental illness, yet none of these guidelines have an adequate focus on the importance of cardiorespiratory fitness testing within this population (De Hert et al., 2011). Cardiorespiratory fitness is an important health outcome measure, predictive for cardiorespiratory diseases and premature mortality (Kodoma et al., 2009) and sensitive to physical activity (Naci and Ioannidis, 2013), also in people with severe mental illness (Vancampfort et al., 2015b). "
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    ABSTRACT: Cardiorespiratory fitness is a major modifiable risk factor for cardiovascular diseases. People with bipolar disorder have a reduced cardiorespiratory fitness and its assessment within a multidisciplinary treatment therefore is necessary. We investigated the validity of the 6min walk test in people with bipolar disorder. A secondary aim was to assess clinical and demographic characteristics that might interfere with cardiorespiratory fitness performance. 19 (5♂) outpatients (47.1±8.3 years) underwent a 6min walk test and a maximal cardiopulmonary exercise test on a cycle ergometer and completed the Positive-and-Negative-Affect-Schedule (PANAS) and Beck Depression Inventory (BDI). The distance achieved on the 6min walk test correlated moderately with peak oxygen uptake obtained during the maximal cardiopulmonary exercise test. The variance in age, weight and the PANAS negative score explained 70% of the variance in the distance achieved on the 6min walk test. The 6min walk test can be used as a measure-of-proxy to gauge cardiorespiratory fitness in people with bipolar disorder when maximal cardiopulmonary exercise test equipment is not available. Negative mood should be considered when evaluating the cardiorespiratory fitness of this vulnerable population.
    11/2015; DOI:10.1016/j.psychres.2015.09.039
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    • "For instance, in the US alone in 2010 it was estimated that the costs associated with chronic pain were between 560 and 635 billion dollars per annum (Gaskin and Richard, 2012), whilst the management of back pain accounts for over 20% of healthcare expenditure in the United Kingdom (DOH, 2009; Breivik et al., 2006). Despite the fact there is increasing recognition that people with schizophrenia have significantly poorer physical health and multiple comorbidities (De Hert et al., 2011; Smith et al., 2013), little research has considered the impact of clinical pain in this population (pain naturally occurring and without medical provocation) (Engels et al., 2013; Stubbs et al., 2014a). "
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    ABSTRACT: The objective of this study was to investigate the relationship between pain and health related quality of life (HRQOL) in people with psychosis. The study utilised a cross sectional design including individuals with established psychosis from five Mental Health Trusts across England. Participants were classified as having pain or not and HRQOL was determined with the EQ-5d-3 L. Covariates considered include the Positive and Negative Syndrome Scale (PANSS), the Montgomery Asberg Depression Rating Scale (MADRS) and Global Assessment of Functioning (GAF). Hierarchical multiple linear regression analyses were conducted. The final sample included 438 individuals with psychosis (47.5 years, SD 10.1, 193 females (42.9%)). 160 participants reported pain (36.5%) and compared to the non-pain group (N=278) they had significantly higher depressive symptoms (MADRS 14.91 vs 8.68), total (51.8 vs 47.9) and general PANSS scores (26.8 vs. 23.5) and lower overall HRQOL (54.7 vs 68.3). The final regression analysis (n=387) demonstrated that lower levels of pain were a predictor of better HRQOL (β=.173) after adjusting for the PANSS, MADRS & GAF. Depressive symptoms were the largest predictor of HRQOL (β= -.486). Only 1-2% of the sample were in receipt of analgesic medication suggesting pain is greatly overlooked despite its wider deleterious impact on HRQOL.
    Psychiatry Research 10/2015; DOI:10.1016/j.psychres.2015.10.008 · 2.47 Impact Factor
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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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