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2.
Australas Psychiatry ; : 1039856219889320, 2019 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-31868510

RESUMO

OBJECTIVES: The concept of recovery in mental health has been embraced by many services across the world. Placing the individual (self) at the core of service delivery constituted a profound shift from service-driven models of care. However, cultures described as individualistic or collectivist may hold very different views of individuality. In cultures with collectivist orientation, the notion of 'individualism' is integrated into the structure and dynamics of the family. The families in such cultures play a major and lifetime role in caring for its members, making decisions and acting in consideration of the welfare of all. The needs and priorities of individuals, especially women, may be superseded by those of their families. This commentary is on the effect of culture on the identity of self in the recovery process and its relevance to mental health care. CONCLUSION: In multicultural societies like Australia that include Indigenous people, the process of acculturation may be different. For the Indigenous people, the shift was from a collectivist culture to one that was predominantly individualistic. In the provision of recovery-oriented mental health care, there needs to be an awareness of the cultural variations in the relational dynamics of individualism.

3.
JAMA Psychiatry ; 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31268507

RESUMO

Importance: Genome-wide association studies (GWASs) in European populations have identified more than 100 schizophrenia-associated loci. A schizophrenia GWAS in a unique Indian population offers novel findings. Objective: To discover and functionally evaluate genetic loci for schizophrenia in a GWAS of a unique Indian population. Design, Setting, and Participants: This GWAS included a sample of affected individuals, family members, and unrelated cases and controls. Three thousand ninety-two individuals were recruited and diagnostically ascertained via medical records, hospitals, clinics, and clinical networks in Chennai and surrounding regions. Affected participants fulfilled DSM-IV diagnostic criteria for schizophrenia. Unrelated control participants had no personal or family history of psychotic disorder. Recruitment, genotyping, and analysis occurred in consecutive phases beginning January 1, 2001. Recruitment was completed on February 28, 2018, and genotyping and analysis are ongoing. Main Outcomes and Measures: Associations of single-nucleotide polymorphisms and gene expression with schizophrenia. Results: The study population included 1321 participants with schizophrenia, 885 family controls, and 886 unrelated controls. Among participants with schizophrenia, mean (SD) age was 39.1 (11.4) years, and 52.7% were male. This sample demonstrated uniform ethnicity, a degree of inbreeding, and negligible rates of substance abuse. A novel genome-wide significant association was observed between schizophrenia and a chromosome 8q24.3 locus (rs10866912, allele A; odds ratio [OR], 1.27 [95% CI, 1.17-1.38]; P = 4.35 × 10-8) that attracted support in the schizophrenia Psychiatric Genomics Consortium 2 data (rs10866912, allele A; OR, 1.04 [95% CI, 1.02-1.06]; P = 7.56 × 10-4). This locus has undergone natural selection, with the risk allele A declining in frequency from India (approximately 72%) to Europe (approximately 43%). rs10866912 directly modifies the abundance of the nicotinate phosphoribosyltransferase gene (NAPRT1) transcript in brain cortex (normalized effect size, 0.79; 95% CI, 0.6-1.0; P = 5.8 × 10-13). NAPRT1 encodes a key enzyme for niacin metabolism. In Indian lymphoblastoid cell lines, (risk) allele A of rs10866912 was associated with NAPRT1 downregulation (AA: 0.74, n = 21; CC: 1.56, n = 17; P = .004). Preliminary zebrafish data further suggest that partial loss of function of NAPRT1 leads to abnormal brain development. Conclusions and Relevance: Bioinformatic analyses and cellular and zebrafish gene expression studies implicate NAPRT1 as a novel susceptibility gene. Given this gene's role in niacin metabolism and the evidence for niacin deficiency provoking schizophrenialike symptoms in neuropsychiatric diseases such as pellagra and Hartnup disease, these results suggest that the rs10866912 genotype and niacin status may have implications for schizophrenia susceptibility and treatment.

