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1.
Sci Rep ; 12(1): 15092, 2022 Sep 05.
Artículo en Inglés | MEDLINE | ID: mdl-36064811

RESUMEN

Psychiatric patients have become the focus of public attention, and current research suggests a possible link between Toxoplasma gondii (T. gondii) infection and mental illness. To understand the current situation of T. gondii infection in psychiatric patients in the study area, the relationship between T. gondii infection and mental diseases, and the influence of T. gondii infection on psychiatric patients, this study examined 3101 psychiatric inpatients from 2015 to 2020. All people included in the study were tested for anti-Toxoplasma IgM antibody and anti-Toxoplasma IgG antibody. Additionally, 4040 individuals from the general population were included as controls. The chi-square test and logistic regression analysis were carried out to determine the association between psychiatric disorders and T. gondii infection. The seroprevalence of anti-Toxoplasma IgM antibody was 0.23% (7/3101) in psychiatric inpatients and 0.11% (2/1846) in the general population, and there was no significant difference (p > 0.05). The seroprevalence rate of anti-Toxoplasma IgG antibodies was 3.03% (94/3101) in psychiatric inpatients and 1.05% (23/2194) in the general population, and there was a significant difference (p < 0.01). The seroprevalence of anti-Toxoplasma IgG antibody in psychiatric inpatients was significantly different between different age groups (p < 0.01). The positivity rate of anti-Toxoplasma IgG antibodies was 5.17% (3/58) in patients with mania, 3.24% (8/247) in patients with recurrent depressive disorder, 3.54% (13/367) in patients with depression, 3.22% (39/1213) in patients with schizophrenia, 2.41% (18/748) in patients with bipolar disorder and 2.25% (2/89) in patients with dissociative disorder. Compared to the general population, patients with mania (OR = 5.149 95% CI 1.501-17.659 p = 0.009), schizophrenia (OR = 3.136 95% CI 1.864-5.275 p = 0.000), depression (OR = 3.466 95% CI 1.740-6.906 p = 0.000), recurrent depressive disorder (OR = 3.160 95% CI 1.398-7.142 p = 0.006) and bipolar disorder (OR = 2.327 95% CI 1.249-4.337 p = 0.008) were found to be significantly associated with the seroprevalence of anti-Toxoplasma IgG antibody. This study suggests that the seroprevalence of T. gondii infection in psychiatric patients was higher and that age was an influencing factor of T. gondii infection in psychiatric patients. T. gondii infection was associated with mania, schizophrenia, depression, recurrent depressive disorder and bipolar disorder.


Asunto(s)
Trastornos Mentales , Toxoplasma , Toxoplasmosis , Anticuerpos Antiprotozoarios , Estudios Transversales , Humanos , Inmunoglobulina G , Inmunoglobulina M , Manía , Trastornos Mentales/complicaciones , Trastornos Mentales/epidemiología , Factores de Riesgo , Estudios Seroepidemiológicos , Toxoplasmosis/complicaciones , Toxoplasmosis/epidemiología
3.
BMC Psychiatry ; 22(1): 585, 2022 09 03.
Artículo en Inglés | MEDLINE | ID: mdl-36057589

