Impact of Medical Comorbidity on Medication Management of Schizophrenia

CNS Spectrums ◽  
2007 ◽  
Vol 12 (S21) ◽  
pp. 15-17
Author(s):  
Dan W. Haupt
Keyword(s):  
Cardiovascular Disease ◽  
Mental Illness ◽  
General Population ◽  
Serious Mental Illness ◽  
Medication Management ◽  
Population Sample ◽  
Unipolar Depression ◽  
Medical Comorbidity ◽  
Medical Comorbidities ◽  
Poor Access

Schizophrenia is associated with increased medical comorbidity likely caused by interactions between life-style, environment, and the disease itself. High rates of medical comorbidity exist among all forms of serious mental illness. Affective disorders such as bipolar disorder and unipolar depression are associated with 1.5–2 times the mortality rate observed in the general population, and high rates of HIV and hepatitis A, B, and C exist among patients with severe mental illness. However, schizophrenia is particularly affected by medical comorbidities, and is associated with a 20% shorter-than-normal lifespan. This discussion focuses on rates of medical comorbidity in people with schizophrenia and the effects of medication on cardiometabolic risk factors. It is also important to recognize that lifestyle and environmental factors associated with serious mental illness, as well as poor access to healthcare, contribute to the elevated rates of medical illnesses observed in these populations as well.Studies of the association between schizophrenia and medical comorbidities have suggested that the introduction of second-generation antipsychotics (SGAs) may be responsible for the increases observed in cardiovascular disease rates in this patient population, and that cardiovascular disease mortality may be shifting to an earlier stage of life. Ösby and colleagues observed that while overall cardiovascular mortality in schizophrenia patients in Sweden increased from 1976–1995, an even greater increase occurred in men from 1991–1995. This latter increase corresponded temporally to an increased use of SGAs.Osborne and colleagues recently confirmed the observation made by Osby and colleagues. They compared 46,000 people with serious mental illness and a general population sample of ∼300,000 people from 1987–2002.

scholarly journals Risk of cardiovascular disease in people taking psychotropic medication: a literature review

2019 ◽  
Vol 8 (3) ◽  
pp. 136-144
Author(s):  
Herbert Mwebe ◽  
Danielle Roberts
Keyword(s):  
Cardiovascular Disease ◽  
Mental Illness ◽  
General Population ◽  
Serious Mental Illness ◽  
Psychotropic Medication ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Premature Death ◽  
Mortality And Morbidity ◽  
Physical Health Problems

In people with serious mental illness, mortality and morbidity are significantly increased compared to the general population. This is often as a result of physical health problems; about two-thirds of premature death in people with serious mental illness has been attributed to natural causes including cardiovascular disease and diabetes. Cardiovascular disease risk in people with serious mental illness is higher than the general population, this risk is further increased in those with serious mental illness taking psychotropic medication. In this article, cardiovascular disease risk in serious mental illness, particularly the association with psychotropic interventions and monitoring required, is examined.

scholarly journals Risk of cardiovascular disease in people taking psychotropic medication: a literature review

2019 ◽  
Vol 8 (3) ◽  
pp. 136-144 ◽  
Author(s):  
Herbert Mwebe ◽  
Danielle Roberts
Keyword(s):  
Cardiovascular Disease ◽  
Mental Illness ◽  
General Population ◽  
Serious Mental Illness ◽  
Psychotropic Medication ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Premature Death ◽  
Mortality And Morbidity ◽  
Physical Health Problems

In people with serious mental illness, mortality and morbidity are significantly increased compared to the general population. This is often as a result of physical health problems; about two-thirds of premature death in people with serious mental illness has been attributed to natural causes including cardiovascular disease and diabetes. Cardiovascular disease risk in people with serious mental illness is higher than the general population, this risk is further increased in those with serious mental illness taking psychotropic medication. In this article, cardiovascular disease risk in serious mental illness, particularly the association with psychotropic interventions and monitoring required, is examined.

