2015 Rundberg Health & Wellness Initiative: Community Health Assessment (original) (raw)
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Eight-year trends of cardiometabolic morbidity and mortality in patients with schizophrenia
General Hospital Psychiatry, 2012
Objective: We examined cardiometabolic disease and mortality over 8 years among individuals with and without schizophrenia. Method: We compared 65,362 patients in the Veteran Affairs (VA) health system with schizophrenia to 65,362 VA patients without serious mental illness (non-SMI) matched on age, service access year and location. The annual prevalence of diagnosed cardiovascular disease, diabetes, dyslipidemia, hypertension, obesity, and all-cause and cause-specific mortality was compared for fiscal years 2000-2007. Mean years of potential life lost (YPLLs) were calculated annually. Results: The cohort was mostly male (88%) with a mean age of 54 years. Cardiometabolic disease prevalence increased in both groups, with non-SMI patients having higher disease prevalence in most years. Annual between-group differences ranged from b1% to 6%. Annual mortality was stable over time for schizophrenia (3.1%) and non-SMI patients (2.6%). Annual mean YPLLs increased from 12.8 to 15.4 in schizophrenia and from 11.8 to 14.0 for non-SMI groups. Conclusions: VA patients with and without schizophrenia show increasing but similar prevalence rates of cardiometabolic diseases. YPLLs were high in both groups and only slightly higher among patients with schizophrenia. The findings highlight the complex population served by the VA while suggesting a smaller mortality impact from schizophrenia than previously reported. Published by Elsevier Inc.
Subjective memory impairments during the course of electroconvulsive therapy in depressed patients
Australian and New Zealand Journal of Psychiatry 2007; 41(Suppl. 2): 402.
Background: Memory impairment is one of the common side effects of electro convulsive therapy (ECT). Apart from objective impairment, subjective complaints of memory loss are also quite common in ECT and a major source of distress for the patients. Investigating the nature and extent of such subjective memory complaints thus becomes an important endeavour with major implications on practice of ECT. Aim: To examine the short term subjective and objective memory impairments in depressed patients during the course of ECT. Method: Patients with severe depression (n32) were followed up while they were receiving ECT’s, and up to a month after that. They were rated independently and blindly on the MMSE for global cognitive dysfunction, the PGI Memory Scale (PGIMS; Pershad, 1979) for objective memory loss, Self Rating Scale of Memory Functions (SRSMF; Squire et al., 1979) for subjective memory loss and the Montgomery-Asberg Depression Rating Scale (MADRS) for severity of depression. Results: MMSE and PGIMS (objective memory) scores dipped during the course of ECT, but picked up in the week and month following cessation of treatment. MADRS scores registered a gradual decline as patients improved throughout the course of ECT. The SRSMF (subjective memory) scores also showed a gradual improvement during the course of ECT. However, subjective memory scores did showconsistent correlations with MMSE, MADRS and objective memory. Conclusions: There is considerable subjective memory impairment during a course of ECT, even in the short term. However, subjective memory scores do improve with treatment.
Anxiety disorders and rapid cycling: data from a cohort of 8129 youths with bipolar disorder.
Anxiety disorders (ADs) are common in youths with bipolar disorder (BD). We examine psychiatric comorbidity, hospitalization, and treatment in youths with versus without AD and rapid cycling (four or more cycles per year). Data from the Integrated Healthcare Information Services cohort were used and included 8129 youths (ages ≤18 years). Prevalence of AD, demographic, type of AD, hospitalization, and use of psychotropics were compared between rapid and nonrapid cycling. Overall, 51% of the youths met criteria for at least one comorbid AD; they were predominantly female and were between 12 and 17 years of age. The most common comorbid ADs were generalized ADs and separation ADs. In the patients with rapid cycling, 65.5% met criteria for comorbid AD. The BD youths with AD were more likely to have major depressive disorders and other comorbid ADs, to be given more psychotropics, and to be hospitalized for depression and medical conditions more often than were those without AD.
Anxiety Disorders and Rapid Cycling
The Journal of Nervous and Mental Disease, 2013
Anxiety disorders (ADs) are common in youths with bipolar disorder (BD). We examine psychiatric comorbidity, hospitalization, and treatment in youths with versus without AD and rapid cycling (four or more cycles per year). Data from the Integrated Healthcare Information Services cohort were used and included 8129 youths (ages ≤18 years). Prevalence of AD, demographic, type of AD, hospitalization, and use of psychotropics were compared between rapid and nonrapid cycling. Overall, 51% of the youths met criteria for at least one comorbid AD; they were predominantly female and were between 12 and 17 years of age. The most common comorbid ADs were generalized ADs and separation ADs. In the patients with rapid cycling, 65.5%met criteria for comorbid AD. The BD youths with AD were more likely to have major depressive disorders and other comorbid ADs, to be given more psychotropics, and to be hospitalized for depression and medical conditions more often than were those without AD.
