Lijuan Fang

Obesity among individuals with serious mental illness

Objective:u2002 To study the distribution and correlates of body mass index (BMI) among individuals with serious mental illness.

Quality of Life in Individuals With Serious Mental Illness and Type 2 Diabetes

Diabetes is a pervasive metabolic disease that disproportionately affects persons with serious mental illness. The authors studied the effect of diabetes on quality of life in a sample of 369 adult outpatients with schizophrenia or major mood disorder, 201 of whom had type 2 diabetes. Patients with diabetes reported greater impairment in both physical and mental-health quality of life than those without diabetes. The diabetes patients also reported less satisfaction with health but not with other life domains. Medical providers need to be attentive to the burden of disease experienced by patients with both serious mental illness and diabetes.

A comparison of adherence to hypoglycemic medications between Type 2 diabetes patients with and without serious mental illness

Inadequate self-management of chronic medical conditions like Type 2 diabetes may play a role in the poor health status of individuals with serious mental illnesses. We compared adherence to hypoglycemic medications and blood glucose control between 44 diabetes patients with a serious mental illness and 30 patients without a psychiatric illness. The two groups did not differ in their ability to manage a complex medication regimen as assessed by a performance-based measure of medication management capacity. However, significantly fewer patients with a mental illness self-reported nonadherence to their hypoglycemic regimens compared to those without a mental illness. Although individuals with mental illnesses also had better control of blood glucose, this metabolic parameter was not correlated with adherence to hypoglycemic medications in either patient group. The experience of managing a chronic mental illness may confer advantages to individuals with serious mental illnesses in the self-care of co-occurring medical conditions like Type 2 diabetes.

Consumer satisfaction with psychiatric services: The role of shared decision making and the therapeutic relationship.

OBJECTIVEnAlthough dissatisfaction is a primary reason for disengagement from outpatient psychiatric care among consumers with serious mental illnesses, little is known about predictors of their satisfaction with medication management visits. The primary purpose of this study was to explore how dimensions of consumer preferences for shared decision making (i.e., preferences for obtaining knowledge about ones mental illness, being offered and asked ones opinion about treatment options, and involvement in treatment decisions) and the therapeutic relationship (i.e., positive collaboration and type of clinician input) were related to visit satisfaction.nnnMETHODSnParticipants were 228 Veterans with serious mental illnesses who completed a 19-item self-report questionnaire assessing satisfaction with visits to prescribers (524 assessments) immediately after visits. In this correlational design, a 3-level mixed model with the restricted maximum likelihood estimation procedure was used to examine shared decision-making preferences and therapeutic alliance as predictors of visit satisfaction.nnnRESULTSnPreferences for involvement in treatment decisions was the unique component of shared decision making associated with satisfaction, such that the more consumers desired involvement, the less satisfied they were. Positive collaboration and prescriber input were associated with greater visit satisfaction.nnnCONCLUSIONS AND IMPLICATIONS FOR PRACTICEnWhen consumers with serious mental illnesses express preferences to be involved in shared decision making, it may not be sufficient to only provide information and treatment options; prescribers should attend to consumers interest in involvement in actual treatment decisions. Assessment and tailoring of treatment approaches to consumer preferences for shared decision making should occur within the context of a strong therapeutic relationship.

Predictors of mortality in patients with serious mental illness and co-occurring type 2 diabetes

Persons with serious mental illness (SMI) have higher rates of chronic medical conditions such as type 2 diabetes and mortality than the general population. We assessed demographic and health related factors in the prediction of all-cause mortality among SMI patients with diabetes and a comparison group of diabetic patients without SMI. From 1999 to 2002, 201 patients with type 2 diabetes and SMI were recruited from community mental health centers and 99 persons with type 2 diabetes and no identified mental illness were recruited from nearby primary clinics. Deaths over an average seven-year period after baseline assessment were identified using the Social Security Administrations Death Master File. Twenty-one percent in each group died over follow-up. Age, smoking status, duration of diabetes, and diabetes-related hospitalization in the 6months prior to baseline assessment predicted mortality in all patients. Among the non-SMI patients, those who were prescribed insulin had over a four-fold greater odds of mortality whereas this association was not found in the SMI patients. Diabetes likely contributes to mortality in persons with SMI. Providers need to be especially vigilant regarding mortality risk when patients require hospitalization for diabetes and as their patients age. Smoking cessation should also be aggressively promoted.

