A cognitive/behavioral group intervention for weight loss in patients treated with atypical antipsychotics Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study Increased prevalence of type 2 diabetes mellitus among psychiatric inpatients with bipolar I affective and schizoaffective disorders independent of psychotropic drug use. Serious Cardiovascular Events and Mortality Among Patients with Schizophrenia Effects of a Multifaceted Psychiatric Intervention Targeted for the Complex Medically Ill: A Randomized Controlled Trial An exploratory randomized controlled study of a healthy living intervention in early intervention services for psychosis: the INTERvention to encourage ACTivity, improve diet, and reduce weight gain (INTERACT) study. Randomised controlled trial of a healthy lifestyle intervention among smokers with psychotic disorders: Outcomes to 36 months Management of Antipsychotic-Induced Weight Gain: Prospective Naturalistic Study of the Effectiveness of a Supervised Exercise Programme Prevalence and Correlates of Obesity in a Community Sample of Individuals with Severe and Persistent Mental Illness Factors influencing the choice of new generation antipsychotic medication in the treatment of patients with schizophrenia Coronary Heart Disease Risk Reduction Intervention Among Overweight Smokers with a Psychotic Disorder: Pilot Trial A randomized study of quality of life during multiple risk factor intervention in treated hypertensive men at high cardiovascular risk Comorbidity of depression and diabetes: an application of biopsychosocial model Medical burden in bipolar disorder: findings from the Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder study (Bipolar CHOICE). Cardiac rehabilitation adapted to transient ischaemic attack and stroke (CRAFTS): a randomised controlled trial A randomized controlled trial undertaken to test a nurse-led weight management and exercise intervention designed for people with serious mental illness who take second generation antipsychotics Acute coronary syndrome and predictors of quality of life.
Obesity and diabetes have caused problems for individuals with schizophrenia long before atypical antipsychotic agents . The prevalence of obesity , insulin resistance , impaired glucose tolerance , type 2 diabetes mellitus , dyslipidemia , and the Metabolic Syndrome has increased in people with schizophrenia as compared to the general population . Risk reduction studies for persons with obesity , diabetes , and cardiovascular disease indicate that cognitive/behavioral interventions that promote motivation and provide strategies to overcome the barriers in adherence to diet and activity modification are effective interventions for weight management and risk reduction . In the l and mark multi-center r and omized-controlled trial study , the Diabetes Prevention Project ( DPP ) , a cognitive/behavioral intervention , was more successful in producing weight loss and preventing diabetes than the drugs metformin , troglitazone or placebo . This pilot study examined the effectiveness of a cognitive/behavioral group intervention , modified after the DPP program , in individuals with schizophrenia or schizoaffective disorder taking atypical antipsychotics in a large urban public mental health system . Outcome measures included body weight , body mass index , waist-hip ratios , and fasting glucose levels . Both groups demonstrated elevated fasting glucose levels and were obese with a mean BMI of 33 . The group that received the cognitive/behavioral group intervention  lost more weight than the treatment as usual group . The CB group participants lost an average of 5.4 lb or 2.9 % of body weight , and those in the control group lost 1.3 lb or 0.6 % body weight . The range of weight loss for the treatment group was from 1 to 20 lb . This pilot study has demonstrated that weight loss is possible with cognitive/behavioral interventions in a population with a psychotic disorder Objectives To develop and vali date up date d QRISK3 prediction algorithms to estimate the 10 year risk of cardiovascular disease in women and men accounting for potential new risk factors . Design Prospect i ve open cohort study . Setting General practice s in Engl and providing data for the Q Research data base . Participants 1309 Q Research general practice s in Engl and : 981 practice s were used to develop the scores and a separate set of 328 practice s were used to vali date the scores . 