RESUMEN

BACKGROUND: The life expectancy of people with severe mental illness (SMI) is shorter than those without SMI, with multimorbidity and poorer physical health contributing to health inequality. Screening tools could potentially assist the optimisation of medicines to protect the physical health of people with SMI. The aim of our research was to design and validate a medicines optimisation tool (OPTIMISE) to help clinicians to optimise physical health in people with SMI. METHODS: A review of existing published guidelines, PubMed and Medline was carried out. Literature was examined for medicines optimisation recommendations and also for reference to the management of physical illness in people with mental illness. Potential indicators were grouped according to physiological system. A multidisciplinary team with expertise in mental health and the development of screening tools agreed that 83 indicators should be included in the first draft of OPTIMISE. The Delphi consensus technique was used to develop and validate the contents. A 17-member multidisciplinary panel of experts from the UK and Ireland completed 2 rounds of Delphi consensus, rating their level of agreement to 83 prescribing indicators using a 5-point Likert scale. Indicators were accepted for inclusion in the OPTIMISE tool after achieving a median score of 1 or 2, where 1 indicated strongly agree and 2 indicated agree, and 75th centile value of ≤ 2. Interrater reliability was assessed among 4 clinicians across 20 datasets and the chance corrected level of agreement (kappa) was calculated. The kappa statistic was interpreted as poor if 0.2 or less, fair if 0.21-0.4, moderate if 0.41-0.6, substantial if 0.61-0.8, and good if 0.81-1.0. RESULTS: Consensus was achieved after 2 rounds of Delphi for 62 prescribing indicators where 53 indicators were accepted after round 1 and a further 9 indicators were accepted after round 2. Interrater reliability of OPTIMISE between physicians and pharmacists indicated a substantial level of agreement with a kappa statistic of 0.75. CONCLUSIONS: OPTIMISE is a 62 indicator medicines optimisation tool designed to assist decision making in those treating adults with SMI. It was developed using a Delphi consensus methodology and interrater reliability is substantial. OPTIMISE has the potential to improve medicines optimisation by ensuring preventative medicines are considered when clinically indicated. Further research involving the implementation of OPTIMISE is required to demonstrate its true benefit. TRIAL REGISTRATION: This article does not report the results of a health care intervention on human participants.


Asunto(s)
Disparidades en el Estado de Salud , Trastornos Mentales , Adulto , Consenso , Técnica Delfos , Humanos , Trastornos Mentales/complicaciones , Trastornos Mentales/tratamiento farmacológico , Reproducibilidad de los Resultados
4.
Cancer ; 128(19): 3564-3572, 2022 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-35916651

RESUMEN

BACKGROUND: Long-term mental health outcomes were characterized in patients who were diagnosed with Hodgkin lymphoma (HL), and risk factors for the development of mental health disorders were identified. METHODS: Patients who were diagnosed with HL between 1997 and 2014 were identified in the Utah Cancer Registry. Each patient was matched with up to five individuals from a general population cohort identified within the Utah Population Database, a unique source of linked records that includes patient and demographic data. RESULTS: In total, 795 patients who had HL were matched with 3575 individuals from the general population. Compared with the general population, patients who had HL had a higher risk of any mental health diagnosis (hazard ratio, 1.77; 95% confidence interval, 1.57-2.00). Patients with HL had higher risks of anxiety, depression, substance-related disorders, and suicide and intentional self-inflicted injuries compared with the general population. The main risk factor associated with an increased risk of being diagnosed with mental health disorders was undergoing hematopoietic stem cell transplantation, with a hazard ratio of 2.06 (95% confidence interval, 1.53-2.76). The diagnosis of any mental health disorder among patients with HL was associated with a detrimental impact on overall survival; the 10-year overall survival rate was 70% in patients who had a mental health diagnosis compared with 86% in those patients without a mental health diagnosis (p < .0001). CONCLUSIONS: Patients who had HL had an increased risk of various mental health disorders compared with a matched general population. The current data illustrate the importance of attention to mental health in HL survivorship, particularly for patients who undergo therapy with hematopoietic stem cell transplantation.


Asunto(s)
Enfermedad de Hodgkin , Trastornos Mentales , Enfermedad de Hodgkin/complicaciones , Enfermedad de Hodgkin/epidemiología , Enfermedad de Hodgkin/patología , Humanos , Trastornos Mentales/complicaciones , Trastornos Mentales/epidemiología , Salud Mental , Factores de Riesgo , Tasa de Supervivencia
5.
J Am Coll Cardiol ; 80(9): 918-933, 2022 Aug 30.
Artículo en Inglés | MEDLINE | ID: mdl-36007991

RESUMEN

People with severe mental illness, consisting of schizophrenia, bipolar disorder, and major depression, have a high burden of modifiable cardiovascular risk behaviors and conditions and have a cardiovascular mortality rate twice that of the general population. People with acute and chronic cardiovascular disease are at a higher risk of developing mental health symptoms and disease. There is emerging evidence for shared etiological factors between severe mental illness and cardiovascular disease that includes biological, genetic, and behavioral mechanisms. This state-of-the art review will describe the relationship between severe mental illness and cardiovascular disease, explore the factors that lead to poor cardiovascular outcomes in people with severe mental illness, propose strategies to improve the cardiovascular health of people with severe mental illness, and present areas for future research focus.