8.
BMC Psychiatry ; 17(1): 22, 2017 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-28095811

RESUMO

BACKGROUND: Over past decades, improvements in longer-term clinical and personal outcomes for individuals experiencing serious mental illness (SMI) have been moderate, although recovery has clearly been shown to be possible. Recovery experiences are inherently personal, and recovery can be complex and non-linear; however, there are a broad range of potential recovery contexts and contributors, both non-professional and professional. Ongoing refinement of recovery-oriented models for mental health (MH) services needs to be fostered. DISCUSSION: This descriptive paper outlines a service-wide Integrated Recovery-oriented Model (IRM) for MH services, designed to enhance personally valued health, wellbeing and social inclusion outcomes by increasing access to evidenced-based psychosocial interventions (EBIs) within a service context that supports recovery as both a process and an outcome. Evolution of the IRM is characterised as a series of five broad challenges, which draw together: relevant recovery perspectives; overall service delivery frameworks; psychiatric and psychosocial rehabilitation approaches and literature; our own clinical and service delivery experience; and implementation, evaluation and review strategies. The model revolves around the person's changing recovery needs, focusing on underlying processes and the service frameworks to support and reinforce hope as a primary catalyst for symptomatic and functional recovery. Within the IRM, clinical rehabilitation (CR) practices, processes and partnerships facilitate access to psychosocial EBIs to promote hope, recovery, self-agency and social inclusion. Core IRM components are detailed (remediation of functioning; collaborative restoration of skills and competencies; and active community reconnection), together with associated phases, processes, evaluation strategies, and an illustrative IRM scenario. The achievement of these goals requires ongoing collaboration with community organisations. CONCLUSIONS: Improved outcomes are achievable for people with a SMI. It is anticipated that the IRM will afford MH services an opportunity to validate hope, as a critical element for people with SMI in assuming responsibility and developing skills in self-agency and advocacy. Strengthening recovery-oriented practices and policies within MH services needs to occur in tandem with wide-ranging service evaluation strategies.


Assuntos
Prestação Integrada de Cuidados de Saúde/métodos , Esperança , Transtornos Mentais/psicologia , Transtornos Mentais/reabilitação , Serviços de Saúde Mental , Modelos Psicológicos , Prestação Integrada de Cuidados de Saúde/tendências , Humanos , Transtornos Mentais/diagnóstico , Serviços de Saúde Mental/tendências , Características de Residência
9.
BMC Health Serv Res ; 17(1): 2, 2017 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-28049472

RESUMO

BACKGROUND: An ongoing service evaluation project was initiated following the establishment of a new, purpose-built, 20-bed sub-acute Intermediate Stay Mental Health Unit (ISMHU). This paper: provides an overview of the targeted 6-week program, operating within an Integrated Recovery-oriented Model (IRM); characterises the clients admitted during the first 16 months; and documents their recovery needs and any changes. METHODS: A brief description of the unit's establishment and programs is initially provided. Client needs and priorities were identified collaboratively using the Mental Health Recovery Star (MHRS) and addressed through a range of in-situ, individual and group interventions. Extracted client and service data were analysed using descriptive statistics, paired t-tests examining change from admission to discharge, and selected correlations. RESULTS: The initial 154 clients (165 admissions, average stay = 47.86 days) were predominately male (72.1%), transferred from acute care (75.3%), with schizophrenia or related disorders (74.0%). Readmission rates within 6-months were 16.2% for acute and 3.2% for sub-acute care. Three MHRS subscales were derived, together with stage-of-change categories. Marked improvements in MHRS Symptom management and functioning were identified (z-change = -1.15), followed by Social-connection (z-change = -0.82) and Self-belief (z-change = -0.76). This was accompanied by a mean reduction of 2.59 in the number of pre-action MHRS items from admission to discharge (z-change = 0.98). Clinician-rated Health of the Nation Outcome Scales (HoNOS) improvements were smaller (z-change = 0.41), indicative of illness chronicity. Staff valued the elements of client choice, the holistic and team approach, program quality, review processes and opportunities for client change. Addressing high-levels of need in the 6-week timeframe was raised as a concern. CONCLUSIONS: This paper demonstrates that a recovery-oriented model can be successfully implemented at the intermediate level of care. It is hoped that ongoing evaluations support the enthusiasm, commitment and feedback evident from staff, clients and carers.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Transtornos Mentais/reabilitação , Serviços de Saúde Mental , Cuidados Semi-Intensivos/organização & administração , Adulto , Cuidadores , Feminino , Hospitalização , Humanos , Masculino , Transtornos Mentais/psicologia , Serviços de Saúde Mental/tendências , Alta do Paciente , Instituições Residenciais
10.
Early Interv Psychiatry ; 9(5): 357-62, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24438348

