scholarly journals Circadian Characteristics in Patients under Treatment for Substance Use Disorders and Severe Mental Illness (Schizophrenia, Major Depression and Bipolar Disorder)

2021 ◽  
Vol 10 (19) ◽  
pp. 4388
Author(s):  
Ana Belén Serrano-Serrano ◽  
Julia E. Marquez-Arrico ◽  
José Francisco Navarro ◽  
Antonio Martinez-Nicolas ◽  
Ana Adan
Keyword(s):  
Bipolar Disorder ◽  
Mental Illness ◽  
Substance Use ◽  
Severe Mental Illness ◽  
Light Cycle ◽  
Dual Disorders ◽  
Major Depressive ◽  
Clinical Complications ◽  
Morning Type ◽  
Circadian Typology

Dual disorders (substance use and mental illness comorbidity) are a condition that has been strongly associated with severe symptomatology and clinical complications. The study of circadian characteristics in patients with Severe Mental Illness or Substance Use Disorder (SUD) has shown that such variables are related with mood symptoms and worse recovery. In absence of studies about circadian characteristics in patients with dual disorders we examined a sample of 114 male participants with SUD and comorbid Schizophrenia (SZ+; n = 38), Bipolar Disorder (BD+; n = 36) and Major Depressive Disorder (MDD+; n = 40). The possible differences in the sample of patients according to their psychiatric diagnosis, circadian functioning with recordings of distal skin temperature during 48 h (Thermochron iButton®), circadian typology and sleep-wake schedules were explored. MDD+ patients were more morning-type, while SZ+ and BD+ had an intermediate-type; the morning-type was more frequent among participants under inpatient SUD treatment. SZ+ patients had the highest amount of sleeping hours, lowest arousal and highest drowsiness followed by BD+ and MDD+, respectively. These observed differences suggest that treatment for patients with dual disorders could include chronobiological strategies to help them synchronize patterns with the day-light cycle, since morning-type is associated with better outcomes and recovery.

Mortality and rehospitalization rates among patients with severe mental illness (SMI) at different levels of hospital spending

2020 ◽  
Author(s):  
Shih-Chi Lin ◽  
Kuan-Yi Tsai ◽  
Hung-Yu Wang ◽  
Shih-Pei Shen ◽  
Frank Chou
Keyword(s):  
Bipolar Disorder ◽  
Mental Illness ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Severe Mental Illness ◽  
Treatment Outcomes ◽  
Psychiatric Hospitalization ◽  
Major Depressive ◽  
National Health Research Institute ◽  
Patient Level

Abstract Background Evidence has shown that the relationships between hospital spending and treatment outcomes for physical conditions have been inconclusive. So to investigate the association between hospital spending and both risk-adjusted mortality and rehospitalization rates among patients with severe mental illness (SMI). Method This was a retrospective cohort study that used the Taiwan National Health Research Institute Database (NHRID) from 1999 to 2010. Hospital end-of-life (EOL) spending was used to quantify hospital spending and was determined by the total medical costs of the last year of life of patients with at least one previous psychiatric hospitalization. Patients with schizophrenia (n=13,229), bipolar disorder (n=4,476) and major depressive disorder (n=5,177) were followed for mortality and rehospitalization to psychiatric wards from 2009 to 2010 after they had been discharged from the study hospitals. Results Patients with schizophrenia had lower rehospitalization and mortality rates when treated at higher-spending hospitals than when treated at the lowest-spending hospitals. However, these associations became weak, even nonsignificant, when adjusted for patient-level variables. There were no significant findings for patients with bipolar disorder and major depressive disorder when patient-level variables were adjusted for. Patient-level variables showed more determinant roles than hospital-level variables in the relationships between hospital spending and treatment outcomes. Conclusion Hospitals that spend more at the EOL had lower mortality and rehospitalization rates for patients with schizophrenia but higher rates for bipolar disorder and major depressive disorder. Most of these associations could be explained by patients’ characteristics more than hospitals’ characteristics.

scholarly journals Appraisal of patient-level health economic models of severe mental illness: systematic review

2021 ◽  
pp. 1-12
Author(s):  
James Altunkaya ◽  
Jung-Seok Lee ◽  
Apostolos Tsiachristas ◽  
Felicity Waite ◽  
Daniel Freeman ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Mental Illness ◽  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Severe Mental Illness ◽  
Economic Models ◽  
Model Verification ◽  
Major Depressive ◽  
Patient Level

