Chronic Physical Health Problems Research Articles

A qualitative study: Barriers and facilitators to health care access for individuals with psychiatric disabilities.

This qualitative study was conducted as part of a larger randomized trial to examine barriers and facilitators to accessing and providing comprehensive primary health care for individuals with serious mental illnesses. We examined the perspectives of administrators and providers in a behavioral health organization surrounding the use of a nurse practitioner model of delivering primary healthcare. Ten key informant interviews were conducted and analyzed using qualitative data analysis software. Concepts and themes regarding access to and delivery of primary healthcare were inductively derived from the data. Results confirmed significant issues related to chronic physical health problems among individuals with psychiatric disabilities and detailed a host of barriers to receiving health care as well as the perceived benefits of the nurse practitioner intervention. Financial challenges played a significant role in the organization's ability to make primary and mental health care integration a sustainable endeavor. In addition, staff faced increased burdens on their time due to adding a focus on physical health to their existing job duties. A nurse practitioner stationed in a behavioral healthcare setting is viewed by administrators and providers as extremely beneficial in addressing issues of access to comprehensive and integrated primary healthcare for individuals with severe psychiatric disabilities but sustaining such a model of care is not without organizational challenges.

The association between chronic illness, multimorbidity and depressive symptoms in an Australian primary care cohort

To assess the link between multimorbidity, type of chronic physical health problems and depressive symptoms The study was a cross-sectional postal survey conducted in 30 General Practices in Victoria, Australia as part of the diamond longitudinal study. Participants included 7,620 primary care attendees; 66% were females; age range from 18 to 76 years (mean = 51 years SD = 14); 81% were born in Australia; 64% were married and 67% lived in an urban area. The main outcome measures include the Centre for Epidemiologic Studies Depression Scale (CES-D) and a study-specific self-report check list of 12 common chronic physical health problems. The prevalence of probable depression increased with increasing number of chronic physical conditions (1 condition: 23%; 2 conditions: 27%; 3 conditions: 30%; 4 conditions: 31%; 5 or more conditions: 41%). Only 16% of those with no listed physical conditions recorded CES-D scores of 16 or above. Across the listed physical conditions the prevalence of 'probable depression' ranged from 24% for hypertension; 35% for emphysema; 35% for dermatitis to 36% for stroke. The dose-response relationship is reduced when functional limitations and self-rated health are taken into account, suggesting that these factors mediate the relationship. A clear dose-response relationship exists between the number of chronic physical problems and depressive symptoms. The relationship between multimorbidity and depression appears to be mediated via self-perceived health related quality of life. Primary care practitioners will identify more cases of depression if they focus on those with more than one chronic health problem, no matter what the problems may be, being especially aware in the group who rate their health as poor/fair.

Employment After Prison: A Longitudinal Study of Former Prisoners

Finding sustained employment is an important component of the transition from prison to the community for exiting prisoners. Anecdotal reports from former prisoners indicate that most individuals experience great difficulties finding jobs after their release. However, little systematic information is available about the employment experiences of individuals released from prison or the characteristics of former prisoners who are successful in locating employment. Using a causal framework, this paper examines the employment experiences of a multi-state sample of former prisoners, and identifies the individual factors influencing the likelihood of employment after release from prison, using data gathered from interviews with prisoners before and at multiple times after release. Findings indicate that consistent work experience before incarceration, connection to employers before release, and conventional family relationships improve employment outcomes after release. Individuals who relapse to drug use quickly after release, have chronic physical or mental health problems, and are older or nonwhite are employed fewer months after a period of incarceration.

