assist. prof. Igor Filipčić, MD, PhD
Psychiatric Hospital „Sveti Ivan”
Zagreb, Croatia
Prevention of mortality
and morbidi...
Overview
• Increased Morbidity and Mortality Associated with
Serious Mental Illness (SMI)
• Increased Morbidity and Mortal...
In Serious Mental Illness (schizophrenia, depression, bipolar)
1. mortality is being 2 to 3 times higher compared to the g...
Potential factors for high rates of the co-morbid physical
illnesses in schizophrenic patients
environment
schizophre
nial...
Mortality and somatic morbidity in schizophrenic patients
Percentageofdeaths
50
40
20
10
0
30
Heart disease Cancer Cerebro...
People with SMI have limited access to physical health care
N=8227
Schizophrenic patients use less
than general population...
We can improve the detection and treatment of comorbid
somatic illnesses in schizophrenic patients by.......
…taking more ...
Somatic comorbidity in psychiatric patients - PH „Sveti Ivan”
hospitalizations from 2013 to August 2015
N=13 686
• schizop...
Somatic comorbidity in psychiatric patients - PH „Sveti Ivan”
35,8% patients had
endocrine system
disease
41.80%
34.90%
25...
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
2012. 2013. 2014.
10.80%
18.30%
29.70%
16.70%
23.50%
34.50%
SCHIZOPH...
Prevalence and relative risks factors (RR) in schizophrenia
and depression /bipolar in PH „Sveti Ivan”compared to the
gene...
Conducted In
 hospital
 daily hospital
 outpatient
 collaborating institutions
Program for integrative psychiatry
Team...
more responsibility for the patient in 3 steps
Program for integrative psychiatry
preventive programme
personalized pharma...
3
A. patients with major menthal health
problem
B. family – caregivers
Lifestyle changes with behavioural
treatments
over...
www.pbsvi.hr
380 employees
40 psychiatrists
9 teachers
125 nurses
700 patients
550 beds
150 daily hospital places
Prevention of mortality and morbidity in acute and chronic psychiatric patients
Prevention of mortality and morbidity in acute and chronic psychiatric patients
Prevention of mortality and morbidity in acute and chronic psychiatric patients
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Prevention of mortality and morbidity in acute and chronic psychiatric patients

Prevention of mortality and morbidity in acute and chronic psychiatric patients
Published on: Mar 4, 2016
Published in: Health & Medicine      
Source: www.slideshare.net


Transcripts - Prevention of mortality and morbidity in acute and chronic psychiatric patients

