50 slides on physical health mental health comorbidity (ajmitchell nov2012))
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DESCRIPTION
This is a talk given as a keynote lecture at the University of northampton, 07-Nov-2012 on the topic of physical health-mental health comorbidity.TRANSCRIPT
Alex J Mitchell [email protected]
Long term conditions and mental health, Northampton November 2012
Physical Health / Mental Health:Evidence based exploration of co-morbidity
Alex J Mitche
ll (201
2)
Contents
1. Psychiatric ‐ Physical illness Comorbidity
2. Psychiatric complications of Specific Physical illnesses
3. Psychiatric Physical Comorbidity => Burden
4. Psychiatric Physical Comorbidity => Mortality
5. Medical Care for Psychiatric Patients
6. Monitoring and Treatment
Alex J Mitche
ll (201
2)
National Reports
1. Psychiatric ‐ Physical illness Comorbidity1. Psychiatric ‐ Physical illness Comorbidity
Large Surveys
Alex J Mitche
ll (201
2)
2007 Australian National Survey of Mental Health and Wellbeing (n= 8841, 16-85 years)
anxiety affective
substance use
0.8
3.9
0.2
1.7
12.62.5
1.6
19%
8%
4%
Women
Alex J Mitche
ll (201
2)
Washington State Survey (n=23,000)
69%31% alone
32%5% alone
36%5% alone
Alex J Mitche
ll (201
2)
Depressive Symptoms in Medical Conditions (on CES-D8) n=8400
Alex J Mitche
ll (201
2)
Mental Health Comorbidity in Medical dis(n=8800 (WMH-CIDI 3.0)
Data from Teesson et al.Affective and anxiety disorders and their relationship with chronic physical conditions in Australia: findings of the 2007 National Survey of Mental Health and Wellbeing. Aus NZJP 2011 Nov;45(11):939-46.
5
7
10
6.8
9.6
12.8
7.9
11.4
17.4 17.6
22.5
19.7
25.6
18.7
13.5
20.5 21.2
23.3 23.4
29.7
21.9
0
5
10
15
20
25
30
35
No P
hysic
al Co
nditi
on
Diab
etes
Stro
ke o
r CHD
Canc
er
Asth
ma
Arth
ritis
Any P
hysic
al Co
nditio
n
Any affective disorder
Any anxiety disorder
Any affective or anxiety disorder
50%
Alex J Mitche
ll (201
2)
Gili: Mental Comorbidity in Medical dis(n=8000 PRIME-MD Spain)
>
>
0.380.411
0.477
0.412 0.418
0.604
0.514
0.566
0.217
0.294
0.346
0.2810.259
0.47
0.3650.385
0.093
0.13 0.129
0.0840.064 0.072
0.42
0.066
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
Card
iova
scul
ar d
iseas
e
Resp
irato
ry d
iseas
e
Gastro
inst
estin
al di
seas
e
Metab
olic
dise
ase
Muscu
losk
eleta
l dise
ase
Neur
olog
ical d
iseas
e
Hepa
tic d
iseas
e
Oncol
ogica
l dise
ase
Affective Disorder Anxiety Disorder Alcohol Use Disorder
Data from Gili et al.- Comorbidity between common mental disorders and chronic somatic diseases in primary care patients. General Hospital Psychiatry 2010; 32: 240-245 PRIME-MD interview DSMIV 1925 GPs 8000 patients. 57% vs 49%
42%
2. Psychiatric complications of Specific Phys illness2. Psychiatric complications of Specific Phys illness
Whats new?
