Advanced dental disease in people with severe mental illness:
                        systematic review and meta-analysis

BackgroundPsychiatric patients have increased comorbid physical illness. There is less information concerning dental disease in this population in spite of risk factors including diet and psychotropic side-effects (such as xerostomia).AimsTo compare the oral health of people with severe mental illness with that of the general population.MethodA systematic search for studies from the past 20 years was conducted using Medline, PsycINFO, Embase and article bibliographies. Papers were independently assessed. The primary outcome was total tooth loss (edentulousness), the end-stage of both untreated caries and periodontal disease. We also assessed dental decay through standardised measures: the mean number of decayed, missing and filled teeth (DMFT) or surfaces (DMFS). For studies lacking a control group we used controls of similar ages from a community survey within 10 years of the study.ResultsWe identified 21 papers of which 14 had sufficient data (n = 2784 psychiatric patients) and suitable controls (n = 31 084) for a random effects meta-analysis. People with severe mental illness had 3.4 times the odds of having lost all their teeth than the general community (95% CI 1.6–7.2). They also had significantly higher scores for DMFT (mean difference 6.2, 95% CI 0.6–11.8) and DMFS (mean difference 14.6, 95% CI 4.1–25.1). Fluoridated water reduced the gap in oral health between psychiatric patients and the general population.ConclusionsPsychiatric patients have not shared in the improving oral health of the general population. Management should include oral health assessment using standard checklists that can be completed by non-dental personnel. Interventions include oral hygiene and management of xerostomia.

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Oral health inequality in people with severe mental illness: a cross-sectional study using National Health and Nutrition Examination Survey 1999-2016

10.1101/2021.03.17.21253840 ◽

2021 ◽

Author(s):

Jing Kang ◽

Jianhua Wu ◽

Vishal Aggarwal ◽

David Shiers ◽

Tim Doran ◽

...

Keyword(s):

Risk Factors ◽

Mental Illness ◽

Oral Health ◽

General Population ◽

Health Outcomes ◽

Severe Mental Illness ◽

Tooth Loss ◽

List Type ◽

Cross Sectional ◽

Oral Health Outcomes

AbstractOBJECTIVETo explore whether people with severe mental illness (SMI) experience worse oral health compared to the general population, and the risk factors for poor oral health in people with SMI.METHODThis study used cross-sectional data from the National Health and Nutrition Examination Survey (1999-2016) including on self-rated oral health, ache in mouth, tooth loss, periodontitis stage, and number of decayed, missing, and filled teeth. Candidate risk factors for poor oral health included demographic characteristics, lifestyle factors, physical health comorbidities, and dental hygiene behaviours. The authors used ordinal logistic regression and zero-inflated negative binomial models to explore predictors of oral health outcomes.RESULTS53,348 cases were included in the analysis, including 718 people with SMI. In the fully adjusted model, people with SMI were more likely to suffer from tooth loss (OR 1.40, 95% CI: 1.12-1.75). In people with SMI, the risk factors identified for poor oral health outcomes were older age, white ethnicity, lower income, smoking history, and diabetes. Engaging in physical activity and daily use of dental floss were associated with better oral health outcomes.CONCLUSIONSPeople with SMI experience higher rates of tooth loss than the general population, and certain subgroups are particularly at risk. Having a healthy lifestyle such as performing regular physical exercise and flossing may lower the risk of poor oral health. These findings suggest opportunities for targeted prevention and early intervention strategies to mitigate adverse oral health outcomes.Significant outcomes (x3)People with severe mental illness were at 40% higher risk of tooth loss when compared to the general population.Older adults, smokers and people with diabetes were at particularly high risk of poor oral health.Physical exercise and daily use of dental floss were associated with better oral health outcomes.Limitations (x3)The number of cases with data on periodontal disease was limited.The study was cross-sectional so causation could not be inferred.The analysis used prescriptions of antipsychotic and mood stabilising medication as a proxy measure of severe mental illness, as clinical diagnoses were not available in the dataset.Data availability statementThe NHANES 1999-2016 data is available at CDC website: https://www.cdc.gov/nchs/nhanes/index.htm, and is accessible and free to download for everyone.