RESUMO

AIM: This study aimed to assess the prevalence of metabolic syndrome (MS) and subthreshold MS in antipsychotic naïve patients with schizophrenia by pooling the data from three different centres in India. METHODS: One hundred thirty-seven antipsychotic naïve patients with schizophrenia were evaluated for MS using common criteria for clinical diagnosis. RESULTS: Twenty-six patients (19%) met consensus criteria. Additionally, 56 patients (40.9%) fulfilled one criterion and 32 patients (23.3%) fulfilled two criteria of MS out of five criteria. CONCLUSION: One-fifth of antipsychotic naïve patients with schizophrenia had MS and another two-third had at least one metabolic abnormality. Awareness of such a high risk is vitally important for rational selection of antipsychotic medications as well as effective implementation of preventive measures.


Assuntos
Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Síndrome Metabólica/epidemiologia , Esquizofrenia/epidemiologia , Adolescente , Adulto , Idoso , Comorbidade , Grupo com Ancestrais do Continente Europeu/psicologia , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Adulto Jovem
12.
Soc Psychiatry Psychiatr Epidemiol ; 47(9): 1429-40, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22068211

RESUMO

PURPOSE: Inpatient psychiatric units are dynamic in nature, potentially creating a different treatment experience for each person, which may be difficult to quantify. Among the goals of this multi-centre service evaluation project was an assessment of shift-to-shift changes in unit-level events and their impact on the social-emotional environment. METHODS: Over 1 year, various nurse-completed logs were used within the 11 participating Australian psychiatric units (n = 5,546 admissions) to record patient- and unit-level events per shift, including ratings of the overall social-emotional climate using a novel shift climate ratings (SCR) scale (n = 8,176 shifts). These were combined with admission-level patient characteristics to investigate shift climate profiles and correlates. RESULTS: Occupancy rates averaged 88% and two-thirds of admissions were involuntary. The psychometric performance of the SCR scale was considered to be satisfactory (e.g., high internal consistency, unidimensional factor structure, and evidence of discriminant and predictive validity). A series of hierarchical regressions revealed considerable variation in SCR total scores, with poorer climates being significantly associated with: day/afternoon shifts; higher occupancy levels; higher proportions of experienced staff, and male, older, or involuntary patients; higher rates of less serious aggressive incidents; reporting of additional staffing demands; and unit location in a stand-alone psychiatric hospital. CONCLUSIONS: The day-to-day social-emotional climate can have important consequences for patient engagement and recovery. Improved understanding of the role played by unit, staff and patient characteristics, together with routine monitoring, should facilitate the development and evaluation of targeted interventions to reduce adverse incidents and improve the overall social-emotional climate.