Asunto(s)
Trastorno Bipolar , Enfermedades Cardiovasculares , Trastornos Mentales , Esquizofrenia , Trastorno Bipolar/epidemiología , Enfermedades Cardiovasculares/diagnóstico , Humanos , Trastornos Mentales/complicaciones , Trastornos Mentales/epidemiología , Salud Mental , Esquizofrenia/complicaciones , Esquizofrenia/epidemiología
6.
Artículo en Inglés | MEDLINE | ID: mdl-35954764

RESUMEN

Multiple studies imply a strong relationship between global warming (GW) and complex disorders. This review summarizes such reports concentrating on three disorders-mental disorders (MD), primary hypertension, and type 2 diabetes (T2D). We also attempt to point at potential mechanisms mediating the effect of GW on these disorders. Concerning mental disorders, immediate candidates are brain levels of heat-shock proteins (HSPs). In addition, given that heat stress increases reactive oxygen species (ROS) levels which may lead to blood-brain barrier (BBB) breakdown and, hence, enhanced protein extravasation in the brain, this might finally cause, or exacerbate mental health. As for hypertension, since its causes are incompletely understood, the mechanism(s) by which heat exposure affects blood pressure (BP) is an open question. Since the kidneys participate in regulating blood volume and BP they are considered as a site of heat-associated disease, hence, we discuss hyperosmolarity as a potential mediator. In addition, we relate to autoimmunity, inflammation, sodium excretion, and HSP70 as risk factors that might play a role in the effect of heat on hypertension. In the case of T2D, we raise two potential mediators of the effect of exposure to ambient hot environment on the disease's incidence-brown adipose tissue metabolism and HSPs.


Asunto(s)
Diabetes Mellitus Tipo 2 , Hipertensión , Trastornos Mentales , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Calentamiento Global , Proteínas HSP70 de Choque Térmico/metabolismo , Proteínas de Choque Térmico/metabolismo , Humanos , Hipertensión/etiología , Trastornos Mentales/complicaciones
7.
PLoS One ; 17(8): e0272498, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35980891

RESUMEN

BACKGROUND: People with severe mental illness (SMI) are at higher risk of physical health conditions compared to the general population, however, the impact of specific underlying health conditions on the use of secondary care by people with SMI is unknown. We investigated hospital use in people managed in the community with SMI and five common physical long-term conditions: cardiovascular diseases, COPD, cancers, diabetes and liver disease. METHODS: We performed a systematic review and meta-analysis (Prospero: CRD42020176251) using terms for SMI, physical health conditions and hospitalisation. We included observational studies in adults under the age of 75 with a diagnosis of SMI who were managed in the community and had one of the physical conditions of interest. The primary outcomes were hospital use for all causes, physical health causes and related to the physical condition under study. We performed random-effects meta-analyses, stratified by physical condition. RESULTS: We identified 5,129 studies, of which 50 were included: focusing on diabetes (n = 21), cardiovascular disease (n = 19), COPD (n = 4), cancer (n = 3), liver disease (n = 1), and multiple physical health conditions (n = 2). The pooled odds ratio (pOR) of any hospital use in patients with diabetes and SMI was 1.28 (95%CI:1.15-1.44) compared to patients with diabetes alone and pooled hazard ratio was 1.19 (95%CI:1.08-1.31). The risk of 30-day readmissions was raised in patients with SMI and diabetes (pOR: 1.18, 95%CI:1.08-1.29), SMI and cardiovascular disease (pOR: 1.27, 95%CI:1.06-1.53) and SMI and COPD (pOR:1.18, 95%CI: 1.14-1.22) compared to patients with those conditions but no SMI. CONCLUSION: People with SMI and five physical conditions are at higher risk of hospitalisation compared to people with that physical condition alone. Further research is warranted into the combined effects of SMI and physical conditions on longer-term hospital use to better target interventions aimed at reducing inappropriate hospital use and improving disease management and outcomes.