Prevalence of depression in Oncology settings
70 studies involving 10,071 individuals;14 countries.16.3% (95% CI = 13.9% to 19.5%)
Mj 15% Mn 19% Adj 20% Anx 10% Dysthymia 3%
Proportion meta-analysis plot [random effects]
0.0 0.3 0.6 0.9
combined 0.1730 (0.1375, 0.2116)
Colon et al (1991) 0.0100 (0.0003, 0.0545)
Massie and Holland (1987) 0.0147 (0.0063, 0.0287)
Hardman et al (1989) 0.0317 (0.0087, 0.0793)
Derogatis et al (1983) 0.0372 (0.0162, 0.0720)
Lansky et al (1985) 0.0455 (0.0291, 0.0676)
Mehnert et al (2007) 0.0472 (0.0175, 0.1000)
Katz et al (2004) 0.0500 (0.0104, 0.1392)
Singer et al (2008) 0.0519 (0.0300, 0.0830)
Sneeuw et al (1994) 0.0540 (0.0367, 0.0761)
Pasacreta et al (1997) 0.0633 (0.0209, 0.1416)
Lee et al (1992) 0.0660 (0.0356, 0.1102)
Reuter and Hart (2001) 0.0761 (0.0422, 0.1244)
Grassi et al (2009) 0.0826 (0.0385, 0.1510)
Grassi et al (1993) 0.0828 (0.0448, 0.1374)
Walker et al (2007) 0.0831 (0.0568, 0.1165)
Kawase et al (2006) 0.0851 (0.0553, 0.1240)
Coyne et al (2004) 0.0885 (0.0433, 0.1567)
Alexander et al (2010) 0.0900 (0.0542, 0.1385)
Love et al (2002) 0.0957 (0.0650, 0.1346)
Ozalp et al (2008) 0.0971 (0.0576, 0.1510)
Morasso et al (2001) 0.0985 (0.0535, 0.1625)
Costantini et al (1999) 0.0985 (0.0535, 0.1625)
Silberfarb et al (1980) 0.1027 (0.0587, 0.1638)
Desai et al (1999) [early] 0.1111 (0.0371, 0.2405)
Morasso et al (1996) 0.1121 (0.0593, 0.1877)
Prieto et al (2002) 0.1227 (0.0825, 0.1735)
Ibbotson et al (1994) 0.1242 (0.0776, 0.1853)
Payne et al (1999) 0.1290 (0.0363, 0.2983)
Kugaya et al (1998) 0.1328 (0.0793, 0.2041)
Alexander et al (1993) 0.1333 (0.0594, 0.2459)
Gandubert et al (2009) 0.1597 (0.1040, 0.2300)
Razavi et al (1990) 0.1667 (0.1189, 0.2241)
Akizuki et al (2005) 0.1797 (0.1376, 0.2283)
Leopold et al (1998) 0.1887 (0.0944, 0.3197)
Devlen et al (1987) 0.1889 (0.1141, 0.2851)
Berard et al (1998) 0.1900 (0.1184, 0.2807)
Joffe et al (1986) 0.1905 (0.0545, 0.4191)
Berard et al (1998) 0.2100 (0.1349, 0.3029)
Maunsell et al (1992) 0.2146 (0.1605, 0.2772)
Grandi et al (1987) 0.2222 (0.0641, 0.4764)
Evans et al (1986) 0.2289 (0.1438, 0.3342)
Spiegel et al (1984) 0.2292 (0.1495, 0.3261)
Golden et al (1991) 0.2308 (0.1353, 0.3519)
Fallowfield et al (1990) 0.2565 (0.2054, 0.3131)
Hosaka and Aoki (1996) 0.2800 (0.1623, 0.4249)
Kathol et al (1990) 0.2961 (0.2248, 0.3754)
Green et al (1998) 0.3125 (0.2417, 0.3904)
Jenkins et al (1991) 0.3182 (0.1386, 0.5487)
Burgess et al (2005) 0.3317 (0.2672, 0.4012)
Hall et al (1999) 0.3722 (0.3139, 0.4333)
Morton et al (1984) 0.3958 (0.2577, 0.5473)
Baile et al (1992) 0.4000 (0.2570, 0.5567)
Passik et al (2001) 0.4167 (0.2907, 0.5512)
Bukberg et al (1984) 0.4194 (0.2951, 0.5515)
Massie et al (1979) 0.4850 (0.4303, 0.5401)
Ciaramella and Poli (2001) 0.4900 (0.3886, 0.5920)
Levine et al (1978) 0.5600 (0.4572, 0.6592)
Plumb & Holland (1981) 0.7750 (0.6679, 0.8609)
proportion (95% confidence interval)
1.99
1.12
1.32 1.29
1.05
1.46
0
0.5
1
1.5
2
2.5
3
Depression Anxiety
< 2 years
2 to 10 years
> 10 years
3. Psychiatric Physical Comorbidity => Burden3. Psychiatric Physical Comorbidity => Burden
How to measure burden?
Subjective
Objective
34.4
42.9 42.7
33.8
39.3
41.239.8
30.6
36.6
9
14.315.2
3.9
7.3
17.3
7.7
1.92.5
5.1
2.6 2.2 1.8 1.7 1.4 10.3 0.1
0
5
10
15
20
25
30
35
40
45
50
Depression Panic disorder PTSD Specific phobia Social phobia Bipolar disorder GAD Alcohol abuse Drug abuse
Yearly DOR
Unique
PAR%
Impairment: Days totally out of role per year (Alonso n=63,000) WHO WHM survey x 24co.
