ABSTRACT
BACKGROUND: Individuals with serious mental illness have a markedly shorter life expectancy. A major contributor to premature death is cardiovascular disease (CVD). We investigated associations of (genetic liability for) depressive disorder, bipolar disorder and schizophrenia with a range of CVD traits and examined to what degree these were driven by important confounders. METHODS: We included participants of the Dutch Lifelines cohort (N = 147 337) with information on self-reported lifetime diagnosis of depressive disorder, bipolar disorder, or schizophrenia and CVD traits. Employing linear mixed-effects models, we examined associations between mental illness diagnoses and CVD, correcting for psychotropic medication, demographic and lifestyle factors. In a subsample (N = 73 965), we repeated these analyses using polygenic scores (PGSs) for the three mental illnesses. RESULTS: There was strong evidence that depressive disorder diagnosis is associated with increased arrhythmia and atherosclerosis risk and lower heart rate variability, even after confounder adjustment. Positive associations were also found for the depression PGSs with arrhythmia and atherosclerosis. Bipolar disorder was associated with a higher risk of nearly all CVD traits, though most diminished after adjustment. The bipolar disorder PGSs did not show any associations. While the schizophrenia PGSs was associated with increased arrhythmia risk and lower heart rate variability, schizophrenia diagnosis was not. All mental illness diagnoses were associated with lower blood pressure and a lower risk of hypertension. CONCLUSIONS: Our study shows widespread associations of (genetic liability to) mental illness (primarily depressive disorder) with CVD, even after confounder adjustment. Future research should focus on clarifying potential causal pathways between mental illness and CVD.
Subject(s)
Atherosclerosis , Cardiovascular Diseases , Mental Disorders , Humans , Cohort Studies , Mental Disorders/epidemiology , Cardiovascular Diseases/epidemiology , Arrhythmias, CardiacABSTRACT
BACKGROUND: In contrast to several other countries, smoking is not an integral part of treatment during admission to a psychiatric hospital in The Netherlands.
AIM: Implementation of a smoking cessation program for patients and employees of a psychiatric ward of an academic medical center in The Netherlands.
METHOD: Prospective, mixed-method study of implementation of a smoking cessation program for patients and employees of a psychiatric academic hospital in Amsterdam. The program consisted of 7 weekly group meetings by certified smoking cessation coaches. Nicotine replacement therapy was provided for free, if necessary.
RESULTS: During 14 months, 65 individuals were seeking help to stop smoking: 39 patients and 26 employees. Of these, 29 patients and 16 employees participated in group meetings with an average of 2.6 times per person. There were 20 individuals who visited the group meetings or received individual coaching at least 3 times (6 patients and 14 employees). Fifty-five percent of these individuals reported to be smoke-free at 3 months after joining the first meeting. Employees were much more likely to quit than patients. From interviews with 20 participants, it was noticed that combining patients and employees in one group was perceived as a barrier due to a gap in processing speed.
CONCLUSION: On the psychiatric ward of an academic hospital in The Netherlands, there was a positive experience with providing smoking cessation treatment. A small number of employees and patients participated in a smoking cessation program and quitting smoking was reached by only a few patients. Supporting smoking cessation in a psychiatric hospital asks for intensive screening, diagnosing, treatment and smoke-free policies.
Subject(s)
Smoking Cessation , Hospitals, Psychiatric , Humans , Netherlands , Prospective Studies , Smoking , Tobacco Use Cessation DevicesABSTRACT
AIM: To provide an overview of the literature on transitions towards smoke-free psychiatric hospitals and the risk of aggression.
METHOD: A systematic search was made in medline, Embase and Psycinfo. Studies were included if they reported data on: a smoke-free intervention in a psychiatric hospital or ward, the number of aggressive incidents, and seclusions or prn drugs.
RESULTS: A total of 17 studies matched the inclusion/exclusion criteria; 5 reported a decrease in the number of aggressive incidents after implementation of a smoke-free ward, 7 showed an increase in the number of incidents, and 5 studies reported no differences. Heterogeneity between the studies was high with respect to the definition and implementation of the intervention, the definition and measurement of aggression, study design, length of follow-up, and the sample size.
CONCLUSION: These findings suggest that, after changing the policy towards a smoke-free psychiatric hospital, the risk of aggression is limited. However, several precautions related to the preparation and implementation of this transition seem to be essential. The results support further investment in the implementation of smoke-free psychiatric hospitals in the Netherlands, while maintaining safety.
Subject(s)
Aggression , Hospitals, Psychiatric/legislation & jurisprudence , Smoke-Free Policy , Aggression/psychology , Humans , Netherlands , Smoking Cessation , ViolenceABSTRACT
BACKGROUND: A key indicator of quality of treatment from the patient's perspective is expressed by satisfaction with care. Our aim was to (i) explore satisfaction and its relation to clinical outcome measures; and (ii) explore the predictive value of satisfaction for the course of outcomes over three years. METHODS: Data of 654 patients with a non-affective psychosis included in a naturalistic longitudinal cohort study were analyzed. We included 506 males and 148 females with a mean age of 30.47 (SD 7.24) from The Netherlands. Satisfaction was measured with the self-rating Client Satisfaction Questionnaire-8. A wide range of interviewer-rated (e.g., Positive and Negative Symptom Scale) and self-rated (e.g., World Health Organization Quality of Life); outcomes of low, intermediate and high satisfied patients were compared using ANOVA, Chi2 or Kruskal-Wallis tests. The predictive value of satisfaction level on clinical outcomes after three years was tested using regression models. RESULTS: Satisfaction levels were low (19.4%), intermediate (48.9%) or high (31.7%). High satisfied patients showed significantly better interviewer-rated outcomes, e.g., less severe psychotic symptoms, and self-rated outcomes, e.g., better quality of life, compared to patients with intermediate or low satisfaction. Higher levels of satisfaction with care at baseline predicted a reduction of positive symptoms three years later (B=-.09, P-value=.013). CONCLUSIONS: Satisfaction of patients with psychosis is a valuable monitoring measure since high satisfied patients show more favorable outcomes ranging from psychopathological symptoms to quality of life. Further research into explanations of lower levels of satisfaction is commendable in order to improve outcomes.
Subject(s)
Outcome Assessment, Health Care/methods , Patient Satisfaction , Psychotic Disorders/psychology , Quality of Life/psychology , Adult , Female , Humans , Longitudinal Studies , Male , Netherlands , Psychopathology , Surveys and QuestionnairesABSTRACT
Cystic neoplasms of the pancreas are rare. They may present as a mucinous (malignant or potentially malignant) tumour or as benign serous cystadenoma. Accurate preoperative diagnosis is therefore essential, as an asymptomatic serous tumour may safely be followed clinically for years, whereas mucinous tumours require aggressive surgery. Thirteen patients with cystadenoma and cystadenocarcinoma of the pancreas were reviewed and how best to improve the rate of preoperative diagnosis was considered. Fine-needle aspiration cytology and computed tomography enable accurate preoperative distinction between mucinous and serous cystic tumours of the pancreas.