  • 1. assist. prof. Igor Filipčić, MD, PhD Psychiatric Hospital „Sveti Ivan” Zagreb, Croatia Prevention of mortality and morbidity in acute and chronic psychiatric patients Program for integrative psychiatry
  • 2. Overview • Increased Morbidity and Mortality Associated with Serious Mental Illness (SMI) • Increased Morbidity and Mortality – data from Psychiatric Hospital „Sv Ivan” • Program for integrative psychiatry (PIPS) – in three steps • Conclusion
  • 3. In Serious Mental Illness (schizophrenia, depression, bipolar) 1. mortality is being 2 to 3 times higher compared to the general population 2. 60% of this excess mortality is due to physical illness (MI, CVI, embol.) 3. high risk of undetected somatic co-morbidity 4. incidence is much higher than in the normal population for • cardiovascular diseases / infarct my. stroke/ • unrecognized cancer /lungs, colon/ • diabetes mellitus, metabolic syndrome • respiratory diseases /COPD 5. psychiatric patients • have still limited access to physical health care • physical complaints at a late and more serious stage Data from Oud et al 2009 BMC Family Practice Crump et al. 2013 AM J Psychiatry Leucht et al.2007 AP Scandinavica Introduction
  • 4. Potential factors for high rates of the co-morbid physical illnesses in schizophrenic patients environment schizophre nialifestyle BEHAVIOR • psychotic symptoms • negative sy./ low energy • cognitive disturbances • reduced communication • isolated LIFESTYLE • smoking • using drugs • alcohol • poor diets/obesity • not enough exercise SYSTEM-RELATED FACTORS • not covered by health insurance • less access to health care • not adequate access to medical treatment • unemployment TREATMENT Antipsychotics • side effects • weight gain, diabetes • increased prolactin level
  • 5. Mortality and somatic morbidity in schizophrenic patients Percentageofdeaths 50 40 20 10 0 30 Heart disease Cancer Cerebrovascular Chronic respiratory Diabetes Influenza/pneumoniaAccidents Suicide MO OK RI TX UT VA *Average data from 1996–2000 Colton & Manderscheid 2006, Crump et al. 2013 AM J Psychiatry Schizophrenic patients are at risk of under-diagnosis and under-treatment • men with schizophrenia die 15 years earlier • women die 12 years earlier The leading causes of death in persons with schizophrenia are ischemic heart disease and cancer
  • 6. People with SMI have limited access to physical health care N=8227 Schizophrenic patients use less than general population • general medical services • coronary revascularization • standard diabetes care • antihypertensive medication • lipid-lowering medication  Risk factors  smoking  alcohol  drugs/narcotics  poor nutrition  not exercise
  • 7. We can improve the detection and treatment of comorbid somatic illnesses in schizophrenic patients by....... …taking more responsibility for the patient …implementing systematic education …improving parity in health care access and provision …forging collaborations with other medical specialist Fleischhacker WW et al. Comorbid Somatic Illness in Patients with Severe Mental Disorders: Clinical, Policy and Research Challenges J Clin Psychiatry. 2008; 68:514-519
  • 8. Somatic comorbidity in psychiatric patients - PH „Sveti Ivan” hospitalizations from 2013 to August 2015 N=13 686 • schizophrenia 31% • depression 28% • bipolar 10% 78.9% 15.8% 5.7% 3.9% 3.9% 3.5% Prevalence of cardiovascular diseases hypertension cardiomyopathy atrial fibrillation paroxysmal tachycardia ishemic heart disease sequelae of myocardial infarction 39,3% of patients had cardiovascular disease personal data
  • 9. Somatic comorbidity in psychiatric patients - PH „Sveti Ivan” 35,8% patients had endocrine system disease 41.80% 34.90% 25.70% 24.50% 4.00% 3.60% Prevalence of endocrine system diseases diabetes hiperlipidemia hypothyreosis adiposity anemia struma
  • 10. 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00% 2012. 2013. 2014. 10.80% 18.30% 29.70% 16.70% 23.50% 34.50% SCHIZOPHRENIA endocrine system disease cardiovascular disease 0.00% 10.00% 20.00% 30.00% 40.00% 50.00% 2012. 2013. 2014. 19.70% 28.30% 37.90% 22.60% 32.10% 42.10% DEPRESSION&BIPOLAR endocrine system disease cardiovascular disease Mortality: MI /CVI/embolis 64 patients - 8 patients (2013) 77 patients - 9 patients (2014) 69 patients - 9 patients (2015)* Cancer: 4.9% (2013) 5.8% (2014) 6.3% (2015) * 2015 . first 8 months personal data
  • 11. Prevalence and relative risks factors (RR) in schizophrenia and depression /bipolar in PH „Sveti Ivan”compared to the general population in Croatia RR = relative risk Risk factors schizophrenia Prevalence RR depression/ bipolar Prevalence RR Obesity 51.9% 2 36.3% 2 Smoking 72.2% 4 61.5% 3 DM 29.2% 2 33.4% 2 Hypertension 37.3% 3 49.7% 3 Dyslipidemia 55.4% 5 26.9% 3 personal data 2013-2015
  • 12. Conducted In  hospital  daily hospital  outpatient  collaborating institutions Program for integrative psychiatry Team  psychiatrists, psychotherapists  nurses, occupational therapists  psychologists, social workers, nutritionist  internal medicine specialist, neurologist Goals  reduction of mortality  comprehensive treatment  rehabilitation  early identification  quality of life improvement in psychiatric patient with chronic somatic diseases
  • 13. more responsibility for the patient in 3 steps Program for integrative psychiatry preventive programme personalized pharmacotherapy & psychotherapy a. physical examinations b. screening  BMI, weight, waist blood pressure  fasting glucose, HbA1C  fasting lipids, HDL-cholesterol  ECG c. screening habits (smoke, drug abuse, alcohol abuse, activity, fast food) d. questionnaires, scales (PANS, CGI,QLSQ….) 1 2 a. pharmacotherapy strategies • drugs selection & monitoring • plasma concentration, • side effects (metabolic,prolactin level) • switch medications b. psychotherapy strategies  psychodynamic group therapy  CBT  multifamily therapy
  • 14. 3 A. patients with major menthal health problem B. family – caregivers Lifestyle changes with behavioural treatments overweight, obesity & diet training smoking cessation / non-smoking tr. physical activity training metacognitive training anti-suicidal programme anti-stigma programme adherence programme wellbeing programme education C. Professionals  psychiatrists  GP  others
  • 15. www.pbsvi.hr
  • 16. 380 employees 40 psychiatrists 9 teachers 125 nurses 700 patients 550 beds 150 daily hospital places

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