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50 slides on Physical health Mental health Comorbidity (ajmitchell Nov2012))
 

50 slides on Physical health Mental health Comorbidity (ajmitchell Nov2012))

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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.

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.

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    50 slides on Physical health Mental health Comorbidity (ajmitchell Nov2012)) 50 slides on Physical health Mental health Comorbidity (ajmitchell Nov2012)) Presentation Transcript

    • Physical Health / Mental Health: Evidence based exploration of co-morbidity Alex J Mitchell ajm80@le.ac.ukLong term conditions and mental health, Northampton November 2012
    • Alex J Mitchell (2012)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
    • National ReportsAlex J Mitchell (2012)
    • 1. Psychiatric ‐ Physical illness Comorbidity Large Surveys
    • Alex J Mitchell (2012)2007 Australian National Survey of MentalHealth and Wellbeing (n= 8841, 16-85 years) Women 19% 8% anxiety affective 3.9 12.6 2.5 1.6 0.2 0.8 substance use 1.7 4%
    • Alex J Mitchell (2012)Washington State Survey (n=23,000) 69% 31% alone 32% 5% alone 36% 5% alone
    • Alex J Mitchell (2012)Depressive Symptoms in MedicalConditions (on CES-D8) n=8400
    • Alex J Mitchell (2012)Mental Health Comorbidity in Medical dis(n=8800 (WMH-CIDI 3.0) 35 50% Any affective disorder Any anxiety disorder 29.7 30 Any affective or anxiety disorder 25.6 25 23.3 23.4 22.5 21.9 21.2 20.5 19.7 20 18.7 17.4 17.6 15 13.5 12.8 11.4 10 9.6 10 7.9 7 6.8 5 5 0 n es HD er n a is o m tio nc rit et iti rC th di th nd ab Ca As n o Ar Di Co Co ke ro l al ica sic St ys hy Ph yP No AnData 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.
    • Alex J Mitchell (2012)Gili: Mental Comorbidity in Medical dis(n=8000 PRIME-MD Spain) > 0.7 42% 0.604 0.6 Affective Disorder Anxiety Disorder Alcohol Use Disorder 0.566 0.514 0.5 0.477 0.47 > 0.411 0.412 0.418 0.42 0.4 0.38 0.385 0.365 0.346 0.294 0.3 0.281 0.259 0.217 0.2 0.13 0.129 0.093 0.084 0.1 0.064 0.072 0.066 0 e e e e e e e e as as as as as as as as ise se ise ise ise ise ise ise di ld ld d d d d d tic lic lar ry ica al ica al to pa bo tin let u g og sc ira lo He ta es ke ol va co sp Me st os ur io On in Re ul Ne rd ro scCa st Mu GaData from Gili et al.- Comorbidity between common mental disorders and chronic somatic diseases in primary care patients. General HospitalPsychiatry 2010; 32: 240-245 PRIME-MD interview DSMIV 1925 GPs 8000 patients. 57% vs 49%
    • 2. Psychiatric complications of Specific Phys illness Whats new?
    • Prevalence of depression in Oncology settings Plumb & Holland (1981) Proportion meta-analysis plot [random effects] 0.7750 (0.6679, 0.8609) Levine et al (1978) 0.5600 (0.4572, 0.6592) Ciaramella and Poli (2001) 0.4900 (0.3886, 0.5920) Massie et al (1979) 0.4850 (0.4303, 0.5401)70 studies involving 10,071 individuals;14 countries. Bukberg et al (1984) Passik et al (2001) 0.4194 (0.2951, 0.5515) 0.4167 (0.2907, 0.5512)16.3% (95% CI = 13.9% to 19.5%) Baile et al (1992) Morton et al (1984) Hall et al (1999) 0.4000 (0.2570, 0.5567) 0.3958 (0.2577, 0.5473) 0.3722 (0.3139, 0.4333) Burgess et al (2005) 0.3317 (0.2672, 0.4012) Jenkins et al (1991) 0.3182 (0.1386, 0.5487)Mj 15% Mn 