Access to Medical Care Among Persons With Psychotic and Major Affective Disorders

Bradford, Daniel W.; Kim, Mimi M.; Braxton, Loretta E.; Marx, Christine E.; Butterfield, Marian I.; Elbogen, Eric B.

doi:10.1176/ps.2008.59.8.847

Cited by 130 publications

(60 citation statements)

References 40 publications

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“…Compared with the general population, people with serious mental illnesses (SMI) exhibit higher rates of undiagnosed and untreated medical illnesses and higher morbidity and mortality from physical illnesses, primarily because of modifiable lifestyle risk factors 8 . The poor psychiatric and medical health outcomes in people with SMI may primarily be attributed to disparities in access to, utilization of, and provision of health care [9][10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

Patterns of psychiatric diagnoses in inpatient and outpatient psychiatric settings in Saudi Arabia

Alosaimi

Alzain²,

Asiri³

et al. 2017

Arch. Clin. Psychiatry (São Paulo)

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Objective: This study aimed to explore the current patterns of psychiatric diagnoses in inpatient and outpatient psychiatric settings in Saudi Arabia. Methods: Cross-sectional study was conducted on patients seeking psychiatric advice at six hospitals in the five main regions of Saudi Arabia. The data were primarily obtained by reviewing patient charts. Results: Total of 1,205 patients were recruited. The majority was unemployed (71.4%), had a low level of education (85.5%), and had low income (61.9%). The most common psychiatric diagnoses among inpatients were schizophrenia (55.8%), bipolar disorder (23.3%) and major depressive disorder (7.2%). The most common psychiatric diagnoses among outpatients were major depressive disorder (29.3%), schizophrenia (28.9%), generalized anxiety disorder (15.6%) and bipolar disorder (11.5%). Primary psychotic disorders and secondary psychiatric disorders were significantly more frequent among men whereas primary bipolar disorders and depressive disorders were significantly more frequent among women in both inpatient and outpatient settings. Psychotic and bipolar disorders were significantly more frequent among younger patients whereas depressive disorders were significantly more frequent among older patients; anxiety disorders were of similar frequency in all age groups. Discussion: The most common psychiatric diagnoses among inpatients were schizophrenia and bipolar disorder whereas the most common psychiatric diagnoses among outpatients were major depressive disorder and schizophrenia.Alosaimi FD et al. / Arch Clin Psychiatry. 2017;44(3):77-83

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Section: Introductionmentioning

confidence: 99%

Patterns of psychiatric diagnoses in inpatient and outpatient psychiatric settings in Saudi Arabia

Alosaimi

Alzain²,

Asiri³

et al. 2017

Arch. Clin. Psychiatry (São Paulo)

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“…Metabolic abnormalities are common in patients with BD, with a relative risk for metabolic syndrome (MetS) and type 2 diabetes of 1.6-2 in patients with BD compared with the general population (Murray et al 2009;Vancampfort et al 2013Vancampfort et al , 2015a. Patients with BD, especially during depressive phases, are inactive, often eat unhealthy food, smoke more cigarettes (Bly et al 2014;Fagiolini et al 2008;Vancampfort et al 2015b), do not take care of themselves, and do not attend medical checkups (Bradford et al 2008), by all these reasons increasing the risk for metabolic and eventually cardiovascular disease. These patients also take several medications, such as mood stabilizers, antipsychotics, and antidepressants.…”

Section: Introductionmentioning

confidence: 99%

High H1-affinity antidepressants and risk of metabolic syndrome in bipolar disorder

et al. 2015

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RationaleMetabolic syndrome (MetS) is common in patients with bipolar disorder, with a relative risk of 1.6-2 compared to the general population. The increased risk is believed to be due to unhealthy lifestyles and use of medications. Although antipsychotics and mood stabilizers have been associated with weight gain and MetS, the impact of antidepressants has not been comprehensively evaluated. ObjectiveThe objective of the study is to assess the risk of MetS in patients exposed to different types of antidepressants. MethodsIn this cross-sectional study, 294 patients with bipolar disorder were consecutively recruited. MetS was diagnosed according to NCEP ATP-III modified criteria. Antidepressants used by the patients were classified according to the usual nomenclature (SSRI, TCA, SNRI, and other antidepressants) and a pharmacodynamic classification taking into account histamine 1-receptor (H1-R) affinity. ResultsUse of antidepressants in general was not associated with MetS (prevalence ratio [PR], 1.08; 95% confidence interval, 0.73 to 1.62; p = 0.70). However, subjects using H1-R high-affinity antidepressants (N = 15) showed a substantial increase in the prevalence of MetS (PR, 2.17; 95 % confidence interval, 1.24 to 3.80; p = 0.007). When we included the inhibition constant (Ki) as a continuous covariate in the models, we found an inverse association between Ki and prevalence of MetS (p = 0.004). ConclusionWe observed for the first time in a clinical setting that a pharmacodynamic-based classification of antidepressants could be more useful than the traditional one to predict the risk of MetS in patients with bipolar disorder. Clinical consequences may be relevant. However larger studies are warranted to generalize these results.

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“…The DVA system is enriched in schizophrenic subjects since it is a safety net source of care for poor veterans who are often homeless and/or unemployed. In general, individuals with schizophrenia, as is the case with individuals with other major mental illnesses, experience difficulty receiving indicated medical care (34). The patients in our series had access to care in the DVA system, although they may have had difficulty navigating it.…”

Section: Discussionmentioning

confidence: 83%

Adjuvant chemotherapy for breast cancer in patients with schizophrenia

et al. 2012

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Abstract. The outcomes of treatment of physical illnesses are strongly affected by the presence of schizophrenia. We aimed to quantify the clinical course of schizophrenic breast cancer patients who were eligible for adjuvant chemotherapy to determine whether patients with this mental illness receive appropriate treatment for this physical illness. We searched the national Department of Veterans Affairs (DVA) computer database using computer codes for schizophrenia to identify patients who later developed breast cancer and were treated in DVA medical centers. Computer-based data were supplemented with chart-based clinical indicators. There were 55 subjects who appeared to be appropriate candidates for adjuvant systemic therapy. A number of these candidates were not offered postoperative endocrine or cytotoxic chemotherapy, while others refused treatment or were non-compliant. Behaviors typical of schizophrenic subjects, including hostility to caregivers, often disrupt their care. Schizophrenic patients often have advanced-stage cancer at diagnosis, often delay diagnosis and are frequently hostile towards healthcare workers. Many of these patients refuse therapy and/or are non-compliant.

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Access to Medical Care Among Persons With Psychotic and Major Affective Disorders

Abstract: Persons with psychotic disorders and bipolar disorder reported markedly more difficulty in obtaining a primary care physician and greater barriers to care than the general population. Interventions are needed to improve provision of primary medical care to this population.

Cited by 130 publications

References 40 publications

Patterns of psychiatric diagnoses in inpatient and outpatient psychiatric settings in Saudi Arabia

Patterns of psychiatric diagnoses in inpatient and outpatient psychiatric settings in Saudi Arabia

High H1-affinity antidepressants and risk of metabolic syndrome in bipolar disorder

Adjuvant chemotherapy for breast cancer in patients with schizophrenia

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