Sleep Loss and Partner Violence Victimization

Intimate partner violence victimization has been associated with serious health problems among women, including many disorders that involve sleep disturbances. However, there has been only limited examination of sleep duration among women with victimization experiences. A total of 756 women with a domestic violence order (DVO) against a male intimate partner were interviewed about their health, mental health, substance use, and partner violence victimization. Face-to-face interviews were conducted from February 2001 to November 2003 for data collection in three rural and one urban county representing different jurisdictional settings. Because the current analyses focused on understanding intimate partner victimization in the past year and associations with sleep disturbance, 147 participants were excluded for reporting a relationship with the DVO partner for less than 6 months in the past year. The final sample for this article was 609. The women reported an average of a little above 5.5 hours of sleep per night. For women in the current study, significant predictors of sleep disturbance included race, number of children, number of other symptoms of depression in the past 2 weeks excluding sleep criteria, number of other symptoms of PTSD in the past 2 weeks excluding sleep criteria, number of chronic physical health problems, and severity of physical violence by the DVO partner in the past year. Addressing short sleep duration among partner victims in health care settings might enhance safety planning and prevent the development of health/mental health problems that can arise from victimization.

Training Teachers to Deliver Mindfulness-Based Interventions: Learning from the UK Experience

Several randomised controlled trials suggest that mindfulness-based approaches are helpful in preventing depressive relapse and recurrence, and the UK Government’s National Institute for Health and Clinical Excellence has recommended these interventions for use in the National Health Service. There are good grounds to suggest that mindfulness-based approaches are also helpful with anxiety disorders and a range of chronic physical health problems, and there is much clinical and research interest in applying mindfulness approaches to other populations and problems such as people with personality disorders, substance abuse, and eating disorders. We review the UK context for developments in mindfulness-based approaches and set out criteria for mindfulness teacher competence and training steps, as well as some of the challenges and future directions that can be anticipated in ensuring that evidence-based mindfulness approaches are available in health care and other settings.

New guidelines on depression from NICE

In September 2009, NICE will publish two new guidelines in the field of depression - depression in adults and depression in chronic physical health problems. The guideline on depression in adults includes major changes to current prescribing practice. The most important of these is the recommendation that antidepressants drugs are switched if there is no response after three to four weeks. This reflects the growing recognition that antidepressants have a prompt onset of action and that failure to respond early in treatment predicts ultimate failure to respond. Also included is a strengthened recommendation for the use of additive antipsychotics (olanzapine, quetiapine, risperidone and aripiprazole) as a first-line option in refractory depression. The guideline on depression in chronic physical health problems mirrors recommendations in the adult guideline and adds specific recommendations for the use of antidepressants in a variety of physical disorders. In this guideline, drug choice is based to some extent on drug interactions and contra-indications. The outcome of this is that less often used drugs (mianserin, mirtazapine, trazodone) are recommended in a number of situations.

NICE focuses on depression in chronic ill health

AbstractIdentifying and treating depression in adults with chronic physical health problems (including neurological disorders) is highlighted in a new clinical guideline from the National Institute for Health and Clinical Excellence (NICE).1 The new guideline is linked with an updated version of NICE's depression clinical guideline.2 SteveTitmarsh reports from a Press briefing held in London to announce the new guidelines. Copyright © 2009 Wiley Interface Ltd

Interpersonal Violence is Associated with Depression and Chronic Physical Health Problems in Midlife Women

This research describes interpersonal violence (IPV) exposure in a community-based sample of midlife women from three ethnic groups and explores relationships among these exposures and variables associated with health outcomes. IPV, physical health, depression, and social support were measured by self-report questionnaires. More than 33% reported a history of physical abuse or sexual abuse and at least 20% reported both. Approximately 20% experienced sexual harassment in the past year. IPV exposure was associated with more chronic health problems and depressive symptoms. IPV, whenever it occurs, is detrimental to women's health regardless of socioeconomic status or ethnicity.