19% Adj 20% Anx 10% Dysthymia 3% Green et al (1998) 0.3125 (0.2417, 0.3904) Kathol et al (1990) 0.2961 (0.2248, 0.3754) Hosaka and Aoki (1996) 0.2800 (0.1623, 0.4249) Fallowfield et al (1990) 0.2565 (0.2054, 0.3131) Golden et al (1991) 0.2308 (0.1353, 0.3519) Spiegel et al (1984) 0.2292 (0.1495, 0.3261) Evans et al (1986) 0.2289 (0.1438, 0.3342) Grandi et al (1987) 0.2222 (0.0641, 0.4764) Maunsell et al (1992) 0.2146 (0.1605, 0.2772) Berard et al (1998) 0.2100 (0.1349, 0.3029) Joffe et al (1986) 0.1905 (0.0545, 0.4191) Berard et al (1998) 0.1900 (0.1184, 0.2807) Devlen et al (1987) 0.1889 (0.1141, 0.2851) Leopold et al (1998) 0.1887 (0.0944, 0.3197) Akizuki et al (2005) 0.1797 (0.1376, 0.2283) Razavi et al (1990) 0.1667 (0.1189, 0.2241) Gandubert et al (2009) 0.1597 (0.1040, 0.2300) Alexander et al (1993) 0.1333 (0.0594, 0.2459) Kugaya et al (1998) 0.1328 (0.0793, 0.2041) Payne et al (1999) 0.1290 (0.0363, 0.2983) Ibbotson et al (1994) 0.1242 (0.0776, 0.1853) Prieto et al (2002) 0.1227 (0.0825, 0.1735) Morasso et al (1996) 0.1121 (0.0593, 0.1877) Desai et al (1999) [early] 0.1111 (0.0371, 0.2405) Silberfarb et al (1980) 0.1027 (0.0587, 0.1638) Costantini et al (1999) 0.0985 (0.0535, 0.1625) Morasso et al (2001) 0.0985 (0.0535, 0.1625) Ozalp et al (2008) 0.0971 (0.0576, 0.1510) Love et al (2002) 0.0957 (0.0650, 0.1346) Alexander et al (2010) 0.0900 (0.0542, 0.1385) Coyne et al (2004) 0.0885 (0.0433, 0.1567) Kawase et al (2006) 0.0851 (0.0553, 0.1240) Walker et al (2007) 0.0831 (0.0568, 0.1165) Grassi et al (1993) 0.0828 (0.0448, 0.1374) Grassi et al (2009) 0.0826 (0.0385, 0.1510) Reuter and Hart (2001) 0.0761 (0.0422, 0.1244) Lee et al (1992) 0.0660 (0.0356, 0.1102) Pasacreta et al (1997) 0.0633 (0.0209, 0.1416) Sneeuw et al (1994) 0.0540 (0.0367, 0.0761) Singer et al (2008) 0.0519 (0.0300, 0.0830) Katz et al (2004) 0.0500 (0.0104, 0.1392) Mehnert et al (2007) 0.0472 (0.0175, 0.1000) Lansky et al (1985) 0.0455 (0.0291, 0.0676) Derogatis et al (1983) 0.0372 (0.0162, 0.0720) Hardman et al (1989) 0.0317 (0.0087, 0.0793) Massie and Holland (1987) 0.0147 (0.0063, 0.0287) Colon et al (1991) 0.0100 (0.0003, 0.0545) combined 0.1730 (0.1375, 0.2116) 0.0 0.3 0.6 0.9 proportion (95% confidence interval)
    • 3 < 2 years2.5 2 to 10 years > 10 years 1.99 2 1.461.5 1.32 1.29 1.12 1.05 10.5 0 Depression Anxiety
    • 3. Psychiatric Physical Comorbidity => Burden How to measure burden? Subjective Objective
    • Impairment: Days totally out of role per year 50 (Alonso n=63,000) WHO WHM survey x 24co. Yearly DOR45 Unique 42.9 42.7 PAR% 41.2 39.840 39.3 36.635 34.4 33.8 30.6302520 17.3 15.215 14.310 9 7.3 7.7 5.15 3.9 2.6 2.2 2.5 1.8 1.7 1.9 1.4 1 0.3 0.10 Depression Panic disorder PTSD Specific phobia Social phobia Bipolar disorder GAD Alcohol abuse Drug abuse
    • Alex J Mitchell (2012)2007 Auz National Survey of Mental Health& Wellbeing(n=8800 18-65) 120 109.2 100 80 73.2 72 64.8 60 48 40 31.2 26.4 20 12 0 ly n ity on n n ly y er io on o tio nl on id rd iti iti dit ro di rb nd on so nd er on on de mo co iti rd co di lc lc or nd so ty Co l al ica ica dis ica xie co di ic ys ys ys ys ty an l e ica tiv ph xie ph ph ph d ys fec an An nd or d d Ph an an Af a , ive ety ty ive y, ct ie xi iet ffe ct nx an nx ffe ]A ]A e, ,a ]A [2 tiv [2 ive [2 fec ct af ffe No ]A [3Teesson 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.