7.89 million patients aged 25 - 84 years were in the derivation cohort and 2.67 million patients in the validation cohort . Patients were free of cardiovascular disease and not prescribed statins at baseline . Methods Cox proportional hazards models in the derivation cohort to derive separate risk equations in men and women for evaluation at 10 years . Risk factors considered included those already in QRISK2 ( age , ethnicity , deprivation , systolic blood pressure , body mass index , total cholesterol : high density lipoprotein cholesterol ratio , smoking , family history of coronary heart disease in a first degree relative aged less than 60 years , type 1 diabetes , type 2 diabetes , treated hypertension , rheumatoid arthritis , atrial fibrillation , chronic kidney disease ( stage 4 or 5 ) ) and new risk factors ( chronic kidney disease ( stage 3 , 4 , or 5 ) , a measure of systolic blood pressure variability ( st and ard deviation of repeated measures ) , migraine , corticosteroids , systemic lupus erythematosus ( SLE ) , atypical antipsychotics , severe mental illness , and HIV/AIDs ) . We also considered erectile dysfunction diagnosis or treatment in men . Measures of calibration and discrimination were determined in the validation cohort for men and women separately and for individual subgroups by age group , ethnicity , and baseline disease status . Main outcome measures Incident cardiovascular disease recorded on any of the following three linked data sources : general practice , mortality , or hospital admission records . Results 363 565 incident cases of cardiovascular disease were identified in the derivation cohort during follow-up arising from 50.8 million person years of observation . All new risk factors considered met the model inclusion criteria except for HIV/AIDS , which was not statistically significant . The models had good calibration and high levels of explained variation and discrimination . In women , the algorithm explained 59.6 % of the variation in time to diagnosis of cardiovascular disease ( R2 , with higher values indicating more variation ) , and the D statistic was 2.48 and Harrell ’s C statistic was 0.88 ( both measures of discrimination , with higher values indicating better discrimination ) . The corresponding values for men were 54.8 % , 2.26 , and 0.86 . Overall performance of the up date d QRISK3 algorithms was similar to the QRISK2 algorithms . Conclusion Up date d QRISK3 risk prediction models were developed and vali date d. The inclusion of additional clinical variables in QRISK3  ( chronic kidney disease , a measure of systolic blood pressure variability ( st and ard deviation of repeated measures ) , migraine , corticosteroids , SLE , atypical antipsychotics , severe mental illness , and erectile dysfunction ) can help enable doctors to identify those at most risk of heart disease and stroke BACKGROUND There are numerous reports of abnormal glucose metabolism , including increased rates of type 2 diabetes mellitus , in psychiatric patients . It remains unclear , however , whether there is an intrinsic relationship between abnormal glucose metabolism and particular psychiatric disorders , because the relationship is complicated by treatment with psychotropic medications that promote weight gain and hyperglycemia . This study aim ed to clarify this relationship . METHODS The medical records of 243 in patients , aged 50 - 74 years , with diagnoses of major depression , bipolar I disorder , schizoaffective disorder , schizophrenia , and dementia were review ed . Psychiatric and type 2 diabetes mellitus diagnoses , medications , body mass index ( BMI ) , age , gender , and race were recorded . Diabetes rates were compared to age , race , and gender-matched rates in the US general population . RESULTS Rates of type 2 diabetes mellitus were : schizoaffective ( 50 % ) > bipolar I ( 26 % ) > major depression ( 18 % ) = dementia ( 18 % ) > schizophrenia ( 13 % ) ( p < 0.006 ) . Diabetic patients had a higher mean BMI ( p = 0.01 ) , but not a significantly higher use of psychotropic medications previously reported to be associated with new-onset type 2 diabetes ( e.g. , phenothiazines , clozapine , olanzapine ) . Logistic regression revealed that psychiatric diagnosis and BMI were the only significant and independent predictors of diabetes diagnosis . Compared to national norms , diabetes rates were significantly elevated only in bipolar I affective and schizoaffective patients . LIMITATIONS This study was a retrospective chart review of older , hospitalized patients . CONCLUSIONS This is the first published study to show an increased prevalence of type 2 diabetes mellitus among psychiatric patients with particular psychiatric illnesses independent of the effects of age , race , gender , medication , and body mass . This finding , which requires replication in a larger scale , prospect i ve study , suggests an intrinsic relationship between abnormal glucose metabolism and bipolar I affective and schizoaffective disorders This study compared the risks of cardiovascular morbidity and mortality in people with schizophrenia who use antipsychotic medications to risks in individuals without schizophrenia in a large managed care organization . A sample of 1,920 schizophrenia patients was matched by age , sex , date , and health plan to 9,600 persons r and omly selected from the health plan general membership .  