Severe Illness Research Articles

Prevalence and patient characteristics associated with cardiovascular disease risk factor screening in UK primary care for people with severe mental illness: an electronic healthcare record study

BackgroundPeople with severe mental illness (SMI) are at increased risk of cardiovascular disease (CVD), and initiatives for CVD risk factor screening in the UK have not reduced disparities.ObjectivesTo describe the...

COVID-19 in patients with severe mental illness: An analysis of in-patients at a psychiatric hospital in Cape Town

Background: Psychiatric patients in specialist units are more vulnerable to infections such as SARS-COV-2 (severe acute respiratory syndrome coronavirus 2) because of hospital infrastructure and patients’ mental health.Aim: This study aimed to describe the psychiatric and medical profile, and the risk factors associated with more severe disease and clinical outcomes of coronavirus disease 2019 (COVID-19) in patients with severe mental illness (SMI) admitted to a specialist psychiatric hospital in South Africa between 01 April 2020 and 30 September 2021.Setting: The study was executed at the Vàlkenberg Hospital (VBH), which is a government-funded, specialised psychiatric hospital. The hospital comprises 370 beds made up of 145 forensic service beds and 225 acute service beds. It provides in-patient and out-patient services.Methods: Demographic and clinical information were collected for all VBH in-patients who tested positive for SARS-COV-2 from 01 April 2020 to 30 September 2021.Results: A total of 254 participants tested positive for SARS-COV-2. The sample comprised 75% (n = 191) males with a mean age of 35.7 years. Most patients were diagnosed with schizophrenia (37%, n = 94), bipolar disorder (21%, n = 54) and schizoaffective disorder (19%, n = 49). Reported comorbidities included nicotine use (71%, n = 181), hypertension (11%, n = 28) and human immunodeficiency virus (7%, n = 18). Most patients (62%, n = 156) were symptomatic for COVID-19. Seven per cent (n = 17) required transfer to a medical ward. Almost all patients (99%, n = 252) recovered and 1% (n = 2) died.Conclusion: Contrary to early fears of high mortality among institutionalised SMI patients, most experienced mild COVID-19 illness and recovered.Contribution: This descriptive study provided information on in-patients with COVID-19 disease at a specialised psychiatric hospital during the pandemic.

Quality of Life in Patients With Severe Mental Illness in a Tertiary Care Unit in Greece: The Role of Sociodemographic, Clinical Factors, and Social Support

Quality of Life in Patients With Severe Mental Illness in a Tertiary Care Unit in Greece: The Role of Sociodemographic, Clinical Factors, and Social Support

Incarcerated Women and Mental Illness: An Interpretative Phenomenological Analysis (IPA)

A significant number of incarcerated women experience severe and persistence mental illness. Even though a sizable body of research finds that mental health can be significantly worsened during periods of incarceration, surprisingly few studies to date have explored how incarcerated women negotiate, manage, and process their clinical diagnoses while in custody. To address this research void, the current study conducted an interpretative phenomenological analysis of ( n = 15) women with mental illness incarcerated in a medium-maximum security, state prison located in the Southeastern United States. Respondents cited six themes associated with these experiences: (1) Coming to terms with a diagnosis; (2) Managing mental illness; (3) The value of communication; (4) Negative impacts of mental illness; (5) Stigmatization and labeling; and (6) Isolation. Findings are discussed with reference to policy initiatives aimed at improving the mental and physical welfare of justice-involved women.

Assessing the physical health of service users with severe mental illness

Assessing the physical health of service users with severe mental illness

Implementation of RedCap data systems in Kenyan psychiatric rehabilitation: a community case study

Data collection systems are vital in implementation of interventions within patient care as they allow us to better understand and improve the care given. This is equally true in the field of psychiatric rehabilitation, which has been steadily growing in the medical world for the past 20 years. It has recently been a focus of psychiatric medicine in Kenya with the Kenya Mental Health Action Plan 2021-2025 calling for improvement of care in the field. With psychiatric rehabilitation growing in low- and middle-income countries in recent years studies have come out showing the effects of newly employed programs and stressing the need for data collection practices that can be used to encourage best practices in local communities. This paper describes the implementation of data systems for the Moi Teaching and Referral Hospital Nawiri Skills and Recovery Centre (Nawiri) in Eldoret, Kenya. The goals of the data systems were 1) To collect and organize information for continuous quality improvement of services at Nawiri, 2) To collect information for reporting to MTRH leadership, Ministry of Health as well as private funders, 3) To provide data to assess outcomes of people who receive services at Nawiri to create evidence for effective interventions to help create policy to make psychiatric rehabilitation more available to people living with Severe mental illness in Kenya. Lessons learned from data systems implementation included insights into ease of data collection, adaptability of data instruments to fit facility needs, and ability to reproduce RedCap data collection in other settings.

