The effects of a computerized clinical decision aid on clinical decision-making in psychosis care

Objective Clinicians in mental healthcare have few objective tools to identify and analyze their patient's care needs. Clinical decision aids are tools that support this process. This study examines whether 1) clinicians working with a clinical decision aid (TREAT) discuss more of their patient's care needs compared to usual treatment, and 2) agree on more evidence-based treatment decisions. Methods Clinicians participated in consultations (n = 166) with patients diagnosed with psychotic disorders from four Dutch mental healthcare institutions (research registration number 201700763). Primary outcomes were measured with the modified Clinical Decision-making in Routine Care questionnaire and combined with psychiatric, physical and social wellbeing related care needs. A multilevel analysis compared discussed care needs and evidence-based treatment decisions between treatment as usual (TAU) before, TAU after and the TREAT condition. Results First, a significant increase in discussed care needs for TREAT compared to both TAU conditions (β = 20.2, SE = 5.2, p = 0.00 and β = 15.8, SE = 5.4, p = 0.01) was found. Next, a significant increase in evidence-based treatments decisions for care needs was observed for TREAT compared to both TAU conditions (β = 16.7, SE = 4.8, p = 0.00 and β = 16.0, SE = 5.1, p = 0.01). Conclusion TREAT improved the discussion about physical health issues and social wellbeing related topics. It also increased evidence-based treatment decisions for care needs which are sometimes overlooked and difficult to treat. Our findings suggest that TREAT makes sense of routine outcome monitoring data and improves guideline-informed care

Measuring personal recovery in people with a psychotic disorder based on CHIME:A comparison of three validated measures

Living well in spite of residual symptoms of mental illness is measured with the construct of personal recovery. The CHIME framework might be suitable to evaluate personal recovery measures and guide instrument choice. Three validated measures were evaluated in Dutch patients with a psychotic disorder (N = 52). We compared the Recovery Assessment Scale (RAS), the Mental Health Recovery Measure (MHRM), and the Netherlands Empowerment List (NEL). The measures were assessed on six criteria: content validity (based on CHIME), convergent validity with a social support measure, internal consistency, floor and ceiling effects, item interpretability, and ease of administration. The MHRM scored high on content validity with a balanced distribution of items covering the CHIME framework. The MHRM and the NEL showed moderate convergent validity with social support. In all three measures, internal consistency was moderate and floor and ceiling effects were absent. The NEL scores demonstrated a high degree of item interpretability. Ease of administration was moderate for all three measures. Finally, the CHIME framework demonstrated good utility as a framework in guiding instrument choice and evaluation of personal recovery measures. The MHRM showed the best overall result. However, differences between measures were minimal. Generalization of the results is limited by cultural and linguistic factors in the assessment for the subjective measures (i.e. content validity and item interpretability). The broad and multidimensional construct of personal recovery might lead to ambiguous interpretations. Scientific consensus on a well-defined personal recovery construct is needed

Progress in drug metabolism, volume 1 Edited by J. W. Bridges and L. F. Chasseaud John Wiley and Sons; London, New York, Sydney, Toronto, 1976 xiii + 286 pages. $ 19.75, £ 9.80

Objective: People with psychotic disorders have an increased metabolic risk and a shortened life expectancy compared to the general population. Two large studies showed that metabolic disorders were untreated in a majority of the patients. Since then, guidelines have urged monitoring of metabolic health. This study examined the course of metabolic disorders over time in people with psychotic disorders and investigated current treatment rates. Methods: A total of 1,259 patients with psychotic disorders, as defined by the DSM-IV, from 4 Dutch mental health institutions participated in 3 yearly assessments of the Pharmacotherapy Monitoring and Outcome Survey (PHAMOUS) between 2006 and 2014. Patients' metabolic parameters were measured, and the use of pharmacologic treatment for hypertension (systolic blood pressure >= 140 mm Hg and/or diastolic blood pressure >= 90 mm Hg), dyslipidemia (5% = 2.5 mmol/L or SCORE risk >= 10% and LDL cholesterol level >= 1.8 mmol/L and/or triglycerides >= 2.3 mmol/L), and hyperglycemia (hemoglobin A(1c) concentration > 7% and/or fasting glucose concentration >= 7.2 mmol/L) was recorded. Results: Prevalence of the metabolic syndrome, as defined by the National Cholesterol Education Program criteria, was > 50% at each assessment. On the basis of the European Society of Cardiology guidelines, pharmacotherapy for metabolic disorders was recommended for 52%-59% of the patients at each assessment. Treatment rates with antihypertensive (from 31% to 38%, P <.001) pharmacotherapy increased throughout the assessments. However, half of the patients were not treated for their metabolic risk factors while being monitored for 3 years or longer. Older patients were more likely to receive treatment, and patients who received treatment had lower blood pressure and lower cholesterol and triglyceride concentrations than patients not receiving the recommended treatment. Conclusions: Metabolic risk factors are still seriously undertreated in people with psychotic disorders. Better adherence to and better implementation of guidelines about monitoring and treating metabolic disorders in psychiatry are crucial. (C) Copyright 2017 Physicians Postgraduate Press, Inc