Asunto(s)
Enfermedades Cardiovasculares , Trastornos Mentales , Enfermedad Pulmonar Obstructiva Crónica , Adulto , Enfermedades Cardiovasculares/epidemiología , Comorbilidad , Hospitalización , Humanos , Trastornos Mentales/complicaciones , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/epidemiología
8.
Artículo en Inglés | MEDLINE | ID: mdl-35805615

RESUMEN

The purpose of this study was to compare associations between stress and sleep disorders (insomnia, hypersomnia, and sleep apnea), identify potential modifying effects, and compare associations between stress and types of sleep disorders with selected mental health conditions. Analyses were based on 21,027 employees aged 18-64 years in 2020 who were insured by the Deseret Mutual Benefit Administrators (DMBA). The risk of stress (2.3%) was significantly greater in women, singles, and those with dependent children. The risk of a sleep disorder was 12.1% (2.1% for insomnia, 1.0% for hypersomnia, and 10.1% for sleep apnea). The risk of stress was significantly greater for those with a sleep disorder (136% overall, 179% for insomnia, and 102% for sleep apnea after adjusting for age, sex, marital status, dependent children, and sleep disorders). The risk of stress among those with sleep apnea was significantly greater for singles than for married individuals. Approximately 9.5% had anxiety, 8.5% had depression, 2.0% had ADHD, 0.6% had bipolar disorder, 0.4% had OCD, and 0.1% had schizophrenia. Each of these mental health conditions was significantly positively associated with stress and sleep disorders. Bipolar disorder and schizophrenia were more strongly associated with stress and sleep disorders than were the other mental health conditions. Insomnia was more strongly associated with anxiety, bipolar disorder, OCD, and schizophrenia than was sleep apnea.


Asunto(s)
Trastornos de Somnolencia Excesiva , Trastornos Mentales , Síndromes de la Apnea del Sueño , Trastornos del Inicio y del Mantenimiento del Sueño , Trastornos del Sueño-Vigilia , Niño , Trastornos de Somnolencia Excesiva/complicaciones , Femenino , Humanos , Masculino , Trastornos Mentales/complicaciones , Trastornos Mentales/epidemiología , Salud Mental , Sueño , Síndromes de la Apnea del Sueño/complicaciones , Trastornos del Inicio y del Mantenimiento del Sueño/complicaciones , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Trastornos del Sueño-Vigilia/complicaciones , Trastornos del Sueño-Vigilia/epidemiología
9.
Schizophr Bull ; 48(5): 981-998, 2022 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-35786737

RESUMEN

BACKGROUND AND HYPOTHESIS: People with severe mental illness (SMI) may experience excess mortality and inequitable treatment following acute coronary syndrome (ACS). However, cardioprotective pharmacotherapy and SMI diagnoses other than schizophrenia are rarely examined in previous reviews. We hypothesized that SMI including bipolar disorder (BD) is associated with increased post-ACS mortality, decreased revascularization, and cardioprotective medication receipt relative to those without SMI. STUDY DESIGN: We performed a meta-analysis to quantitatively synthesize estimates of post-ACS mortality, major adverse cardiac events (MACEs), and receipt of invasive coronary procedures and cardioprotective medications in patients with SMI, comprising schizophrenia, BD, and other nonaffective psychoses, relative to non-SMI counterparts. Subgroup analyses stratified by SMI subtypes (schizophrenia, BD), incident ACS status, and post-ACS time frame for outcome evaluation were conducted. STUDY RESULTS: Twenty-two studies were included (n = 12 235 501, including 503 686 SMI patients). SMI was associated with increased overall (relative risk [RR] = 1.40 [95% confidence interval = 1.21-1.62]), 1-year (1.68 [1.42-1.98]), and 30-day (1.26 [1.05-1.51]) post-ACS mortality, lower receipt of revascularization (odds ratio = 0.57 [0.49-0.67]), and cardioprotective medications (RR = 0.89 [0.85-0.94]), but comparable rates of any/specific MACEs relative to non-SMI patients. Incident ACS status conferred further increase in post-ACS mortality. Schizophrenia was associated with heightened mortality irrespective of incident ACS status, while BD was linked to significantly elevated mortality only in incident ACS cohort. Both schizophrenia and BD patients had lower revascularization rates. Post-ACS mortality risk remained significantly increased with mild attenuation after adjusting for revascularization. CONCLUSIONS: SMI is associated with increased post-ACS mortality and undertreatment. Effective multipronged interventions are urgently needed to reduce these physical health disparities.


