Diabetes and cardiovascular risk in severe mental illness: a missed opportunity and challenge for the future

2010 ◽  
Vol 27 (2) ◽  
pp. 79-84ii ◽  
Author(s):  
RIG Holt ◽  
RC Peveler
Keyword(s):  
Mental Illness ◽  
Cardiovascular Risk ◽  
Severe Mental Illness ◽  
The Future ◽  
Missed Opportunity

scholarly journals Skin autofluorescence assessment of cardiovascular risk in people with severe mental illness

BJPsych Open ◽  
2018 ◽  
Vol 4 (4) ◽  
pp. 313-316 ◽  
Author(s):  
Daniëlle Emmerink ◽  
Sybiel Bakker ◽  
Thomas Van Bemmel ◽  
Eric O. Noorthoorn ◽  
Paul Naarding
Keyword(s):  
Risk Assessment ◽  
Mental Illness ◽  
Cardiovascular Risk ◽  
Severe Mental Illness ◽  
Ease Of Use ◽  
Glycation End Products ◽  
Prospective Longitudinal ◽  
Score Table ◽  
Observation Period

BackgroundPeople with severe mental illness (SMI) show significantly shorter life expectancy, mostly due to more prevalent cardiovascular disease. Although age is a prominent contributor to contemporary risk assessment and SMI usually affects younger people, these assessments still do not reveal the actual risk. By assessing advanced glycation end products (AGEs), cardiovascular risk can be assessed independent of age.AimsTo establish whether detection of AGEs with the AGE-reader will give a more accurate cardiovascular risk assessment in people with SMI.MethodWe compared assessment with the AGE-reader with that of the Systematic Coronary Risk Evaluation (SCORE) table in a group of 120 patients with SMI.ResultsThe AGE-reader showed an increased cardiovascular risk more often than the SCORE table, especially in the youngest group.ConclusionsBecause of its ease of use and substantiation by studies done on other chronic diseases, we advocate use of the AGE-reader in daily care for patients with SMI to detect cardiovascular risk as early as possible. However, the findings of the current study should be evaluated with caution and should be seen as preliminary findings that require confirmation by a prospective longitudinal cohort study with a substantial follow-up observation period.Declaration of interestNone.

scholarly journals Effectiveness and cost-effectiveness of a cardiovascular risk prediction algorithm for people with severe mental illness (PRIMROSE)

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e018181 ◽  
Author(s):  
Ella Zomer ◽  
David Osborn ◽  
Irwin Nazareth ◽  
Ruth Blackburn ◽  
Alexandra Burton ◽  
...  
Keyword(s):  
Mental Illness ◽  
Cardiovascular Risk ◽  
Cost Effectiveness ◽  
General Population ◽  
Cost Saving ◽  
Severe Mental Illness ◽  
Secondary Outcome ◽  
Health Improvement ◽  
Parameter Estimates ◽  
Life Years

ObjectivesTo determine the cost-effectiveness of two bespoke severe mental illness (SMI)-specific risk algorithms compared with standard risk algorithms for primary cardiovascular disease (CVD) prevention in those with SMI.SettingPrimary care setting in the UK. The analysis was from the National Health Service perspective.Participants1000 individuals with SMI from The Health Improvement Network Database, aged 30–74 years and without existing CVD, populated the model.InterventionsFour cardiovascular risk algorithms were assessed: (1) general population lipid, (2) general population body mass index (BMI), (3) SMI-specific lipid and (4) SMI-specific BMI, compared against no algorithm. At baseline, each cardiovascular risk algorithm was applied and those considered high risk (>10%) were assumed to be prescribed statin therapy while others received usual care.Primary and secondary outcome measuresQuality-adjusted life years (QALYs) and costs were accrued for each algorithm including no algorithm, and cost-effectiveness was calculated using the net monetary benefit (NMB) approach. Deterministic and probabilistic sensitivity analyses were performed to test assumptions made and uncertainty around parameter estimates.ResultsThe SMI-specific BMI algorithm had the highest NMB resulting in 15 additional QALYs and a cost saving of approximately £53 000 per 1000 patients with SMI over 10 years, followed by the general population lipid algorithm (13 additional QALYs and a cost saving of £46 000).ConclusionsThe general population lipid and SMI-specific BMI algorithms performed equally well. The ease and acceptability of use of an SMI-specific BMI algorithm (blood tests not required) makes it an attractive algorithm to implement in clinical settings.