Satisfaction with social connectedness as a predictor for positive and negative symptoms of psychosis:A PHAMOUS study

PURPOSE: This study examines satisfaction with social connectedness (SSC) as predictor of positive and negative symptoms in people with a psychotic disorder. METHODS: Data from the Pharmacotherapy Monitoring and Outcome Survey (PHAMOUS) was used from patients assessed between 2014 and 2019, diagnosed with a psychotic disorder (N = 2109). Items about social connectedness of the Manchester short assessment of Quality of Life (ManSA) were used to measure SSC. Linear mixed models were used to estimate the association of SSC with the Positive and Negative Syndrome Scale (PANSS) after one and two years against α = 0.01. Analyses were adjusted for symptoms, time since onset, gender and age. Additionally, fluctuation of positive and negative symptom scores over time was estimated. RESULTS: The mean duration of illness of the sample was 18.8 years (SD 10.7) with >65% showing only small variation in positive and negative symptoms over a two to five-year time period. After adjustment for covariates, SSC showed to be negatively associated with positive symptoms after one year (β = -0.47, p < 0.001, 95% CI = -0.70, -025) and two years (β = -0.59, p < 0.001, 95% CI = -0.88, -0.30), and for negative symptoms after one year (β = -0.52, p < 0.001, 95% CI = -0.77, -0.27). The prediction of negative symptoms was not significant at two years. CONCLUSION: This research indicates that interventions on SSC might positively impact mental health for people with psychosis. SSC is a small and robust predictor of future levels of positive symptoms. Negative symptoms could be predicted by SSC at one year

Feasibility, validity and reliability of the Dutch translation of INCRESE (INCRESE-NL) inventory to characterize mental health recovery narratives

Objective: Characterizing mental health recovery narratives is needed to select helpful narratives to support the recovery process of other people. The Inventory of Characteristics of Recovery Stories (INCRESE) is an existing English-language tool to characterize recovery narratives, which is not available in Dutch. The aims of this study were to create a Dutch translation of INCRESE and to evaluate the feasibility of sustained and routine use, as well as its validity and reliability.Research design and methods: INCRESE was translated into Dutch (INCRESENL) using an established translation methodology. Six coders with different professional backgrounds rated 30 purposively selected narratives using INCRESENL and then completed an evaluation survey. Feasibility was rated qualitatively and content validity was assessed both qualitatively and quantitatively. The Gwet’s AC1 agreement coefficient was used to calculate the intercoder reliability.Results: Coders evaluated INCRESE-NL as a suitable instrument to capture important characteristics of recovery narratives with an acceptable administrative burden. The content validity index was sufficient for 5/7 sections of INCRESE-NL. Most items were found to be clear and suitable to capture the corresponding characteristic and some missed strict coding rules or clear descriptions, especially in section 4 about narrative characteristics. The Gwet’s AC1 could be calculated for 67/77 items, of which 62 scored sufficient and five scored below threshold. TheGwet’s AC1 coefficients corresponded well with the original INCRESE Fleiss Kappa values.Conclusions: INCRESE-NL has sufficient feasibility, validity and reliability and canbe used to characterize Dutch recovery narratives

The effect of mind-body and aerobic exercise on negative symptoms in schizophrenia:A meta-analysis