Death , myocardial infa rct ion , arrhythmia , and new-onset diabetes were identified using a National Death Index search and medical cl aims records . The adjusted all-cause mortality rate in the group of treated schizophrenics was four times higher than in the control group regardless of whether patients were given a typical or an atypical antipsychotic medication . Users of typical antipsychotics had a fivefold higher risk of myocardial infa rct ion than the control subjects . Among patients with schizophrenia , cardiovascular risk was inversely associated with intensity of use of antipsychotic drugs , suggesting that the observed risks may not be due to a simple or direct effect of drugs . Patients treated for schizophrenia had higher rates of new-onset diabetes than did the general population controls . This risk was most pronounced in persons with more intense exposure to drugs and appeared to be indistinguishable in users of typical antipsychotics , of atypical products , or of both Background : This study evaluated a multifaceted psychiatric intervention targeted at the complex medically ill identified by means of the INTERMED , an instrument to assess case complexity . Methods : Of 885 rheumatology in patients and diabetes out patients who were assessed for eligibility , 247 were identified as complex ( INTERMED score > 20 ) and r and omized to the intervention ( n = 125 , 84 rheumatology and 41 diabetes patients ) or care as usual ( n = 122 , 78 rheumatology and 44 diabetes patients ) . For the majority of the cases the multifaceted intervention consisted of an intervention conducted by a psychiatric liaison nurse and /or of referral to a liaison psychiatrist , followed by advice to the treating physician or organization of a multidisciplinary case conference . Baseline and follow-up at months 3 , 6 , 9 and 12 measured prevalence of major depression ( Mini-International Neuropsychiatric Interview ) , depressive symptoms ( Center for Epidemiological Studies Depression Rating Scale ) , physical and mental health ( SF-36 ) , quality of life ( EuroQol ) , health care utilization and HbA1c levels ( diabetic patients ) . Results : Prevalence of major depression was reduced from 61 % ( T0 ) to 28 % ( T4 ) in the intervention group and remained stable in care as usual ( 57 % at T0 to 50 % at T4 ) . Compared to care as usual , significant improvement over time was observed in the intervention group with regard to depressive symptoms ( F = 11.9 ; p = 0.001 ) , perception of physical ( F = 5.7 ; p = 0.018 ) and mental health ( F = 3.9 ; p = 0.047 ) and quality of life ( F = 21.8 ; p < 0.001 ) . Effects tended to be stronger in diabetes patients , in patients with baseline major depression and in patients with moderate INTERMED scores . Finally , hospital admissions occurred less often in the intervention group , reaching statistical significance for the period between 6 and 9 months of follow-up ( p = 0.02 ) . Conclusions : The results suggest that a psychiatric intervention targeted for complex medical patients can improve health outcomes BACKGROUND People with psychosis often experience weight gain , which places them at risk of cardiovascular disease , diabetes , and early death . OBJECTIVE To determine the uptake , adherence , and clinical effectiveness of a healthy living intervention design ed to reduce weight gain . METHOD An exploratory r and omized controlled trial , comparing the intervention with treatment as usual ( TAU ) in 2 early intervention services for psychosis in Engl and . DSM-IV classification was the diagnostic criteria used to assign the psychiatric diagnoses . The primary outcome was change in body mass index ( BMI ) from baseline to 12-month follow-up . The study was conducted between February 2009 and October 2012 . RESULTS 105 service users , with a BMI of ≥ 25 ( ≥ 24 in South Asians ) , were r and omized to intervention  ( n = 54 ) or  TAU  ( n = 51 ) after stratification by recent commencement of antipsychotic medication . Ninety-three service users ( 89 % ) were followed up at 12 months . Between-group difference in change in BMI was not significant ( effect size = 0.11 ) . The effect of the intervention was larger ( effect size = 0.54 , not significant ) in 15 intervention ( 28 % ) and 10 TAU ( 20 % ) participants who were taking olanzapine or clozapine at r and omization . CONCLUSIONS The healthy living intervention did not show a significant difference in BMI reduction compared to the TAU group . TRIAL REGISTRATION www.is rct n.org identifier : IS RCT N22581937 Objective : People living with psychotic disorders ( schizophrenia spectrum and bipolar disorders ) have high rates of cardiovascular disease risk behaviours , including smoking , physical inactivity and poor diet . We report cardiovascular disease risk , smoking cessation