scholarly journals Incremental changes in QRS duration as predictor for cardiovascular disease: a 21-year follow-up of a randomly selected general population

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Xiaojing Chen ◽  
Per-Olof Hansson ◽  
Erik Thunström ◽  
Zacharias Mandalenakis ◽  
Kenneth Caidahl ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
General Population ◽  
Cardiovascular Events ◽  
Population Sample ◽  
Cox Regression Analysis ◽  
Major Cardiovascular Events ◽  
Increased Risk ◽  
Qrs Duration ◽  
Group 1

AbstractThe QRS complex has been shown to be a prognostic marker in coronary artery disease. However, the changes in QRS duration over time, and its predictive value for cardiovascular disease in the general population is poorly studied. So we aimed to explore if increased QRS duration from the age of 50–60 is associated with increased risk of major cardiovascular events during a further follow-up to age 71. A random population sample of 798 men born in 1943 were examined in 1993 at 50 years of age, and re-examined in 2003 at age 60 and 2014 at age 71. Participants who developed cardiovascular disease before the re-examination in 2003 (n = 86) or missing value of QRS duration in 2003 (n = 127) were excluded. ΔQRS was defined as increase in QRS duration from age 50 to 60. Participants were divided into three groups: group 1: ΔQRS < 4 ms, group 2: 4 ms ≤ ΔQRS < 8 ms, group 3: ΔQRS ≥ 8 ms. Endpoints were major cardiovascular events. And we found compared with men in group 1 (ΔQRS < 4 ms), men with ΔQRS ≥ 8 ms had a 56% increased risk of MACE during follow-up to 71 years of age after adjusted for BMI, systolic blood pressure, smoking, hyperlipidemia, diabetes and heart rate in a multivariable Cox regression analysis (HR 1.56, 95% CI:1.07–2.27, P = 0.022). In conclusion, in this longitudinal follow-up over a decade QRS duration increased in almost two out of three men between age 50 and 60 and the increased QRS duration in middle age is an independent predictor of major cardiovascular events.

scholarly journals Chronic pain diagnoses and opioid dispensings among individuals with serious mental illness

2019 ◽  
Author(s):  
Ashli Owen-Smith ◽  
Christine Stewart ◽  
Musu M. Sesay ◽  
Sheryl M. Strasser ◽  
Bobbi Jo Yarborough ◽  
...  
Keyword(s):  
Mental Health ◽  
Chronic Pain ◽  
Mental Illness ◽  
Healthcare Utilization ◽  
Serious Mental Illness ◽  
Research Network ◽  
Prescription Opioid ◽  
Medical Comorbidities ◽  
Pain Diagnosis ◽  
Opioid Medications

Abstract Background Individuals with major depressive disorder (MDD) and bipolar disorder (BD) have particularly high rates of chronic non-cancer pain (CNCP) and are also more likely to receive prescription opioids for their pain. However, there have been no known studies published to date that have examined opioid treatment patterns among individuals with schizophrenia. Methods Using electronic medical record data across 13 Mental Health Research Network sites, individuals with diagnoses of MDD (N=65,750), BD (N=38,117) or schizophrenia or schizoaffective disorder (N=12,916) were identified and matched on age, sex and Medicare status to controls with no documented mental illness. CNCP diagnoses and prescription opioid medication dispensings were extracted for the matched samples. Multivariate analyses were conducted to evaluate (1) the odds of receiving a pain-related diagnosis and (2) the odds of receiving opioids, by separate mental illness diagnosis category compared with matched controls, controlling for age, sex, Medicare status, race/ethnicity, income, medical comorbidities, healthcare utilization and chronic pain diagnoses. Results Multivariable models indicated that having a MDD (OR=1.90; 95% CI=1.85–1.95) or BD (OR=1.71; 95% CI=1.66–1.77) diagnosis was associated with increased odds of a CNCP diagnosis after controlling for age, sex, race, income, medical comorbidities and healthcare utilization. By contrast, having a schizophrenia diagnosis was associated with decreased odds of receiving a chronic pain diagnosis (OR=0.86; 95% CI=0.82– 0.90). Having a MDD (OR=2.59; 95% CI=2.44–2.75) or BD (OR=2.12; 95% CI=1.97–2.28) diagnosis was associated with increased odds of receiving chronic opioid medications, even after controlling for age, sex, race, income, medical comorbidities, healthcare utilization and chronic pain diagnosis; having a schizophrenia diagnosis was not associated with receiving chronic opioid medications. Conclusions Individuals with serious mental illness, who are most at risk for developing opioid-related problems, continue to be prescribed opioids more often than their peers without mental illness. Healthcare providers need to be especially conservative in prescribing opioids – or avoid opioid therapy altogether – for this population. Mental health clinicians may be particularly well-suited to lead pain assessment and management efforts for these patients.

