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.

Efectividad de un proyecto de colaboración entre atención primaria y salud mental para mejorar el registro de factores de riesgo cardiovascular en pacientes con psicosis / Effectiveness of a joint project between primary care and mental health to improve the recording of cardiovascular risk factors in patients with psychosis

Objetivo: Evaluar la efectividad de una intervención conjunta entre niveles asistenciales, atención primaria (AP) y salud mental (SM), en pacientes con psicosis, para mejorar la información de los factores de riesgo cardiovascular (FRCV) en la historia clínica (HC). Diseño: Estudio multicéntrico de intervención antes-después. Emplazamiento: Participan 7 centros de AP y 2 de SM, en Barcelona. Participantes: Se incluyeron los pacientes con psicosis asignados a los equipos de AP, y confirmados por estos, entre 18-65 años (n = 690). Intervención: Sesiones clínicas compartidas, para elaborar y utilizar un protocolo de colaboración entre AP-SM. Medidas principales: Variables: sexo, edad, número de citas por centro/año, registro en HC de: hábito tabáquico, presión arterial, índice masa corporal (IMC), colesterol total, colesterol HDL, triglicéridos, glucosa, perímetro abdominal, RCV. Análisis: comparación de registros de FRCV, mediante el test de Cochran (datos apareados). Cálculo de prevalencia de FRCV, según los criterios definitorios de síndrome metabólico y criterios incluidos en el protocolo. Resultados: Edad media 42,3 (DE: 11,4), hombres 67%. Todos los FRCV han presentado un aumento del registro tras la intervención. Los FRCV que han aumentado más han sido: parámetros analíticos y perímetro abdominal. El porcentaje de pacientes con niveles alterados en los criterios de síndrome metabólico supera el 35%. Los criterios para derivar al equipo de AP identifican, en el 2010, 51,9% obesos, 23,9% hipertensos, 20,4% hipercolesterolémicos y 11,6% diabéticos. Conclusiones: Mejora del registro de FRCV. Elevado porcentaje de pacientes que requieren intervención de los profesionales de AP debido a los FRCV (AU)

Objective: To evaluate the effectiveness of a joint team intervention between primary care (PC) and mental health (MH) to improve information on cardiovascular risk factors (CVRF) in psychotic patients. Design: Multicenter before-after intervention study. Location: Seven primary care and 2 mental health centers in Barcelona participated. Participants: All patients between 18-65 years old with a confirmed diagnosis of psychosis assigned to PC teams (n = 690) are included. Intervention: Shared clinical sessions, developing a joint GP-MH protocol and implement it. Primary measurements: Variables: Gender, age, number of Appointments per center/year, smoking, blood pressure, body mass index (BMI), total cholesterol, HDL cholesterol, triglycerides, glucose, waist circumference (WC), Cardiovascular Risk. Analysis: Comparison of CVRF records from 2008 to 2010 using statistical tests for paired data. Calculation of CVRF prevalence in accordance with metabolic syndrome criteria and the criteria for referral to GP. Results: The mean age was 42.3 (SD 11.4) years, with 67% males. All CVRF significantly Increased in clinical notes, particularly all blood test parameters and WC. More than 35% of patients had a CVRF according to metabolic syndrome criteria. Criteria to refer to PC physician (2010) identified: obesity 51.9%, 23.9% hypertension, high cholesterol 20.4% and 11.6% diabetes. Conclusions: CVRF recording improvement. High percentage of patients needed GP intervention due to a CVRF (AU)

[Effectiveness of a joint project between primary care and mental health to improve the recording of cardiovascular risk factors in patients with psychosis]. / Efectividad de un proyecto de colaboración entre atención primaria y salud mental para mejorar el registro de factores de riesgo cardiovascular en pacientes con psicosis.

OBJECTIVE: To evaluate the effectiveness of a joint team intervention between primary care (PC) and mental health (MH) to improve information on cardiovascular risk factors (CVRF) in psychotic patients. DESIGN: Multicenter before-after intervention study. LOCATION: Seven primary care and 2 mental health centers in Barcelona participated. PARTICIPANTS: All patients between 18-65 years old with a confirmed diagnosis of psychosis assigned to PC teams (n = 690) are included. INTERVENTION: Shared clinical sessions, developing a joint GP-MH protocol and implement it. VARIABLES: Gender, age, number of Appointments per center/year, smoking, blood pressure, body mass index (BMI), total cholesterol, HDL cholesterol, triglycerides, glucose, waist circumference (WC), Cardiovascular Risk. ANALYSIS: Comparison of CVRF records from 2008 to 2010 using statistical tests for paired data. Calculation of CVRF prevalence in accordance with metabolic syndrome criteria and the criteria for referral to GP. RESULTS: The mean age was 42.3 (SD 11.4) years, with 67% males. All CVRF significantly Increased in clinical notes, particularly all blood test parameters and WC. More than 35% of patients had a CVRF according to metabolic syndrome criteria. Criteria to refer to PC physician (2010) identified: obesity 51.9%, 23.9% hypertension, high cholesterol 20.4% and 11.6% diabetes. CONCLUSIONS: CVRF recording improvement. High percentage of patients needed GP intervention due to a CVRF.