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THE LANCET PSYCHIATRY COMMISSION The Lancet Psychiatry Commission:A Blueprint for Protecting Physical Health in People with Mental IllnessJoseph Firth REF _Ref4765012 \r \h \* MERGEFORMAT 1, REF _Ref4765037 \r \h \* MERGEFORMAT 2, REF _Ref4765040 \r \h \* MERGEFORMAT 3, Najma Siddiqi* REF _Ref4765072 \r \h \* MERGEFORMAT 4, REF _Ref4765078 \r \h \* MERGEFORMAT 5, Ai Koyanagi* REF _Ref4765113 \r \h \* MERGEFORMAT 6, REF _Ref4765115 \r \h \* MERGEFORMAT 7, Dan Siskind* REF _Ref4765136 \r \h \* MERGEFORMAT 8, REF _Ref4765138 \r \h \* MERGEFORMAT 9, Simon Rosenbaum*10,11, Prof. Cherrie Galletly*10,12 Stephanie Allan13, Constanza Caneo14, Rebekah Carney2,15, Andre F. Carvalho16,17, Mary-Lou Chatterton18, Prof. Christoph U. Correll19,20,21, Jackie Curtis22, Prof. Fiona Gaughran23,24, Adrian Heald25,26, Erin Hoare27, Sarah Jackson28, Steve Kisely29,30, Prof. Karina Lovell15,31, Prof. Mario Maj32, Prof. Patrick McGorry33,3, Prof. Cathrine Mihalopoulos34, Hannah Myles35, Brian O'Donoghue33,3, Toby Pillinger24,36,37, Prof. Jerome Sarris38,1,, Prof. Felipe B. Schuch39,40, David Shiers41,2, Lee Smith42, Marco Solmi43, Shuichi Suetani44,45, 8 Johanna Taylor4, Scott B. Teasdale10,22,46, Prof. Sir. Graham Thornicroft47, John Torous48, Prof. Tim Usherwood49,50, Davy Vancampfort51,52, Nicola Veronese53, Prof. Philip B. Ward54,10,22 , Prof. Alison Yung2,3,33, Prof. Eoin Killackey^3,33, Brendon Stubbs^24,23*Lead authors for Parts 1,2,3,4,5, respectively^Co-final authors Corresponding Author: Dr. Joseph FirthNICM Health Research Institute, Western Sydney University, Westmead AustraliaDivison of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UKCentre for Youth Mental Health, University of Melbourne, Melbourne, AustraliaHealth Sciences, University of York, Hull York Medical SchoolBradford District Care NHS Foundation Trust, UKResearch and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, SpainInstituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, SpainMetro South Addiction and Mental Health Service, Brisbane, AustraliaSchool of Medicine, University of Queensland, Brisbane, AustraliaSchool of Psychiatry, Faculty of Medicine, UNSW Sydney, AustraliaBlack Dog Institute, Prince of Wales Hospital, Sydney, New South Wales, AustraliaNorthern Adelaide Local Health Network, Adelaide, SA, AustraliaInstitute of Health and Wellbeing, University of Glasgow, Glasgow, UKDepartamento de Psiquiatría, Pontificia Universidad Católica de Chile, Santiago centro, Santiago, ChileGreater Manchester Mental Health NHS Foundation Trust, Manchester, UKCentre for Addiction and Mental Health, Toronto, Ontario, CanadaDepartment of Psychiatry, University of Toronto, Toronto, Ontario, CanadaSchool of Health and Social Development, Deakin UniversityHofstra Northwell School of Medicine Hempstead, New York, NY, USADepartment of Psychiatry, Zucker Hillside Hospital, New York, NY, USADepartment of Child and Adolescent Psychiatry, Charité Universit?tsmedizin, Berlin, GermanyKeeping the Body in Mind, South Eastern Sydney Local Health District, NSW, AustraliaSouth London and Maudsley NHS Foundation Trust, London, UKInstitute of Psychiatry, Psychology and Neuroscience, King's College London, London, UKThe School of Medical Sciences and Manchester Academic Health Sciences Centre, University of Manchester, ManchesterDepartment of Diabetes and Endocrinology, Salford Royal Hospital, SalfordDeakin University, Food and Mood CentreDepartment of Orthopedics and Sports Medicine Boston Children’s Hospital Boston USADepartment of Psychiatry, Dalhousie University, Halifax, Nova Scotia, CanadaSchool of Medicine, The University of Queensland, Australia.Division of Nursing and Midwifery, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, ItalyOrygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, AustraliaSchool of Health and Social Development, Deakin UniversityDiscipline of Psychiatry, The University of Adelaide, Adelaide, SA, AustraliaMedical Research Council London Institute of Medical Sciences, London, EnglandInstitute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, EnglandDepartment of Psychiatry, University of Melbourne, the Melbourne Clinic, Melbourne, AustraliaPost Graduate Program in Health and Human Development, La Salle University, Canoas, BrazilHospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, BrazilPsychosis Research Unit, Greater Manchester Mental Health NHS Foundation TrustThe Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UKDepartment of Neurosciences, University of Padua, Padua, ItalyQueensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, AustraliaQueensland Brain Institute, The University of Queensland, St