Palliative Psychiatry: Current Challenges and Recommendations

Palliative psychiatry is an emerging field focused on improving the quality of life for individuals with severe, chronic, and treatment-resistant psychiatric conditions. It emphasizes holistic, person-centered care that respects patients' dignity and addresses their physical, emotional, social, and existential needs. Unlike traditional psychiatric care, which prioritizes symptom reduction, palliative psychiatry acknowledges that some conditions may not respond to conventional treatments. Despite its potential, the field faces significant challenges, including limited research, inconsistent definitions, and a lack of standardized guidelines. Additionally, ethical issues, societal stigma, and insufficient training in psychiatric programs hinder its implementation. This article discusses current challenges and provides recommendations for developing guidelines and classification systems and integrating palliative psychiatry into clinical practice, ultimately improving care for individuals with severe mental illness.

Characteristics and long-term health outcomes of the first domestic COVID-19 outbreak cases in Da Nang, Vietnam: a longitudinal cohort study

BackgroundVietnam experienced the first COVID-19 domestic outbreak due to the Wuhan strain (B.1.1) in Da Nang from July 2020. COVID-19 can cause acute as well as long-term health problems. We aimed to characterise clinical features and risk factors related to severe illness of COVID-19 among Da Nang outbreak cases and to describe long-term health outcomes among survivors of this outbreak.MethodsWe conducted an ambidirectional cohort study. Study subjects were all hospitalised cases with positive real-time PCR test of SARS-CoV-2 in the three major hospitals in Da Nang from 25 July to 28 August 2020. Clinical and demographic information was retrospectively collected from medical charts. Then, the survivors were followed-up prospectively at 6 and 16 months after acute infection to assess their health status via standardized questionnaires, physical examinations, chest X-rays and pulmonary function tests.ResultsA total of 362 cases including 20 fatal cases were enrolled into the study retrospectively. The median age of the participants included in the medical chart review was 46.5 years and 60.8% were female. Overall, 7.8% of the participants required respiratory support during hospitalisation and 20 of them died. Compared to the survivors, the fatal cases were significantly older (median age of survivors 45.0 yr vs fatal cases 66.5 yr, P < 0.001) and more likely to have underlying conditions. The proportions of participants who had at least one long COVID symptom within the 7 days of each follow-up at 6 and 16 months were 72.0% (134/186) and 63.5% (47/74), respectively. We also found that females and adults reported symptoms more often in the follow-up surveys, 78.9% (90/114) [females] vs 61.1% (44/72) [males] at 6 months, P = 0.008; 68.7% (46/67) [≥ 20 years] vs 14.3% (1/7) [< 20 years] at 16 months, P = 0.004.ConclusionsIn the first domestic COVID-19 outbreak in Vietnam, the mortality rate was approximately 6% and associated with underlying medical conditions. In the follow-up surveys, a substantial proportion of participants reported long COVID related health problems, although the prevalence declined over time. Females and adults reported symptoms more often, which might be due to the pathophysiological differences according to sex and age.

Evaluation of Hypoxia Markers in Critically Ill Patients Categorized by Their Burden of Organ Dysfunction: A Novel Approach to Detect Pathophysiological and Clinical Relevance in a Secondary Analysis of a Prospective Observational Study

In critically ill patients, compromised microcirculation causes tissue hypoxia, organ failure, and death. These pathophysiological processes occur particularly in patients with high illness severity, so reliable hypoxia biomarkers should reflect this in their occurrence. This secondary analysis of a prospective study categorized patients by their burden of organ dysfunction (BOD) using the cohort’s median initial sequential organ failure assessment (SOFA) score of 8 as a cutoff. The kinetic parameters of the hypoxia markers lactate and S-adenosylhomocysteine (SAH) were analyzed for correlation with organ dysfunction severity and mortality prediction. In low BOD patients, neither marker correlated with SOFA. In high BOD patients, lactate showed a moderate correlation and SAH showed a strong correlation. Lactate correlated with organ dysfunction in survivors but not in non-survivors, while SAH correlated strongly in non-survivors but not in survivors. In univariate logistic regression, lactate predicted mortality moderately in low BOD (areas under the receiver operating characteristic curves (AUROCs) 0.7–0.8) but poorly in high BOD patients (AUROCs 0.5–0.7). SAH’s prediction improved from poor to excellent (AUROCs 0.8–0.9) with higher BOD. Thus, SAH appears superior to lactate in the detection of organ dysfunction severity and mortality prediction in high BOD patients.