Asunto(s)
Síndrome Coronario Agudo , Trastorno Bipolar , Trastornos Mentales , Esquizofrenia , Síndrome Coronario Agudo/complicaciones , Trastorno Bipolar/complicaciones , Mortalidad Hospitalaria , Humanos , Trastornos Mentales/complicaciones , Esquizofrenia/complicaciones , Esquizofrenia/tratamiento farmacológico
10.
Curr Opin Psychiatry ; 35(4): 277-284, 2022 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-35781467

RESUMEN

PURPOSE OF REVIEW: Cardiovascular disease (CVD) is a major cause of premature death in people with severe mental disorders (SMDs). This review provides an update on the level of CVD mortality and morbidity, as well as the socioeconomic, psychosocial and genetic factors associated with the comorbidity, and offer directions for improved interventions to reduce CVD in SMDs. RECENT FINDINGS: The level of CVD mortality and morbidity has sustained high in people with SMDs during the past decades, but the causal mechanism must be further elucidated. Psychosocial and socioeconomic challenges are frequent in SMDs as well as in CVD. Further, recent studies have revealed genetic variants jointly associated with SMDs, CVD risk and social factors. These findings highlight the need for more targeted interventions, prediction tools and psychosocial approaches to comorbid CVD in SMDs. SUMMARY: The level of CVD comorbidity remains high in SMDs, indicating that most people with SMDs have not benefitted from recent medical advances. A complex interplay between genetic and social vulnerability to CVD, which differs across subgroups of patients, seems to be involved. Further research is required to meet the urgent need for earlier, more efficient intervention approaches and preventive strategies for comorbid CVD in SMD.


Asunto(s)
Enfermedades Cardiovasculares , Trastornos Mentales , Enfermedades Cardiovasculares/epidemiología , Humanos , Trastornos Mentales/complicaciones , Trastornos Mentales/epidemiología , Mortalidad Prematura
11.
Iowa Orthop J ; 42(1): 63-68, 2022 06.
Artículo en Inglés | MEDLINE | ID: mdl-35821955

RESUMEN

Background: Patients with psychiatric comorbidities represent a significant subset of those sustaining pilon fractures. The purpose of this study is to examine the association of psychiatric comorbidities (PC) in patients with pilon fractures and clinical outcomes. Methods: A multi-institution, retrospective review was conducted. Inclusion/exclusion criteria were skeletally mature patients with a tibia pilon fracture (OTA Type 43B/C) who underwent definitive fracture fixation utilizing open reduction internal fixation (ORIF) with a minimum of 24 weeks of follow-up. Patients were stratified into two groups for comparison: PC group and no PC group. Results: There were 103 patients with pilon fractures that met the inclusion/exclusion criteria of this study. Of these patients, 22 (21.4%) had at least one psychiatric comorbidity (PC) and 81 (78.6%) did not have psychiatric comorbidities (no PC). There was a higher percentage of female patients (PC: 59.1% vs no PC: 25.9%, p=0.0.005), smokers (PC: 40.9% vs no PC: 16.0%, p=0.02), and drug users (PC: 22.7% vs no PC: 8.6%, p=0.08) amongst PC patients. Fracture comminution (PC: 54.5% vs no PC: 32.1%, p=0.05) occurred more frequently in PC patients. The PC group had a higher incidence of weightbearing noncompliance (22.7% vs 7.5%, p=0.04) and reoperation (PC: 54.5% vs no PC: 29.6%, p=0.03). Conclusion: Patients with psychiatric comorbidities represent a significant percentage of pilon fracture patients and appear to be at higher risk for postoperative complication. Risk factors that may predispose patients in the PC group include smoking/substance use, weightbearing noncompliance, and fracture comminution. Level of Evidence: III.


