Serious Mental Illness Patients Research Articles

How sleep in patients with serious mental illness is recorded and treated, and its impact on service engagement

BackgroundSleep and mental health share a bidirectional relationship whereby problems in one exacerbate the other. Accordingly, sleep problems are frequent and severe in serious mental illness (SMI) populations, exacerbating SMI symptoms. This study examined the documentation and treatment of sleep problems within anonymised clinical records of SMI patients, and their association with attendance rates and number of appointments scheduled. MethodsPatient records between 01.09.2021 and 31.08.2022 were identified and relevant records (n = 229) extracted from an NHS Trust database. Content analysis was used to assess documentation and treatment of sleep problems and Chi-square tests were used to assess demographic differences. Mann-Whitney U tests were used to compare attendance rates and number of appointments scheduled between patients with/without sleep problems. ResultsMost (n = 170; 84 %) patients with sleep problems had no or minimal assessment of the sleep problem within their records. Patients were primarily offered no (n = 115; 57 %) or non-recommended (n = 69; 34 %) sleep treatment. More outpatients were offered no sleep treatment (n = 89; 64 %) than inpatients (n = 26; 41 %) (p = .002) whilst more inpatients were offered non-recommended sleep treatments (n = 33; 52 %) than outpatients (n = 36; 26 %) (p < .001). No significant associations were found between sleep and attendance or appointments scheduled. ConclusionsThere is a lack of routine clinical attention to sleep assessment and treatment in SMI groups. Where sleep is addressed, treatment often conflicts with guidelines. Improved sleep assessment and treatment could significantly enhance current SMI patient care.

Clinician and Patient Perspectives on the Use of Passive Mobile Monitoring and Self-Tracking for Patients With Serious Mental Illness: User-Centered Approach.

Early intervention in mental health crises can prevent negative outcomes. A promising new direction is remote mental health monitoring using smartphone technology to passively collect data from individuals to rapidly detect the worsening of serious mental illness (SMI). This technology may benefit patients with SMI, but little is known about health IT acceptability among this population or their mental health clinicians. We used the Health Information Technology Acceptability Model to analyze the acceptability and usability of passive mobile monitoring and self-tracking among patients with serious mental illness and their mental health clinicians. Data collection took place between December 2020 and June 2021 in 1 Veterans Administration health care system. Interviews with mental health clinicians (n=16) assessed the acceptability of mobile sensing, its usefulness as a tool to improve clinical assessment and care, and recommendations for program refinements. Focus groups with patients with SMI (n=3 groups) and individual usability tests (n=8) elucidated patient attitudes about engaging in health IT and perceptions of its usefulness as a tool for self-tracking and improving mental health assessments. Clinicians discussed the utility of web-based data dashboards to monitor patients with SMI health behaviors and receiving alerts about their worsening health. Potential benefits included improving clinical care, capturing behaviors patients do not self-report, watching trends, and receiving alerts. Clinicians' concerns included increased workloads tied to dashboard data review, lack of experience using health IT in clinical care, and how SMI patients' associated paranoia and financial instability would impact patient uptake. Despite concerns, all mental health clinicians stated that they would recommend it. Almost all patients with SMI were receptive to using smartphone dashboards for self-monitoring and having behavioral change alerts sent to their mental health clinicians. They found the mobile app easy to navigate and dashboards easy to find and understand. Patient concerns centered on privacy and "government tracking," and their phone's battery life and data plans. Despite concerns, most reported that they would use it. Many people with SMI would like to have mobile informatics tools that can support their illness and recovery. Similar to other populations (eg, older adults, people experiencing homelessness) this population presents challenges to adoption and implementation. Health care organizations will need to provide resources to address these and support successful illness management. Clinicians are supportive of technological approaches, with adapting informatics data into their workflow as the primary challenge. Despite clear challenges, technological developments are increasingly designed to be acceptable to patients. The research development-clinical deployment gap must be addressed by health care systems, similar to computerized cognitive training. It will ensure clinicians operate at the top of their skill set and are not overwhelmed by administrative tasks, data summarization, or reviewing data that do not indicate a need for intervention. RR2-10.2196/39010.