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Diagnose, indicate, and treat severe mental illness (DITSMI) as appropriate care: A three-year follow-up study in long-term residential psychiatric patients on the effects of re-diagnosis on medication prescription, patient functioning, and hospital bed utilization

European Psychiatry ◽

10.1192/j.eurpsy.2020.46 ◽

2020 ◽

Vol 63 (1) ◽

Author(s):

H. M. Veereschild ◽

E. O. Noorthoorn ◽

H. L. I. Nijman ◽

C. L. Mulder ◽

M. Dankers ◽

...

Keyword(s):

Mental Illness ◽

Severe Mental Illness ◽

Psychosocial Functioning ◽

Psychiatric Patients ◽

Control Group ◽

Chi Square ◽

Medication Prescription ◽

Appropriate Care ◽

Severely Mentally Ill

Abstract Background. While polypharmacy is common in long-term residential psychiatric patients, prescription combinations may, from an evidence-based perspective, be irrational. Potentially, many psychiatric patients are treated on the basis of a poor diagnosis. We therefore evaluated the DITSMI model (i.e., Diagnose, Indicate, and Treat Severe Mental Illness), an intervention that involves diagnosis (or re-diagnosis) and appropriate treatment for severely mentally ill long-term residential psychiatric patients. Our main objective was to determine whether DITSMI affected changes over time regarding diagnoses, pharmacological treatment, psychosocial functioning, and bed utilization. Methods. DITSMI was implemented in a consecutive patient sample of 94 long-term residential psychiatric patients during a longitudinal cohort study without a control group. The cohort was followed for three calendar years. Data were extracted from electronic medical charts. As well as diagnoses, medication use and current mental status, we assessed psychosocial functioning using the Health of the Nations Outcome Scale (HoNOS). Bed utilization was assessed according to length of stay (LOS). Change was analyzed by comparing proportions of these data and testing them with chi-square calculations. We compared the numbers of diagnoses and medication changes, the proportions of HoNOS scores below cut-off, and the proportions of LOS before and after provision of the protocol. Results. Implementation of the DITSMI model was followed by different diagnoses in 49% of patients, different medication in 67%, some improvement in psychosocial functioning, and a 40% decrease in bed utilization. Conclusions. Our results suggest that DITSMI can be recommended as an appropriate care for all long-term residential psychiatric patients.

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A Systematic Review and Meta-Analysis of the Association Between Poor Oral Health and Severe Mental Illness

Psychosomatic Medicine ◽

10.1097/psy.0000000000000135 ◽

2015 ◽

Vol 77 (1) ◽

pp. 83-92 ◽

Cited By ~ 58

Author(s):

Steve Kisely ◽

Hooman Baghaie ◽

Ratilal Lalloo ◽

Dan Siskind ◽

Newell W. Johnson

Keyword(s):

Systematic Review ◽

Mental Illness ◽

Oral Health ◽

Severe Mental Illness ◽

Meta Analysis

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Violent and non-violent crime against adults with severe mental illness

The British Journal of Psychiatry ◽

10.1192/bjp.bp.114.147843 ◽

2015 ◽

Vol 206 (4) ◽

pp. 275-282 ◽

Cited By ~ 37

Author(s):

H. Khalifeh ◽

S. Johnson ◽

L. M. Howard ◽

R. Borschmann ◽

D. Osborn ◽

...

Keyword(s):

Mental Illness ◽

General Population ◽

Severe Mental Illness ◽

Violence Prevention ◽

Psychiatric Patients ◽

Survey Questionnaire ◽

Increased Risk ◽

Relative Extent ◽

Psychosocial Morbidity ◽

Population Controls

BackgroundLittle is known about the relative extent of crime against people with severe mental illness (SMI).AimsTo assess the prevalence and impact of crime among people with SMI compared with the general population.MethodA total of 361 psychiatric patients were interviewed using the national crime survey questionnaire, and findings compared with those from 3138 general population controls participating in the contemporaneous national crime survey.ResultsPast-year crime was experienced by 40% of patients v. 14% of controls (adjusted odds ratio (OR) = 2.8, 95% CI 2.0–3.8); and violent assaults by 19% of patients v. 3% of controls (adjusted OR = 5.3, 95% CI 3.1–8.8). Women with SMI had four-, ten- and four-fold increases in the odds of experiencing domestic, community and sexual violence, respectively. Victims with SMI were more likely to report psychosocial morbidity following violence than victims from the general population.ConclusionsPeople with SMI are at greatly increased risk of crime and associated morbidity. Violence prevention policies should be particularly focused on people with SMI.