Lucia, AustraliaKeeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, AustraliaCentre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UKBeth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USADepartment of General Practice, Westmead Clinical School, The University of Sydney, Westmead, AustraliaThe George Institute for Global Health, University of New South Wales, Sydney, AustraliaKU Leuven Department of Rehabilitation Sciences, Leuven, BelgiumUniversity Psychiatric Centre KU Leuven, Kortenberg, BelgiumNational Research Council, Neuroscience Institute, Aging Branch, Padova, ItalySchizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, NSW AustraliaExecutive SummaryThe poor physical health of people with mental illness is a multi-faceted, transdiagnostic, and global problem. Physical health disparities are observed across the entire spectrum of mental illnesses, in low, middle- and high-income countries. This stems from both a heightened risk of physical diseases in people with mental illness, along with their reduced access to adequate healthcare. The high rates of physical comorbidities (and typically-poor clinical management of this) drastically reduces life expectancy, and also increases the personal, social and economic burden of illness across the lifespan. This Commission has brought together an international team of researchers, clinicians, and key stakeholders from various backgrounds and professionally / personally-relevant experience, in order to summarize advances in understanding on this topic, and present clear directions for health promotion, clinical care and future research. The breadth and multifactorial nature of physical health disparities across the range of mental health diagnoses poses an almost limitless number of potential considerations. Therefore, rather than attempting to cover all of the different possible combinations of physical-mental comorbidities individually, the aim of this Commission was to: (i) establish highly-pertinent aspects of physical health-related morbidity and mortality which apply transdiagnostically, (ii) highlight the common modifiable factors driving these disparities, (iii) present actions and initiatives for health policy and clinical services to address these issues, and (iv) identify promising areas for future research towards discovering novel solutions. This was addressed across 5 different Parts of the Commission: Parts 1 and 2 determined the scope, priorities and key targets for physical health improvement across multiple mental illnesses. Parts 3, 4 and 5 discussed emerging strategies and produced recommendations for improving physical health outcomes in people with mental illness. Leaders and contributors for each Part are shown in the Appendix (pg.1) . Part 1: ‘Its more than premature mortality’Part 1 identified almost 100 systematic reviews/meta-analyses examining the prevalence of physical comorbidities in mental illness. Around 70% of the meta-research focused on cardiometabolic diseases; consistently reporting that mental illnesses were associated with 1.4- to 2-fold increased risk for obesity, diabetes and cardiovascular diseases compared to the general population. Although mostly studied in ‘severe mental illness’ (‘SMI’, and particularly psychotic disorders), the prevalence of cardiometabolic diseases was similarly elevated across a broad range of other diagnoses, including substance use disorders (SUDs), and ‘common mental disorders’ (‘CMDs’, such as depression and anxiety). Part 2: Key modifiable factors in health behaviours and health servicesPart 2 built on the findings of Part 1 with a hierarchal evidence synthesis of modifiable risk factors for physical diseases in mental illness. The bulk of top-tier evidence identified that smoking, excessive alcohol consumption, sleep disturbance, physical inactivity and dietary risks were elevated across a broad range of diagnoses, across various economic settings, and from illness onset. Additionally, Parts 1 and 2 identified a scarcity of meta-research on prevalence or risk factors for (i) infectious diseases, and (ii) physical multimorbidity, in mental illness; along with highlighting how further attention in these areas is particularly crucial for tackling the physical-mental comorbidities observed in LMIC settings.Part 3: The interplay between psychiatric medications and physical healthPart 3 examined the interaction between psychotropic medications and physical health, across a range of conditions. Antipsychotics remain the best evidence-based treatments for psychotic disorders, and reduce mortality rates compared to no treatment, but have adverse impact on multiple aspects of physical health. Although antidepressants have less immediate impact on cardiometabolic health than antipsychotics ‘per individual’, antidepressants