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Physical health care monitoring for people with serious mental illness

  1. Graeme Tosh1,
  2. Andrew V Clifton2,
  3. Jun Xia3,*,
  4. Margueritte M White4

Editorial Group: Cochrane Schizophrenia Group

Published Online: 17 JAN 2014

Assessed as up-to-date: 1 DEC 2012

DOI: 10.1002/14651858.CD008298.pub3


How to Cite

Tosh G, Clifton AV, Xia J, White MM. Physical health care monitoring for people with serious mental illness. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD008298. DOI: 10.1002/14651858.CD008298.pub3.

Author Information

  1. 1

    Rotherham, Doncaster and South Humber NHS Foundation Trust (RDASH), Early Intervention in Psychosis and Community Therapies, Swallownest, UK

  2. 2

    University of Huddersfield, School of Human and Health Sciences, Huddersfield, South West Yorkshire, UK

  3. 3

    The University of Nottingham, Cochrane Schizophrenia Group, Nottingham, UK

  4. 4

    Global Community Writer, Valley Center, California, USA

*Jun Xia, Cochrane Schizophrenia Group, The University of Nottingham, Institute of Mental Health, University of Nottingham Innovation Park, Triumph Road,, Nottingham, NG7 2TU, UK. Jun.Xia@nottingham.ac.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 17 JAN 2014

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Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Becker 2005Allocation: cluster randomisation.

Participants: majority with affective disorder, 1/3 with schizophrenia, remainder with another IDC-Chapter V diagnosis.

Intervention: education in outcome management - not physical health monitoring.

Bushe 2010Allocation: randomised.

Participants: people diagnosed with schizophrenia.

Intervention: effects of olanzapine or quetiapine on glucose, lipids and weight - not physical health monitoring.

Carmeli 2012Allocation: randomised.

Participants: people diagnosed with schizophrenia.

Intervention: looked at whether increase glutathione levels modulate EEG synchronization - not physical health monitoring.

Jürgens 2008Allocation: randomised.
Participants: people diagnosed with schizophrenia.
Intervention: genotype monitoring versus intense clinical monitoring - not physical health monitoring.

Kluge 2012Allocation: randomised, double-blind.

Participants: people diagnosed with schizophrenia.

Intervention: effects of clozapine and olanzapine on sleep propensity - not physical health monitoring.

Krakowski 2011Allocation: randomised, double-blind.

Participants: people diagnosed with schizophrenia.

Intervention: effects of clozapine, olanzapine and haloperidol on cholesterol levels and cognition - not physical health monitoring.

Lan 2007Allocation: randomised.
Participants: people diagnosed with schizophrenia, schizoaffective disorder, schizophreniform disorder.
Intervention: monitoring of the effect of aripiprazole and aripiprazole plus haloperidol on prolactin levels - not physical health monitoring.

Lin 2010Allocation: randomised.

Participants: people with schizophrenia.

Intervention: effect of health intervention on constipation - not physical health monitoring.

Nielsen 2012Allocation: randomised.

Participants: people with schizophrenia.

Intervention: evaluating capillary blood sampling device versus venous sampling in patients taking clozapine - not physical health monitoring.

Ozguven 2011Allocation: randomised.

Participants: women with unclear diagnosis (within spectrum of atypical antipsychotic monotherapy).

Intervention: measured effects of olanzapine and quetiapine on weight gain, BMI, lipid profile - no standard care comparison.

Peuskens 2011Allocation: randomised.

Participants: people with schizophrenia.

Intervention: evaluated the effect of sertindole or risperidone on metabolic profile - no standard care comparison.

Rostow 1980Allocation: randomised.
Participants: people with "compulsive or persistent pacing", not necessarily having a diagnosis of serious mental illness.

Saddichha 2011Allocation: not randomised, cross-sectional survey.

Participants: patients diagnosed with schizophrenia or schizoaffective disorder.

Intervention: reported prevalence of diabetes hypertension and obesity on patients on antipsychotic medications.

Strom 2011Allocation: randomised.

Participants: patients with schizophrenia.

Intervention: death associated with olanzapine and ziprasidone use.

Tanasiewicz 2011Allocation: randomised.

Participants: people with schizophrenia on atypical and classical neuroleptics.

Intervention: oral hygienic training - not physical health monitoring.

 
Characteristics of ongoing studies [ordered by study ID]
ISRCTN63382258

Trial name or titleThree Shires Early Intervention Dental Trial (ISRCTN63382258).

MethodsAllocation: cluster randomised.