A well-being programme in severe mental illness. reducing risk for physical ill-health: A post-programme service evaluation at 2 years

2007 ◽  
Vol 22 (7) ◽  
pp. 413-418 ◽  
Author(s):  
Shubulade Smith ◽  
David Yeomans ◽  
Chris J.P. Bushe ◽  
Cecilia Eriksson ◽  
Tom Harrison ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mental Illness ◽  
Cardiovascular Risk ◽  
Physical Health ◽  
Severe Mental Illness ◽  
Cardiovascular Risk Factors ◽  
Well Being ◽  
Self Esteem ◽  
Service Evaluation ◽  
Support Programme

AbstractintroductionCardiovascular disease is more prevalent in patients with severe mental illness (SMI) than in the general population.MethodSeven geographically diverse centres were assigned a nurse to monitor the physical health of SMI patients in secondary care over a 2-year period in the “Well-being Support Programme” (WSP). A physical health screen was performed and patients were given individual weight and lifestyle advice including smoking cessation to reduce cardiovascular risk.ResultsNine hundred and sixty-six outpatients with SMI >2 years were enrolled. The completion rate at 2 years was 80%. Significant improvements were observed in levels of physical activity (p < 0.0001), smoking (p < 0.05) and diet (p < 0.0001). There were no changes in mean BMI although 42% lost weight over 2 years. Self-esteem improved significantly. Low self-esteem decreased from 43% at baseline to 15% at 2 years (p < 0.0001). At the end of the programme significant cardiovascular risk factors remained, 46% of subjects smoked, 26% had hypertension and 81% had BMI >25.ConclusionPhysical health problems are common in SMI subjects. Many patients completed 2 years follow up suggesting that this format of programme is an acceptable option for SMI patients. Cardiovascular risk factors were significantly improved. interventions such as the Well-being Support Programme should be made widely available to people with SMI.

scholarly journals Reforming care without bureaucracy

2018 ◽  
Vol 43 (3) ◽  
pp. 104-105
Author(s):  
Peter Tyrer
Keyword(s):  
Mental Illness ◽  
Severe Mental Illness ◽  
Good Practice ◽  
Care Programme ◽  
The Future ◽  
Discharge From Hospital ◽  
Intangible Benefit

The Care Programme Approach was a valiant attempt to improve the aftercare of people with severe mental illness after discharge from hospital. It was introduced as a response to a scandal, not an advance in knowledge, and has always suffered by being a reaction to events rather than a trailblazer for the future. It may have dragged the worst of care upwards, but at the expense of creating a bureaucratic monstrosity that has hindered good practice by excessive attention to risk, and vastly increased paperwork with intangible benefit. It needs to be simplified to allow practitioners greater scope for collaborative solutions, less minatory oversight and better use of strained resources.Declaration of interestNone.

scholarly journals A collaboration between service users and professionals for the development and evaluation of a new program for cardiovascular risk management in persons with a diagnosis of severe mental illness: French multicenter qualitative and feasibility studies

2019 ◽  
Vol 13 (1) ◽  
Author(s):  
Antoine Baleige ◽  
Jean-François Besnard ◽  
Nicolas Meunier-Beillard ◽  
Vincent Demassiet ◽  
Alain Monnier ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Promotion ◽  
Mental Illness ◽  
Risk Management ◽  
Cardiovascular Risk ◽  
Severe Mental Illness ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Health Promotion Program ◽  
Cardiovascular Risk Management

Abstract Background Persons with a diagnosis of severe mental illness have a life expectancy that is 20 years lower than the general population, and they are disproportionately affected by cardiovascular disorders. Improving the management of cardiovascular risk is one of the main challenges for the public health system. In the care pathway of persons with a diagnosis of severe mental illness, a better understanding of limiting and facilitating factors is required. The objective was to include persons with a diagnosis of severe mental illness, carers, and primary and mental health professionals in the creation and evaluation (feasibility) of a health promotion program designed to improve cardiovascular risk management through empowerment. Methods This study combines a mixed methodology with qualitative and quantitative components. A multicenter prospective qualitative study was conducted in seven mental health units in France and was coordinated by a steering committee composed of persons with a diagnosis of severe mental illness, carers, and primary and mental health professionals. Results This health promotion program must enable persons with a diagnosis of severe mental illness to assert their right to self-determination and to exercise greater control over their lives, beyond their diagnosis and care. Following a preliminary feasibility study, the effectiveness of this new tool will be evaluated using a randomized controlled trial in a second study. Conclusions The findings can be used by health organizations as a starting point for developing new and improved services for persons with a diagnosis of severe mental illness. Trial registration Clinical Trials Gov NCT03689296. Date registered September 28, 2018

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