Images of spectral relatedness: How couples anchor life together in a nursing home in Denmark

AbstractWhen one partner in a couple moves into a nursing home, the sense of shared everyday life and home is disturbed. In this article, we examine how couples respond to radical ruptures in their shared everyday lives, homes, and imagined futures when one partner moves into a nursing home due to severe illness. We draw on the field of imagistic anthropology that attends to the uncertain, ambiguous, and imaginative dimensions of life to capture the often overlooked, albeit important, dimensions of peoples’ lives in situations of uncertainty, rupture, and loss. Inspired by the concept of spectral kinship, we delve into experiences of transgressing space and time, the material and the immaterial, the “real,” the dreamed of and imagined as they are anchored in a play of imagination, a book, and a dream. We call these anchors of belonging. We suggest the concept spectral relatedness to highlight both mundane and spectral dimensions of homemaking and being together. We argue that attending to imagistic qualities in fraught life situations can help bring forth nuances and complexities of how couples face severe illness and the relational and practical changes such life situations entails in the context of homemaking in institutional settings.

Structural and Functional Glycosylation of the Abdala COVID-19 Vaccine.

Abdala is a COVID-19 vaccine produced in Pichia pastoris and is based on the receptor-binding domain (RBD) of the SARS-CoV-2 spike. Abdala is currently approved for use in multiple countries with clinical trials confirming its safety and efficacy in preventing severe illness and death. Although P. pastoris is used as an expression system for protein-based vaccines, yeast glycosylation remains largely uncharacterised across immunogens. Here, we characterise N-glycan structures and their site of attachment on Abdala and show how yeast-specific glycosylation decreases binding to the ACE2 receptor and a receptor-binding motif (RBM) targeting antibody compared to the equivalent mammalian-derived RBD. Reduced receptor and antibody binding is attributed to changes in conformational dynamics resulting from N-glycosylation. These data highlight the critical importance of glycosylation in vaccine design and demonstrate how individual glycans can influence host interactions and immune recognition via protein structural dynamics.

Assessment of Day Care Centers under Public Mental Health Program in a District of Kerala: An Observational Study

Abstract Introduction: Day care is a component of service provisioning for persons with severe mental illness living in the community. This study assesses day care centers under a public mental health program in a district of Kerala. Methods: We did a documentary review of program documents to describe how the day care program had envisaged its structure, function, and expected outcome. Field visits were made to assess the centers on the same attributes. The lead staff members and all program attendees were interviewed. The sociodemographic and clinical profile was assessed while disability was measured using the WHODAS 2.0 12-item Scale. Results: The two centers were assessed 8 years after their inception. The centers functioned as drop-in-type social care facilities located on local government premises, and each center was serviced by a nursing personnel, a nursing attendant, and a social work personnel who worked as an occupational therapist and program coordinator for both centers. The estimated cost of running each center was 20 lakhs/year. Occupational therapy activities were geared toward day engagement and did not aspire to impart vocational skills or employment opportunities onsite or outside and almost all work-based occupational therapy activities fizzled out after a limited trial. Centers catered to both persons with mental illness and intellectual developmental disorders. There was no formal exit plan for the attendees, the mean duration of attendance was 4.4 ± 2.63 years, the total attendees since inception were 75, and the currently active number was 28. Nonspecific reasons and family inconvenience were noted as reasons for disengagement. Disability assessment revealed a mean score of 8.45 ± 6.8 (median 6.5, range 0–27), indicating low levels of disability, although 60% were formally certified with median disability of 60%. Overall, staff opined, based on their interactions with the attendees’ families, that day care attendance offered benefits over routine outpatient care in terms of providing a meeting place outside the home for recreation and socialization. Discussion: Our assessment concludes that the modest benefits that attendees get from the centers are derived largely from the socializing and companionship that the meeting place provides. We suggest that more such drop-in centers can be started with a lesser cost outlay while at the same time upgrading the existing ones with more resources to derive greater benefits than from the current meeting place orientation.

Leptospira biofilms: implications for survival, transmission, and disease management.