Assuntos
Unidades Hospitalares/organização & administração , Pacientes Internados/psicologia , Transtornos Mentais/terapia , Psicometria/instrumentação , Meio Social , Inquéritos e Questionários , Atitude do Pessoal de Saúde , Austrália , Análise Fatorial , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Recursos Humanos de Enfermagem no Hospital/normas , Escalas de Graduação Psiquiátrica , Reprodutibilidade dos Testes
13.
Aust Occup Ther J ; 57(4): 261-7, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20854601

RESUMO

BACKGROUND/AIM: Supported employment (SE) programmes have been found to improve the rates of competitive employment for people with severe mental illness. Evidence has suggested that the most effective SE model is one in which the employment specialist is co-located with mental health services. However, this may not always be achievable. The aim of this study was to investigate the effectiveness of the enhanced intersectoral links approach to SE. METHODS: A total of 43 people with a mental illness participated in the programme in which formal links were created between a community mental health team and three employment services. The outcomes of the programme were evaluated over 24 months. RESULTS: Of all participants, 77% achieved a competitive employment outcome, with 60.6% remaining in employment at the end of the evaluation period. The average duration of employment was 44.8 weeks. For those who were unable to maintain a job, the average period of employment was 14.2 weeks. The study found that participants with less severe symptoms at baseline were more likely to obtain employment and those who had worked in the year preceding entry into the programme were employed for a higher proportion of time. The factors related to job loss were the short-term nature of the position, cognitive difficulties and social skills. CONCLUSIONS: The study found that the enhanced intersectoral links approach was effective in achieving outcomes consistent with international studies of SE programmes and may offer a viable alternative to the co-location of employment specialists with community mental health teams.


Assuntos
Avaliação da Deficiência , Emprego/psicologia , Transtornos Mentais/reabilitação , Saúde Mental , Terapia Ocupacional , Reabilitação Vocacional , Adulto , Escalas de Graduação Psiquiátrica Breve , Serviços de Saúde Comunitária , Comportamento Competitivo , Feminino , Humanos , Masculino , Serviços de Saúde Mental , Psicometria , Fatores de Tempo , Avaliação da Capacidade de Trabalho , Adulto Jovem
14.
Schizophr Res ; 121(1-3): 199-202, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20538429

RESUMO

INTRODUCTION: Antipsychotic medication and lifestyle factors are implicated in the high rates of obesity and metabolic syndrome in schizophrenia. While the two Consensus Statements made in 2004 concluded they were unclear whether psychiatric disorders per se accounted for increased prevalence of metabolic disorders several later studies have presented the case for an association between schizophrenia and metabolic disorders, especially impaired glucose metabolism and Type 2 diabetes mellitus, independent of antipsychotic drug treatment. METHODS: This is a comparative study of 51 patients with chronic schizophrenia who never received antipsychotic drug treatment and 51 healthy controls. Physical and laboratory assessments were made to measure body-mass index and diagnose metabolic syndrome using the International Diabetes Federation (2006) criteria. RESULTS: The study observed a significantly lower mean body-mass index in patients (19.4) than controls (22.7) and very low and comparable rates of metabolic syndrome (3.9% in patients, 7.8% in controls). DISCUSSION: Economic affordability and lifestyles modified by living conditions were discussed as factors underlying the high rates of underweight in the patient population and low rates of metabolic disorders in all the study subjects. The study concluded that schizophrenia in the absence of antipsychotic drug treatment is not a factor contributing to high prevalence of metabolic abnormalities. Lifestyle factors and the social and economic circumstances that drive them should be considered for better understanding and management of excess weight gain and metabolic abnormalities in people with schizophrenia.


Assuntos
Doenças Metabólicas/epidemiologia , Obesidade/epidemiologia , Esquizofrenia/epidemiologia , Adulto , Glicemia , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Colesterol/sangue , Doença Crônica , Feminino , Humanos , Masculino , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/etiologia , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/etiologia , Prevalência , Esquizofrenia/complicações
15.
Aust J Rural Health ; 18(2): 66-71, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20398046