Do mental health problems in childhood predict chronic physical conditions among males in early adulthood? Evidence from a community-based prospective study

Previous studies have documented associations between mental and physical health problems in cross-sectional studies, yet little is known about these relationships over time or the specificity of these associations. The aim of the current study was to examine the relationship between mental health problems in childhood at age 8 years and physical disorders in adulthood at ages 18-23 years. Multiple logistic regression analyses were used to examine the relationship between childhood mental health problems, reported by child, parent and teacher, and physical disorders diagnosed by a physician in early adulthood. Significant linkages emerged between childhood mental health problems and obesity, atopic eczema, epilepsy and asthma in early adulthood. Specifically, conduct problems in childhood were associated with a significantly increased likelihood of obesity and atopic eczema; emotional problems were associated with an increased likelihood of epilepsy and asthma; and depression symptoms at age 8 were associated with an increased risk of asthma in early adulthood. Our findings provide the first evidence of an association between mental health problems during childhood and increased risk of specific physical health problems, mainly asthma and obesity, during early adulthood, in a representative sample of males over time. These data suggest that behavioral and emotional problems in childhood may signal vulnerability to chronic physical health problems during early adulthood.

Severe Hyperlipidemia Associated With Olanzapine and Quetiapine Use

Back to table of contents Previous article Next article Letters to the EditorFull AccessSevere Hyperlipidemia Associated With Olanzapine and Quetiapine UseRYAN M. CARNAHAN Pharm.D., M.S.ANTONIO A. REANTASO M.D.BETH A. TEEGARDEN D.O.,TODD POGUE D.O.,RYAN M. CARNAHAN Pharm.D., M.S.Search for more papers by this authorANTONIO A. REANTASO M.D.Search for more papers by this authorBETH A. TEEGARDEN D.O.Search for more papers by this author,TODD POGUE D.O.Search for more papers by this author,Published Online:1 Oct 2007https://doi.org/10.1176/appi.ajp.2007.07020253AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To The Editor: Atypical antipsychotics are associated with metabolic side effects, including weight gain, hyperlipidemia, and type II diabetes. We present a case of severe hyperglycemia, hypercholesterolemia, and hypertriglyceridemia during treatment with olanzapine and quetiapine. To our knowledge, this is the highest triglyceride level during antipsychotic treatment reported to date.The patient was a 48-year-old, 6 feet tall, 230 lb Caucasian male presenting to an indigent care clinic. He was first hospitalized for depression three years before. Subsequently, he was diagnosed with mania and bipolar I disorder. His substance abuse history was negative. He was eventually stabilized receiving the following medications: olanzapine (40 mg every night), quetiapine (300 mg every night), sertraline (100 mg every morning), and zolpidem (10 mg every night).The patient was psychiatrically stable and reported no history of chronic physical health problems. However, he reported diabetes symptoms, including thirst, frequent urination, and a 60 lb weight loss over the past year. He had generalized papular pruritic xanthomatous dermatitis and abdominal pain that was determined to be diverticulitis, both of which are associated