Leptospirosis is a zoonotic disease caused by Leptospira bacteria, affecting humans and a broad range of wild and domestic animals in diverse epidemiological settings (rural, urban, and wild). The disease's pathogenesis and epidemiology are complex networks not fully elucidated. Epidemiology reflects the One Health integrated approach of environment-animal-human interaction, causing severe illness in humans and animals, with consequent public health burdens. Saprophytic and pathogenic leptospires have been shown to form biofilms in vivo, in vitro, and in environmental samples. Biofilms are characterized by a polymeric matrix that confers protection against hostile environments (both inside and outside of the host), favoring bacterial survival and dissemination. Despite its significance, the role of this bacterial growth mode in leptospiral survival, transmission, and decreased antibiotic susceptibility remains poorly understood and underexplored. Even so, the literature indicates that biofilms might be correlated with lower antimicrobial susceptibility and chronicity in leptospirosis. In this minireview, we discuss the aspects of biofilm formation by Leptospira and their significance for epidemiology and therapeutic management. Understanding the current scenario provides insight into the future prospects for biofilm diagnosis, prevention, and treatment of leptospirosis.

Impaired insight in schizophrenia is associated with higher frontoparietal cerebral blood flow: an arterial spin labeling study

Impaired insight into illness occurs in up to 98% of patients with schizophrenia, depending on the stage of illness, and leads to negative clinical outcomes. Previous neuroimaging studies suggest that impaired insight in patients with schizophrenia may be related to structural and functional anomalies in frontoparietal brain regions. To date, limited studies have investigated the association between regional cerebral blood flow (CBF) and impaired insight in schizophrenia. Therefore, we sought to investigate the relationship between regional CBF, as measured by arterial spin labeling (ASL), and impaired insight in participants with schizophrenia. A total of 32 participants were included in the analysis. Impaired insight in patients with schizophrenia was measured using the VAGUS, Self-report (VAGUS-SR). Resting-state regional CBF was measured using pseudo-continuous ASL (pCASL) and extracted using SPM12 and REX toolbox. Whole brain analysis found that impaired insight was associated with higher regional CBF in the right angular gyrus, left supramarginal gyrus, and right superior frontal region when controlling for age, gender, smoking status, and illness severity. The results indicate that impaired insight in schizophrenia is related to regional CBF in frontoparietal areas. These neuroimaging findings can serve as therapeutic targets for intervention, such as with non-invasive brain stimulation.

The Incidence and Outcomes of Acute Kidney Disease in Critically Ill Children.

Acute kidney disease (AKD) includes abnormalities of kidney function present for <90 days. Acute kidney injury (AKI) is defined as a subset of AKD, with onset within seven days. There is scant data on the rates of AKD in children and its association with outcomes. Our primary objective was to examine the rates of AKD with and without AKI and compare major adverse events (MAKE) in children in the pediatric intensive care unit (PICU). This is a retrospective cohort study of patients ≤18 years old who were admitted to a quaternary care PICU between 2009 and 2016 using the high-density pediatric database. All patients included in the primary analysis had a known baseline serum creatinine. Patients who had a baseline estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 or a history of dialysis dependence or kidney transplant were excluded. AKI and AKD were defined by Kidney Disease: Improving Global Outcomes definitions. MAKE-90 was defined as a composite outcome of death, dialysis, or persistent kidney dysfunction 90 days after PICU admission. Among 5,922 children included in this study, 1,199 (20.2%) had AKD, of which 1,092 (91%) had AKD with AKI and 107 (8.9%) had AKD without AKI. MAKE-90 occurred in 26% (308/1,199) of those with AKD compared to 3.6% (172/4723) without (p=<0.001). MAKE-90 occurred in 26% (279/1,092) of AKD with AKI and 27% (29/107) of AKD without AKI. After adjusting for age, sex, and illness severity, compared to patients that had no AKD, patients with AKD with AKI (aOR: 14.39, 95% CI: 11.06-18.72) and patients with AKD without AKI (aOR: 7.83, 95% CI: 4.54-13.51) had a greater odds of MAKE-90. More than a quarter of pediatric critically ill patients with AKD develop MAKE-90. Even in the absence of AKI, AKD is an independent risk factor for MAKE-90.

Rapid Assessment of Future Pandemic Effects in Individuals with Severe Mental Illness: Can Ongoing Population-Representative Cohorts Contribute?