Mortality and Medical Comorbidity Among Patients With Serious Mental Illness

2006 ◽  
Vol 57 (10) ◽  
pp. 1482-1487 ◽  
Author(s):  
Brian J. Miller ◽  
C. Bayard Paschall ◽  
Dale P. Svendsen
Keyword(s):  
Mental Illness ◽  
Serious Mental Illness ◽  
Medical Comorbidity

Burden of chronic conditions among persons with HIV/AIDS and psychiatric comorbidity

2021 ◽  
Vol 19 ◽  
Author(s):  
Sumedha Chhatre ◽  
George Woody ◽  
David S Metzger ◽  
Ravishankar Jayadevappa
Keyword(s):  
Cardiovascular Disease ◽  
Substance Use ◽  
Infectious Diseases ◽  
Metabolic Disorders ◽  
Psychiatric Comorbidity ◽  
Medical Expenditure ◽  
Medical Comorbidity ◽  
Medical Comorbidities ◽  
Persons Living With Hiv ◽  
Intermediate Outcomes

Background: Improved survivorship among persons living with HIV translates into higher risk of medical comorbidities. Objective : We assessed the association between intersection of physical (HIV) and mental health (psychiatric) conditions and intermediate outcomes. Methods: Cross-sectional study of Medical Expenditure Panel Survey (MEPS)-Household Component between 1996 and 2016. We created four groups for persons aged ≥18: (1) HIV + psychiatric comorbidity, (2) HIV, (3) psychiatric comorbidity, and (4) no-HIV/no-psychiatric comorbidity. We compared the burden of medical comorbidities (metabolic disorders, cardiovascular disease, cancers, infectious diseases, pain, and substance use) across groups using chi square tests. We used logistic regression to determine the association between group status and medical comorbidity. Results: Of 218,133,630 (weighted) persons aged ≥18, 0.18% were HIV-positive. Forty-three percent of HIV group and 19% of no-HIV group had psychiatric comorbidities. Half of the HIV+ psychiatric disorder group had at least one medical comorbidity. Compared to the no-HIV/no-psychiatric comorbidity group, the HIV + psychiatric comorbidity group had highest odds of medical comorbidity (OR= 3.69, 95% CI = 2.99, 4.52). Conclusion: Persons presenting with HIV + psychiatric comorbidity had higher odds of medical comorbidities of pain, cancer, cardiovascular disease, substance use, metabolic disorders and infectious diseases, beyond that experienced by persons with HIV infection or psychiatric disorders, independently. Future research will focus on the mediating effects of social determinants and biological factors on outcomes as quality of life, cost and mortality. This will facilitate a shift away from the single-disease framework and compress morbidity of the aging cohort of HIV-infected persons.

scholarly journals History and Correlates of Smoking Cessation Behaviors Among Smokers With Serious Mental Illness