    • n=245 404 participants from 60 countriesQuality of life: Moussavi et al (2007) Lancet 2007; 370: 851–58
    • 4. Psychiatric Physical Comorbidity => Mortality Whats new? Morbidity  Mortality
    • Alex J Mitchell (2012)Mortality and Depression - IHD Psychosomatic Med (2004) Barth et al
    • Alex J Mitchell (2012)Mortality after MI => +11%
    • Alex J Mitchell (2012) Five-year Mortality rates 30 People with schizophrenia 28% People without schizophrenia 25 22% 20 19% 15 12% 10 9% 8% 5 0 CHD Diabetes StrokeHippisley-Cox J et al (2006) A comparison of survival rates for people with mental healthproblems 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 Mitchell (2012)Schizophrenia – all cause mortality >Pooled estimate=2.50 Saha (2007) AGP (95% CI=2.18‐2.83)Mortality Gap: 22.5 yrs
    • Alex J Mitchell (2012)Osborne – Mortality CVD
    • Alex J Mitchell (2012)Problem….poor matching  Severity and type of mental illness  Age matched  Suicides  socioec, IQ, education  BP, smoking, BMI
    • Alex J Mitchell (2012)Mortality HR by Hospital Admission Diag.for 1million men born b1951-b1958 10 9.01 9 8 7.66 7 6 5 4.3 3.9 4 3.56 3.41 3.28 2.98 3 2 1 0 58 8 58 58 8 58 58 8 95 95 95 19 19 19 19 19 -1 -1 -1 1- 1- - - 1- 51 51 51 51 51 95 5 5 19 19 19 19 19 19 19 t1 ar ol a y on es e en ni it us oh ol os al si re tm ip on lc e s ch ph us B nc re A rs y zo ep dj ta Ps Pe bs A hi D Sc er ic Su t th ro O eu NGale CR, Arch Gen Psychiatry. 2012 Aug;69(8):823-31. Adj for suicide, age socioec, bmi, IQ, BP, education
    • Sc hi zo ph Sc re hi ni zo a ph 19 Sc re 51 0 2 4 6 8 10 12 14 16 18 20 hi ni -1 zo a 95 ph 19 8 re 59 2.98 ni -1 a 96 19 7 68 4.12 -1 97 B 6 ip 5.05 ol ar B 19 ip 51 ol ar -1 95 B 19 8 ip 59 3.41 ol ar -1 96 19 7 68 D -1 ep 97 re 6 ss D 4.21 4.44 io ep n re 19 ss 51 D io -1 ep n 95 re 19 8 for 1million men born b1951-b1958 ss 59 io -1 n 96 Su 19 7 68 3.56 3.83 bs -1 ta 97 nc 6 Su e 5.75 bs us ta e Mortality HR by Hospital Admission Diag. nc 19 Su e 51 bs us -1 ta e 95 nc 19 8 e 59 7.66 us -1 e 96 19 7 68 13.1 -1 97 6 17.2Gale CR, Arch Gen Psychiatry. 2012 Aug;69(8):823-31. Adj for suicide, age socioec, bmi, IQ, BP, education Alex J Mitchell (2012)
    • Alex J Mitchell (2012)Mortality trends in Stockholm County1976–79 to 1990–95, cardiovascular causes of death 1.4 Patients with schizophrenia* 1976–79 period of reference 1.2 1.0 Deaths/100,000 0.8 0.6 General population** 0.4 0.2 0 1976–79 1980–85 1986–89 1990–95**Standardised by the sex and age distribution of the patients Osby et al 2000
    • Alex J Mitchell (2012)Cardiovascular disease is primary cause ofdeath in persons with mental illness* 50 Percentage of deaths 40 10-20% 30 20 10 0 MO OK RI TX UT VA Heart disease Cancer Cerebrovascular Chronic respiratory Accidents Diabetes Influenza/pneumonia Suicide*Average data from 1996–2000 Lutterman et al 2003; Colton & Manderscheid 2006
    • Alex J Mitchell (2012)
    • Depression as arisk for dementia RR = 1.75 Over mean of 7 years
    • 5. Medical Care for Psychiatric Patients Psychiatric Care Comparative Care
    • Alex J Mitchell (2012)Quality of Care comparisons Psychiatric Care vs Psychiatric Care General patients Medical patients Psychiatric Care vs Medical Care Medical patients Medical patients Medical Care vs Medical Care Medical patients Psychiatric patients