RESUMO

OBJECTIVE: Employing rural and urban patient populations, the aim of the study was to examine the differences in rehabilitation intervention outcomes, particularly in regard to the social and clinical determinants. DESIGN: The study employed a retrospective, cross-sectional analysis of patient outcome and characteristics. SETTING: Community-based psychiatric rehabilitation service in regional and rural Australia. PARTICIPANTS: A total of 260 patients were included in the service evaluation phase of the study and 86 in the second part of the study. Participants were community-based and suffered from a chronic mental illness. MAIN OUTCOME MEASURE(S): Clinical and functional outcomes were measured using the Health of Nations Outcome Scale and the 16-item Life Skills Profile. The outcome score employed was the difference between scores at intake and at the last complete assessment. Clinical and sociodemographic characters were recorded using a proforma developed for the study. RESULTS: Patients from rural Maitland had a significantly larger mean reduction in total scores and classified more often as 'Improved' on both the Health of Nations Outcome Scale and Life Skills Profile than patients from either of the urban areas (P < 0.01). Study of randomly selected patients showed that those from an urban area had a more complex illness with multiple needs and less often received family support than their rural counterparts. CONCLUSIONS: For rural communities the improvement in rehabilitation outcomes might be attributable to a more benign form of the illness and the availability of higher levels of social capital.


Assuntos
Transtorno Bipolar/reabilitação , Serviços Comunitários de Saúde Mental , População Rural , Esquizofrenia/reabilitação , População Urbana , Adulto , Fatores Etários , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New South Wales , Escalas de Graduação Psiquiátrica , Estudos Retrospectivos , Apoio Social , Resultado do Tratamento , Adulto Jovem
16.
Soc Psychiatry Psychiatr Epidemiol ; 44(2): 151-61, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18726241

RESUMO

BACKGROUND: Relationships within acute psychiatric units between patient-level experiences and events and fluctuations in mental state have rarely been examined. AIM: Data from a multi-centre service evaluation (11 units, 5,546 admissions) were used to examine mental state patterns and associations with clinical characteristics, events and adverse incidents. METHOD: During the 12-month evaluation period, nursing staff completed shift-level ratings using a new rating scale, the observed mental state (OMS) scale, which assessed active psychopathology (emotional distress, disinhibition, psychosis, cognitive impairment) and withdrawal (45,885 sets of day/afternoon shift ratings). RESULTS: The OMS scale performed satisfactorily and is worth considering elsewhere (e.g., active psychopathology: internal consistency, alpha=0.72; short-term stability, r=0.72; sensitivity to change, adjusted standardised difference, ASD=0.71). Levels of active psychopathology were much higher on shifts in which reportable (ASD=1.47) and less serious aggression occurred (ASD=1.44), compared with other shifts in which pro re nata medications were also administered (ASD=0.76), suggesting that medication usage often followed these events, and possibly that agitation and distress levels either rose rapidly or went initially unnoticed on these shifts. Although mental state improved steadily across the admission, one-fifth of the patients with schizophrenia received OMS psychosis ratings in the moderate to severe range during the days prior to discharge. CONCLUSIONS: Observed mental state ratings were strongly linked with diagnosis and reflected key events and incidents. Routine recording using the OMS scale may assist clinical decision-making and evaluation in acute psychiatric units.


Assuntos
Hospitais Psiquiátricos/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Transtornos Mentais/diagnóstico , Saúde Mental/estatística & dados numéricos , Doença Aguda , Adulto , Agressão , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , New South Wales/epidemiologia , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Agitação Psicomotora/diagnóstico , Agitação Psicomotora/tratamento farmacológico , Agitação Psicomotora/epidemiologia , Reprodutibilidade dos Testes , Esquizofrenia/diagnóstico , Esquizofrenia/tratamento farmacológico , Esquizofrenia/epidemiologia , Índice de Gravidade de Doença , Estresse Psicológico/diagnóstico , Estresse Psicológico/tratamento farmacológico , Estresse Psicológico/epidemiologia
17.
Am J Psychiatry ; 166(2): 206-15, 2009 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18829870