Chlamydia and Gonorrhea Testing Patterns Among Women with and Without Serious Mental Illness.

Rates of the sexually transmitted infections (STIs) Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) have risen in women by 13% and 40%, respectively, since 2015. Women with Serious Mental Illness (SMI) are at disproportionate risk for STIs. A retrospective chart review was performed at a safety-net healthcare system in the Southeastern United States (US) from 2014 to 2017. CT/GC positivity rates did not differ between the general and SMI populations (6.6% vs. 6.5% for CT and 1.8% vs. 2.2% for GC, respectively). Emergency Medicine accounted for more positive STI test results in SMI patients than the general population (25.2% vs. 19.1% for CT, 47.8% vs. 35.5% for GC, respectively). SMI patients received large portions of STI care in emergency settings, where follow-up is poor. Point of Care (POC) testing could improve care in this setting, and mental healthcare providers must address sexual health with patients who otherwise may not receive this care.

How is physical healthcare experienced by staff, service users, and carers in adult community mental health services in a south London mental health trust? A service evaluation.

Adults with a serious mental illness (SMI) are at greater risk of physical health morbidity and premature death than the general population, largely as a result of preventable physical health issues. Staff working in mental health services have a role to play in addressing these inequalities, but little is known about how they perceive their role and how this impacts on their practice. Understanding this better would enable services to improve their approach and support better health outcomes for SMI patients. A service evaluation was undertaken to investigate how physical healthcare is approached within adult community mental health teams (CMHTs) at a South London (UK) Mental Health Trust. This was a prospective, cross-sectional evaluation design. Interviews and focus groups were conducted with clinical staff, service users and carers (non-professional caregivers e.g., family or friends, of adults living with an SMI), to understand their experiences and to identify key barriers and facilitators to supporting physical healthcare support for adults with SMI. Thematic analysis was conducted to identify key themes which were classified into five main categories. 50 participants took part in the study, 38 were clinical staff, eight were service users and four were carers. We found staff widely recognised the importance of supporting physical healthcare. However, there was variability in how staff approached physical healthcare in routine practice, and differences in how physical healthcare is experienced by service users and carers. Staff were keen to engage in changes to the way physical healthcare is delivered in CMHTs. However, they sought clearer guidance on their roles and responsibilities, and wanted to better understand the rationale for changes in community mental health practice, such as increased screening for physical healthcare. Service users and carers felt equally that the role of CMHTs in physical healthcare was unclear, which limited their ability to access it and understand the benefit for their overall care. Staff articulated gaps in leadership and training that impacted on their ability to implement the overall vision for physical healthcare within the Trust. Mental health staff recognise the role they play in supporting the physical health of adults living with SMI. This evaluation provides insight into common barriers and facilitators faced by staff, service users and carers when providing or accessing physical healthcare within adult CMHTs. These findings indicate a more comprehensive and better articulated approach to physical healthcare in mental health Trusts is needed to ensure service users and their carers understand what support is available and how to access it and to equip staff to provide and sustain that care in routine practice.

Optimization of Sleep classification in Patients With Serious Mental Illness Using Accelerometer and ECG Data From a Wearable Patch

