Could we do more?

Nielsen, René Ernst; Licht, Rasmus W

doi:10.1111/bdi.12702

Cited by 9 publications

(4 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In general, there is data supporting a less positive attitude towards patients with SMI resulting in poor communication, disregard for patients’ dignity and delays in investigation or treatment in the physical treatment setting (Happell et al 2012; Neupane et al 2016; Noblett et al 2017), as well as in the community (Mirnezami et al 2016). Several experts have proposed the initiation of coordinated or combined treatment options with collaboration between specialized psychiatric and somatic care for patients with SMI to increase the likelihood of optimal treatment as well as reducing attrition rates of patients treated (Fleischhacker et al 2008; Nielsen and Licht 2018). The increased collaborative treatment options proposed have also been endorsed by associations and societies associated with mental health, diabetes and cardiology (De Hert et al 2009).…”

Section: Discussionmentioning

confidence: 99%

Why are somatic diseases in bipolar disorder insufficiently treated?

Nielsen

Kugathasan

Straszek

et al. 2019

Int J Bipolar Disord

Self Cite

View full text Add to dashboard Cite

Background Somatic diseases, including cardiovascular, respiratory, and cancer diseases, are the main contributors to a shortened life expectancy of 10–20 years in patients with bipolar disorder as compared to the general population. In the general population an increase in survival has been observed over the last decades, primarily due to the advances in primary prophylaxis, medical treatment and progress in early detection and monitoring of somatic diseases. In this narrative review, we discuss the existing literature on treatment and outcomes of cardiovascular, respiratory, and cancer diseases in patients with bipolar disorder, and put this in the context of findings in studies on patients diagnosed with other severe mental disorders. Main body The existing literature suggests that patients with bipolar disorder receive fewer or delayed medical interventions, when admitted with severe somatic diseases, compared to those not diagnosed with bipolar disorder. Cardiovascular disease is the most investigated disease regarding outcomes in patients with severe mental illness, and novel findings indicate that the increased mortality following cardiac events in these patients can be reduced if they are intensively treated with secondary prophylactic cardiac intervention. Elderly patients diagnosed with mental disorders and cancer experience a delay in receiving specific cancer treatment. No studies have investigated treatment outcomes in patients with severe mental disease and respiratory diseases. Conclusion It is surprising and of major concern that patients with bipolar disorder have not benefitted from the significant improvement that has taken place over time over time of somatic treatments in general, especially in countries with equal and free access to healthcare services. Therefore, no matter whether this situation is a result of a negative attitude from health care providers to patients with mental illness, the result of the patient’s lack of awareness of their physical illness or the results of other factors, further attention including research on developing strategies for improving the management of somatic diseases in patients with bipolar disorder is needed.

show abstract

Section: Discussionmentioning

confidence: 99%

Why are somatic diseases in bipolar disorder insufficiently treated?

Nielsen

Kugathasan

Straszek

et al. 2019

Int J Bipolar Disord

Self Cite

View full text Add to dashboard Cite

show abstract

“… 91 However, screening and monitoring of cardiovascular risk factors in patients with SMI are generally suboptimal. 92 , 93 Concerningly, the rate of patients with SMI not treated for established cardiovascular risk factors has been reported to be as high as 88% for dyslipidaemia, 62% for hypertension, and 30% for diabetes. 94–96 …”

Section: Cardiovascular Preventive Strategies In Severe Mental Illnessmentioning

confidence: 99%

Severe mental illness: cardiovascular risk assessment and management

Polcwiartek,

O’Gallagher,

Friedman

et al. 2024

European Heart Journal

Self Cite

View full text Add to dashboard Cite

Patients with severe mental illness (SMI) including schizophrenia and bipolar disorder die on average 15–20 years earlier than the general population often due to sudden death that, in most cases, is caused by cardiovascular disease. This state-of-the-art review aims to address the complex association between SMI and cardiovascular risk, explore disparities in cardiovascular care pathways, describe how to adequately predict cardiovascular outcomes, and propose targeted interventions to improve cardiovascular health in patients with SMI. These patients have an adverse cardiovascular risk factor profile due to an interplay between biological factors such as chronic inflammation, patient factors such as excessive smoking, and healthcare system factors such as stigma and discrimination. Several disparities in cardiovascular care pathways have been demonstrated in patients with SMI, resulting in a 47% lower likelihood of undergoing invasive coronary procedures and substantially lower rates of prescribed standard secondary prevention medications compared with the general population. Although early cardiovascular risk prediction is important, conventional risk prediction models do not accurately predict long-term cardiovascular outcomes as cardiovascular disease and mortality are only partly driven by traditional risk factors in this patient group. As such, SMI-specific risk prediction models and clinical tools such as the electrocardiogram and echocardiogram are necessary when assessing and managing cardiovascular risk associated with SMI. In conclusion, there is a necessity for differentiated cardiovascular care in patients with SMI. By addressing factors involved in the excess cardiovascular risk, reconsidering risk stratification approaches, and implementing multidisciplinary care models, clinicians can take steps towards improving cardiovascular health and long-term outcomes in patients with SMI.

show abstract

“…In a randomized trial, combined treatment consisting of optimized pharmacological interventions, individual and group psychoeducation, the possibility of psychotherapeutic interventions and a high knowledge base for the treatment of bipolar disorders was shown to be superior to treatment as usual 4. Here, the same clinicians and nurses often treat patients throughout the duration of the outpatient program, thereby establishing a therapeutic relationship, which increases the likelihood of early intervention when the patient observes a negative change in mental state.…”

mentioning

confidence: 99%

“…In this model, the responsibility for establishing contact and getting treatment is laid upon the patient. Several interventions have been proposed to minimize these problems, for example, combining somatic and psychiatric healthcare with both psychiatric and somatic treatment conducted by one treatment team nested in psychiatry 4. Such teams would be beneficial for most patients with SMI, but would probably mainly treat minor physical issues as seen from the perspective of internal medicine consultants, which could make it difficult to attract professionals to these positions.…”

mentioning

confidence: 99%