Cardiovascular Disease and Metabolic Risk Factors in Male Patients With Schizophrenia, Schizoaffective Disorder, and Bipolar Disorder

University of Pittsburgh, Pittsburgh, Pennsylvania, United States
Psychosomatics (Impact Factor: 1.86). 09/2007; 48(5):412-7. DOI: 10.1176/appi.psy.48.5.412
Source: PubMed


The authors determined whether diagnoses of cardiovascular disease (CVD) and CVD-related conditions differed by psychiatric diagnosis among male Veterans Administration patients from the mid-Atlantic region. Among 7,529 patients (mean age: 54.5 years), the prevalence of diagnoses ranged from 3.6% (stroke) to 35.4% (hypertension). Compared with schizophrenia patients, those with bipolar disorder were 19% more likely to have diabetes, 44% more likely to have coronary artery disease, and 18% more likely to have dyslipidemia, after adjustment. Clinical suspicion for CVD-related conditions, as well as risk-modification strategies, in patients with serious mental illness should incorporate differences in prevalence across specific psychiatric diagnoses.

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    • "For example, mood symptoms can decrease motivation to seek medical care when needed and increase sedentary lifestyle, leading to subsequent weight gain [9]. Psychotic symptoms can also impede healthy behaviors and increase the risk of substance use [10]. "
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    ABSTRACT: Background Persons with serious mental illnesses (SMI) are more likely to die earlier than the general population, primarily due to increased medical burden, particularly from cardiovascular disease (CVD). Life Goals Collaborative Care (LG-CC) is designed to improve health outcomes in SMI through self-management, care management, and provider support. This single-blind randomized controlled effectiveness study will determine whether patients with SMI receiving LG-CC compared to usual care (UC) experience improved physical health in 12 months. Methods Patients diagnosed with SMI and at least one CVD risk factor receiving care at a VA mental health clinic were randomized to LG-CC or UC. LG-CC included five self-management sessions covering mental health symptom management reinforced through health behavior change; care coordination and health monitoring via a registry, and provider feedback. The primary outcome is change in physical health-related quality of life score (VR-12) from baseline to 12 months. Secondary outcomes include changes in mental health-related quality of life, CVD risk factors (blood pressure, BMI), and physical activity from baseline to 12 months later. Results Out of 304 enrolled, 139 were randomized to LG-CC and 145 to UC. Among patients completing baseline assessments (N = 284); the mean age was 55.2 (SD = 10.9; range 28–75 years), 15.6% were women, the majority (62%) were diagnosed with depression, and the majority (63%) were diagnosed with hypertension or were overweight (BMI mean ± SD = 33.3 ± 6.3). Baseline VR-12 physical health component score was below population norms (50.0 ± SD = 10) at 33.4 ± 11.0. Conclusions Findings from this trial may inform initiatives to improve physical health for SMI patient populations.
    Contemporary Clinical Trials 09/2014; 39(1). DOI:10.1016/j.cct.2014.07.007 · 1.94 Impact Factor
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    • "Re-Engage is a national VA program which has three core components: panel management, brief care management, and proactive outreach services that are designed to re-engage in VA healthcare veterans with serious mental illness (i.e., schizophrenia or bipolar disorder) who previously received VA healthcare, but have not been seen in VA healthcare for at least one year. Re-Engage was initially developed by VA Office of Medical Inspector as a quality improvement program based on awareness that veterans with serious mental illness face high rates of medical comorbidities that require regular medical care [43-45], and that gaps in healthcare services among this population contribute to early mortality [5,46]. The VA Office of Medical Inspector quality improvement program was completed in 2010 and found that veterans with SMI who returned to care had lower rates of mortality (0.3%) than veterans who were targeted for re-engagement, but did not return to care (3.9%) [11,47]. "
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    ABSTRACT: Persons with serious mental illness are disproportionately burdened by premature mortality. This disparity is exacerbated by poor continuity of care with the health system. The Veterans Health Administration (VA) developed Re-Engage, an effective population-based outreach program to identify veterans with SMI lost to care and to reconnect them with VA services. However, such programs often encounter barriers getting implemented into routine care. Adaptive designs are needed when the implementation intervention requires augmentation within sites that do not initially respond to an initial implementation intervention. This protocol describes the methods used in an adaptive implementation design study that aims to compare the effectiveness of a standard implementation strategy (Replicating Effective Programs, or REP) with REP enhanced with External Facilitation (enhanced REP) to promote the uptake of Re-Engage.Methods/design: This study employs a four-phase, two-arm, longitudinal, clustered randomized trial design. VA sites (n = 158) across the United States with a designated Re-Engage provider, at least one Veteran with SMI lost to care, and who received standard REP during a six-month run-in phase. Subsequently, 88 sites with inadequate uptake were stratified at the cluster level by geographic region (n = 4) and VA regional service network (n = 20) and randomized to REP (n = 49) vs. enhanced REP (n = 39) in phase two. The primary outcome was the percentage of veterans on each facility outreach list documented on an electronic web registry. The intervention was at the site and network level and consisted of standard REP versus REP enhanced by external phone facilitation consults. At 12 months, enhanced REP sites returned to standard REP and 36 sites with inadequate participation received enhanced REP for six months in phase three. Secondary implementation outcomes included the percentage of veterans contacted directly by site providers and the percentage re-engaged in VA health services. Adaptive implementation designs consisting of a sequence of decision rules that are tailored based on a site's uptake of an effective program may produce more relevant, rapid, and generalizable results by more quickly validating or rejecting new implementation strategies, thus enhancing the efficiency and sustainability of implementation research and potentially leading to the rollout of more cost-efficient implementation strategies.Trial registration: Current Controlled Trials ISRCTN21059161.
    Implementation Science 11/2013; 8(1):136. DOI:10.1186/1748-5908-8-136 · 4.12 Impact Factor
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    • "Severe psychiatric deficits, including hallucinations, delusions, cognitive difficulties, and poor social and occupational functioning, plus a debilitating course of lifelong cognitive impairments are characteristic of patients diagnosed with schizophrenia, severe bipolar disorder, and chronic clinical depression [1]. These disorders are also characterized by significantly decreased life expectancy with the chief factors of this excess risk of death arising from cigarette smoking, obesity, metabolic disorders associated with diabetes, hypertension, and stroke [2, 3]. A recent survey of over 1000 subjects with psychotic disorders conducted in Australia noted that over 75 % of all patients were overweight or obese, 20 % suffered from diabetes and hypertension, and over 50 % of patients met criteria for metabolic syndrome, defined by a combination of central obesity plus 2 or more of the following risk factors: elevated HDL C levels, increased blood pressure, increased blood glucose levels [4]. "
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    ABSTRACT: Severe psychotic disorders, which on their own may be a risk factor for metabolic disorder and cardiovascular illness, are clinically compounded by the significant adverse side effects of antipsychotic medications. The majority of patients with severe psychotic disorders (i.e., schizophrenia, bipolar disorder, mania, and depression) must take antipsychotic medications to treat their psychoses and, subsequently, will require efficacious interventions to manage the metabolic consequences of pharmacologic treatment to mitigate excessive mortality associated with cardiovascular illness. We have reviewed the metabolic consequences of antipsychotic treatment and discussed pilot findings from a new nonpharmacologic intervention study looking at the clinical benefits of regular exercise as a management tool for the cardiometabolic risk factors in a cohort with severe mental illness.
    Current Cardiovascular Risk Reports 08/2013; 7(4):283-287. DOI:10.1007/s12170-013-0321-1
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