Long-term glucose control among type 2 diabetes patients with and without serious mental illness.

Although studies suggest that patients with diabetes with a serious mental illness (SMI) have poor diabetes outcomes, reports conflict regarding the quality of their diabetes care and level of glucose control. In an observational follow-up to our initial cross-sectional study, we compared glucose control (glycosylated hemoglobin [HbA1c]) between patients with diabetes with SMI versus those without SMI at two postbaseline assessments during an approximately 5-year period. Both groups continued to have glucose levels higher than what is considered good control and neither group demonstrated a significant change in mean HbA1c at the two follow-up time points. Those with SMI continued to have lower HbA1c levels than those without SMI even after adjusting for potential confounders. More effective strategies are needed to assist patients with diabetes to improve the management of their glucose levels.

Patterns of Emergency Department Use for Medical Conditions Among Persons With Serious Mental Illness

OBJECTIVEnThis study examined predictors of medical emergency department use among veterans with serious mental illness.nnnMETHODSnParticipants were 118 psychiatrically hospitalized veterans with a serious mental illness who were identified as at risk for treatment dropout. Participants completed an interview and had their charts reviewed as part of a larger study.nnnRESULTSnNearly half of participants had at least one medical emergency visit, and 20% had two or more visits in the six months after hospital discharge. Outpatient service utilization of both general medical treatment and mental health-substance abuse treatment, as well as psychiatric symptoms, anxiety, and lower levels of satisfaction with current living situation, were associated with increased medical emergency department use.nnnCONCLUSIONSnMedical emergency department use was relatively common in this population of veterans with serious mental illness. Mental health and general medical health needs should be addressed in an integrated fashion to reduce the use of the emergency department.

Predictors of patient communication in psychiatric medication encounters among veterans with serious mental illnesses.

OBJECTIVEnPerson-centered psychiatric services rely on consumers actively sharing personal information, opinions, and preferences with their providers. This research examined predictors of consumer communication during appointments for psychiatric medication prescriptions.nnnMETHODSnThe Roter Interaction Analysis System was used to code recorded Veterans Affairs psychiatric appointments with 175 consumers and 21 psychiatric medication prescribers and categorize communication by purpose: biomedical, psychosocial, facilitation, or rapport-building.nnnRESULTSnRegression analyses found that greater provider communication, symptomology, orientation to psychiatric recovery, and functioning on the Repeatable Battery for the Assessment of Neuropsychological Status Attention and Language indices, as well as consumer diagnostic label, were positive predictors of consumer communication, though the types of communication impacted varied.nnnCONCLUSIONS AND IMPLICATIONS FOR PRACTICEnProvider communication is the easiest variable to intervene on to create changes in consumer communication. Future research should also consider how cognitive and symptom factors may impact specific types of consumer communication in order to identify subgroups for targeted interventions. (PsycINFO Database Record

Predictors of quality of life in type 2 diabetes patients with schizophrenia, major mood disorder, and without mental illness.

PurposeThe aim of the current study is to compare the predictors of health-related quality of life in individuals with schizophrenia, major mood disorder, and no mental illness, all with type 2 diabetes.MethodsA total of 100 individuals with schizophrenia, 101 with a major mood disorder, and 99 without mental illness, all with type 2 diabetes, rated their health-related quality of life on the Medical Outcomes Survey, Short Form-12; physical and mental composite scores (PCS and MCS) were calculated. We performed a hierarchical multiple regression on PCS and MCS in each sample starting with a basic set of predictors and then adding diabetes-related variables. We compared the regression weights and incremental variance explained within each group.ResultsThe number of co-occurring medical conditions was significantly associated with lower PCS in all three groups and with lower MCS in the no mental illness group. Diabetes-related variables added significant incremental variance to the prediction of PCS in the no mental illness group but not in either psychiatric group.ConclusionsFor persons with diabetes and mental illness, as well as with no mental illness, additional medical conditions exert a strong effect on physical well-being. The impact on quality of life of diabetes-related factors may be lower in persons with diabetes and serious mental illness compared to those with diabetes and no mental illness.