Asunto(s)
Fracturas de Tobillo , Fracturas Conminutas , Trastornos Mentales , Fracturas de la Tibia , Fracturas de Tobillo/cirugía , Femenino , Fijación Interna de Fracturas/efectos adversos , Humanos , Trastornos Mentales/complicaciones , Fracturas de la Tibia/complicaciones , Fracturas de la Tibia/cirugía
12.
Transl Psychiatry ; 12(1): 280, 2022 Jul 13.
Artículo en Inglés | MEDLINE | ID: mdl-35831289

RESUMEN

Health systems are essential for suicide risk detection. Most efforts target people with mental health (MH) diagnoses, but this only represents half of the people who die by suicide. This study seeks to discover and validate health indicators of suicide death among those with, and without, MH diagnoses. This case-control study used statistical modeling with health record data on diagnoses, procedures, and encounters. The study included 3,195 individuals who died by suicide from 2000 to 2015 and 249,092 randomly selected matched controls, who were age 18+ and affiliated with nine Mental Health Research Network affiliated health systems. Of the 202 indicators studied, 170 (84%) were associated with suicide in the discovery cohort, with 148 (86%) of those in the validation cohort. Malignant cancer diagnoses were risk factors for suicide in those without MH diagnoses, and multiple individual psychiatric-related indicators were unique to the MH subgroup. Protective effects across MH-stratified models included diagnoses of benign neoplasms, respiratory infections, and utilization of reproductive services. MH-stratified latent class models validated five subgroups with distinct patterns of indicators in both those with and without MH. The highest risk groups were characterized via high utilization with multiple healthcare concerns in both groups. The lowest risk groups were characterized as predominantly young, female, and high utilizers of preventive services. Healthcare data include many indicators of suicide risk for those with and without MH diagnoses, which may be used to support the identification and understanding of risk as well as targeting of prevention in health systems.


Asunto(s)
Trastornos Mentales , Suicidio , Adolescente , Estudios de Casos y Controles , Femenino , Humanos , Trastornos Mentales/complicaciones , Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Factores de Riesgo , Suicidio/prevención & control , Encuestas y Cuestionarios
13.
BMC Psychiatry ; 22(1): 479, 2022 07 19.
Artículo en Inglés | MEDLINE | ID: mdl-35850709

RESUMEN

BACKGROUND: People with severe mental illness (SMI), such as schizophrenia, have higher rates of physical long-term conditions (LTCs), poorer health outcomes, and shorter life expectancy compared with the general population. Previous research exploring SMI and diabetes highlights that people with SMI experience barriers to self-management, a key component of care in long-term conditions; however, this has not been investigated in the context of other LTCs. The aim of this study was to explore the lived experience of co-existing SMI and LTCs for service users, carers, and healthcare professionals. METHODS: A qualitative study with people with SMI and LTCs, their carers, and healthcare professionals, using semi-structured interviews, focused observations, and focus groups across the UK. Forty-one interviews and five focus groups were conducted between December 2018 and April 2019. Transcripts were coded by two authors and analysed thematically. RESULTS: Three themes were identified, 1) the precarious nature of living with SMI, 2) the circularity of life with SMI and LTCs, and 3) the constellation of support for self-management. People with co-existing SMI and LTCs often experience substantial difficulties with self-management of their health due to the competing demands of their psychiatric symptoms and treatment, social circumstances, and access to support. Multiple long-term conditions add to the burden of self-management. Social support, alongside person-centred professional care, is a key facilitator for managing health. An integrated approach to both mental and physical healthcare was suggested to meet service user and carer needs. CONCLUSION: The demands of living with SMI present a substantial barrier to self-management for multiple co-existing LTCs. It is important that people with SMI can access person-centred, tailored support for their LTCs that takes into consideration individual circumstances and priorities.