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Let's get physical: improving the medical care of people with severe mental illness

Advances in Psychiatric Treatment ◽

10.1192/apt.bp.111.009068 ◽

2012 ◽

Vol 18 (3) ◽

pp. 216-225 ◽

Cited By ~ 8

Author(s):

Alex J. Mitchell ◽

Vijay Delaffon ◽

Oliver Lord

Keyword(s):

Mental Health ◽

Mental Illness ◽

General Population ◽

Medical Treatment ◽

Medical Care ◽

Severe Mental Illness ◽

Psychiatric Patients ◽

Medical Comorbidity ◽

Preventive Healthcare ◽

Related Mortality

SummaryThere is clear evidence of increased medical comorbidity and related mortality in people with severe mental illness, despite numerous guidelines for managing medical conditions in this population. This article assesses inequalities in medical treatment and preventive healthcare received by psychiatric patients compared with the general population. It considers whether the medical care provided is adequate and whether published guidelines improve it. Mental health specialists, general practitioners and hospital specialists appear to deliver poorer than average medical care for this vulnerable population. Implementation of physical healthcare guidelines is incomplete and the guidelines must be matched with resources to address this deficit.

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Dietary intake of people with severe mental illness: systematic review and meta-analysis

The British Journal of Psychiatry ◽

10.1192/bjp.2019.20 ◽

2019 ◽

Vol 214 (5) ◽

pp. 251-259 ◽

Cited By ~ 40

Author(s):

Scott B. Teasdale ◽

Philip B. Ward ◽

Katherine Samaras ◽

Joseph Firth ◽

Brendon Stubbs ◽

...

Keyword(s):

Bipolar Disorder ◽

Mental Illness ◽

Dietary Intake ◽

Physical Health ◽

Severe Mental Illness ◽

Diet Quality ◽

Psychotic Disorders ◽

Meta Analysis ◽

Mean Difference ◽

Dietary Intakes

BackgroundSevere mental illness (SMI) is thought to be associated with lower diet quality and adverse eating behaviours contributing towards physical health disparities. A rigorous review of the studies looking at dietary intake in psychotic disorders and bipolar disorder is lacking.AimsTo conduct a systematic, comprehensive evaluation of the published research on dietary intake in psychotic disorders and bipolar disorder.MethodSix electronic databases were searched for studies reporting on dietary intakes in psychotic disorders and bipolar disorder. Dietary-assessment methods, and dietary intakes, were systematically reviewed. Where possible, data was pooled for meta-analysis and compared with healthy controls.ResultsIn total, 58 eligible studies were identified. People with SMI were found to have significantly higher dietary energy (mean difference 1332 kJ, 95% CI 487–2178 kJ/day, P = 0.002, g = 0.463) and sodium (mean difference 322 mg, 95% CI 174–490 mg, P < 0.001, g = 0.414) intake compared with controls. Qualitative synthesis suggested that higher energy and sodium intakes were associated with poorer diet quality and eating patterns.ConclusionsThese dietary components should be key targets for preventative interventions to improve weight and other physical health outcomes in people with SMI.Declaration of interestS.B.T. and E.T. have clinical dietitian appointments within the South Eastern Sydney Local Health District and do not receive any further funding.