Background Healthcare decision makers require accurate long-term economic models to evaluate the cost-effectiveness of new mental health interventions. Aims To assess the suitability of current patient-level economic models to estimate long-term economic outcomes in severe mental illness. Method We undertook pre-specified systematic searches in MEDLINE, Embase and PsycINFO to identify reviews and stand-alone publications of economic models of interventions for schizophrenia, bipolar disorder and major depressive disorder (PROSPERO: CRD42020158243). We screened paper titles and abstracts to identify unique patient-level economic models. We conducted a structured extraction of identified models, recording the presence of key predefined model features. Model quality and validation were appraised using the 2014 ISPOR and 2016 AdViSHE model checklists. Results We identified 15 unique patient-level models for psychosis and major depressive disorder from 1481 non-duplicate records. Models addressed schizophrenia (n = 6), bipolar disorder (n = 2) and major depressive disorder (n = 7). The predominant model type was discrete event simulation (n = 9). Model complexity and incorporation of patient heterogeneity varied considerably, and only five models extrapolated costs and outcomes over a lifetime horizon. Key model parameters were often based on low-quality evidence, and checklist quality assessment revealed weak model verification procedures. Conclusions Existing patient-level economic models of interventions for severe mental illness have considerable limitations. New modelling efforts must be supplemented by the generation of good-quality, contemporary evidence suitable for model building. Combined effort across the research community is required to build and validate economic extrapolation models suitable for accurately assessing the long-term value of new interventions from short-term clinical trial data.

Evolving U.S. service model for patients with severe mental illness and co-occurring substance use disorder

2004 ◽  
Vol 16 (1) ◽  
pp. 36-40 ◽  
Author(s):  
R. E. Drake ◽  
G. Morse ◽  
M. F. Brunette ◽  
W. C. Torrey
Keyword(s):  
Mental Illness ◽  
Substance Use ◽  
Severe Mental Illness ◽  
Substance Use Disorder ◽  
Leadership Training ◽  
Service Model ◽  
Dual Disorders ◽  
Engagement Assessment ◽  
Implementation Leadership ◽  
The U.S

Co-occurring severe mental illness and substance use disorder has been recognized as a common problem in the U.S. since the early 1980s (1–3). For these individuals with co-occurring disorders, research demonstrates the effectiveness of various forms of combining, blending, or integrating mental health and substance abuse treatments (4). The evolving U.S. service model for integrated dual disorders treatment emphasizes several key elements: implementation, leadership, training, engagement, assessment, counseling for all patients, ancillary treatments for those with multiple needs, secondary treatments for patients who are nonresponders, and quality assurance regarding process and outcomes.

scholarly journals Total and cause-specific mortality in patients with personality disorders: the association between comorbid severe mental illness and substance use disorders

2021 ◽  
Author(s):  
Anne Høye ◽  
Bjarne K. Jacobsen ◽  
Jørgen G. Bramness ◽  
Ragnar Nesvåg ◽  
Ted Reichborn-Kjennerud ◽  
...  
Keyword(s):  
Mental Illness ◽  
Substance Use ◽  
Severe Mental Illness ◽  
Personality Disorders ◽  
Health Care Services ◽  
Causes Of Death ◽  
Proportional Hazards ◽  
Young Female ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Models

Abstract Purpose To investigate the mortality in both in- and outpatients with personality disorders (PD), and to explore the association between mortality and comorbid substance use disorder (SUD) or severe mental illness (SMI). Methods All residents admitted to Norwegian in- and outpatient specialist health care services during 2009–2015 with a PD diagnosis were included. Standardized mortality ratios (SMRs) with 95% confidence intervals (CI) were estimated in patients with PD only and in patients with PD and comorbid SMI or SUD. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) with 95% CIs in patients with PD and comorbid SMI or SUD compared to patients with PD only. Results Mortality was increased in both in- and outpatients with PD. The overall SMR was 3.8 (95% CI 3.6–4.0). The highest SMR was estimated for unnatural causes of death (11.0, 95% CI 10.0–12.0), but increased also for natural causes of death (2.2, 95% CI 2.0–2.5). Comorbidity was associated with higher SMRs, particularly due to poisoning and suicide. Patients with comorbid PD & SUD had almost four times higher all-cause mortality HR than patients with PD only; young women had the highest HR. Conclusion The SMR was high in both in- and outpatients with PD, and particularly high in patients with comorbid PD & SUD. Young female patients with PD & SUD were at highest risk. The higher mortality in patients with PD cannot, however, fully be accounted for by comorbidity.

Sign in / Sign up

Export Citation Format

Share Document