and other risk behaviour outcomes over 36 months following recruitment into a two-arm r and omised controlled trial among smokers with psychotic disorders . Methods : Participants ( N = 235 ) drawn from three sites were r and omised to receive nicotine replacement therapy plus ( 1 ) a Healthy Lifestyles intervention  delivered over approximately 9 months or ( 2 ) a largely telephone-delivered intervention ( design ed to control for nicotine replacement therapy provision , session frequency and other monitoring ) . The primary outcome variables were 10-year cardiovascular disease risk and smoking status , while the secondary outcomes included weekly physical activity , unhealthy eating , waist circumference , psychiatric symptomatology , depression and global functioning . Results : Significant reductions in cardiovascular disease risk and smoking were detected across the 36-month follow-up period in both intervention conditions , with no significant differences between conditions . One-quarter ( 25.5 % ) of participants reported reducing cigarettes per day by 50 % or more at multiple post-treatment assessment s ; however , few ( 8.9 % ) managed to sustain this across the majority of time points . Changes in other health behaviours or lifestyle factors were modest ; however , significant improvements in depression and global functioning were detected over time in both conditions . Participants experiencing worse ‘ social discomfort ’ at baseline ( e.g. anxiety , mania , poor self-esteem and social disability ) had on average significantly worse global functioning , lower scores on the 12-Item Short Form Health Survey physical scale and significantly greater waist circumference . Conclusion : Although the telephone-delivered intervention was design ed as a comparison condition , it achieved excellent retention and comparable outcomes . Telephone-delivered smoking cessation support may potentially help to reduce smoking rates among people with psychotic disorders . Discomfort in social situations may also be a useful target for future health interventions , addressing confidence and social skills , and promoting social networks that reduce inactivity Objective : To determine the potential effectiveness of a behavioural weight control programme including physical exercise in the prevention of antipsychotic-induced weight gain and associated comorbid conditions in out patients with schizophrenia and mood disorders . Methods : A prospect i ve , comparative , open and naturalistic study was carried out for a total of 110 patients with schizophrenia , schizoaffective or bipolar disorders ( DSM-IV ) , on treatment with atypical antipsychotics . Of these , 59 patients participated in an 18 month weight control programme that included an educational activity about dietary and physical activity counselling as well as a structured , supervised , facility-based exercise programme . The control group consisted of 51 patients with the same baseline characteristics who did not receive the clinical programme .  Anthropometric measurements , plasma lipid – lipoprotein profile , and fasting plasma glucose concentrations were assessed at 11 time-points over the study . In addition , serum concentrations of prolactin , thyrotropin-stimulating hormone ( TSH ) , and glycated haemoglobin ( HbA1c ) were assessed at four time-points . Finally , the Clinical Global Impression scale ( CGI ) , the Brief Psychiatric Rating Scale ( BPRS ) and the Short Form (SF)-36 Health Survey were used . Results : The adherence rate of patients was 85 % , both in the active and in the control group . Whereas the control group experienced a significant increase in bodyweight ( 4.1 % ) , body mass index ( BMI ; 5.5 % ) and waist circumference ( WC ; 4.2 % ) , the active group significantly reduced their bodyweight ( −3.5 % ) , BMI ( −4.4 % ) , and WC ( −4.6 % ) at the study end-point . In addition , a significant increase in low-density lipoprotein (LDL)-cholesterol ( 14.8 % ) and in triglyceride concentrations ( 12.3 % ) was observed at month 18 in the control group . In contrast , high-density lipoprotein-cholesterol ( HDL ) significantly increased ( 21.4 % ) , and LDL cholesterol ( −13.7 % ) , triglycerides ( −26.2 % ) , total cholesterol ( −12.1 % ) , fasting glucose concentrations ( −12.0 % ) , and HbA1c ( −11.4 % ) significantly decreased compared to baseline in the active group . No significant changes were observed regarding serum concentrations of prolactin and TSH during the study . In regard to the changes observed in psychological measures , no between-group differences were seen in the clinical ratings of CGI and BPRS . However , the SF-36 showed that physical health was improved only for subjects in the active group at months 12 and 18 compared to baseline ( p<0.05 ) , and mental health was significantly improved for both groups at months 12 and 18 compared to baseline . Conclusion : Bodyweight and metabolic risk profile in patients receiving atypical antipsychotic medications can be effectively managed with a weight control programme including physical activity Individuals with severe and persistent mental illness ( SPMI ) have a preponderance of weight problems , possibly even greater than the obesity epidemic in the general population . Although atypical antipsychotics cause weight gain , their contribution to obesity has not been characterized in a community setting where individuals may take multiple psychotropics associated with weight gain . Using survey information including measured height and weight from a r and om sample of Maryl and Medicaid recipients with SPMI , we compared obesity prevalence to the National Health and Nutrition Examination Survey ( NHANES III ) sample and a Maryl and sample ( Behavioral Risk Factor Surveillance System ) of the general population adjusted to SPMI demographic characteristics . We investigated correlates of obesity in the SPMI sample . The results indicate that both men and especially women with SPMI had a higher prevalence of obesity than the general population ; this portends substantial health implication s. A fourfold association between atypical antipsychotics and prevalent obesity was found in men but not in women ; further work should clarify mechanisms of obesity in the SPMI OBJECTIVE This prospect i ve , naturalistic study investigated the factors influencing physicians ' choice of antipsychotic drug therapy in the treatment of patients with schizophrenia . METHOD 108 in- and out patients treated at the Department of Psychiatry of the Medical University Innsbruck who started treatment with a new generation antipsychotic ( except clozapine ) were included . The following factors were investigated : sociodemographic and illness-related variables , pretreatment , the reasons for change of treatment ( lack of efficacy , side effects , non-compliance ) , side effects of pretreatment and body-mass-index ( BMI ) . RESULTS Sociodemographic and most illness-related variables did not have an influence on the physicians ' choice of medication . Risperidone was more frequently prescribed in patients with severe positive symptoms than amisulpride or quetiapine .  Rigidity , orthostatic dizziness and gynecomastia during pretreatment were frequently associated with starting patients on ziprasidone . In patients with diminished  sexual desire  ziprasidone was preferred over olanzapine . Amisulpride was used more commonly than olanzapine if patients had experienced weight gain during pretreatment . Moreover , patients who were prescribed amisulpride had a significantly higher BMI in comparison to patients who were prescribed olanzapine . The reasons for current change of treatment , as well as the drug history ( total number of antipsychotic drugs prescribed during the course of the illness ) did not have an influence on the physicians ' choice of antipsychotic . CONCLUSION In summary , the data suggest that side effects have a larger influence on the choice of antipsychotic than demographic or illness-related variables , except the severity of positive symptoms Objective : The aim of the present pilot study was to test the feasibility and short-term impact of a multi-component risk factor intervention for reducing ( i ) coronary heart disease ( CHD ) risk ; ( ii ) smoking ; and ( iii ) weight among smokers with psychosis . Secondary dependent variables included physical activity , unhealthy eating , substance use , psychiatric symptomatology , treatment retention , general functioning , and quality of life . Method : This was a feasibility study utilizing a pre – post-treatment design with  no control group ( n=43 ) . All participants provided written informed consent and were assessed before treatment and again a mean of 19.6weeks later . The treatment consisted of nine individual 1h sessions of motivational interviewing and cognitive behaviour therapy plus nicotine replacement therapy , in addition to treatment as usual . Research assistants who had not been involved in the delivery of the treatment programme conducted post-treatment assessment s. Results : The intervention was associated with significant reductions in CHD risk scores , smoking and weight . A significant improvement was also reported in level of moderate physical activity , and a small change in the unhealthy eating index was reported . No improvement in biological measures ( cholesterol and blood pressure ) was evident . Conclusions : A multi-component CHD risk factor intervention among smokers with psychosis appears to be feasible and effective in the short-term . A r and omized controlled trial replicating and extending these findings is warranted Objective To examine the effect on quality of life in hypertensive men of a multiple risk factor intervention programme  compared with that of usual care .  