Alex J Mitchell ajm80@le.ac.uk

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