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Tolerability of statin-based management of patients with a history of statin-associated muscle symptoms: protocol for a systematic review

BMJ Open ◽

10.1136/bmjopen-2021-052341 ◽

2021 ◽

Vol 11 (8) ◽

pp. e052341

Author(s):

Fanny Villoz ◽

Christina Lyko ◽

Cinzia Del Giovane ◽

Nicolas Rodondi ◽

Manuel R Blum

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Mean Difference ◽

Control Group ◽

Cochrane Central Register ◽

Eligibility Criteria ◽

Clinical Issue ◽

Standard Data ◽

Evaluation Approach ◽

History Of

IntroductionStatin-associated muscle symptoms (SAMSs) are a major clinical issue in the primary and secondary prevention of cardiovascular events. Current guidelines advise various approaches mainly based on expert opinion. We will lead a systematic review and meta-analysis to explore the tolerability and acceptability and effectiveness of statin-based therapy management of patients with a history of SAMS. We aim to provide evidence on the tolerability and different strategies of statin-based management of patients with a history of SAMS.Methods and analysisWe will conduct a systematic review of randomised controlled trials (RCTs) and non-randomised studies with a control group. We will search in Data sources MEDLINE, EMBASE, Cochrane Central Register of Controlled Clinical Trials, Scopus, Clinicaltrials.gov and Proquest from inception until April 2021. Two independent reviewers will carry out the study selection based on eligibility criteria. We will extract data following a standard data collection form. The reviewers will use the Cochrane Collaboration’s tools and Newcastle-Ottawa Scale to appraise the study risk of bias. Our primary outcome will be tolerability and our secondary outcomes will be acceptability and effectiveness. We will conduct a qualitative analysis of all included studies. In addition, if sufficient and homogeneous data are available, we will conduct quantitative analysis. We will synthesise dichotomous data using OR with 95% CI and continuous outcomes by using mean difference or standardised mean difference (with 95% CI). We will determine heterogeneity visually with forest plots and quantitatively with I2 and Q-test. We will summarise the confidence in the quantitative estimate by using Grading of Recommendations Assessment, Development and Evaluation approach.Ethics and disseminationAs a systematic review of literature without collection of new clinical data, there will be no requirement for ethical approval. We will disseminate findings through peer-reviewed publications.PROSPERO registration numberCRD42020202619.

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Nutrition interventions in people with severe mental illness: Novel strategies for addressing physical health co-morbidity in a high-risk population

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2320 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S620-S620 ◽

Cited By ~ 1

Author(s):

S. Teasdale ◽

P. Ward ◽

K. Samaras ◽

S. Rosenbaum ◽

J. Curtis ◽

...

Keyword(s):

Mental Illness ◽

Weight Gain ◽

Severe Mental Illness ◽

Meta Analysis ◽

Nutrition Intervention ◽

High Risk Population ◽

List Type ◽

Nutrition Interventions ◽

Glucose Levels ◽

Co Morbidity

IntroductionNutrition interventions are critical for weight management and cardiometabolic risk reduction in people experiencing severe mental illness (SMI). As mental health teams evolve to incorporate nutrition interventions, evidence needs to guide clinical practice.AimsA systematic review and meta-analysis was performed to assess whether nutrition interventions improve:– anthropometric and biochemical measures,– nutritional intake of people experiencing SMI.To evaluate the effectiveness of a dietician-led nutrition intervention, as part of a broader lifestyle intervention, in the early stages of antipsychotic prescription.MethodAn electronic database search was conducted to identify all trials with nutritional components. Included trials were pooled for meta-analysis. Meta-regression analyses were run on potential anthropometric moderators. Weekly individualised dietetic consultations plus group cooking classes were then offered to clients attending a Community Early Psychosis Programme, who had recently commenced antipsychotics for a 12-week period.ResultsFrom pooled trials, nutrition interventions resulted in significant weight loss (19 studies, g = –0.39, P < 0.001), reduced BMI (17 studies, g = –0.40, P < 0.001), decreased waist circumference (10 studies, g = –0.27, P < 0.001) and lower blood glucose levels (5 studies, g = –0.37, P = 0.02). Dietician-led interventions (g = –0.90) and trials focussing on preventing weight gain (g = –0.61) were the most effective. The 12-week nutrition intervention resulted in a 47% reduction in discretionary (junk) food intake (P < 0.001) and reductions in daily energy (–24%, P < 0.001) and sodium intakes (–26%, P < 0.001), while improving diet quality (P < 0.05).ConclusionEvidence supports the inclusion of nutrition interventions as part of standard care for preventing weight gain and metabolic deterioration among people with SMI.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Social stigma in severe mental illness in Tunisia: Clinical and socio-demographic correlates

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.861 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S577-S577 ◽