with hypertriglyceridemia. Notable nonfasting laboratory results included the following: total cholesterol, 980 mg/dl; triglycerides, 9,450 mg/dl; and glucose, 507 mg/dl. High- and low-density lipoprotein were unobtainable because of severe lipemia of the blood sample. Metformin (500 mg bid) and gemfibrozil (600 mg bid) were initiated. Olanzapine and quetiapine were tapered and replaced with aripiprazole, which was then titrated to 30 mg. After 1 week, the patient’s lipids were reexamined, with instruction to fast. His total cholesterol level was 408 mg/dl, and his total triglyceride level was 2,796 mg/dl. Unfortunately, he developed depression and akathisia with the switch to aripiprazole. The aripiprazole dose was tapered to 15 mg, and a regimen, including enteric-coated valproic acid (1500 mg every night), sertraline (100 mg every morning), clonazepam (0.5 mg bid), and zolpidem (10 mg every night), appeared to be effective. One month later, the patient’s total cholesterol level was 310 mg/dl and total triglyceride level was 1,313 mg/dl. After another month, the total cholesterol decreased to 260 mg/dl and the total triglycerides decreased to 400 mg/dl, respectively; high-density lipoprotein was 32 mg/dl, low-density lipoprotein was 48 mg/dl, and glucose was153 mg/dl.After another month, the patient’s total cholesterol level was 263 mg/dl, and his total triglyceride level increased to 527 mg/dl. He reported difficulty sleeping and receiving quetiapine at night (100–300 mg). After observing the lipid increase, the patient agreed to discontinue quetiapine. One month later, his total cholesterol level was 207 mg/dl and total triglyceride level was 300 mg/dl. This case illustrates severe metabolic adverse effects associated with atypical antipsychotics, and one might question whether the combination of olanzapine and quetiapine increased these effects. The patient presented with severe hyperglycemia and hyperlipidemia, with extreme hypertriglyceridemia. Obesity and uncontrolled diabetes certainly contributed to the presentation. A Naranjo (1) score of 7 indicates a probable association with antipsychotics. Causal inference is limited, since no weights or laboratory values were available prior to olanzapine and quetiapine initiation. However, the increase in lipids after reinitiation of quetiapine supports a relationship of the metabolic presentation with antipsychotic treatment, even with relatively low doses of quetiapine as commonly used off-label for insomnia. Providers should recognize that these low doses may not be benign. Tulsa, Okla.Ardmore, Okla.Dr. Carnahan has received research support from Eli Lilly, Wyeth, Forest Laboratories, and Boehringer-Ingelheim. Drs. Reantaso, Teegarden, and Pogue report no competing interests.This letter (doi: 10.1176/appi.ajp.2007.07020253) was accepted for publication in July 2007.Reference1. Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, Janecek E, Domecq C, Greenblatt DJ: A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981; 30:239–245Google Scholar FiguresReferencesCited byDetailsCited ByQJM, Vol. 108, No. 3Quetiapine-Induced Hyperglycemic Crisis and Severe Hyperlipidemia: A Case Report and Review of the LiteraturePsychosomatics, Vol. 55, No. 6Journal of Affective Disorders, Vol. 150, No. 1Pharmacoepidemiology and Drug Safety, Vol. 17, No. 5 Volume 164Issue 10 October, 2007Pages 1614-1615THE AMERICAN JOURNAL OF PSYCHIATRY October 2007 Volume 164 Number 10 Metrics PDF download History Published online 1 October 2007 Published in print 1 October 2007