Asunto(s)
Trastornos Mentales , Automanejo , Cuidadores , Atención a la Salud , Personal de Salud , Humanos , Trastornos Mentales/complicaciones , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , Investigación Cualitativa
14.
Artículo en Inglés | MEDLINE | ID: mdl-35886166

RESUMEN

Self-harm injury among older adults is a pressing problem that demands social attention in South Korea. This study sought to identify the association between physical and mental illness and hospitalization following self-harm injuries, compared to non-self-harm injuries, among older adults living in Korea. We analyzed individuals aged 65 and older who were admitted to hospitals either for self-harm or non-self-harm from a population-based survey of the Korea National Hospital Discharge In-depth Injury Survey (KNHDIS). A logistic regression analysis was performed. Compared with non-self-harm-related hospitalization, self-harm hospitalization was associated with higher odds of depression, other disorders of the nervous system, malignancies, alcohol misuse and dependence, and drug-related dependence. Dementia, anxiety disorder, diabetes, arthritis, cerebral palsy, and other paralytic syndromes had a lower likelihood of leading to self-harm than non-self-harm hospitalization. The findings of this study can inform medical professionals to identify older adults with a heightened risk of self-harming behavior leading to hospitalization.


Asunto(s)
Trastornos Mentales , Conducta Autodestructiva , Trastornos Relacionados con Sustancias , Anciano , Trastornos de Ansiedad/complicaciones , Hospitalización , Humanos , Trastornos Mentales/complicaciones , Trastornos Mentales/epidemiología , Conducta Autodestructiva/epidemiología , Trastornos Relacionados con Sustancias/complicaciones
15.
Expert Rev Gastroenterol Hepatol ; 16(7): 689-697, 2022 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-35708303

RESUMEN

BACKGROUND: In this study, we evaluate the clinical impact of psychiatric illnesses (PI) on the hospital outcomes of patients admitted with alcoholic liver disease (ALD). METHODS: From the National Inpatient Sample from 2012-2017, patients with alcoholic cirrhosis or alcoholic hepatitis were selected and stratified using the presence/absence of PI (which was a composite of psychiatric conditions). The cases were propensity score-matched to PI-absent controls and were compared to the following endpoints: mortality, death due to suicide, length of stay (LOS), hospitalization charges, and hepatic complications. RESULTS: After matching, there were 122,907 PI with and 122,907 without PI. Those with PI were younger (51.8 vs. 51.9 years p = 0.02) and more likely to be female (39.2 vs. 38.7% p = 0.01); however, there was no difference in race. Patients with PI had lower rates of alcoholic cirrhosis but higher rates of alcoholic hepatitis/alcoholic hepatic steatosis. In multivariate, patients with PI had lower rates of all-cause mortality (aOR 0.51 95%CI 0.49-0.54); however, they experienced higher rates of deaths due to suicide (aOR 3.00 95%CI 1.56-5.78) and had longer LOS (aOR 1.02 95%CI 1.01-1.02). CONCLUSION: Presence of PI in ALD patients is associated with prolonged hospital stay and higher rates deaths due to suicide.


Asunto(s)
Hepatitis Alcohólica , Hepatopatías Alcohólicas , Trastornos Mentales , Femenino , Hepatitis Alcohólica/diagnóstico , Hepatitis Alcohólica/epidemiología , Hospitales , Humanos , Cirrosis Hepática Alcohólica/diagnóstico , Cirrosis Hepática Alcohólica/epidemiología , Hepatopatías Alcohólicas/complicaciones , Hepatopatías Alcohólicas/epidemiología , Masculino , Trastornos Mentales/complicaciones , Estudios Retrospectivos
16.
Artículo en Inglés | MEDLINE | ID: mdl-35682429

RESUMEN

People with severe mental illness (PSMI) have a shorter life expectancy and are more likely to have cardiovascular disease than the general population. Patients, carers, psychiatric professionals and primary care providers can all play a role in increasing PSMI physical health. The present qualitative exploratory study aimed to explore the views of these four populations as part of the multi-phase COPsyCAT project, whose objective is to build and test a cardiovascular risk prevention programme for PSMI. Overall, 107 people participated in the study's 16 focus groups, which were transcribed and analysed in a thematic analysis. With a view to building the health promotion programme, major themes identified in the corpus were translated into a list of needs as follows: communication, information, training and support. Results show that it is essential to improve communication between all the different stakeholders in mental health. The greatest challenge facing this programme will be to adapt it to the needs and expectations of PSMI while facilitating work between the various mental health stakeholders. Simple and inexpensive actions could be taken to improve the cardiovascular health of PSMI and will be experimented with during the programme's feasibility study which will start in September 2022.