AbstractIntroductionSleep is an important behavioral biomarker for patients with serious mental illness (SMI). The ability to accurately quantify sleep in a real-world setting could thus provide insight into patient well-being. In this study, patients in a sleep lab wore a patch that is part of a digital medicine system (aripiprazole with sensor (AS)) designed to provide objective records of medication ingestion. The patch provided accelerometer and electrocardiogram (ECG) data; polysomnography (PSG) data was collected to be used as the gold standard for sleep stage classification. The accelerometer and ECG data were used to build machine learning classification models to distinguish periods of wake from periods of sleep. To optimize these models for a real-world environment, different data sampling paradigms and methodologies were explored, and resultant model performances were analyzed.MethodsData was collected for a total of 220 nights, across 73 unique subjects—42 subjects had a diagnosed SMI (schizophrenia, bipolar disorder I, or major depressive disorder) and 31 subjects were healthy volunteers. PSG data, which provides a sleep stage designation at 30-second intervals, was combined into 5-minute windows, labeled as either “Sleep” or “Wake” based on which class comprised the majority of the 30-second intervals within the window. Accelerometer and ECG features were derived for each 5-minute window. Models were trained with three learning methodologies: a light gradient boosting machine (LGBM), a conditional random field (CRF), and a long short-term memory (LSTM) network. Model performance was tested with the full complement of accelerometer and ECG data, as well as down-sampled subsets of data. Additionally, ECG data from the PSG system was incorporated to test the effect of other ECG sampling strategies.ResultsCRF models produced the best classification performance (AUC = 0.91) with the full patch dataset. Down-sampling to include less than half of the accelerometer data did begin to degrade the specificity of the model. Down-sampling to include less frequent ECG collection did not have a significant effect on model performance; however, changing the sampling paradigm to continuous ECG collection from a block sampling paradigm did lead to more robust classification of when a patient was awake.ConclusionsAccurately recording sleep in a logistically simple way can provide insights into the well-being of SMI patients. Combining these insights with the objective medication ingestion records provided by AS would be of great value to SMI patients, as well as their caregivers and physicians. This research explores what amount of sensor data is required to accurately quantify sleep and some of the machine learning strategies that can ameliorate data limitations, providing guidance for the optimization of digital device design.FundingOtsuka Pharmaceutical Development &amp; Commercialization, Inc.

SMI Adviser to Bring Hands-On Learning to Annual Meeting

SMI Adviser to Bring Hands-On Learning to Annual Meeting

Screening for obstructive sleep apnoea in patients with serious mental illness.

Patients with serious mental illness (SMI) are at increased risk of obstructive sleep apnoea (OSA). Despite this, OSA is frequently under-recognised in the psychiatric population. This study describes the results of OSA screening in SMI patients. Patients with SMI attending a metropolitan mental health clinic were screened for OSA using the OSA50, STOP-BANG Questionnaire (SBQ), Epworth Sleep Score (ESS) and the Pittsburgh Sleep Quality Index (PSQI). They were then offered diagnostic sleep testing via ResMed ApneaLinkTM and polysomnography. Of the 65 patients recruited, 65% had a primary diagnosis of schizophrenia or schizoaffective disorder, 85% were on antipsychotic medications and the majority were obese. Approximately 50% of patients reported poor sleep quality via the PSQI, in contrast to 12% with elevated daytime sleepiness via the ESS. 46% of our cohort were at risk of OSA due to an elevated OSA50 or SBQ. Of the five patients who agreed to proceed to diagnostic sleep testing, three were diagnosed with OSA. A high proportion of patients with psychiatric illness are at risk of sleep-disordered breathing. Sleep dissatisfaction is high. The low uptake of sleep investigation requires improved patient engagement to improve OSA diagnosis in this high-risk group.

Practical Approaches to Antipsychotic-Associated Corrected QT Interval Prolongation in Patients With Serious Mental Illness: A Review of Cases

Background: There is no consensus for assessment and management of patients with serious mental illness (SMI) who are at risk for cardiac morbidity and mortality due to antipsychotic-associated QTc prolongation. Objective: The objective of this review was to assess methods for risk scoring, QT correction calculation, and clinical management in SMI patients with antipsychotic-associated QTc prolongation. Methods: A search was performed in PubMed for case reports that described QTc prolongation in adult patients with schizophrenia or bipolar disorder prescribed an antipsychotic. Reports published in North America between 2000 and 2020 were eligible. The Mayo, Tisdale, and RISQ-PATH scoring tools were applied to cases to categorize risk level. Results: Seventeen cases were included. Most patients were prescribed a second-generation antipsychotic for schizophrenia, with baseline and maximum QTc values of 429 milliseconds and 545 milliseconds, respectively. The Mayo scoring tool identified 17 (100%) cases as “high risk,” Tisdale identified 9 (53%) cases as “moderate risk” and 7 (41%) cases as “low risk,” while RISQ-PATH identified 9 (53%) cases as “not low risk” and 8 (47%) cases as “low risk.” Three cases reported the QT correction formula utilized (18%). The most common intervention to address antipsychotic-associated QTc prolongation was switching to a different antipsychotic (35%). Approximately one third of patients experienced Torsades de Pointes. Conclusion: There is a lack of standardization for antipsychotic-associated QTc prolongation risk assessment and management in patients with SMI. This review provides real-world data representing actual clinical practice.

