Quality of medical care for people with and without comorbid
                        mental illness and substance misuse: systematic review of comparative
                        studies

Mitchell, Alex J.; Malone, Darren; Doebbeling, Caroline Carney

doi:10.1192/bjp.bp.107.045732

Cited by 295 publications

(253 citation statements)

References 96 publications

(182 reference statements)

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“…However, individuals with depression make less use of preventative services. 83 No studies have specifically looked at adherence to osteoporosis screening and treatment in depressed older adults. When prescribing an SSRI, it is therefore useful to inquire about the older patient's adherence with osteoporosis and fracture-prevention guidelines.…”

Section: Depression and Falls: Clinical Implicationsmentioning

confidence: 99%

The Complex Interplay of Depression and Falls in Older Adults: A Clinical Review

Iaboni

Flint

2013

The American Journal of Geriatric Psychiatry

219

178

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Depression and falls have a significant bidirectional relationship. Excessive fear of falling, which is frequently associated with depression, also increases the risk of falls. Both depression and fear of falling are associated with impairment of gait and balance, an association that is mediated through cognitive, sensory, and motor pathways. The management of depression in fall-prone individuals is challenging, since antidepressant medications can increase the risk of falls, selective serotonin reuptake inhibitors may increase the risk of fragility fractures, and data are lacking about the effect of fall rehabilitation programs on clinically significant depression. Based on the current state of knowledge, exercise (particularly Tai Chi) and cognitive-behavioral therapy should be considered for the first-line treatment of mild depression in older fallers. Antidepressant medications are indicated to treat moderate to severe depression in fall-prone individuals, but with appropriate precautions including low starting dose and slow dose titration, use of psychotropic monotherapy whenever possible, and monitoring for orthostatic hypotension and hyponatremia. To date, there have been no recommendations for osteoporosis monitoring and treatment in individuals prescribed antidepressant medications, beyond the usual clinical guidelines. However, treatment of the older depressed person who is at risk of falls provides the opportunity to inquire about his or her adherence with osteoporosis and fracture-prevention guidelines. KeywordsAntidepressants; depression; falls; fear of falling; fractures One-third of community-dwelling seniors fall each year, with half of these individuals falling more than once. Ten percent of all falls result in a major injury, which can lead to institutionalization and death. 1 Falls often result in a fear of further falls, leading to fearrelated restriction of activities: this activity restriction has been associated with subsequent impairment in balance, mobility, and disability. 2,3 Send correspondence and reprint requests to Alastair

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Section: Depression and Falls: Clinical Implicationsmentioning

confidence: 99%

The Complex Interplay of Depression and Falls in Older Adults: A Clinical Review

Iaboni

Flint

2013

The American Journal of Geriatric Psychiatry

219

178

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“…5 Compared to persons without depression or other psychiatric conditions, persons with comorbid psychiatric disorders and medical conditions such as diabetes and cardiovascular disease may receive a poorer quality of medical care. 6 Observational studies have…”

Section: Introductionmentioning

confidence: 99%

Multimorbidity, Depression, and Mortality in Primary Care: Randomized Clinical Trial of an Evidence-Based Depression Care Management Program on Mortality Risk

et al. 2015

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“…The patients in this study experienced their mental and physical health as interrelated and both were of great concern for the patients. However, often people with mental illness do not get the necessary physical treatment and there is a risk of these patients to fall in between two health care systems (Mainz, Sloth, & Kjølbye, 2014;Mitchell, Malone, & Doebbeling, 2009). Thus, the constructions of many Western health care systems conflicts with the patients' desires for holistic care, which suggests that placing a physical health examination in a psychiatric setting, could be highly beneficial.…”

Section: Discussionmentioning

confidence: 99%

Physical Health Examinations in a Psychiatric Setting: The Interactions between Medical Doctor and Patients

Andersen¹,

Laugesen²,

Nielsen³

et al. 2018

AASoci

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The purpose of this article is to shed light on the possible stigmatization during a physical health examination in a psychiatric setting and explore the medical doctor and patients' perceptions of such an integrated care model. This is a qualitative case study using semi-structured interviews and observations. Empirical findings are analyzed using the theory of stigma in order to explore the role of stigmatization in an integrated care setting. The analysis finds three main themes: 1) The advantages of a safe and familiar setting, 2) To be treated as a human being-not an illness, 3) Interpersonal communication with mutual understanding can reduce stigmatization. The results show that stigmatization does occur at some points. However, both patients and the medical doctor think that the integrated care setting contributes to a successful physical health examination. This is due to the location as well as interpersonal aspects.

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Quality of medical care for people with and without comorbid mental illness and substance misuse: systematic review of comparative studies

Abstract: Despite similar or more frequent medical contacts, there are often disparities in the physical healthcare delivered to those with psychiatric illness although the magnitude of this effect varies considerably.

Cited by 295 publications

References 96 publications

The Complex Interplay of Depression and Falls in Older Adults: A Clinical Review

The Complex Interplay of Depression and Falls in Older Adults: A Clinical Review

Multimorbidity, Depression, and Mortality in Primary Care: Randomized Clinical Trial of an Evidence-Based Depression Care Management Program on Mortality Risk

Physical Health Examinations in a Psychiatric Setting: The Interactions between Medical Doctor and Patients

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