To provide an overview of ongoing cohorts including severely mentally ill patients to study collateral effects of pandemics.Systematic literature search.None of the ongoing German health cohorts includes people with severe mental illness (SMI). Four cohorts include individuals with severe depressive and anxiety symptoms.German population-representative cohorts do not make a significant contribution to the rapid detection of future pandemic effects in individuals with SMI. Care-based patient cohorts seem better suitable for generating insights into the protection of this vulnerable group under pandemic conditions.

Pathophysiology, management and therapeutic challenges of coagulopathy in COVID-19 patients

The pathophysiology of COVID-19-associated coagulopathy is characterized by a complex of interactions within viral factors, abnormal haemostasis, dysfunction of endothelial cells, and inflammatory reactions, necessitating the research to elucidate underlying mechanisms and identify novel therapeutic targets. Severe COVID-19 conditions are frequently coupled with an increased immunological response, dubbed a cytokine storm, which facilitates the release of pro-inflammatory cytokines (e.g., interleukin-6, tumour necrosis factor-alpha). The cytokine storm contributes to widespread inflammation and endothelial activation, disrupting the balance between pro-coagulant and anticoagulant factors. Additionally, it is capable of being transmitted by contacting surfaces that are contaminated and then rubbing the face. Biomarkers such as D-dimer levels serve as valuable tools in risk assessment and monitoring, yet their interpretation requires careful consideration within the clinical context. Although some COVID-19 patients may not exhibit any symptoms, they can still spread the virus to others, and there is proof that the virus can spread via the air in some environments, especially confined areas with inadequate ventilation. Vaccines have been developed and deployed globally to prevent COVID-19 infection and reduce severe illness, hospitalizations, and deaths. Governments and health authorities worldwide have implemented policies including lockdowns, social isolation, mask-wearing, investigation, contact tracking, and vaccination campaigns to control transmission and reduce the impact of the virus. Data were sorted from PubMed, Google Scholar, Springer, Nature, Tailor and Francis, MDPI, BMC and some other related data. This review provides appreciable information on the pathophysiology, management and therapeutic challenges of coagulopathy in Covid-19 patients.

Design, synthesis, and in-Silco ADME prediction of some novel bis(1,3,4-thiadiazoles) encapsulated lipid chitosan nano capsule decorative with magnetic nanoparticles and their potential anti-helicobacter pylori activity.

Helicobacter pylori (H. pylori) is an extremely prevalent human pathogen globally that leads to severe illnesses. Sadly, the worldwide issue of H. pylori's resistance to antimicrobial medications persists. In this context, creating an anti-H. pylori vaccine that can deliver a satisfactory eradication rate with fewer side effects would be highly beneficial. In this regard, a new series of bis(1,3,4-thiadiazoles) was synthesized and assessed for antimicrobial activity against H. pylori. Combining two bioactive 1,3,4-thiadiazole portions within a single molecule to create a new bis-heterocycle represents an efficient strategy to produce powerful compounds and address issues of resistance and effectiveness. Every synthesized compound showed outstanding inhibition results. Compounds 5c and 8 exhibited the lowest MIC values, recorded at 7.5 and 15.6 μg/mL, respectively. Theoretical predictions were employed to evaluate ADME, leading to outcomes of low solubility, stability, and bioavailability. The effective agents aimed at H. pylori were encapsulated in an appropriate newly developed nanocarrier to tackle challenges related to low bioavailability and stability. Further tests were carried out to evaluate the efficacy of antimicrobials against H. pylori, resulting in promising results. Additionally, the MIC values decreased by 4 and 2 times relative to their original synthetic versions. The activity of the enzyme urease was assessed before nanoencapsulation, showing an IC50 value of 8.99 μg/ml, which was reduced to 7.8 μg/ml after nanoencapsulation.

Baseline Cardiovascular Risk Factors in Patients With Severe Mental Illness (SMI) and Second Generation Antipsychotic Use From the Fixed Dose Intervention Trial of New England Enhancing Survival in SMI (FITNESS)

Baseline Cardiovascular Risk Factors in Patients With Severe Mental Illness (SMI) and Second Generation Antipsychotic Use From the Fixed Dose Intervention Trial of New England Enhancing Survival in SMI (FITNESS)

Helping people with psychosis with a low-cost intervention DIALOG+: protocol for the economic evaluation in a randomised control trial in India and Pakistan

BackgroundApproximately 69%–89% of people with severe mental illnesses, particularly psychosis, experience a treatment gap in low- and middle-income countries (LMICs) due to factors such as low public spending on health...