Journal of managed care pharmacy : JMCP, 2008
Patients with bipolar disorder typically present to physicians in the depressed rather than the manic or hypomanic phase of illness. Because the depressive episodes in bipolar disorder may be indistinguishable from those in major depressive disorder (MDD), misdiagnosis may occur. To estimate from administrative claims data and a telephone survey the prevalence of potential misdiagnosis of bipolar disorder among patients with MDD and the humanistic (health-related quality of life [HRQOL] and disability) effects associated with misdiagnosis in a managed care setting. Administrative claims data were used to identify patients with medical claims for MDD from a database of 9 million members of commercial health plans from 3 U.S. regions. The inclusion criteria were as follows: (a) adults aged 18 years or older; (b) at least 2 medical claims, including a primary or secondary diagnosis of MDD: ICD-9-CM codes 296.2x (MDD, single episode), 296.3x (MDD, recurrent episode), or 311 (depressive ...
2008
Objective: We investigated the influence of race/ethnicity in diagnostic and disposition decision-making for children and adolescents presenting to an urban psychiatric emergency service (PES). Method: Medical records were reviewed for 2991 child and adolescent African-American, Hispanic/Latino and white patients, treated in an urban PES between October 2001 and September 2002. A series of bivariate and binomial logistic regression analyses were used to delineate the role of race in the patterns and correlates of psychiatric diagnostic and treatment disposition decisions. Results: Binomial logistic regression analyses reveal that African-American (OR=2.28, Pb.001) and Hispanic/Latino (OR=2.35, Pb.05) patients are more likely to receive psychotic disorders and behavioral disorders diagnoses (African American: OR=1.66, Pb.001; Hispanic/ Latino: OR=1.36, Pb.05) than white children/adolescents presenting to PES. African-American youth compared to white youth are also less likely to receive depressive disorder (OR=0.78, Pb.05), bipolar disorder (OR=.44, Pb.001) and alcohol/substance abuse disorder (OR=.18, Pb.01) diagnoses. African-American pediatric PES patients are also more likely to be hospitalized (OR=1.50, Pb.05), controlling for other sociodemographic and clinical factors (e.g., Global Assessment of Functioning).
T he I nt e rna t iona l J ourna l of Pe rson Ce nt e re d M e dic ine V ol 2 I ssue 4 pp 7 1 6 -7 5 8 716 ARTICLE M e t a -a na lysis a nd m e t a -regre ssion ana lyses e x pla ining he t e roge ne it y in out com es of c hronic c a re m ana gem e nt for de pre ssion: im plic a t ions for pe rson-ce nt e red m e nt a l he a lt hc a re Abst ra c t Rationale, aims and objectives: Chronic care management programmes for depression show variation in effectiveness. This study aims to examine the clinical diversity and methodological heterogeneity related to the effectiveness of such programmes and to explain the heterogeneity in clinical outcomes. Objectives are to enable the understanding of and the decision-making about depression management programmes and to contribute to the implementation of chronic care management strategies for depression as part of advances in person-centered mental healthcare. Method: We performed a systematic review of reviews and empirical studies, including meta-analyses and meta-regression analyses on the most frequently reported outcomes. We explored to what extent the observed heterogeneity can be explained by study quality, length of follow-up, number of components of the Chronic Care Model (CCM) and patient characteristics. Results: Pooled effects of depression management programmes show significant improvement in treatment response (RR=1.38; p<0.05) and treatment adherence (RR=1.36; p<0.05). In meta-regression analysis, study quality and depression severity explain the substantial heterogeneity in respectively treatment response (36.6%; p=0.0352) and treatment adherence (88.7%; p=0.0083). Conclusions: The observed heterogeneity in depression outcomes cannot be explained by the number of intervention components and length of follow-up. Yet, the heterogeneity in treatment response can be explained partly by study quality, demonstrating the importance of good quality studies. Heterogeneity in treatment adherence can be explained partly by severity of the depression, indicating that taking account of depression severity contributes to maximising the effectiveness of chronic care management. Other potential sources of heterogeneity should be investigated to support informed decisionmaking on treating depression as a chronic condition as part of person-centered healthcare.
Rationale, aims and objectives: Chronic care management programmes for depression show variation in effectiveness. This study aims to examine the clinical diversity and methodological heterogeneity related to the effectiveness of such programmes and to explain the heterogeneity in clinical outcomes. Objectives are to enable the understanding of and the decision-making about depression management programmes and to contribute to the implementation of chronic care management strategies for depression as part of advances in person-centered mental healthcare. Method: We performed a systematic review of reviews and empirical studies, including meta-analyses and meta-regression analyses on the most frequently reported outcomes. We explored to what extent the observed heterogeneity can be explained by study quality, length of follow-up, number of components of the Chronic Care Model (CCM) and patient characteristics. Results: Pooled effects of depression management programmes show significant improvement in treatment response (RR=1.38; p<0.05) and treatment adherence (RR=1.36; p<0.05). In meta-regression analysis, study quality and depression severity explain the substantial heterogeneity in respectively treatment response (36.6%; p=0.0352) and treatment adherence (88.7%; p=0.0083). Conclusions: The observed heterogeneity in depression outcomes cannot be explained by the number of intervention components and length of follow-up. Yet, the heterogeneity in treatment response can be explained partly by study quality, demonstrating the importance of good quality studies. Heterogeneity in treatment adherence can be explained partly by severity of the depression, indicating that taking account of depression severity contributes to maximising the effectiveness of chronic care management. Other potential sources of heterogeneity should be investigated to support informed decisionmaking on treating depression as a chronic condition as part of person-centered healthcare.