Alex J Mitche
ll (201
2)
2007 Auz National Survey of Mental Health & Wellbeing(n=8800 18-65)
Teesson et al.Affective and anxiety disorders and their relationship with chronic physical conditions in Australia: findings of the 2007 National Survey of Mental Health and Wellbeing. Aus NZJP 2011 Nov;45(11):939-46.
12
48
26.431.2
73.2 72
64.8
109.2
0
20
40
60
80
100
120
No af
fectiv
e, an
xiety
, or p
hysic
al co
nditi
on
Af
fectiv
e dis
orde
r onl
y
Anxie
ty d
isord
er on
ly
Ph
ysica
l con
ditio
n on
ly
Comor
bidi
ty[2
] Affe
ctive
and
anxie
ty di
sord
er
[2] A
ffect
ive an
d ph
ysic
al co
nditi
on
[2
] Anx
iety
and
phys
ical c
ondit
ion
[3] A
ffect
ive, a
nxiet
y, an
d ph
ysica
l con
ditio
n
Quality of life: Moussavi et al (2007) Lancet 2007; 370: 851–58
n=245 404 participants from 60 countries
4. Psychiatric Physical Comorbidity => Mortality4. Psychiatric Physical Comorbidity => Mortality
Whats new?
Morbidity
Mortality
Alex J Mitche
ll (201
2)
Mortality and Depression - IHD
Psychosomatic Med (2004) Barth et al
Alex J Mitche
ll (201
2)
Mortality after MI => +11%
Alex J Mitche
ll (201
2)
Five-year Mortality rates
28%
19%
22%
12%
9%8%
0
5
10
15
20
25
30
CHD Diabetes Stroke
People with schizophrenia
People without schizophrenia
Hippisley-Cox J et al (2006) A comparison of survival rates for people with mental health problems and the remaining population with specific conditions.Disability Rights Commission. Equal treatment: closing the gap, July 2006
Slide credit: Dr Alan Farmer, Worcestershire Mental Health Partnership NHS Trust
Alex J Mitche
ll (201
2)
Schizophrenia – all cause mortality
Pooled estimate=2.50
(95% CI=2.18‐2.83)
Mortality Gap: 22.5 yrs
>
Saha (2007) AGP
Alex J Mitche
ll (201
2)
Osborne – Mortality CVD
Alex J Mitche
ll (201
2)
Problem….poor matching
Severity and type of mental illness Age matched Suicides socioec, IQ, education BP, smoking, BMI
Alex J Mitche
ll (201
2)
9.01
7.66
4.33.9 3.56 3.41 3.28 2.98
0
1
2
3
4
5
6
7
8
9
10
Alcoho
l 195
1-195
8
Substa
nce u
se 19
51-19
58
Other
Psych
oses
1951
-1958
Person
ality
1951
-1958
Depres
sion 1
951-1
958
Bipolar
1951
-1958
Neuro
tic A
djustm
ent 1
951-1
958
Schizo
phre
nia 19
51-19
58
Mortality HR by Hospital Admission Diag. for 1million men born b1951-b1958
Gale CR, Arch Gen Psychiatry. 2012 Aug;69(8):823-31. Adj for suicide, age socioec, bmi, IQ, BP, education
Alex J Mitche
ll (201
2)
2.984.12
5.05
3.414.21 4.44
3.56 3.83
5.75
7.66
13.1
17.2
0
2
4
6
8
10
12
14
16
18
20
Schizo
phre
nia 19
51-19
58
Schizo
phre
nia 19
59-19
67
Schizo
phre
nia 19
68-19
76Bipo
lar 19
51-19
58
Bipolar
1959
-1967
Bipolar
1968
-1976
Depres
sion 1
951-1
958
Depres
sion 1
959-1
967
Depres
sion 1
968-1
976
Substa
nce u
se 19
51-19
58
Substa
nce u
se 19
59-19
67
Substa
nce u
se 19
68-19
76
Mortality HR by Hospital Admission Diag. for 1million men born b1951-b1958
Gale CR, Arch Gen Psychiatry. 2012 Aug;69(8):823-31. Adj for suicide, age socioec, bmi, IQ, BP, education
Alex J Mitche
ll (201
2)
**Standardised by the sex and age distribution of the patients Osby et al 2000
Mortality trends in Stockholm County 1976–79 to 1990–95, cardiovascular causes of death
0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1976–79 1980–85 1986–89 1990–95
Dea
ths/
100,
000
1976
–79
perio
d of
refe
renc
e
Patients with schizophrenia*
General population**