OBJECTIVE: This meta-analysis aims to evaluate the effects of different types of physical exercise (PE) on negative symptoms in schizophrenia patients. Mind-body exercise (MBE), aerobic exercise (AE) and resistance training (RT) will be investigated. METHOD: The Cochrane Library, Medline, Embase and PsycINFO were searched from their inception until April 26, 2018. Randomized controlled trials comparing PE with any control group in patients with schizophrenia were included when negative symptoms had been assessed. This meta-analysis was conducted according to the PRISMA guidelines. The methodological quality of the included studies was assessed with the Cochrane Risk of Bias assessment tool. Moderator, sensitivity, and meta regression analyses were conducted to explore causes of heterogeneity and impact of study quality. RESULTS: We included 22 studies (N = 1249). The overall methodological quality was poor. The meta-analysis (random effects model) showed a medium significant effect in favor of any PE intervention (Hedges' g = 0.434, 95% CI = 0.196-0.671) versus any control condition. MBE and AE respectively showed a medium significant effect (Hedges' g = 0.461) and a small significant effect (Hedges' g = 0.341) versus any control condition. The effect of RT could not be examined. The overall heterogeneity was high (I2 = 76%) and could not be reduced with moderator or sensitivity analyses. CONCLUSION: This meta-analysis demonstrated that PE could be a promising intervention in the treatment of negative symptoms. However, the quality of the included studies was low and heterogeneity was high, which makes it impossible to make a clear recommendation. Therefore, results should be interpreted with care

The effects of lifestyle interventions on (long-term) weight management, cardiometabolic risk and depressive symptoms in people with psychotic disorders:A meta-analysis

AIMS: The aim of this study was to estimate the effects of lifestyle interventions on bodyweight and other cardiometabolic risk factors in people with psychotic disorders. Additionally, the long-term effects on body weight and the effects on depressive symptoms were examined. MATERIAL AND METHODS: We searched four databases for randomized controlled trials (RCTs) that compared lifestyle interventions to control conditions in patients with psychotic disorders. Lifestyle interventions were aimed at weight loss or weight gain prevention, and the study outcomes included bodyweight or metabolic parameters. RESULTS: The search resulted in 25 RCTs -only 4 were considered high quality- showing an overall effect of lifestyle interventions on bodyweight (effect size (ES)  =  -0.63, p<0.0001). Lifestyle interventions were effective in both weight loss (ES =  -0.52, p<0.0001) and weight-gain-prevention (ES =  -0.84, p = 0.0002). There were significant long-term effects, two to six months post-intervention, for both weight-gain-prevention interventions (ES =  -0.85, p = 0.0002) and weight loss studies (ES =  -0.46, p = 0.02). Up to ten studies reported on cardiometabolic risk factors and showed that lifestyle interventions led to significant improvements in waist circumference, triglycerides, fasting glucose and insulin. No significant effects were found for blood pressure and cholesterol levels. Four studies reported on depressive symptoms and showed a significant effect (ES =  -0.95, p = 0.05). CONCLUSION: Lifestyle interventions are effective in treating and preventing obesity, and in reducing cardiometabolic risk factors. However, the quality of the studies leaves much to be desired

Metabolic risk in people with psychotic disorders: No mental health without physical health

Mensen met psychotische aandoeningen hebben een groter risico op metabole afwijkingen en een lagere gemiddelde levensverwachting dan de algemene bevolking. Routinematig monitoren van metabole risico factoren bij deze patiënten wordt daarom aanbevolen en is al enkele jaren in de Noord-Nederlandse GGZ geïmplementeerd. Dit proefschrift laat zien dat ondanks regelmatig monitoren slechts 43-50% van de patiënten wordt behandeld voor metabole risicofactoren wanneer dit door richtlijnen wordt aanbevolen. Eén van de factoren gerelateerd aan een verhoogd metabool risico, besproken in dit proefschrift, is vitamine D insufficiëntie. Deze relatie kan worden uitgelegd door een complex model waarin negatieve symptomen, antipsychotica en een ongezonde leefstijl een rol spelen. Daarnaast toont dit proefschrift aan dat cannabisgebruikers een lagere BMI, geringere buikomvang en lagere diastolische bloeddruk hebben, maar ook ernstigere psychotische klachten dan niet-gebruikers. Na een jaar waren bij patiënten die gestopt waren met cannabis de BMI, buikomvang, diastolische bloeddruk en triglyceride waarden meer toegenomen, en de psychotische klachten meer afgenomen dan bij andere patiënten. Patiënten met een specifiek AKT1 gen gebruikten vaker cannabis, maar dit speelt geen rol in de relatie tussen cannabisgebruik en BMI. Tevens laat dit proefschrift zien dat de tot nu toe onderzochte leefstijlinterventies het metabole risico bij deze patiëntengroep doen verminderen (afname van lichaamsgewicht, buikomvang, triglyceridewaarden en nuchtere glucose), maar niet doen verdwijnen (geen verbeteringen in bloeddruk en cholesterolwaarden). Dit proefschrift benadrukt dat monitoren niet automatisch leidt tot betere zorg. Dit suggereert dat het huidige proces van monitoren, verwijzen en behandelen van metabole risicofactoren dringend onder de loep moet worden genomen