Blindness: none.

Duration: 12 months.

ParticipantsDiagnosis: serious mental illness.

N = 1074.

Age: >18 years.

Sex: not reported.

History: not reported.

Exclusion: any Early Intervention in Psychosis team that does not wish to take part, any individual care co-ordinator or service user within a team that does not wish to take part, any service user aged less than 18 years old at randomisation.

Setting: multi-centre, community; Early Intervention in Psychosis teams, UK.

Interventions1. dental awareness training for care co-ordinators + an oral health checklist for service users + standard care.

2. standard care.

OutcomesVisit to dentist within one year of exposure to checklist.

Registration with a dentist.

Frequency of tooth brushing.

Reason for dental visit (routine versus for problem).

Quality of life (Oral Impacts on Daily Performance, OIDP).

Economic data.

Leaving the study.

Starting dateFebruary 2012.

Contact informationMiss Hannah Jones, CLAHRC-NDL, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, UK. Email: Hannah.Jones@nottingham.ac.uk

NotesStudy protocol available. Contacted author to request data, data will be available September 2013.

 
Summary of findings for the main comparison. Physical health monitoring compared to no monitoring for people with serious mental illness

Physical health monitoring compared to no monitoring for people with serious mental illness

Patient or population: patients with people with serious mental illness
Settings:
Intervention: physical health monitoring
Comparison: no monitoring

OutcomesIllustrative comparative risks* (95% CI)Relative effect
(95% CI)
No of Participants
(studies)
Quality of the evidence
(GRADE)
Comments

Assumed riskCorresponding risk

No monitoringPhysical health monitoring

Physical health - failure to identify a disease state and provide appropriate treatmentSee commentSee commentNot estimable0
(0)
See commentWe did not identify any trial-based data for any outcome.

Physical health - failure to effectively manage a known disease state

Quality of life: Loss of activities of Daily Living (ADL) skills

Adverse event - clinically important adverse effect

Adverse event - death

Economic - increase costs of care

Social - social isolation as a result of preventable incapacity

 
Table 1. Series of related reviews

TitleReference

Physical health care monitoringThis review

General physical health adviceTosh 2011

Advice regarding smoking cessationKhanna 2012

Advice regarding oral health careKhokhar 2011

Advice regarding HIV/AIDs preventionWright 2012

Advice regarding substance useUnderway

 
Table 2. Reviews suggested by excluded studies

Broad issueSpecific issueExcluded studyExisting review

Antipsychotic adverse effectsclozapine and olanzapine on sleep propensityKluge 2012Komossa 2010

Antipsychotic metabolic adverse effectsaripiprazole and aripiprazole plus haloperidol on prolactin levelsLan 2007

clozapine, olanzapine and haloperidol on cholesterol levels and cognitionKrakowski 2011Asenjo 2010; Essali 2009

olanzapine and quetiapine on weight gain, BMI, lipid profileOzguven 2011Komossa 2010

olanzapine or quetiapine on glucose, lipids and weightBushe 2010

sertindole or risperidone on metabolic profilePeuskens 2011Komossa 2009

Educationeducation in outcome managementBecker 2005

Physiological monitoringevaluating capillary blood sampling device vs venous sampling in patients taking clozapineNielsen 2012

genotype monitoring versus intense clinical monitoringJürgens 2008

glutathione levels modulate EEG-synchronizationCarmeli 2012

Specific physical health issuehealth intervention on constipationLin 2010

oral hygienic trainingTanasiewicz 2011Khokhar 2011

 
Table 3. Suggested design of study

MethodsAllocation: randomised, clearly described.
Blinding: single - particular to specific outcomes (see below).
Duration: 6 months.

ParticipantsDiagnosis: schizophrenia, or any serious mental illness.
N=450.*
Age: any.
Sex: both.
History: any.

Interventions1. General physical health care checklist (e.g. Physical Health Improvement Profile see White 2009): administered by Care Co-ordinator. N=150.

2. Specific aspect of physical health care checklist (e.g. BSDH 2000): administered by Care Co-ordinator. N=150.

3. Standard care: administered by Care Co-ordinator. N=150.

OutcomesDeath.
Morbidity: serious or minor, categorised by type, rates of events - general or specific.
Healthy days.
Service use: visit to heath care practitioner.
Acceptability of checklist.
Compliance: with physical health care advice, including treatments.
Adverse effects: any.

Notes* For 20% difference between groups for a binary outcome to be highlighted with reasonable degree of confidence 150 people are needed per group.