Alex J Mitche
ll (201
2)
Cardiovascular disease is primary cause of death in persons with mental illness*
*Average data from 1996–2000 Lutterman et al 2003; Colton & Manderscheid 2006
Perc
enta
ge o
f dea
ths
50
40
20
10
0
30
Heart disease Cancer Cerebrovascular Chronic respiratory
Diabetes Influenza/pneumoniaAccidents Suicide
MO OK RI TX UT VA
10-20%
Alex J Mitche
ll (201
2)
Depression as a risk for dementia
RR = 1.75Over mean of 7 years
5. Medical Care for Psychiatric Patients5. Medical Care for Psychiatric Patients
Psychiatric Care
Comparative Care
Alex J Mitche
ll (201
2)
Quality of Care comparisons
Psychiatric Care Medical Carevs
Medical Care Medical Carevs
Medical patients Medical patients
Psychiatric patientsMedical patients
Psychiatric Care Psychiatric Carevs
Medical patients General patients
Alex J Mitche
ll (201
2)
% Receiving Any treatment for Depression
10.9 11.3
8.18.8
4.3
5.6
10.9
13.8
6.8
17.9
3.4
5.5
15.4
7.2
0
2
4
6
8
10
12
14
16
18
20
High Inc
ome
Belgium
France
German
y
Israe
l
Italy
Japa
nNeth
erlan
dsNew
Zeala
nd
Spain USALow
Inco
me
ChinaColom
biaSouth
Afri
ca
Ukraine
Wang P et al (2007) Lancet 2007; 370: 841–50
n=84,850 face-to-face interviews
Alex J Mitche
ll (201
2)
% Receiving Any treatment for Mental Health
7.2
34.6
5.7 6.3 6.4
11.7
19.1
14
8.9
3.9 3.25.7
32.7
5 57.7
11
16.1
6.5 6.2
2.3 1.8
0
5
10
15
20
25
30
35
40
All P
atie
nts
Men
tal I
ll H
ealth
No
Men
tal I
ll H
ealth
No
chro
nic
med
ical
con
ditio
ns
1 ch
roni
c m
edic
al c
ondi
tion
2 ch
roni
c m
edic
al c
ondi
tions
3 ch
roni
c m
edic
al c
ondi
tions
18-4
4 ye
ars
45-6
4 ye
ars
65-7
4 ye
ars
75+
Cancer n=4878
No Cancer n=90,737
Maria Hewitt, Julia H. Rowland Mental Health Service Use Among Adult Cancer Survivors: Analyses of the National Health Interview Survey Journal of Clinical Oncology, Vol 20, Issue 23 (December), 2002: 4581-4590
12mo Service Use (NIH, 2002)
Alex J Mitche
ll (201
2)
1660 Cancer Patients in Florida (Jacobsen, 2010)
86
12
38
73
4750
74
57
14
26
34
47
84
95
8482
90
84
97
55
88 88
93
88
0
10
20
30
40
50
60
70
80
90
100
A B C D E F G H I J K Mean
Emotional Wellbeing AssessedPain Assessed
Psychooncology. 2011 Nov;20(11):1221-7. doi: 10.1002/pon.1849. Epub 2010 Sep 27.
52%
Alex J Mitche
ll (201
2)
High income% treated
Low & middle income% treated
Physical disorders
Diabetes 94% 77%
Heart disease 78% 51%
Asthma 65% 44%
Mental disorders
Depression 29% 8%
Bipolar disorder 29% 13%
Panic disorder 33% 9%
Ormel J. et al (2008) British Journal of Psychiatry, 192, 368‐375
Thornicroft, G. (2007) Lancet, 370, 807‐808
Quality of care medical vs psychiatric
Alex J Mitche
ll (201
2)
Adherence to Quality Indicators by Condition(McGlynn/ Rand, 2003)
Condition % Of Recommended Care
Senile Cataract 78.7
Breast Cancer 75.7
Prenatal Care 73.0
Low Back Pain 68.5
Coronary Artery Disease 68.0
Hypertension 64.7
Congestive Health Disease 63.9
Depression 57.7
Osteoarthritis 57.3
Asthma 53.5
Diabetes Mellitus 45.4
Headache 45.2
Urinary Track Infection 40.7
Atrial Fibrillation 24.7
Alcohol Dependence 10.5
Quality of medical care
Alex J Mitche
ll (201
2)
Mammography and Schizophrenia
Chochinov (2009) Canada n=110,240 In comparison to the general population (without schizophrenia)
(n=108,792), women with schizophrenia (n=1448) OR 0.64 of mammography in the selected two year period.