The health and well-being of young Australians: Present patterns and future challenges

The orthodox view of the health and wellbeing of young Australians is one of continuing improvement. This picture underestimates the importance of adverse trends in a range of chronic physical and mental health problems. These have their sources in quite fundamental features of western societies, and optimizing health will mean making correspondingly fundamental social and cultural changes. To achieve this transformation, the politics of health must be seen as much more than the politics of healthcare services. Medicine and other health professions need better to recognize this if they are to continue to be part of the solution to better health, and not become part of the problem.

Continuity of health impairment and substance misuse among adult prisoners in Queensland, Australia

Prisoners experience high rates of chronic physical health problems, poor mental health and high rates of substance misuse. However, little is known about what happens to prisoners after release from custody, except that many re‐offend and a disproportionate number die from drug overdose, suicide, accidents and other causes. Using a prospective design, 160 prisoners in Queensland, Australia were interviewed prior to release then 1 and 4 months post‐release. Most prisoners had a history of substance misuse and many reported poor mental health pre‐release. The prevalence of these problems was also high post‐release and there was a high degree of continuity of impairment. These findings add support to calls for (a) population‐level pre‐release planning and post‐release support for prisoners returning to the community, and (b) screening and targeted intervention for those most at risk of poor post‐release outcomes.

Collaborative Care of a Patient With Multiple, Chronic Physical and Emotional Health Problems

For patients with complex, multisystem chronic illness, traditional models of care that emphasize diagnosis, prescription, and cure are inadequate. The complexities of such conditions require coordinated work with other specialists. The authors argue in this article that providing optimal health care for management of psychosocial and behavioral health concerns of the chronically ill patient calls for a collaborative approach that goes beyond coordination of care. Key elements of extended collaboration include (a) developing and implementing a team approach to patient care, (b) mutual professional socialization and education, (c) open, frequent communication between practitioners and the patient, and (d) establishing appropriate and realistic care goals. Goals must be identified that facilitate effective coping and improve quality of life in the context of chronic, multisystem illness and disability. Achieving treatment objectives should help the patient lead a rewarding life and help both the patient and providers to experience satisfaction with the provider-patient relationship and the collaborators’ individual achievements.

Prevalence, Severity, and Co-occurrence of Chronic Physical Health Problems of Persons With Serious Mental Illness

This study examined Medicaid claims forms to determine the prevalence, severity, and co-occurrence of physical illness within a representative sample of persons with serious mental illness (N=147). Representativeness of health problems in the study sample was established through comparison with a larger sample of persons with serious mental illness enrolled in Medicaid within the same state. Standardized annual costs were then assigned to Medicaid claims diagnoses, and individual health problem severity was measured as the sum of estimated treatment costs for diagnosed conditions. Seventy-four percent of the study sample (N=109) had been given a diagnosis of at least one chronic health problem, and 50 percent (N=73) had been given a diagnosis of two or more chronic health problems. Of the 14 chronic health conditions surveyed, chronic pulmonary illness was the most prevalent (31 percent incidence) and the most comorbid. Persons with chronic pulmonary illness were second only to those with infectious diseases in average annual cost of treatment ($8,277). Also, 50 percent or more of participants in eight other diagnostic categories had chronic pulmonary illness. A regression analysis identified age, obesity, and substance use disorders as significant predictors of individual health problem severity. Risk adjustment for physical health is essential when setting performance standards or cost expectations for mental health treatment. Excluding persons with chronic health problems from mental health service evaluations restricts generalizability of research findings and may promote interventions that are inappropriate for many persons with serious mental illness.

Developmental Processes in Clients with Chronic Health Conditions

"Editor’s Note: In this invited paper, we are very pleased to publish some extracts from the manuscript of a forthcoming book, entitled The Tiger in the Grove: Developmental Process Therapy, by Bill Palmer. A teacher of Gestalt therapists and a body worker, Bill is also trained in Chinese medicine and developmental movement therapy. Here he describes some of the principles behind his work with patients suffering from chronic physical health problems. In this article, drawing on case examples, he describes the three phases of his Gestalt-informed ‘developmental process therapy’. These are (1) to explore the processes of development his clients are struggling with; (2) to help his clients become aware of how they are supported or hindered by the way they ‘inhabit’ their bodies; (3) to suggest experiments clients can use to loosen up habitual ways they use their bodies. This elaboration of the ‘paradoxical theory of change’, applied to this specialised field, has relevance for all therapists, not just those who focus on physical process work. Key words: bodywork, chronic illness, change, medical story, imbalance, development, experiment."

Biofeedback Applications for Psychiatric Nursing

Americans increasingly are becoming disillusioned with traditional medical treatment and are seeking relief in complementary or alternative medicine (CAM) treatments for chronic physical or mental health problems. Biofeedback is a CAM approach that has important implications for holistic psychiatric nursing practice. This article covers the basics of clinical biofeedback and its potential applications for clients with psychiatric mental health issues. Information is provided about the availability of training, supervision, and certification in this expanding field.

Insomnia and health problems in Canadians.