are prescribed at much higher rates, which is increasing overtime. Thus, further research is required to establish on the population burden from cardiometabolic side-effects of antidepressants, particularly from long-term usage. Part 3 also discusses emerging pharmacological strategies for attenuating and managing risk, and provides recommendations for upskilling staff in prescribing practices. Part 4: Multi-Disciplinary approaches to Multi-MorbidityPart 4 discusses on ‘multidisciplinary lifestyle interventions’ in mental healthcare. The ‘Diabetes Prevention Program’ (DPP) is an example of a gold-standard lifestyle intervention, with broadly demonstrated success in the general population. However, people with mental illness rarely have access to DPP-based programs through either primary or secondary care services. On the basis of 'lessons learnt' from large-scale clinical trials, our Commission puts forth that future lifestyle interventions in mental healthcare must take into account the core principles of the DPP, by partnering with appropriately-trained physical health professionals, and providing sufficient access to supervised exercise services. Within this, it must be remembered that “Prevention” sit at the centre of the DPP. Similarly, lifestyle interventions for people with mental illness should be available pre-emptively, in order to protect metabolic health from first illness presentation. Priorities for future initiatives and research include (i) translating DPP-based interventions for people with mental illness - across primary care, secondary services and LMIC settings, and (ii) using implementation science and cost-effectiveness evaluations to develop a business-case for integrating DPP-based interventions as standard in mental healthcare. Part 5: Innovations in integration of physical-mental healthcarePart 5 focuses on the availability, content and context of physical healthcare for people with mental illness. Hart’s “Inverse Care Law” puts forth that the quality of health and social care varies inversely with the need of the population served. This applies clearly to physical healthcare for people with mental illness, who are at higher risk at baseline (Parts 1 and 2), receive physically-compromising treatment (Part 3), and then suffer reduced access to adequate lifestyle and medical interventions (Parts 2, 3 and 4). Nonetheless, Part 5 summarises and signposts to valuable new resources and guidelines from national and international health bodies aimed at addressing these inequalities, across public health and clinical levels. Regarding prevention, there is an urgent need for national health strategies to now provide further consideration to those with mental illness, who are often ‘left behind’ from population-gains in public health. Regarding health services, the development of integrated care models for efficient management physical-mental multimorbidity are a critical step forwards; particularly for in LMICs settings, where health inequalities for people with mental illness are greatest. In relation to this, applying ‘syndemic’ approaches for conceptualising the interaction between physical-mental health comorbidities may improve the implementation of customised health interventions for a given location/social setting. Continuing advances in digital health technologies may also present new opportunities for addressing health inequalities on a global scale, although realising this potential will depend upon further rigorous research. The Commission concludes with a discussion on Accountabilities and Responsibilities around the role of governments, health commissioners, health providers and research funding bodies in turning ideas into action; for implementing the recommendations of this Commission (Figure 1) and addressing the disparities in physical health faced by people with mental illness. 987425-14605006943496606369Figure 1. A blueprint for protecting physical health in people with mental illness. Notes: Box placement on X-axis represents ‘start point’; i.e. applicable from that point in mental health stage, and onwards. Box placement (and line colouring) on Y-axis represents overlap with with ‘areas’ for greater recognition, clinical actions, and future research.00Figure 1. A blueprint for protecting physical health in people with mental illness. Notes: Box placement on X-axis represents ‘start point’; i.e. applicable from that point in mental health stage, and onwards. Box placement (and line colouring) on Y-axis represents overlap with with ‘areas’ for greater recognition, clinical actions, and future research.Part 1: “It’s more than premature mortality”IntroductionThe premature mortality of people with mental illness has been recognised by the medical community for over