Telehealth and Its Prospective for Improving Serious Mental Illness Conditions: A Scoping Review

BACKGROUND: Health care services ought to be continued for people with serious mental illness (SMI), despite the pandemic events. These efforts help prevent recurrences of any of these medical conditions through the use of telehealth techniques. AIM: The aim of this article is to evaluate the application of telehealth among SMI patients. METHODS: This study used a scoping review framework methodology based on the report by Arksey and O’Malley. A comprehensive literature search was carried out to identify precise studies, and vigorous criteria were employed to select the revelant papers. The search was conducted in several databases, including PubMed, CINAHL (EBSCO), and Science Direct. Subsequently, the data collected were extracted by two independent reviewers, synthesized and presented in the table and narrative format. RESULTS: A total of 13 studies were identified in the search selection process based on the review objectives, and 5 of these studies were randomized control trials (RCT), while 8 used varied research designs. CONCLUSION: Based on the results of the scoping review, telehealth services were concluded to be suitable for helping people with SMI obtain the required mental health services.

Decisional capacity determination and serious mental illness in oncology: Implications for equitable and beneficent care.

Patients with Serious Mental Illness (SMI) have worse survival compared to cancer patients without SMI after controlling for delayed diagnosis. Decision-making capacity (DMC) may be impaired in both populations (cancer or SMI). DMC may be further impaired based on coupled vulnerability factors that challenge Shared Decision Making (SDM) for patients with cancer and SMI. Psychiatric consultations for DMC in hospitalized patients with cancer (n=97) were consecutively evaluated across a single institution cancer center. SMI data, demographic, and cancer-related variables were obtained from the medical record. Descriptive data were contrasted in patients with and without DMC and used for logistic regression modeling. Overall, 42% had DMC with no significant differences based on SMI (χ2 =2.60, p=0.11). Patients with SMI were younger, receiving anticancer treatment, and were less likely facing end of life issues. Age (OR 1.03, p=0.05) and no recent anticancer treatments (OR 0.34, p=0.02) were associated with decisional incapacity. At 3 months post discharge, almost two-thirds were dead with no difference based on SMI (χ2 =0.01, p=0.91). But End of Life (EOL) concerns were documented in 63% of non-SMI patients and only 36% of SMI patients (χ2 =5.63, p=0.02). Healthcare proxy (16%), four determinates of DMC (22%), and repeated psychiatric DCM assessments (35%) were documented with no differences based on SMI. SDM is not equitable for cancer patients with SMI. Advanced directives and a robust effort to provide value-congruent care for patient with SMI who develop cancer may lessen this health inequity for cancer patients with SMI.

Telemedicine Among Medicaid Beneficiaries in Community Mental Health Care during the First Three Months of the 2020 Covid‐19 State of Emergency