    • Alex J Mitchell (2012)% Receiving Any treatment for Depression 20 n=84,850 face-to-face interviews 17.9 18 16 15.4 13.8 14 12 11.3 10.9 10.9 10 8.8 8.1 8 7.2 6.8 6 5.6 5.5 4.3 4 3.4 2 0 SA n ca e n m a ly na y e el e ce nd ds m ai m bi an pa n Ita ra u i hi an U ai la fr co n Sp om co gi m Ja Is rla C A kr a Fr el In er In Ze ol U h B he G w ut h C ew et ig Lo SoH N N Wang P et al (2007) Lancet 2007; 370: 841–50
    • Alex J Mitchell (2012) 12mo Service Use (NIH, 2002)40 34.635 32.7 Cancer n=4878 No Cancer n=90,7373025 % Receiving Any treatment for Mental Health 19.120 16.1 1415 11.7 11 8.910 7.7 7.2 6.5 5.7 5.7 5 6.3 6.4 6.2 55 3.9 3.2 2.3 1.80 alth th ons n ns ns ts 75+ rs rs rs itio eal tien itio itio yea yea yea He diti ond Ill H ond ond Pa con l Ill 44 64 74 al c l al c al c nta All nt a 18- 45- 65- cal dic Me dic dic Me edi me me me No cm nic nic nic oni hro hro hro chr 1c 2c 3c No 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
    • Alex J Mitchell (2012) 1660 Cancer Patients in Florida (Jacobsen, 2010)100 Emotional Wellbeing Assessed 97 52% 95 Pain Assessed 93 9090 88 88 88 86 84 84 84 8280 73 747060 57 55 5050 47 4740 38 3430 2620 14 1210 0 A B C D E F G H I J K Mean Psychooncology. 2011 Nov;20(11):1221-7. doi: 10.1002/pon.1849. Epub 2010 Sep 27.
    • Alex J Mitchell (2012)Quality of care medical vs psychiatric High income Low & middle income % treated % 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
    • Alex J Mitchell (2012)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 Mitchell (2012)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)
    • Quality of Medical Treatment i Procedures Summary meta-analysis plot [random effects] [Angiography] Petersen 2003 0.90 (0.83, 0.98) [Any Revascularisation] Abrams 2009 IP 1.00 (0.91, 1.10)[Any Revascularisation] Abrams 2009 OP 0.92 (0.85, 0.99) [Any Revascularisation] Druss 2001 0.74 (0.56, 0.95) [Any Revascularisation] Druss 2001 0.87 (0.79, 0.95) [Any Revascularisation] Kisely 2007 0.92 (0.86, 1.07) Summary meta-analysis plot [random effects] [Any Revascularisation] Laursen et al 0.69 (0.68, 0.70) [Any Revascularisation Men] Lawrence 2003 0.31 (0.21, 0.45) [Any Revascularisation] Petersen 2003 0.89 (0.79, 0.98) [CABG] Druss 2000 0.90 (0.85, 0.96) [Any Revascularisation Women] Lawrence 2003 0.34 (0.18, 0.64) [CABG] Jones 2005 0.91 (0.75, 1.09) [CABG] Jones 2005 0.24 (0.04, 1.41) [CABG] Plomondon 2007 1.02 (0.99, 1.06) [CABG] Young et al 2000 [Younger] 0.71 (0.54, 0.92) [CABG] Young et al 2000 0.79 (0.75, 0.84) [CABG] Young et al 2000 [Older] 0.67 (0.46, 0.95) [CABG] Young et al 2000 0.67 (0.62, 0.72) [Cath] Druss 2000 0.74 (0.70, 0.78) [Cath] Young et al 2000 [Older] 0.51 (0.42, 0.62) [Cath] Plomondon 2007 1.05 (0.98, 1.13) [Cath] Young et al 2000 [Younger] 0.70 (0.63, 0.77) [Cath] Young et al 2000 0.88 (0.86, 0.90) [PTCA] Jones 2005 0.74 (0.41, 1.08) [Cath] Young et al 2000 0.77 (0.75, 0.80) [PTCA] Young et al 2000 [Younger] 0.55 (0.46, 0.65) [PTCA/PCI] Plomondon 2007 1.06 (0.97, 1.15) [PTCA] Druss 2000 0.96 (0.91, 1.02) [PTCA] Young et al 2000 [Older] 0.32 (0.21, 0.47) [PTCA] Jones 2005 1.04 (0.98, 1.10) combined 0.53 (0.44, 0.64) [PTCA] Young et al 2000 0.70 (0.68, 0.73) 0.01 0.1 0.2 0.5 1 2 [PTCA] Young et al 2000 0.68 (0.65, 0.72) relative risk (95% confidence interval) combined 0.86 (0.80, 0.92) 0.5 1 2 odds ratio (95% confidence interval) Any Mental illness SchizophreniaHR = 0.86 (0.80-0.92) HR = 0.53 (0.44 – 0.64)