half a century. ADDIN EN.CITE <EndNote><Cite><Author>Thornicroft</Author><Year>2013</Year><RecNum>1</RecNum><DisplayText><style face="superscript">1,2</style></DisplayText><record><rec-number>1</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754959">1</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Thornicroft, Graham</author></authors></contributors><titles><title>Premature death among people with mental illness</title><secondary-title>BMJ: British Medical Journal (Online)</secondary-title></titles><periodical><full-title>BMJ: British Medical Journal (Online)</full-title></periodical><volume>346</volume><dates><year>2013</year></dates><isbn>1756-1833</isbn><urls></urls></record></Cite><Cite><Author>?deg?rd</Author><Year>1951</Year><RecNum>2</RecNum><record><rec-number>2</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754959">2</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>?deg?rd, ?rnulv</author></authors></contributors><titles><title>Mortality in Norwegian mental hospitals 1926–1941</title><secondary-title>Human Heredity</secondary-title></titles><periodical><full-title>Human Heredity</full-title></periodical><pages>141-173</pages><volume>2</volume><number>2</number><dates><year>1951</year></dates><isbn>0001-5652</isbn><urls></urls></record></Cite></EndNote>1,2 Whilst this was initially demonstrated in severe mental illnesses (SMI) such as schizophrenia and bipolar disorder, there is now evidence showing that individuals across the entire spectrum of mental disorders have substantially reduced life expectancy compared with the general population.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYXRoZXJzPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48
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ADDIN EN.CITE.DATA 14-19 The consequent poor physical health outcomes of people with mental illness have been alluded to as a human rights issue, ADDIN EN.CITE <EndNote><Cite><Author>Thornicroft</Author><Year>2011</Year><RecNum>5</RecNum><DisplayText><style face="superscript">20</style></DisplayText><record><rec-number>5</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754960">5</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Thornicroft, Graham</author></authors></contributors><titles><title>Physical health disparities and mental illness: the scandal of premature mortality</title><secondary-title>The British Journal of Psychiatry</secondary-title></titles><periodical><full-title>The British Journal of Psychiatry</full-title></periodical><pages>441-442</pages><volume>199</volume><number>6</number><dates><year>2011</year></dates><isbn>0007-1250</isbn><urls></urls></record></Cite></EndNote>20 and research on this topic has increased dramatically over the last two decades (see appendix pg.2) . Despite the increasing research in this area and the general advancements in healthcare and medicine, the poor physical health (and associated gap in life expectancy) experienced by people with mental illness has not improved.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IYXllczwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+PFJl
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ADDIN EN.CITE.DATA 21-24 Furthermore, the premature mortality itself is only the end-point of a myriad of health inequalities which can affect people with mental disorders across the life course. However, whilst the psychiatric literature is unified in its consensus on the life shortening impact of physical comorbidities, the prevalence and impact of the range of physical comorbidities that can potentially affect individuals across the spectrum of mental disorders (beyond just SMI) is less widely examined. Physical-Mental Comorbidities: A Meta-Review of the LiteratureTo produce an overview of the literature in this field, we systematically identified all recent systematic reviews and meta-analyses examining chronic physical health conditions in people with common mental disorders (CMDs), SMI, alcohol and substance use disorders (SUDs) and various other mental health conditions. In particular, we sought to identify the top-tier evidence regarding the prevalence of chronic conditions in comparison to the ‘general population’ (generally defined as samples without mental illness). The details of the evidence gathering process are displayed in pg. 2-5 of the appendix. We then considered this body of meta-research, alongside the seminal original studies and key recent reports from healthcare and governmental bodies, in determining the scopes and priorities for the Commission overall. As detailed in Table 1, there have been almost 100 systematic reviews and meta-analyses since the turn of the century examining the physical health comorbidities associated with mental illness. The