Asunto(s)
Enfermedades Cardiovasculares , Trastornos Mentales , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Trastornos Mentales/complicaciones , Trastornos Mentales/epidemiología , Trastornos Mentales/psicología , Investigación Cualitativa , Factores de Riesgo
17.
Behav Ther ; 53(4): 585-599, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-35697424

RESUMEN

The present study tested outcomes of the Transdiagnostic Sleep and Circadian Intervention (TranS-C) among midlife and older adults with serious mental illness (SMI). Further, we tested predictors-credibility, expectancy, usefulness, and utilization-that may affect TranS-C outcomes. Midlife and older participants from a community setting (>49 years, 62.3% female, 37.7% African American or Black) with sleep and circadian problems and SMI were randomized to receive TranS-C plus usual care (TranS-C+UC, n = 27) or usual care followed by delayed treatment with TranS-C (UC-DT, n = 26). Immediate and delayed TranS-C data were combined to increase power (combined n = 52). Outcomes were assessed at pretreatment, posttreatment, and 6-month follow-up. Credibility and expectancy were assessed during the second session. Usefulness and utilization of TranS-C skills were assessed at posttreatment and 6-month follow-up. TranS-C+UC, relative to UC-DT, was associated with improvements in depression symptoms, sleep disturbance, overall sleep health, and select sleep/wake outcomes, though not all improvements were sustained at 6-month follow-up. Lower usefulness of TranS-C skills predicted more severe sleep disturbance at posttreatment and daytime sleep-related impairment at posttreatment and 6-month follow-up. Lower utilization predicted more severe psychiatric symptoms at posttreatment, sleep disturbance at posttreatment and 6-month follow-up, and overall impairment and daytime sleep-related impairment at 6-month follow-up. Higher credibility and expectancy predicted greater usefulness of TranS-C skills at posttreatment and 6-month follow-up and greater utilization at 6-month follow-up. Together, findings highlight benefits of TranS-C for midlife and older adults with SMI. However, boosting credibility, expectancy, utilization, and usefulness may meaningfully improve TranS-C outcomes.


Asunto(s)
Trastornos Mentales , Trastornos del Sueño-Vigilia , Anciano , Femenino , Humanos , Masculino , Trastornos Mentales/complicaciones , Trastornos Mentales/psicología , Trastornos Mentales/terapia , Sueño , Trastornos del Sueño-Vigilia/complicaciones , Trastornos del Sueño-Vigilia/terapia
18.
Clin Pediatr (Phila) ; 61(9): 605-614, 2022 10.
Artículo en Inglés | MEDLINE | ID: mdl-35677990

RESUMEN

The study objective was to assess clinical outcomes and cost avoidance of an intensive day treatment program for children with co-occurring chronic medical disease and emotional problems. Intensive day treatment programs for this population are uncommon, and their effectiveness has not been previously reported. A total of 175 children were enrolled during the 3-year study period. Children had more than 30 medical diagnoses including chronic pain, dysautonomia, neurologic disorders, and diabetes. Complete utilization data were available for 118 patients, and demonstrated decreased hospitalizations and increased behavioral health visits during the 12 months post program compared with 12 months prior. Private insurance and female sex were associated with reduced utilization costs after program participation. Estimated avoided cost for the 118 children was $1 111 485. Patients reported significant improvements in somatic symptoms, sleep problems, inattention, depression, anger, and anxiety. Limited data indicated improvements in school attendance. Additional research addressing other outcomes, such as school-related symptoms, would be helpful.


Asunto(s)
Hospitalización , Trastornos Mentales , Niño , Enfermedad Crónica , Femenino , Humanos , Trastornos Mentales/complicaciones , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Evaluación de Programas y Proyectos de Salud
20.
Artículo en Inglés | MEDLINE | ID: mdl-35561326

RESUMEN

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.


Asunto(s)
Trastornos Mentales , Psiquiatría , Toma de Decisiones , Hospitales Generales , Humanos , Pacientes Internos , Trastornos Mentales/complicaciones , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , Derivación y Consulta
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