RESUMO

OBJECTIVE: The study of ethnically homogeneous populations may help to identify schizophrenia risk loci. The authors conducted a genomewide linkage scan for schizophrenia in an Indian population. METHOD: Participants were 441 individuals (262 affected probands and siblings) who were recruited primarily from one ethnically homogeneous group, the Tamil Brahmin caste, although individuals from other geographically proximal castes also participated. Genotyping of 124 affected sibling pair pedigrees was performed with 402 short tandem repeat polymorphisms. Linkage analyses were conducted using nonparametric exponential LOD (logarithm of the odds ratio for linkage) scores and parametric heterogeneity LOD scores. Parametric heterogeneity scores were calculated using simple dominant and recessive models, correcting for multiple statistics. The data were examined for evidence of consanguinity. Genomewide significance levels were determined using 10,000 gene dropping simulations. RESULTS: These findings revealed genomewide significant linkage to chromosome 1p31.1, through the use of both exponential and heterogeneity LOD scores, incorporating correction for multiple statistics and mild consanguinity. The estimated sibling recurrence risk associated with this putative locus was 1.95. Analysis for heterogeneity LOD scores also detected suggestive linkage to chromosomes 13q22.1 and 16q12.2. Using 117 tag single nucleotide polymorphisms (SNPs), family-based association analyses of phosphodiesterase 4B (PDE4B), the closest schizophrenia candidate gene, detected no convincing evidence of association, suggesting that the chromosome 1 peak represents a novel risk locus. CONCLUSIONS: This is the first study-to the authors' knowledge-to report significant linkage of schizophrenia to chromosome 1p31.1. Further investigation of this chromosome region in diverse populations is warranted to identify underlying sequence variants.


Assuntos
Mapeamento Cromossômico , Cromossomos Humanos Par 1/genética , Esquizofrenia/genética , Adulto , Alelos , Consanguinidade , Nucleotídeo Cíclico Fosfodiesterase do Tipo 4/genética , Feminino , Genótipo , Humanos , Índia , Escore Lod , Masculino , Repetições de Microssatélites/genética , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único/genética , Esquizofrenia/diagnóstico , Esquizofrenia/etnologia
18.
Aust N Z J Psychiatry ; 42(4): 267-82, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18330769

RESUMO

OBJECTIVE: This paper reports findings from a multicentre service evaluation project conducted in acute psychiatric inpatient units in NSW, Australia. Overall rates of aggression, absconding and early readmission are reported, as well as length-of-stay profiles and associations between these outcomes and selected sociodemographic and clinical characteristics routinely collected by health services. METHOD: Data from the 11 participating units were collected for a 12month period from multiple sources, including electronic medical records, routine clinical modules, incident forms, and shift based project-specific logs. For the current analyses, two admission-level datasets were used, comprising aggregated patient-level events (n=3242 admissions) and basic sociodemographic, clinical, admission and discharge information (n=5546 admissions by 3877 patients). RESULTS: The participating units were under considerable strain: 23.3% of admissions were high acuity; 60.4% had previous hospital stays; 47.6% were involuntary; 25-30% involved adverse incidents; bed occupancy averaged 88.4%; median length of stay was 8 days (mean=14.59 days); and 17.4% had a subsequent early readmission. Reportable aggressive incidents (11.2% of admissions) were intermittent (averaging 0.55 incidents per month per occupied bed) and associated with younger age, personality disorder, less serious aggression, longer periods of hospitalization, and subsequent early readmission. Less serious aggressive incidents (15.0% of admissions) were maximal in the first 24h (averaging 3.73 incidents per month per occupied bed) and associated with younger age, involuntary status, bipolar and personality disorders, the absence of depression, and longer hospital stays. Absconding (15.7% of admissions) peaked in the second week following admission and was associated with drug and alcohol disorder, younger age, and longer periods of hospitalization. CONCLUSIONS: By examining relationships between a core set of risk factors and multiple short-term outcomes, we were able to identify several important patterns, which were suggestive of the need for a multi-level approach to intervention, shifting from a risk management focus during the early phase of hospitalization to a more targeted, therapeutic approach during the later phase. But the latter approach may not be achievable under current circumstances with existing resources.