2019 ◽  
Vol 22 (9) ◽  
pp. 1492-1499 ◽  
Author(s):  
Su Fen Lubitz ◽  
Alex Flitter ◽  
E Paul Wileyto ◽  
Douglas Ziedonis ◽  
Nathaniel Stevens ◽  
...  
Keyword(s):  
Mental Illness ◽  
Carbon Monoxide ◽  
Smoking Cessation ◽  
General Population ◽  
Serious Mental Illness ◽  
Smoking Cessation Counseling ◽  
Smoking Cessation Advice ◽  
Smoking Cessation Treatment ◽  
Quit Attempt ◽  
Quit Attempts

Abstract Introduction Individuals with serious mental illness (SMI) smoke at rates two to three times greater than the general population but are less likely to receive treatment. Increasing our understanding of correlates of smoking cessation behaviors in this group can guide intervention development. Aims and Methods Baseline data from an ongoing trial involving smokers with SMI (N = 482) were used to describe smoking cessation behaviors (ie, quit attempts, quit motivation, and smoking cessation treatment) and correlates of these behaviors (ie, demographics, attitudinal and systems-related variables). Results Forty-three percent of the sample did not report making a quit attempt in the last year, but 44% reported making one to six quit attempts; 43% and 20%, respectively, reported wanting to quit within the next 6 months or the next 30 days. Sixty-one percent used a smoking cessation medication during their quit attempt, while 13% utilized counseling. More quit attempts were associated with lower nicotine dependence and carbon monoxide and greater beliefs about the harms of smoking. Greater quit motivation was associated with lower carbon monoxide, minority race, benefits of cessation counseling, and importance of counseling within the clinic. A greater likelihood of using smoking cessation medications was associated with being female, smoking more cigarettes, and receiving smoking cessation advice. A greater likelihood of using smoking cessation counseling was associated with being male, greater academic achievement, and receiving smoking cessation advice. Conclusions Many smokers with SMI are engaged in efforts to quit smoking. Measures of smoking cessation behavior are associated with tobacco use indicators, beliefs about smoking, race and gender, and receiving cessation advice. Implications Consideration of factors related to cessation behaviors among smokers with SMI continues to be warranted, due to their high smoking rates compared to the general population. Increasing our understanding of these predictive characteristics can help promote higher engagement in evidence-based smoking cessation treatments among this subpopulation.

scholarly journals Serious mental illness and medical comorbidities: Findings from an integrated health care system

2017 ◽  
Vol 100 ◽  
pp. 35-45 ◽  
Author(s):  
Amber L. Bahorik ◽  
Derek D. Satre ◽  
Andrea H. Kline-Simon ◽  
Constance M. Weisner ◽  
Cynthia I. Campbell
Keyword(s):  
Health Care ◽  
Mental Illness ◽  
Health Care System ◽  
Serious Mental Illness ◽  
Integrated Health Care ◽  
Medical Comorbidities ◽  
Integrated Health ◽  
Integrated Health Care System ◽  
Care System

scholarly journals Improving life expectancy in people with serious mental illness: Should we place more emphasis on primary prevention?

2017 ◽  
Vol 211 (4) ◽  
pp. 194-197 ◽  
Author(s):  
Athif Ilyas ◽  
Edward Chesney ◽  
Rashmi Patel
Keyword(s):  
Cardiovascular Disease ◽  
Mental Illness ◽  
Primary Prevention ◽  
Life Expectancy ◽  
Physical Health ◽  
Serious Mental Illness ◽  
Health Monitoring ◽  
Prevention Strategies ◽  
Everyday Clinical Practice ◽  
Exercise Interventions

SummaryPeople with serious mental illness have a reduced life expectancy that is partly attributable to increased cardiovascular disease. One approach to address this is regular physical health monitoring. However, physical health monitoring is poorly implemented in everyday clinical practice and there is little evidence to suggest that it improves physical health. We argue that greater emphasis should be placed on primary prevention strategies such as assertive smoking cessation, dietary and exercise interventions and more judicious psychotropic prescribing.

Sign in / Sign up

Export Citation Format

Share Document