Carney and Jones (2006) n=191,356 No difference over five years less likely in the last two years
OR 0.31 (95% CI 0.12-0.83). Werenke (2006) UK n= 533,340
Those with a diagnosis of psychosis were the least likely to attend for mammography
OR 0.33 (95% CI 0.18-0.61) Druss (2002) US
less likely to have had a mammogram in last 2 years (for women aged 50-69 years) adjusted OR 0.78 (95% CI 0.67-0.91).
OR 0.69 mental illness (n=29)
OR 0.53 Psychosis (n=7)
OR 0.82 Affective (n=7)
Summary meta-analysis plot [random effects]
0.5 1 2
combined 0.86 (0.80, 0.92)
[PTCA] Young et al 2000 0.68 (0.65, 0.72)
[PTCA] Young et al 2000 0.70 (0.68, 0.73)
[PTCA] Jones 2005 1.04 (0.98, 1.10)
[PTCA] Druss 2000 0.96 (0.91, 1.02)
[PTCA/PCI] Plomondon 2007 1.06 (0.97, 1.15)
[Cath] Young et al 2000 0.77 (0.75, 0.80)
[Cath] Young et al 2000 0.88 (0.86, 0.90)
[Cath] Plomondon 2007 1.05 (0.98, 1.13)
[Cath] Druss 2000 0.74 (0.70, 0.78)
[CABG] Young et al 2000 0.67 (0.62, 0.72)
[CABG] Young et al 2000 0.79 (0.75, 0.84)
[CABG] Plomondon 2007 1.02 (0.99, 1.06)
[CABG] Jones 2005 0.91 (0.75, 1.09)
[CABG] Druss 2000 0.90 (0.85, 0.96)
[Any Revascularisation] Petersen 2003 0.89 (0.79, 0.98)
[Any Revascularisation] Laursen et al 0.69 (0.68, 0.70)
[Any Revascularisation] Kisely 2007 0.92 (0.86, 1.07)
[Any Revascularisation] Druss 2001 0.87 (0.79, 0.95)
[Any Revascularisation] Druss 2001 0.74 (0.56, 0.95)
[Any Revascularisation] Abrams 2009 OP 0.92 (0.85, 0.99)
[Any Revascularisation] Abrams 2009 IP 1.00 (0.91, 1.10)
[Angiography] Petersen 2003 0.90 (0.83, 0.98)
odds ratio (95% confidence interval)
Summary meta-analysis plot [random effects]
0.01 0.1 0.2 0.5 1 2
combined 0.53 (0.44, 0.64)
[PTCA] Young et al 2000 [Older] 0.32 (0.21, 0.47)
[PTCA] Young et al 2000 [Younger] 0.55 (0.46, 0.65)
[PTCA] Jones 2005 0.74 (0.41, 1.08)
[Cath] Young et al 2000 [Younger] 0.70 (0.63, 0.77)
[Cath] Young et al 2000 [Older] 0.51 (0.42, 0.62)
[CABG] Young et al 2000 [Older] 0.67 (0.46, 0.95)
[CABG] Young et al 2000 [Younger] 0.71 (0.54, 0.92)
[CABG] Jones 2005 0.24 (0.04, 1.41)
[Any Revascularisation Women] Lawrence 2003 0.34 (0.18, 0.64)
[Any Revascularisation Men] Lawrence 2003 0.31 (0.21, 0.45)
relative risk (95% confidence interval)
Any Mental illnessHR = 0.86 (0.80-0.92)
SchizophreniaHR = 0.53 (0.44 – 0.64)
Quality of Medical Treatment i Procedures
Quality of Medical Treatment ii Medication
Summary meta-analysis plot [random effects]
0.5 1 2 5 10 100
combined 0.92 (0.85, 1.00)
HAART (Himelhoch2007) 0.85 (0.71, 1.23)
HAART (Himelhoch2004) 2.28 (1.24, 32.50)
HAART (Mijch) 1.28 (1.04, 1.57)
BBlockers (Petersen) 0.78 (0.69, 0.92)
Bblocker (Plomondon) 1.11 (0.97, 1.28)
Bblocker (Druss2001) 0.85 (0.72, 0.98)
Aspirin (Plomondon) 0.93 (0.83, 1.04)
Aspirin (Petersen) 0.96 (0.81, 1.15)
Aspirin (Druss2001) 0.81 (0.65, 0.98)
ACE-I or ARBb (Plomondon) 0.93 (0.84, 1.01)
ACE (Petersen) 0.92 (0.79, 1.09)
ACE (Druss2001) 0.81 (0.65, 0.98)