Assuntos
Agressão/psicologia , Pacientes Internados/psicologia , Pacientes Internados/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Gestão de Riscos , Adulto , Distribuição por Idade , Austrália , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Administração dos Cuidados ao Paciente , Readmissão do Paciente/estatística & dados numéricos , Fatores de Risco , Distribuição por Sexo , Fatores Socioeconômicos , Carga de Trabalho
19.
Australas Psychiatry ; 15(6): 470-3, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17999257

RESUMO

OBJECTIVE: The aim of this paper was to identify a simple screening measure for detecting metabolic syndrome (MetS) in people with schizophrenia and schizoaffective disorders. METHOD: A total of 202 patients with chronic schizophrenia and schizoaffective disorders on antipsychotic medications were assessed for MetS using the criteria defined by the International Diabetes Federation. Receiver operating characteristic (ROC) analysis was applied using body mass index (BMI) as the test variable for diagnosis of MetS. RESULTS: The prevalence of MetS was 69.3%. Logistic regression analysis identified BMI and gender as significant predictors of MetS. ROC analysis identified BMI >28.7 as the criterion value with highest accuracy in terms of specificity and sensitivity. The likelihood ratios were robust at this cut-off score. The area under the curve was 0.75. CONCLUSION: BMI is a quick and easy measure, and can be used as a screening test for MetS in any clinical or community setting.


Assuntos
Programas de Rastreamento/métodos , Síndrome Metabólica/diagnóstico , Síndrome Metabólica/epidemiologia , Transtornos Psicóticos/epidemiologia , Esquizofrenia/epidemiologia , Adulto , Índice de Massa Corporal , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Prevalência , Transtornos Psicóticos/diagnóstico , Curva ROC , Esquizofrenia/diagnóstico , Distribuição por Sexo
20.
Aust N Z J Psychiatry ; 41(7): 606-10, 2007 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-17558623

RESUMO

OBJECTIVE: People with schizophrenia and bipolar disorders suffer from increased rates of obesity and metabolic syndrome. Metabolic disorders add to the burden of disease and affect treatment and rehabilitation outcomes. This study aimed to study the prevalence of obesity and metabolic syndrome in people with chronic psychotic disorders in a psychiatric rehabilitation setting. METHOD: All patients in the psychiatry rehabilitation program were assessed for obesity and metabolic syndrome using the definition of International Diabetes Federation (2005) was conducted as part of clinical protocol recently introduced into practice. RESULTS: A total of 221 patients were assessed. The prevalence of obesity was 59% and metabolic syndrome 68%. Metabolic syndrome was more frequent in patients receiving polypharmacy with multiple antipsychotics and mood stabilisers. Rates of nontreatment for metabolic disorders ranged from 30% to 88%. CONCLUSIONS: The rates of obesity and metabolic syndrome in patients with chronic severe mental disorders on antipsychotic drug treatment were 2 to 3 times that in the general population. A majority of them were untreated. Detection, monitoring and appropriate treatment of obesity and metabolic disorders should be a component of an assertive care management program to reduce morbidity and mortality and improve rehabilitation outcomes.


Assuntos
Transtorno Bipolar/epidemiologia , Síndrome Metabólica/epidemiologia , Obesidade/epidemiologia , Centros de Reabilitação/estatística & dados numéricos , Esquizofrenia/epidemiologia , Adulto , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/uso terapêutico , Antidepressivos/efeitos adversos , Antidepressivos/uso terapêutico , Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Transtorno Bipolar/reabilitação , Índice de Massa Corporal , Doença Crônica , Serviços Comunitários de Saúde Mental/estatística & dados numéricos , Comorbidade , Estudos Transversais , Quimioterapia Combinada , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Compostos de Lítio/efeitos adversos , Compostos de Lítio/uso terapêutico , Masculino , Síndrome Metabólica/induzido quimicamente , Pessoa de Meia-Idade , Obesidade/induzido quimicamente , Esquizofrenia/reabilitação
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