The effectiveness of lifestyle interventions to reduce cardiovascular risk in patients with severe mental disorders: meta-analysis of intervention studies.

Patients with severe mental illness have higher prevalences of cardiovascular risk factors (CRF). The objective is to determine whether interventions to modify lifestyles in these patients reduce anthropometric and analytical parameters related to CRF in comparison to routine clinical practice. Systematic review of controlled clinical trials with lifestyle intervention in Medline, Cochrane Library, Embase, PsycINFO and CINALH. Change in body mass index, waist circumference, cholesterol, triglycerides and blood sugar. Meta-analyses were performed using random effects models to estimate the weighted mean difference. Heterogeneity was determined using i(2) statistical and subgroups analyses. 26 studies were selected. Lifestyle interventions decrease anthropometric and analytical parameters at 3 months follow up. At 6 and 12 months, the differences between the intervention and control groups were maintained, although with less precision. More studies with larger samples and long-term follow-up are needed.

[Do depressed patients comply with treatments prescribed?: a cross-sectional study of adherence to the antidepressant treatment]. / ¿Toman los pacientes deprimidosel tratamiento prescrito? Estudiodescriptivo sobre el cumplimientodel tratamiento antidepresivo.

INTRODUCTION. Compliance with antidepressant treatment is a very relevant factor in the outcome of depressive disorders. Poor compliance has been associated with worse outcome, increased rate of relapses and greater cost. This study has aimed to describe adherence to antidepressant treatment in a sample of primary care patients with a diagnosis of depression in 2007. METHODS. Randomized sampling was made of patients with depression and antidepressant treatment attended in two primary care teams. Their medical records were reviewed to obtain the total number of prescriptions given to patients and the total number of prescriptions dispensed in the pharmacies. The difference between prescriptions written and collected was calculated. A difference of ± 2 was considered as good compliance. Results are shown as percentages. Comparisons were made with the chi-square, Student's T and ANOVA tests, where appropriate. RESULTS. The simple was made up of 212 patients. Mean age was 63.2 years (SD 15.27). In the sample, 66.5% were treated with only one antidepressant and 24.1% with two. The percentage of non-compliance was 33.96% (95% CI: 25.35­40.57). Treatment-adherent patients have a lower percentage of long-term treatment with other drugs. The percentage of treatment-adherent women was higher than non-adherent (p=0.015). No differences were found in compliance among patients treated in the mental health center. CONCLUSIONS. One third of patients on antidepressant drug treatment were non-compliers because the drugs were not picked up properly from the pharmacies. We need to develop strategies to improve the therapeutic adherence of patients.