Screening for and monitoring of cardio-metabolic risk factors in outpatients with severe mental illness in a primary care setting

Objective: Recent findings suggest that premature death in patients with severe mental illness (SMI) can be attributed to the high comorbidity of cardio-metabolic disorders. This study investigated the prevalence and monitoring of some risk factors for cardio-metabolic disease in a cohort with SMI, compared to the general medical population. Method: 101 participants with SMI and 100 controls were recruited from a primary care clinic. Assessments of risk factors with standard clinical measurements were done after healthcare workers and patient-participants had completed the structured questionnaires. Clinical files were reviewed to determine frequency of monitoring of risk factors. Results: We found no differences between the groups in demographic variables. A similar prevalence of abnormal blood pressure (BP), increased Body Mass Index (BMI) and increased waist circumference was noted in both groups. Females in both groups were more likely to have an abnormal waist circumference. Patients with SMI were significantly less likely to have recordings of their weight or BP in their clinic file. Healthcare workers and patients with SMI were largely unaware of the increased risk of cardio-metabolic illness. Conclusion: This study suggests that patients with SMI received poorer health monitoring than other patients attending a primary care clinic and that both healthcare workers and patients were poorly informed about the increased risk of cardio-metabolic disorders in patients with SMI.Key words: Mental illness; Comorbidity; Risk factors; Metabolic; Cardio-vascula

Post traumatic stress disorder: undiagnosed cases in a tertiary inpatient setting

Objective: Post traumatic stress disorder (PTSD) is a common, debilitating anxiety disorder characterized by emotional and physical symptoms that may occur after exposure to a severely traumatic event. Since it occurs commonly as a comorbid diagnosis with other mood- and anxiety disorders, we postulated that this disorder may be under- diagnosed in therapeutic wards where anxiety and mood disorders are treated. The study thus sought to determine the prevalence of undiagnosed PTSD in an inpatient population, and to compare the demographic details and comorbid diagnoses of subjects with and without PTSD. Method: The Clinician-administered PTSD Scale for DSM-IV (CAPS) was administered to 40 subjects who were inpatients in a therapeutic ward of a large psychiatric hospital and who had never had a diagnosis of PTSD before. Results:16 (40%) subjects met the DSM-IV criteria for PTSD. We did not find significant clinical differentiating factors between subjects with and without PTSD; however subjects with PTSD were more likely to use cannabis. Conclusions: PTSD remains undiagnosed in many patients admitted to therapeutic units. Keywords: Stress Disorders, Post-Traumatic; Diagnosis; Inpatients;African Journal of Psychiatry Vol. 11 (2) 2008 pp. 119-12

Should depression be treated by algorithm? A call to arms against Zombie science

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Social cognition: response to treatment in first episode psychosis

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A study of the clinical outcome following treatment discontinuation after remission in first-episode schizophrenia.

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Discontinuation of antipsychotics in remitted first episode psychosis; a survey of recent trials

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A prospective study of the clinical outcome following treatment discontinuation after remission in first-episode schizophrenia

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The relationship between awareness of tardive dyskinesia and insight into mental illness in schizophrenia.

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Comparison of treatment response in second-episode versus first-episode schizophrenia

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Methamphetamine use and first episode psychosis in Cape Town.

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