Prevalence and correlates of metabolic syndrome in severe mental illness: A cross-sectional survey of inpatients at a tertiary care institute.

BACKGROUND: People with severe mental illness (SMI) die prematurely. They also have disproportionately high burden of diabetes, dyslipidemia, and obesity, which is further compounded by unhealthy lifestyle such as sedentary behavior and substance use. Consequently, there is a high prevalence of metabolic syndrome (MetS) in this population. MetS has been reported in 10%–50% of SMI patients, but its risk factors have been poorly studied. AIMS: The aim of the study is to assess the prevalence and correlates of MetS in SMI. METHODOLOGY: A cross-sectional study at a tertiary care psychiatry hospital was conducted. A total of 304 consecutive inpatients with SMI were administered the WHO-STEPS-2 questionnaire, Brief Psychiatric Rating Scale, and World Health Organization Disability Assessment Schedule (WHODAS); and biochemical measures such as lipid and blood sugar levels were measured. Summary statistics (means and proportions) were described, followed by univariate and multivariate analyses to examine the associations between variables. RESULTS: 25.7% of SMI patients had diabetes mellitus and 43.09% had elevated cholesterol; 23.4% (95% confidence interval 18.6–28.1) had MetS and it was associated with age (P < 0.01), female gender (P < 0.001), being married (P < 0.01), weight (P < 0.001), body mass index (P < 0.001), waist and hip circumference (P < 0.001), and duration of psychiatric illness (P < 0.001). On multivariate analyses, only age (P = 0.002), female gender (P < 0.001), body weight (P < 0.001), abnormal waist to hip ratio (W: H ratio) (P = 0.02), and lower use of alcohol (P = 0.01) were significantly associated with MetS. CONCLUSION: Patients with SMI have a high burden of cardiometabolic risk factors. Monitoring of traditional risk factors such as W: H ratio is an important and cheap option to screen for risk of MetS

Integrating assisted tele-psychiatry into primary healthcare in Goa, India: a feasibility study

BACKGROUND: Tele-psychiatry is an increasingly acceptable and feasible platform to deliver mental health care with the potential to increase access to care in low-resource settings. We aim to examine the acceptability and preliminary impact of the delivery of assisted tele-psychiatry services in primary healthcare settings in Goa, India. METHODS: Before-after uncontrolled treatment cohort study. In total, 161 adults with either a mental or alcohol use disorder were provided tele-consultation by psychiatrists through a customised video conferencing platform, along with medication or counselling (via trained lay counsellors) or both as needed. Data on socio-demographics, clinical outcomes and process indicators were collected at baseline and 3 months post-baseline. Paired t tests were used to assess clinical outcomes pre- and post-treatment using the General Health Questionnaire-12 (GHQ-12) and World Health Organisation Disability Adjustment Schedule (WHODAS) 2.0, and logistic regression was used to find associations between changes in these scores and various factors. RESULTS: The most common diagnosis was depression (35%). Post-treatment, there was a significant reduction in both GHQ-12 and WHODAS 2.0 scores. Participants showed high satisfaction with the tele-psychiatry services and technology platform. Improvement in GHQ-12 score was associated with being employed [OR 8.74 (1.92–39.75, p = 0.005)] and being a homemaker [OR 6.42 (CI 1.61–25.57, p = 0.008)]. CONCLUSION: Treatment of mental disorders through a tele-psychiatry platform appears to be highly acceptable and is associated with improved clinical outcomes. Considering its potential for scalability, a model of assisted tele-psychiatry integrated into primary care can be an important strategy to increase access to mental healthcare in low-resource settings