    • Quality of Medical Treatment ii Medication OR =0.92 OR =0.79 OR =0.72 Summary meta-analysis plot [random effects] Summary meta-analysis plot [random effects] Summary meta-analysis plot [random effects] ACE (Kreyenbuhl) 0.23 (0.12, 0.44) ACE (Druss2001) 0.81 (0.65, 0.98) ACE (Kreyenbuhl) 0.46 (0.18, 1.19) ACE-I or ARBb (Weiss) 0.83 (0.61, 1.14) ACE (Petersen) 0.92 (0.79, 1.09) Aspirin (Desai) 0.75 (0.39, 1.43) Arthritis (Redelmeier) 0.59 (0.57, 0.62) ACE-I or ARBb (Plomondon) 0.93 (0.84, 1.01) Aspirin (Desai) 1.07 (0.49, 2.30) Bblocker (Desai) 0.70 (0.48, 1.03) Aspirin (Hippisley-Cox) 1.00 (0.97, 1.04) Aspirin (Druss2001) 0.81 (0.65, 0.98) Bblocker (Hippisley-Cox) 1.18 (0.94, 1.56) Aspirin (Weiss) 0.89 (0.64, 1.24) Aspirin (Petersen) 0.96 (0.81, 1.15) Bblocker (Wang) 0.55 (0.45, 0.55) Bblocker (Desai) 0.70 (0.43, 1.15) Aspirin (Plomondon) 0.93 (0.83, 1.04) Bblocker (Hippisley-Cox) 0.96 (0.88, 1.06) Chemotherapy (Goodwin) 0.65 (0.43, 1.00) Bblocker (Druss2001) 0.85 (0.72, 0.98) Bblocker (Weiss) 0.96 (0.54, 1.71) Cholesterol (Desai) 1.31 (0.57, 3.00) Cholesterol (Desai) 1.01 (0.37, 2.77) Cholesterol (Hippisley-Cox) 0.86 (0.70, 12.30) Bblocker (Plomondon) 1.11 (0.97, 1.28) Cholesterol (Weiss) 1.85 (1.11, 3.09) HAART (Tegger) 0.36 (0.25, 0.50) BBlockers (Petersen) 0.78 (0.69, 0.92) Insulin (Weiss) 1.44 (0.96, 2.16) Osteoporosis (Bishop) 0.38 (0.15, 0.97) HAART (Yun) 1.43 (1.18, 1.74) HAART (Mijch) 1.28 (1.04, 1.57) Statin (Hippisley-Cox) 0.85 (0.80, 0.91) Statin (Hippisley-Cox) 1.15 (0.80, 1.95) HAART (Himelhoch2004) 2.28 (1.24, 32.50) Statin (Kreyenbuhl) 0.29 (0.11, 0.77) Statin (Kreyenbuhl) 0.14 (0.05, 0.44) HAART (Himelhoch2007) 0.85 (0.71, 1.23) Statin (Weiss) 0.54 (0.36, 0.51) combined 0.72 (0.51, 1.00) combined 0.92 (0.85, 1.00) combined 0.79 (0.66, 0.95) 0.1 0.2 0.5 1 2 5 0.01 0.1 0.2 0.5 1 2 5 10 100 0.5 1 2 5 10 100 odds ratio (95% confidence interval) odds ratio (95% confidence interval) odds ratio (95% confidence interval) SMI Schz Affective
    • Alex J Mitchell (2012)Example  If you have cancer, how likely is it that you will receive treatment?  Would this be affected by your mental health condition?
    • Chances of No Treatment for Colorectal Ca (2011)14121086420 No m ental Substance Other m ental Mood disorder Any m ental Psychotic Dem entia disorder abuse disorder disorder disorder disorder 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 Treatment Monitoring metabolic problems Treating metabolic complications
    • Alex J Mitchell (2012)CATIE: rates of pharmacological interventions forabnormal blood pressure, lipids and glucose Nasrallah et al 2006 n=1488 n=685 n=690 100 89.4 80 68.3 Patients (%) 62.4 60 45.3 40 33.2 20 10.9 0 n=481 n=300 n=75 n=34 n=471 n=421 Hypertension Diabetes Dyslipidaemia Prevalence Lack of medical intervention
    • Alex J Mitchell (2012)Don’t just SCREEN – INTERVENE
    • Alex J Mitchell (2012)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