Cited By ~ 1

Author(s):

U. Ouali ◽

R. Jomli ◽

R. Nefzi ◽

H. Ouertani ◽

F. Nacef

Keyword(s):

Mental Illness ◽

Severe Mental Illness ◽

Cultural Context ◽

Social Inclusion ◽

Psychiatric Patients ◽

Social Stigma ◽

Cross Sectional Study ◽

Local Context ◽

Cross Sectional ◽

Competing Interest

IntroductionMental patients generally internalize some of the negative conceptions about how most people view them: they might be considered incompetent or untrustworthy or believe that people would not want to hire, or marry someone with mental illness. A lot of research on stigma has been conducted in western countries; however, little is still known on the situation in Arab-Muslim societies.ObjectivesTo evaluate social stigma as viewed by patients suffering from severe mental illness (SMI)MethodsThis is a cross-sectional study on clinically stabilized patients with schizophrenia and Bipolar Disorder (BD) according to DSM IV, who were interviewed in our out-patients clinic with the help of a semi-structured questionnaire, containing 8 opinions on the social inclusion and stigmatization of psychiatric patients, with special reference to the local cultural context (e.g.: “It is better to hide mental illness in order to preserve the reputation of my family”)ResultsWe included 104 patients, 51% with schizophrenia and 49% with BD. Mean age was 38.4 years (18–74 years); 59.6% were males. Overall social stigma scores were high. Social stigma in patients was correlated with gender, age, place of residence and diagnosis. Patients with BD showed significantly less social stigma than patients with schizophrenia.ConclusionOur results show the need for a better understanding of this phenomenon in patients with SMI, but also within Tunisian society, in order to elaborate anti stigma strategies adapted to the local context.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Efficacy of Adjuvant Magnesium for Posttonsillectomy Morbidity in Children: A Meta-analysis

Otolaryngology ◽

10.1177/0194599817730354 ◽

2017 ◽

Vol 158 (1) ◽

pp. 27-35 ◽

Cited By ~ 5

Author(s):

Hye Kyung Cho ◽

In Joon Park ◽

Ho Young Yoon ◽

Se Hwan Hwang

Keyword(s):

Meta Analysis ◽

Postoperative Bleeding ◽

Mean Difference ◽

Local Administration ◽

Control Group ◽

Analgesic Requirement ◽

Administration Routes ◽

Randomized Controlled Studies ◽

Subgroup Analyses ◽

Standardized Mean Difference

Objectives The perioperative administration of magnesium is known to reduce postoperative morbidities in adults, such as pain, agitation, and laryngospasm. The objective is to assess the effects of perioperative magnesium as the adjuvant to tonsillectomy as compared with tonsillectomy in children. Data Source Five databases (PubMed, SCOPUS, Embase, Web of Science, Cochrane). Method Two authors independently searched databases up to January 2017. We compared perioperative magnesium administration (magnesium groups) with no administration of magnesium (control group). The following outcomes were measured: postoperative pain intensity, analgesics administration, or other morbidities (laryngospasm, agitation, postoperative bleeding) in the postoperative 24 hours. Additionally, to evaluate the discrepancy of effects according to different administration routes, subgroup analyses regarding effects according to systemic or local administration of magnesium were performed. Results Nine prospective randomized controlled studies (n = 615) that evaluated the effect of magnesium in children having undergone tonsillectomy met inclusion criteria. Compared with control group, the time for first analgesic requirement was significantly delayed in magnesium groups (standardized mean difference = 0.75; 95% CI, 0.20-1.31; P = .0079). Laryngospasm (log odds ratio = −1.09; 95% CI,−2.11 to −0.07; P = .0362) and agitation score (standardized mean difference = −0.67; 95% CI, −0.97 to −0.36; P < .0001) in the recovery room also significantly decreased in magnesium groups. In subgroup analyses regarding pain and laryngospasm-related measurements, local administration of magnesium was shown to be more effective at reducing postoperative morbidities. Conclusions Perioperative magnesium regardless of route may offer pain, agitation, and laryngospasm relief without adverse effects in pediatric tonsillectomy. Based on the high heterogeneity of results within some parameters, further studies need to be performed to affirm these results.

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