Research ObjectiveLittle is known about the effectiveness of telemedicine for patients with serious mental illness (SMI). We sought to identify and describe characteristics of community mental health center (CMHC) SMI patients associated with treatment retention and use of telemedicine during this time.Study DesignThis research is an observational study of retention in services and use of telemedicine during 12/2019–6/2020 (compared to 12/2018–6/2019) in New Hampshire (NH) CMHC patients. Starting in 3/2020, patients were offered in person and/or telemedicine services based on clinical recommendation and personal choice. NH Medicaid claims provided CMHC service, diagnoses, and demographics. Quarterly use of telemedicine was categorized into <25%, 25–75%, or > 75% of total services. Associations between retention and demographic variables were explored using chi‐square test of independence, logistical regression and correspondence multivariate analysis.Population StudiedAll 16,030 NH Medicaid beneficiaries with SMI, including debilitating schizophrenia, bipolar disorder, major depression, PTSD, and anxiety/other diagnoses, who were engaged in CMHC treatment during the three months prior to the COVID‐19 State of Emergency (SOE) was declared in NH.Principal Findings81.7% of patients were retained in treatment in the quarter following the SOE declaration compared to 86.6% of patients in the 2018–2019 period. Comparing 2020 to 2019, youth demonstrated low retention rates (77% compared to 84%, respectively). In 2020, retention among patients with rural zip codes was lower than among those with urban zip codes (78.8% vs 81.2%), and among patients with PTSD (78.1%) and anxiety/ other diagnoses (76.5%) compared to schizophrenia (93.2%) and bipolar disorder (89%).All three multivariate analyses indicate that age, gender, and condition significantly predicted retention. In adjusted models, male gender, age group 18–34, and PTSD diagnosis predicted low retention. In contrast, female gender, age groups 35–54 and 55+, and schizophrenia and bipolar diagnoses predicted high retention.Similar analyses predicting level of telehealth services utilization showed: patients with <25% telehealth services were more likely in the 55+ year age group and schizophrenia diagnosis group; patients with 25% to 75% telehealth services were more likely to be youth and to have PTSD; those with 75% telehealth services were more likely to be in the 18–55 age group, and to have bipolar disorder or major depression.ConclusionsTelemedicine was utilized by the majority of CMHC patients in the months following the pandemic, likely supporting continuity of CMHC care for vulnerable patients with SMI. Yet, even with this substantial rollout of telemedicine, retention in treatment was less than retention in the prior year, and some sub‐populations were more at risk for treatment interruptions than others.Implications for Policy or PracticeTelemedicine promoted continuity of care during the pandemic but it is not clear how much telemedicine should continue after the pandemic, and for which subpopulations of people with SMI. Further research on the effectiveness and limitations of telemedicine in patients with SMI is needed to inform future policies and clinical practice.

The Use of Clozapine in the Serious Mental Illness Patients Enrolled in an Assertive Community Treatment Program.

IntroductionHealth care cost is projected to reach 20% of the nation’s gross national product (GNP) by 2016. 6.2% of this is from mental health. The National Institute of Mental Health (NIMH) estimates the prevalence of serious mental illness (SMI) at 13.1 million or 5.2% of American adults age 18 or over. Hence, mental health care cost for this patient population is significant.Patients with SMI involved in an Assertive Community Treatment (ACT) program are individuals who experience the most intractable symptoms and the greatest level of dysfunction from their mental illness. These individuals typically are institutionalized in a long-term facility such as the state hospital.Clozapine has shown superior efficacy over first- and most second-generation antipsychotics in both treating treatment-resistant and non-treatment-resistant schizophrenia which has been supported by several large trials. There is also evidence of its efficacy in suicidality, aggression and substance misuse. In fact, clozapine has been approved by the FDA for use in refractory schizophrenia and suicidality in schizoaffective disorder. Due to the risk of agranulocytosis, clozapine is underutilized. The purpose of this study is to conduct a retrospective cohort study through chart review to analyze whether the addition of clozapine to ACT treatment of SMI patients in a community hospital from 2008 to 2018 led to decreased frequency of hospitalizations and increased clinical stability.Materials and methodsA retrospective study using electronic medical record (EMR) of patients ages 20 and above who were enrolled in the ACT program at a community hospital from December 1, 2008 to December 31, 2018. Variables were collected from the EMR and de-identified during data collation. Analysis was performed using SPSS software package.ResultsA total of 179 patients enrolled in the ACT program and their data was extracted from the EMR. Twenty-five (62.5%) of these patient enrollments were on clozapine. They were made up of 53.6% male, 81.9% White/Asian, 18.1% Black; 44.1% ages between 36 to 50 years old, 30.2% were aged 18 to 35 years old, and 25.7% greater than 50 years old. There was no difference in age, sex, race, ethnicity, and insurance type in ACT program between those using clozapine and those not on clozapine. There was a higher proportion of psychiatric hospitalizations among clozapine users compared with the non-clozapine user group (62.5% vs 41.5%, p = 0.019). However, the two groups did not differ from one another in terms of psychiatric emergency visits (p = 0.128) or frequency of ACT visits (p = 0.002).ConclusionEffective treatment that will reduce hospitalizations and the burden of chronic disability in patients with SMI would greatly reduce mental health care cost. Clozapine remains the gold standard in the treatment of refractory schizophrenia. But due to the risk of agranulocytosis, clozapine is underutilized. It was hoped that this study will support the use of clozapine in SMI patients. Disappointingly, the use of clozapine did not prevent relapses and hospitalizations in this patient population and patients on clozapine seemed to have increased hospitalizations, compared to those who were not on clozapine. Perhaps, a different outcome would have occurred if the focus was limited to the patients themselves who were on Clozapine and ascertain what the rate of hospitalization was before the start of clozapine vs after the use of clozapine.

