[Collaborative somatic care for patients with severe mental illness]. / Gezamenlijke somatische zorg voor patiënten met een ernstige psychische aandoening.

Patients with severe mental illness have an accumulation of risk factors for physical diseases like cardiovascular diseases, metabolic syndrome, diabetes mellitus and COPD. These patients receive suboptimal care in the Netherlands. A major barrier to optimal care is the lack of collaboration between mental health professionals and general practitioners. An improvement could be made if all medical professionals actively supported these high-risk patients in taking adequate care of their health needs. This improvement can only be made if general practitioners and mental health professionals collaborate in a timely and structured manner.

[Switching to e-cigarettes affects drug concentration]. / Overstap op e-sigaret beïnvloedt medicijnconcentratie.

BACKGROUND: Cytochrome P450 subtype 1A2 (CYP1A2) is responsible for the metabolism of several drugs, including the antipsychotic agent clozapine. Smoking cigarettes induces CYP1A2. Due to this induction, a higher dosage of the drug is required by patients who smoke tobacco. CASE DESCRIPTION: The dosage of clozapine was changed for a 34-year-old male because of suspected active psychosis. However, serum levels of clozapine did not change according to expectations. It appeared that the patient had switched from smoking normal cigarettes to using e-cigarettes and then started smoking cigarettes again during the time of the dosage change. This gave a plausible explanation for the observed clozapine concentrations. CONCLUSION: When patients switch from smoking normal cigarettes to using e-cigarettes induction of the CYP1A2 enzyme stops. A switch of this type may result in a major, undesirable increase in drug concentrations. Doctors should be alert to this when prescribing medication metabolised by CYP1A2 with a narrow therapeutic window.

Evaluation of health promotion programmes in severe mental illness: theory and practice.

Health promotion programmes for patients with severe mental illness (HPP) are not uniformly evaluated. We discuss the evaluation of HPP in theory and practice, as a prerequisite for future uniform evaluation. We explored the expected outcome and mechanism of HPP in the current literature. Based on this theoretical exploration we selected measures assessing the expected outcome and mechanism in current practice. The individual properties of these measures were described. Based on our theoretical exploration the outcome of HPP can be expressed in several aspects of health. Health can be improved through several mechanisms. In the current evaluation of HPP only some of the expected outcomes were evaluated. The measures used for evaluation were not all representative for the constructs they should assess. Important aspects of HPP are currently not evaluated, based on a comparison between our theoretical exploration of expected outcome and mechanism and current practice. Additionally, not all measures in use are suitable for evaluation of HPP. Therefore, development and identification of suitable measures is necessary. Our framework offers valuable directions for the development of such measures and the future evaluation of HPP.

Is somatic health screening in patients with severe mental illness of added value?

PURPOSE: To evaluate the added value of somatic screening for patients with severe mental illness over regular care. DESIGN AND METHODS: We compared the information on somatic health problems collected by screening with the general practitioner (GP) files (n = 118). FINDINGS: The mean number of somatic health problems detected with somatic health screening was significantly higher than those noted in GP records (p < .01). PRACTICE IMPLICATIONS: Somatic health screening is an addition to the care provided by the GP. Advanced mental health nurses can play a key role in somatic health screening and initiating further cooperation and communication of GP and mental health care.

Improvement of care for the physical health of patients with severe mental illness: a qualitative study assessing the view of patients and families.

BACKGROUND: Patients with severe mental illness (SMI) experience more physical comorbidity than the general population. Multiple factors, including inadequate seeking of healthcare and health care related factors such as lack of collaboration, underlie this undesirable situation. To improve this situation, the logistics of physical health care for patients with SMI need to be changed. We asked both patients and their families about their views on the current organization of care, and how this care could be improved. METHODS: Group and individual interviews were conducted with patients and family of patients to explore their needs and preferences concerning the care for the physical health of patients with SMI, and to explore the shortcomings they had experienced. Using thematic analysis, responses were firstly divided into common topics, after which these topics were grouped into themes. RESULTS: Three major themes for the improvement of the physical care of patients with SMI were found. Firstly, the reduced ability of patients with SMI to survey their own physical health interests requires health care that is tailored to these needs. Secondly, the lack of collaboration amongst mental health care professionals and general practitioners (GPs) hinders optimal care. Thirdly, concerns were expressed regarding the implementation of monitoring and supporting a healthy lifestyle. Patients with SMI welcome this implementation, but the logistics of providing this care can be improved. CONCLUSIONS: An optimal approach for caring for the physical health of patients with SMI requires a professional approach, which is different to the routine care provided to the general public. This approach can and should be accomplished within the usual organizational structure. However, this requires tailoring of the health care to the needs of patients with SMI, as well as structural collaboration between mental health care professionals and GPs.

Gaps in health care for the somatic health of outpatients with severe mental illness.

The physical health of outpatients with severe mental illness (SMI) can be improved by changes in the health-care system. Analysis of current practice is necessary to develop these strategies. We compared the number of somatic health problems of outpatients with SMI with the frequency of consulting a general practitioner (GP). This was a cross-sectional study based on interviews, and records from the GP and the pharmacy. We checked whether Dutch community pharmacies had complete and correct information about the patients' medication. We observed that all patients (n = 118) had somatic problems in need of clinical attention. Patients who visited their GP less than once a year (35%, n = 42), had a mean of 2.8 somatic health problems. This was less than patients who consulted their GP more than once a year (P ≤ 0.01). In 37% of cases, the pharmacy did not have adequate information on the drug use. Many patients with SMI seemed to have insufficient contact with their GP for their somatic health problems. Insufficient information about the patients' medication suggested that the pharmacist and GP should increase exchange of information. Mental health nurses can take a lead in coordinating the care to improve somatic health for their patients.