findings from all the most recent systematic reviews/meta-analyses on the prevalence or risk of physical illness for each category of mental illness are shown in appendix (pages 6-14). In common with other reviews, ADDIN EN.CITE <EndNote><Cite><Author>Liu</Author><Year>2017</Year><RecNum>10</RecNum><DisplayText><style face="superscript">25</style></DisplayText><record><rec-number>10</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754960">10</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Liu, Nancy H</author><author>Daumit, Gail L</author><author>Dua, Tarun</author><author>Aquila, Ralph</author><author>Charlson, Fiona</author><author>Cuijpers, Pim</author><author>Druss, Benjamin</author><author>Dudek, Kenn</author><author>Freeman, Melvyn</author><author>Fujii, Chiyo</author></authors></contributors><titles><title>Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas</title><secondary-title>World psychiatry</secondary-title></titles><periodical><full-title>World Psychiatry</full-title><abbr-1>World psychiatry : official journal of the World Psychiatric Association (WPA)</abbr-1></periodical><pages>30-40</pages><volume>16</volume><number>1</number><dates><year>2017</year></dates><isbn>1723-8617</isbn><urls></urls></record></Cite></EndNote>25 we found a shortage of evidence from low and middle-income countries. To date, the majority of meta-research on physical health in mental disorders has focused on cardiovascular or metabolic diseases in high-income countries. Overall, the available evidence here showed that individuals across the entire spectrum of disorders generally have a 1.4 – to 2-fold increased risk for cardiometabolic diseases, compared to individuals without mental illness (see appendix, pages 6-14) . For instance, in depression, Table 1. Map of existing systematic reviews / meta-analyses examining physical comorbidities across different mental mon mental disorders (48 reviews)Severe Mental Illnesses (30 reviews)Alcohol & Substance Use disorders (7 reviews)Other (8 reviews)Mixed mental illness (7)Total reviewsDepressionAnxietyMixed CMDSchizophreniaBipolar DisorderMixed SMIAlcohol disordersSubstance use disordersADHDAutism spectrum disorderEating disordersPersonality disorders?Number of studies331231587514121799Non-communicable diseasesAsthma2PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HYW88L0F1dGhvcj48WWVhcj4yMDE1PC9ZZWFyPjxSZWNO
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ADDIN EN.CITE.DATA 369,370???1 ADDIN EN.CITE <EndNote><Cite><Author>Wu</Author><Year>2016</Year><RecNum>377</RecNum><DisplayText><style face="superscript">371</style></DisplayText><record><rec-number>377</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755035">377</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wu, M. K.</author><author>Wang, H. Y.</author><author>Chen, Y. W.</author><author>Lin, P. Y.</author><author>Wu, C. K.</author><author>Tseng, P. T.</author></authors></contributors><titles><title>Significantly higher prevalence rate of asthma and bipolar disorder co-morbidity: A meta-analysis and review under PRISMA guidelines</title><secondary-title>Medicine (United States)</secondary-title></titles><periodical><full-title>Medicine (United States)</full-title></periodical><pages>e3217</pages><volume>95</volume><number>13</number><dates><year>2016</year></dates><accession-num>609693584</accession-num><label>YY</label><urls><related-urls><url>
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ADDIN EN.CITE.DATA 3721 ADDIN EN.CITE <EndNote><Cite><Author>Zheng</Author><Year>2016</Year><RecNum>379</RecNum><DisplayText><style face="superscript">373</style></DisplayText><record><rec-number>379</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755036">379</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Zheng, Z.</author><author>Zhang, L.</author><author>Zhu, T.</author><author>Huang, J.</author><author>Qu, Y.</author><author>Mu, D.</author></authors></contributors><titles><title>Association between asthma and autism spectrum disorder: A meta-analysis</title><secondary-title>PLoS ONE</secondary-title></titles><periodical><full-title>PLoS One</full-title><abbr-1>PloS one</abbr-1></periodical><volume>11 (6) (no pagination)</volume><number>e0156662</number><dates><year>2016</year></dates><accession-num>610615594</accession-num><label>YY</label><urls><related-urls><url> disorders1PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DdWxsZW48L0F1dGhvcj48WWVhcj4yMDE4PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 398,3991 ADDIN EN.CITE <EndNote><Cite><Author>Prieto</Author><Year>2014</Year><RecNum>406</RecNum><DisplayText><style face="superscript">400</style></DisplayText><record><rec-number>406</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755042">406</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Prieto, M. L.