Stress and Coping With the COVID-19 Pandemic: A Survey of Psychiatric Patients at Clinical Trial Sites

Recent research on the COVID-19 pandemic suggests that individuals who suffer with serious mental illness (SMI) is at heightened risk of infection and have increased mortality, due to their illness or lack of access to healthcare. As a consequence, progress in developing new treatments for the SMI have been disrupted, with many interruptions and holds places on clinical trials in psychiatry due to concerns regarding the pandemic and its risks to SMI patients.

Neurocognitive Impairment in Severe Mental Illness. Comparative study with Spanish Speaking Patients.

Background. Serious mental illness (SMI) represents a category of psychiatric disorders characterized by specific difficulties of personal and social functioning, derived from suffering severe and persistent mental health problems. Aims. We wanted to look into differences in cognitive performance among different SMI patients. Methods. Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) screening was applied in one sample of SMI patients (n = 149) and another of healthy comparison participants (n = 35). Within the SMI sample, three different subsamples were formed: one with 97 patients with schizophrenia, a second with 29 patients with mood disorders, and a third with 23 patients with personality disorder. We performed a comparative study within and between groups. Results. Analysis of covariance was performed. Significant differences were found for cognitive functioning including attention and memory. Conclusions. RBANS can be recommended for the detection of neurocognitive deficits in psychiatric disorders, especially in Schizophrenia.

Chronic care treatment for smoking cessation in patients with serious mental illness: a pilot randomized trial

BackgroundRates of smoking among those with serious mental illness (SMI) are two to three times higher than for the general population. Smoking is rarely addressed in mental health settings. Innovative outreach and treatment strategies are needed to address these disparities. The current study is a pilot study of the feasibility and acceptability of a chronic care model of tobacco cessation treatment implemented in outpatient psychiatry clinics.MethodsParticipants were recruited from two outpatient psychiatric clinics and randomly assigned to intervention (counseling and nicotine replacement for 8 weeks, plus ongoing proactive outreach calls inviting reengagement in treatment) or control (brief education and referral to the state quit line). Assessments were conducted at 8 weeks (end of initial treatment block) and 6 months (end of window for retreatment). Feasibility was assessed by enrollment rate, treatment engagement, and completion of follow-up assessments. Acceptability was assessed both quantitatively and qualitatively. Preliminary efficacy was assessed by 7-day and 30-day abstinence rates, rate of quit attempts, and cigarettes per day. Psychological health was measured to assess for changes related to treatment group or attempts to quit smoking.ResultsNineteen participants were randomized to intervention and 19 to control. Recruitment proved feasible, and high rates of treatment engagement (mean of 4.5 sessions completed in initial treatment block, 89.5% uptake of nicotine replacement) and retention (94.7% of follow-up assessments completed) were observed. Treatment acceptability was high. As anticipated, there were no significant differences in abstinence between groups, but results generally favored the intervention group, including bio-verified 7-day abstinence rates of 21.1% in intervention vs. 17.6% in control and self-reported 30-day abstinence rates of 16.1% in intervention vs. 5.1% in control at 8 weeks. Significantly more intervention participants made at least one quit attempt (94.7% vs 52.6%; OR = 16.20, 95% CI: 1.79–147.01). Cigarettes per day decreased significantly more in the intervention group at 8 weeks (b = − 13.19, SE = 4.88, p = .02).ConclusionsIt was feasible to recruit and retain SMI patients in a smoking cessation trial in the context of outpatient psychiatry. The novel chronic care model treatment was acceptable to patients and showed promise for efficacy. If efficacious, a chronic care model could be effective at reducing smoking among SMI patients.Trial registrationClinicalTrial.gov #: NCT03822416 (registered January 30th 2019).