odds ratio (95% confidence interval)
Summary meta-analysis plot [random effects]
0.1 0.2 0.5 1 2 5
combined 0.79 (0.66, 0.95)
Statin (Weiss) 0.54 (0.36, 0.51)
Statin (Kreyenbuhl) 0.29 (0.11, 0.77)
Statin (Hippisley-Cox) 0.85 (0.80, 0.91)
Osteoporosis (Bishop) 0.38 (0.15, 0.97)
Insulin (Weiss) 1.44 (0.96, 2.16)
Cholesterol (Weiss) 1.85 (1.11, 3.09)
Cholesterol (Desai) 1.01 (0.37, 2.77)
Bblocker (Weiss) 0.96 (0.54, 1.71)
Bblocker (Hippisley-Cox) 0.96 (0.88, 1.06)
Bblocker (Desai) 0.70 (0.43, 1.15)
Aspirin (Weiss) 0.89 (0.64, 1.24)
Aspirin (Hippisley-Cox) 1.00 (0.97, 1.04)
Aspirin (Desai) 1.07 (0.49, 2.30)
Arthritis (Redelmeier) 0.59 (0.57, 0.62)
ACE-I or ARBb (Weiss) 0.83 (0.61, 1.14)
ACE (Kreyenbuhl) 0.23 (0.12, 0.44)
odds ratio (95% confidence interval)
OR =0.92 OR =0.79Summary meta-analysis plot [random effects]
0.01 0.1 0.2 0.5 1 2 5 10 100
combined 0.72 (0.51, 1.00)
Statin (Kreyenbuhl) 0.14 (0.05, 0.44)
Statin (Hippisley-Cox) 1.15 (0.80, 1.95)
HAART (Yun) 1.43 (1.18, 1.74)
HAART (Tegger) 0.36 (0.25, 0.50)
Cholesterol (Hippisley-Cox) 0.86 (0.70, 12.30)
Cholesterol (Desai) 1.31 (0.57, 3.00)
Chemotherapy (Goodwin) 0.65 (0.43, 1.00)
Bblocker (Wang) 0.55 (0.45, 0.55)
Bblocker (Hippisley-Cox) 1.18 (0.94, 1.56)
Bblocker (Desai) 0.70 (0.48, 1.03)
Aspirin (Desai) 0.75 (0.39, 1.43)
ACE (Kreyenbuhl) 0.46 (0.18, 1.19)
odds ratio (95% confidence interval)
OR =0.72
SMI Schz Affective
Alex J Mitche
ll (201
2)
Example
If you have cancer, how likely is it that you will receive treatment?
Would this be affected by your mental health condition?
0
2
4
6
8
10
12
14
No mentaldisorder
Substanceabuse disorder
Other mentaldisorder
Mood disorder Any mentaldisorder
Psychoticdisorder
Dementia
Chances of No Treatment for Colorectal Ca Chances of No Treatment for Colorectal Ca (2011)(2011)
Baillargeon et al Effect of mental disorders on diagnosis, treatment, and survival of older adults with colon cancer. J Am Geriatr Soc. 2011 Jul;59(7):1268-73.
6. Monitoring and Treatment6. Monitoring and Treatment
Monitoring metabolic problems
Treating metabolic complications
Alex J Mitche
ll (201
2)
CATIE: rates of pharmacological interventions for abnormal blood pressure, lipids and glucose
Nasrallah et al 2006
n=1488 n=685 n=690
Patie
nts
(%)
n=481 n=300 n=75 n=34 n=471 n=421
33.2
10.9
68.362.4
45.3
89.4
0
20
40
60
80
100
Hypertension Diabetes Dyslipidaemia
Prevalence Lack of medical intervention
Alex J Mitche
ll (201
2)
Don’t just SCREEN – INTERVENE
Alex J Mitche
ll (201
2)
END: ……..Rule of 50’s
Cancer, neurological disease: 50% clinical disorder Hepatic disease: almost 50% AUD Affective disorder: 50 days lost per year Two people with Schz will suffer 50 years YLL 50% have evidence of depression assessment 50% of CNS identify depression in cancer 50% of identified depressions are treated (1yr) 50% of Schz receive CABG after MI 50% on antipsychotics receive Gc testing 50% on antipsychotics with diabetes receive treatment