Design A prospect i ve , open , r and omized , parallel-group study with allocation either to a comprehensive multiple risk factor modification programme or to usual care . Setting An outpatient clinic in a city hospital . Patients : Five hundred and eight treated hypertensive men , aged 50–72 years , with at least one of the following : serum cholesterol ≥ 6.5 mmol/l , smoking habit or diabetes mellitus . Intervention Nutritional advice , behavioural treatment principles and drug therapy . Main outcome measures : Minor symptoms evaluation profile ( MSEP ) was used to measure change in quality of life . Results The intervention programme led to sustained effects on lifestyle-related variables such as hypercholesterolaemia , body mass index and smoking habits , whereas diastolic blood pressure and HbA1c remained unchanged . The change in the MSEP during follow-up did not differ between the intervention and the usual care groups . There was a close relationship between the measurements of the three MSEP dimensions at baseline and at follow-up ( P < 0.0001 ) . None of the potential risk factors measured at entry was significantly associated with change in the three MSEP dimensions during follow-up . Conclusion The multiple risk factor intervention programme directed towards smoking habits , hypercholesterolaemia and the metabolic control of diabetes mellitus in treated hypertensive men at high cardiovascular risk was not associated with an impaired quality of life compared with that in a control group . The method used , the MSEP , has previously been found to be a reliable method with good validity , and this study 's results provide further evidence of its validity Background Type 2 diabetes ( T2D ) is one of the most psychologically dem and ing chronic medical illness in adult . Comorbidity between diabetes and depression is quite common , but most studies were based on developed country sample . Limited data exists to document biopsychosocial predictors of depressive symptoms in Ethiopian patients . Therefore , the aim of the study was to describe the association of depressive symptoms and T2D and explore the potential underlying associated biopsychosocial risk factors . Methods Institution based cross-sectional study was conducted on 276 patient with T2D at diabetic clinic , Black Lion General Specialized Hospital in Ethiopia . Patients were selected using systematic r and om sampling technique . Depressive symptoms score , which constructed from a vali date d nine-item Patient Health Question naire ( PHQ-9 ) , was an outcome variable . Finally , significant associated factors were identified using multiple linear regression analysis with backward elimination procedure . Statistical Package for Social Science ( SPSS ) version 22.0 ( IBM SPSS Corp. ) was used to perform all analysis . Results Total of 264 patient data was analyzed with 95.7 % response rate . Patients mean ( SD ) current age and age at diagnosis was 55.9 ( 10.9 ) and 43.9 ( 10.9 ) years , respectively . Patients waist circumference ( mean ± SD ) was 98.9 ± 11.1  cm . The average PHQ-9 score was 4.9 ( SD 4.1 ) and fasting blood glucose was 166.4 ( SD 73.2 ) . Marital status ( divorced ) , occupation ( housewife ) , diabetic complication ( nephropathy ) , negative life event in the last six months , and poor social support significantly associated with increased mean PHQ-9 score after adjustment for covariates . Whereas not fearing diabetic-related complication and death significantly lower mean PHQ-9 score . Conclusion Biopsychosocial variables including marital status , negative life event in the last 6 months , occupation , diabetic complication , and poor social support significantly increase average depressive symptoms score . Evidence -based intervention focusing on these identified biopsychosocial factors are necessary to prevent the development of depressive symptoms OBJECTIVES Individuals with bipolar disorder have high rates of other medical comorbidity , which is associated with higher mortality rates and worse course of illness . The present study examined common predictors of medical comorbidity . METHODS The Clinical and Health Outcomes Initiative in Comparative Effectiveness for Bipolar Disorder study ( Bipolar CHOICE ) enrolled 482 participants with bipolar I or bipolar II disorder in a six-month , r and omized comparative effectiveness trial . Baseline assessment s included current and lifetime DSM-IV-TR diagnoses , demographic information , psychiatric and medical history , severity of psychiatric symptoms , level of functioning , and a fasting blood draw . Medical comorbidities were categorized into two groups : cardiometabolic ( e.g. , diabetes , hyperlipidemia , and metabolic syndrome ) and non-cardiovascular ( e.g. , seizures , asthma , and cancer ) . Additionally , we looked at comorbid substance use ( e.g. , smoking and drug