Self-stigma in Serious Mental Illness: A Systematic Review of Frequency, Correlates, and Consequences.

Self-stigma is associated with poor clinical and functional outcomes in Serious Mental Illness (SMI). There has been no review of self-stigma frequency and correlates in different cultural and geographic areas and SMI. The objectives of the present study were: (1) to review the frequency, correlates, and consequences of self-stigma in individuals with SMI; (2) to compare self-stigma in different geographical areas and to review its potential association with cultural factors; (3) to evaluate the strengths and limitations of the current body of evidence to guide future research. A systematic electronic database search (PubMed, Web of Science, PsycINFO, Scopus, and Ovid SP Cumulative Index to Nursing and Allied Health Literature [CINAHL]) following PRISMA guidelines, was conducted on the frequency, correlates, and consequences of self-stigma in SMI. Out of 272 articles, 80 (29.4%) reported on the frequency of self-stigma (n = 25 458), 241 (88.6%) on cross-sectional correlates of self-stigma and 41 (15.0%) on the longitudinal correlates and consequences of self-stigma. On average, 31.3% of SMI patients reported high self-stigma. The highest frequency was in South-East Asia (39.7%) and the Middle East (39%). Sociodemographic and illness-related predictors yielded mixed results. Perceived and experienced stigma-including from mental health providers-predicted self-stigma, which supports the need to develop anti-stigma campaigns and recovery-oriented practices. Increased transition to psychosis and poor clinical and functional outcomes are both associated with self-stigma. Psychiatric rehabilitation and recovery-oriented early interventions could reduce self-stigma and should be better integrated into public policy.

The Research Protocol of SENIOR Project-Psychiatric Services and Support System for Serious Mental Illness in Old Age, Kerala, India.

Background:India has the second-largest population of elderly in the world. Serious mental illness (SMI) is a subset of the mental disorders that result in significant functional impairment and is usually long term. Persons with SMI face several challenges in their old age that are different from the issues faced by younger people with SMI. Understanding the problems faced by elderly individuals suffering from SMI is fundamental for planning programs to address them. The SENIOR (Support Systems Evaluation of Neuropsychiatric Illness in Old age) project is a study aimed at evaluating the problems faced in obtaining mental health care by elderly persons having SMI in the Kerala state of India.Aim:To describe the scientific methodology of the SENIOR project.Methods:This study employs mixed-methods cross-sectional design among a minimum sample of 768 SMI patients identified through cluster sampling from three districts, and Focus Group Discussion among mental health program officials.Discussion:This paper presents a methodological model to assist researchers in future field epidemiological studies on mental illness. Assessing service needs and barriers to access for the most vulnerable among the mentally ill will help the policymakers make evidence-based decisions to improve their quality of life.