The objective of this study was to determine the prevalence of, and to identify the relative contribution of selected factors associated with insomnia in the Canadian population age 15 and older. Weighted analysis of cross-sectional data from the Canadian General Social Survey, Cycle 6, 1991. Prevalence estimates were calculated for the total and age-specific Canadian population age 15 and older. Multiple logistic regression techniques were employed to study the contribution of an array of sociodemographic, lifestyle, stress, and physical health factors to the experience of insomnia. N/A. A representative sample of the Canadian household population age 15+ (n=11,924). N/A. Twenty-four percent of the Canadian population age 15+ report insomnia. The following factors were associated with insomnia in multivariate logistic regression: female gender, being widowed or single, low education, low income, not being in the labor force, ever having smoked, life stress, specific chronic physical health problems (circulatory, digestive and respiratory disease, migraine, allergy and rheumatic disorders), pain, activity limitation and health dissatisfaction. Age was not significantly associated with insomnia. Insomnia was highly prevalent among the non-institutionalized Canadian population age 15 and older. A very stressful life, severe pain and dissatisfaction with one's health demonstrated the highest odds ratios associated with insomnia. Increasing age per se and lifestyle factors were not significantly associated with insomnia.

Problemas de salud y factores determinantes del número de visitas a demanda en pacientes hiperutilizadores de un centro de salud

To describe the social and demographic characteristics and health problems of over-users of a health centre and to determine the number of attendances requested on demand at the general medical clinic. Retrospective and descriptive. Multivariate analysis: multiple linear regression. Urban health centre. Patients who requested a consultation at the health centre on at least nine occasions in 1999 (N = 7852). Random sample of 386 patients (alpha 0.05, 95% accuracy). Dependent variable: number of on-demand consultations requested in 1999. age, family size, area of residence, active or pensioner, inclusion in programmes, health problems (CIAP-2), number of drugs on repeat prescription (Anatomical Classification), short-term time off work. 57% of over-users were women (CI, 52.9-62.7%); mean age 55 (SD 18.5); family size 2.7 members (SD 1.457); 58.8% pensioners. Mean number of appointments 15 (SD 6.7). Mean habitual consumption of 1.58 medicines (SD 2.46). Inclusion in programmes: 37.7% hypertension, 16% diabetes, 17% dyslipaemia, 16% nursing clinic. Most prevalent pathologies: cardio-circulatory (43.8%), endocrino-metabolic (32%), traumatology (26.7%) and mental health (21%). The regression model included the variables of age, number of medicines and having had short-term time off. Over-users of our health centre are middle-aged women with chronic physical health problems and with mental health problems. The number of attendances is related to age and administrative requirements: medication and sick notes.

Health behind bars: utilization and evaluation of medical care among jail inmates.

Jail and prison inmates experience disproportionately high levels of chronic and acute physical health problems, resulting in increased utilization of health services in correctional institutions. Variations in both health status and health care utilization are likely, although several important factors have been under-researched. Gender, in particular, is presumed to influence health outcomes and use of medical care in correctional facilities. The current study explores the physical health status of a systematic sample of 198 male and female inmates incarcerated in a large county jail located in a medium-sized Southern city. Using multiple regression analysis, predictors of physical health status, utilization of medical care, and inmates' evaluations of the accessibility and quality of health care are identified. The results indicate that gender and age are the most consistent demographic predictors of health status and medical care utilization, with females and older inmates reporting higher morbidity and concomitantly higher numbers of medical encounters. The experience of incarceration also appears to influence the physical health of inmates, as self-reported health problems increase with inmates' duration of incarceration. Evaluations of jail medical care differ significantly by gender, with female inmates reporting more difficulty accessing health services, yet higher satisfaction with the quality of services received. The results suggest a need for medical care in correctional settings to adapt to the medical needs of older inmates and women, in addition to improving treatment for chronic conditions and preventive services.

Primary health care service for long-stay psychiatric in-patients

Aims and methodA retrospective review of the activity of a general practitioner employed specifically to provide a primary health care service to the residents of an ‘old long-stay’ psychiatric ward was undertaken.ResultsAll but one patient had a chronic physical health problem requiring active management. Presenting pathology covered all organ systems. The review indicated that these health problems had not previously been satisfactorily managed by psychiatrists. This service was acceptable to and valued by patients.Clinical implicationsThe success of the service was only achieved by dedicating specific resources to meet primary health care needs. The extent to which this model could be extended to ‘new long-stay’ populations located in dispersed hospital hostels is less certain.