dependence ) . RESULTS We found that 96.3 % of participants had at least one other medical comorbidity . Older age predicted a greater likelihood of having a cardiometabolic condition . Early age of onset of bipolar symptoms was associated with a lower chance of having a cardiometabolic condition , but a greater chance of having other types of medical comorbidity . Additional predictors of other medical comorbidities in bipolar disorder included more time spent depressed , less time spent manic/hypomanic , and longer duration of illness . Medications associated with weight gain were associated with low high-density lipoprotein and abnormal triglycerides . CONCLUSIONS There appears to be a substantial medical burden associated with bipolar disorder , highlighting the need for collaborative care among psychiatric and general medical providers to address both psychiatric and other medical needs concomitantly in this group of patients Background Coronary Heart Disease and Cerebrovascular Disease share many predisposing , modifiable risk factors ( hypertension , abnormal blood lipids and lipoproteins , cigarette smoking , physical inactivity , obesity and diabetes mellitus ) . Lifestyle interventions and pharmacological therapy are recognised as the cornerstones of secondary prevention . Cochrane review has proven the benefits of programmes incorporating exercise and lifestyle counselling in the cardiac disease population . A Cochrane review highlighted as priority , the need to establish feasibility and efficacy of exercise based interventions for Cerebrovascular Disease . Methods A single blind r and omised controlled trial is proposed to examine a primary care cardiac rehabilitation programme for adults post transient ischemic attack ( TIA ) and stroke in effecting a positive change in the primary outcome measures of cardiac risk scores derived from Blood Pressure , lipid profile , smoking and diabetic status and lifestyle factors of habitual smoking , exercise and healthy eating participation . Secondary outcomes of interest include health related quality of life as measured by the Hospital Anxiety and Depression Scale , the Stroke Specific Quality of Life scale and WONCA COOP Functional Health Status charts and cardiovascular fitness as measured by a sub-maximal fitness test .  A total of 144 patients , over 18 years of age with confirmed diagnosis of ischaemic stroke or TIA , will be recruited from Dublin community stroke services and two tertiary T.I.A clinics . Exclusion criteria will include oxygen dependence , unstable cardiac conditions , uncontrolled diabetes , major medical conditions , claudication , febrile illness , pregnancy or cognitive impairment . Participants will be block-statified , r and omly allocated to one of two groups using a pre-prepared computer generated r and omisation schedule . Both groups will receive a two hour education class on  risk reduction  post stroke  .  The intervention group will receive a 10 week programme of supervised aerobic exercises ( twice weekly ) and individually tailored brief intervention lifestyle counselling . Both groups will be tested on week one and week ten of the programme . Follow-up at 1 year will assess longer term benefits . Analysis will test for significant changes in the key variables indicated . Discussion Application of the Cardiac Rehabilitation paradigm to patients with ischaemic stroke or TIA has not been explored despite the obvious overlap in aetiology . It is hoped the anticipated improvement in vascular risk factors and fitness result ing from such a programme will enhance health and social gain in this population .Trial Registration Current Controlled Trials ISCTRN90272638 Aim To test the effect of a nurse-led intervention on weight gain in people with serious mental illness prescribed and taking second generation antipsychotic medication . Background Weight gain and obesity has reached epidemic proportions in the general population with the prevalence of Metabolic Syndrome reaching 20–25 % of the global population . People with serious mental illness are at even higher risk , particularly those taking second generation antipsychotic medication . Design An experimental r and omized controlled trial was undertaken . Method The control group received a 12-week healthy lifestyle booklet . In addition to the booklet , the intervention group received weekly nutrition and exercise education , exercise sessions , and nurse support .  