Teletherapy with serious mental illness populations during COVID-19: telehealth conversion and engagement

ABSTRACT The COVID-19 pandemic completely changed daily lives and psychotherapy clinical operations. Treatment engagement with serious mental illness (SMI) populations is inherently challenging. COVID-19 may pose more challenges to treatment engagement with SMI populations due to the rapid change to telehealth and exacerbation of symptoms. SMI patients may be less likely to convert to telehealth or stay engaged in treatment compared to non-SMI patients during COVID-19. Nevertheless, treatment engagement via teletherapy is vital to supporting the vulnerable SMI populations during this stressful pandemic. In this study, we compared teletherapy conversion and utilization rates between SMI and general populations in an outpatient psychiatric clinic (n = 816) during COVID-19. We found no differences in telehealth conversion for patients with SMI (52%) and non-SMI (48%), suggesting equivalent adoption of teletherapy among SMI and non-SMI populations. Beyond conversion, we found that the SMI group had a significantly greater number of teletherapy visits compared to non-SMI patients, indicating that SMI group utilized teletherapy regularly after conversion. There were no group differences in new patients beginning therapy via telehealth, which shows that the SMI group was not more deterred to seek help. Our findings inform the feasibility of telehealth for serious mental illness populations during the pandemic.

History of Serious Mental Illness Is a Predictor of Morbidity and Mortality in Cardiac Surgery

Serious mental illness (SMI), defined as a mental disorder causing functional impairment, affects 9.8 million Americans. SMI correlates with earlier onset, more extensive cardiac disease, and reduced life expectancy by 25 years. The impact of SMI on patients undergoing cardiac surgery has not been extensively studied. We hypothesized that patients with SMI have worse cardiac surgery outcomes. Using our institution's Society of Thoracic Surgeons database of 16,781 cardiac operations (2002-2017),a total of 1445 (8.7%) patients with SMI were identified and stratified into anxiety, mood disorders, andpsychosis. The risk-adjusted impact on morbidity and mortality were evaluated using multivariable regression. Patients with SMI were more often female patients, were younger, and had more comorbid disease. SMI patients were more likely to have had previous cardiac surgery and require urgent or emergent procedures (both P < .05). Among specific SMI diagnoses, patients with psychosis had worse outcomes compared with the general population, with higher operative mortality (9.1% vs 4.2%; P= .001), major morbidity (30.4% vs 15.8%; P < .0001), and cost ($50,211 vs $38,820; P < .001). After multivariable risk adjustment, SMI and psychosis remained independently associated with composite mortality and major morbidity (odds ratio, 1.21; P= .012; and odds ratio, 1.68; P= .003, respectively). SMI is independently associated with morbidity and mortality after cardiac surgery. SMI patients, especially the subset with psychosis, are complicated, high-risk, and resource-consuming. Refined strategies to reduce postoperative complications and improve care coordination are necessary in this population.

Late Potentials and Early Repolarisation Are Associated With Serious Mental Illness and May Portend Increased Arrhythmic Risk

Patients with serious mental illness (SMI) have an increased risk of sudden death. Higher rates of signal-averaged electrocardiogram (SAECG) abnormal late potentials (LP), which may be a predictor of sudden death risk, have been shown in patients with schizophrenia. We aimed to assess the prevalence and predictors of electrocardiograph (ECG) and SAECG abnormalities in a mixed SMI population. Consecutive consenting inpatients with SMI had 12-lead ECG and SAECG recorded in addition to demographics, diagnoses and medications. Standard criteria for abnormal SAECG were applied. Multivariate regression analysis was performed to determine predictors of SAECG abnormalities including diagnoses, body mass index, ECG parameters, psychotropic medication use, and medications associated with Long QT or Brugada syndromes. Eighty (80) patients, 49% male, mean age 39±17 years were included. SAECG criteria abnormality for 1, 2 or 3 criteria were seen in 19, 3 and 5 cases (34% in total) respectively. Early repolarisation pattern was seen in 19% of patients. SAECG abnormality was associated with male gender (OR 7.3; 95% CI 2.3-23.4), and schizophrenia/schizoaffective disorder diagnosis (OR 7.4; 95% CI 1.9-29.0), but not with medication type or dose. In the mixed SMI population studied, there was a high rate of SAECG-detected late potentials (34%) and early repolarisation pattern (19%). Schizophrenia/schizoaffective disorder diagnosis was the strongest multivariate predictor identified. Further studies are needed to define the mechanism and significance of these cardiac abnormalities in SMI patients.