Participants ( n = 101 ) were assessed at baseline and 12 weeks . Data were collected between March 2008–December 2010 . Seven outcome measures were used : body measurements included girth ( cm ) , weight ( kg ) , height ( cm ) , and body mass index ( kg/m2 ) ; question naires included the medication compliance question naire , the Drug Attitude Inventory , the Liverpool University Neuroleptic Side Effect Rating Scale , and the Medical Outcomes Study Short Form 36 . Differences in primary outcome measures between baseline and 12 weeks follow-up were compared between intervention and control groups using st and ard bi-variate statistical tests . The study was conducted between 2008–2010 . Results The analysis of outcome measures for the control group ( n = 50 ) and intervention group ( n = 51 ) was not statistically significant . There was a mean weight change of −0·74 kg at 12 weeks for the intervention group ( n = 51 ) , while the control group ( n = 50 ) had a mean weight change of −0·17 kg at 12 weeks . Conclusion The results were not statistically significant INTRODUCTION Coronary disease in its various forms of presentation is associated with a reduction in the patients ' own perception of their quality of life ( QoL ) . QoL is an important measure of effectiveness of treatment ; however , the predictors of QoL after admission for acute coronary syndrome ( ACS ) are not completely clear . AIM To identify the clinical , demographic and psychosocial characteristics of patients admitted for ACS that were predictive of QoL in clinical follow-up . METHODS  Physical and mental QoL  were prospect ively evaluated in 278 patients admitted for ACS , using Short Form-36  v2 physical ( PCS ) and mental ( MCS ) component summary scales . Based on the median PCS ( 55 ) and MCS ( 56 ) scores , the population was divided into two groups . Depressive symptoms were assessed using the Beck Depression Inventory . RESULTS The patients with a better QoL perception were male , young , smokers and had more than 12 years ' education . A greater proportion of patients with PCS and MCS below the median score presented prior cardiovascular events and depressive symptoms . A worse physical QoL perception was more common in unmarried , hypertensive and diabetic patients . There was no association between clinical evolution or in-hospital complications and baseline QoL scores . Baseline PCS and MCS were 55 + /- 24 and 55 + /- 27 and at 16 months , 63 + /- 25 and 66 + /- 29 . Clinical follow-up was achieved in 181 patients . A worse mental QoL perception at follow-up was related to female gender , baseline MCS < 56 and depressive symptoms . A PCS below median score at follow-up was more frequent in women and in patients with prior cardiovascular events , hypertension , diabetes , dyslipidemia and a lower level of education . Patients with better physical QoL at follow-up were smokers , presented higher baseline PCS and MCS , and had fewer depressive symptoms . Percutaneous myocardial revascularization was associated with a better physical QoL. In a logistic regression model the independent predictors of PCS were : gender , baseline PCS , level of education and prior cardiovascular events . Gender and depressive symptoms were independent predictors of MCS . CONCLUSIONS In the study population , baseline clinical and psychosocial characteristics were the most important predictors of QoL after ACS . Depression was associated with worse mental QoL. In-hospital evolution and treatment did not appear to strongly affect patients ' follow-up perceptions of
Results The results of the meta- analysis show an effect toward the experimental group .
Notably , prevention studies with individual psychoeducational programmes that include diet and /or physical activity seem to have the highest impact .
Conclusions When compared with treatment as usual in psychotic patients , preventive and individual lifestyle interventions that include diet and physical activity generally prove to be effective in reducing weight .
This percentage is below the 5 % to 10 % weight loss deemed sufficient to improve weight-related complications such as hypertension , type II diabetes , and dyslipidemia .
However , it is reported that outcomes associated with metabolic risk factors may have greater health implication s than weight changes alone .
Background Psychiatric patients have more physical health problems and much shorter life expectancies compared to the general population , due primarily to premature cardiovascular disease .
A multi-causal model which includes a higher prevalence of risk factors has provided a valid explanation .
It takes into consideration not only risks such as gender , age , and family history that are inherently non-modifiable , but also those such as obesity , smoking , diabetes , hypertension , and dyslipidemia that are modifiable through behavioural changes and improved care .
Thus , it is crucial to focus on factors that increase cardiovascular risk .
Obesity in particular has been associated with both the lifestyle habits and the side effects of antipsychotic medications .
The present systematic review and meta- analysis aims at collecting and updating available evidence on the efficacy of non-pharmacological health promotion programmes for psychotic patients in r and omised clinical trials .