</author><author>Cuellar-Barboza, A. B.</author><author>Bobo, W. V.</author><author>Roger, V. L.</author><author>Bellivier, F.</author><author>Leboyer, M.</author><author>West, C. P.</author><author>Frye, M. A.</author></authors></contributors><titles><title>Differential risk of myocardial infarction and stroke in bipolar disorder: A systematic review and meta-analysis</title><secondary-title>Biological Psychiatry</secondary-title></titles><periodical><full-title>Biological Psychiatry</full-title></periodical><pages>211S-212S</pages><volume>1)</volume><dates><year>2014</year></dates><accession-num>71434473</accession-num><label>YY</label><urls><related-urls><url>
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ADDIN EN.CITE.DATA 37,406-409????????1 ADDIN EN.CITE <EndNote><Cite><Author>Catala-Lopez</Author><Year>2015</Year><RecNum>416</RecNum><DisplayText><style face="superscript">410</style></DisplayText><record><rec-number>416</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755045">416</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Catala-Lopez, F.</author><author>Suarez-Pinilla, M.</author><author>Suarez-Pinilla, P.</author><author>Valderas, J. M.</author><author>Gomez-Beneyto, M.</author><author>Martinez, S.</author><author>Balanza-Martinez, V.</author><author>Climent, J.</author><author>Valencia, A.</author><author>McGrath, J.</author><author>Crespo-Facorro, B.</author><author>Sanchez-Moreno, J.</author><author>Vieta, E.</author><author>Tabares-Seisdedos, R.</author></authors></contributors><titles><title>Inverse and direct cancer Comorbidity in people with central nervous system disorders: A meta-Analysis of cancer incidence in 577,013 Participants of 50 observational studies</title><secondary-title>Psychotherapy and Psychosomatics</secondary-title></titles><periodical><full-title>Psychotherapy and psychosomatics</full-title></periodical><pages>89-105</pages><volume>83</volume><number>2</number><dates><year>2015</year></dates><accession-num>603918173</accession-num><label>YY</label><urls><related-urls><url>
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ADDIN EN.CITE.DATA 411-4171 ADDIN EN.CITE <EndNote><Cite><Author>Smith</Author><Year>2018</Year><RecNum>11</RecNum><DisplayText><style face="superscript">26</style></DisplayText><record><rec-number>11</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754961">11</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Smith, K. J.</author><author>Deschenes, S. S.</author><author>Schmitz, N.</author></authors></contributors><titles><title>Investigating the longitudinal association between diabetes and anxiety: a systematic review and meta-analysis</title><secondary-title>Diabetic Medicine</secondary-title></titles><periodical><full-title>Diabetic Medicine</full-title></periodical><pages>677-693</pages><volume>35</volume><number>6</number><dates><year>2018</year></dates><accession-num>621384372</accession-num><label>YY</label><urls><related-urls><url>
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ADDIN EN.CITE.DATA 30???1 ADDIN EN.CITE <EndNote><Cite><Author>Nieto-Martinez</Author><Year>2017</Year><RecNum>19</RecNum><DisplayText><style face="superscript">34</style></DisplayText><record><rec-number>19</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754962">19</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Nieto-Martinez, R.</author><author>Gonzalez-Rivas, J. P.</author><author>Medina-Inojosa, J. R.</author><author>Florez, H.</author></authors></contributors><titles><title>Are Eating Disorders Risk Factors for Type 2 Diabetes? A Systematic Review and Meta-analysis</title><secondary-title>Current Diabetes Reports</secondary-title></titles><periodical><full-title>Current Diabetes Reports</full-title></periodical><volume>17 (12) (no pagination)</volume><number>138</number><dates><year>2017</year></dates><accession-num>619501487</accession-num><label>YY</label><urls><related-urls><url> - anorexia nervosa
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ADDIN EN.CITE.DATA 28,424,4251 ADDIN EN.CITE <EndNote><Cite><Author>Goldbacher</Author><Year>2007</Year><RecNum>434</RecNum><DisplayText><style face="superscript">426</style></DisplayText><record><rec-number>434</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755049">434</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Goldbacher, E. M.</author><author>Matthews, K. A.</author></authors></contributors><titles><title>Are psychological characteristics related to risk of the metabolic syndrome? A review of the literature</title><secondary-title>Annals of Behavioral Medicine</secondary-title></titles><periodical><full-title>Annals of Behavioral Medicine</full-title></periodical><pages>240-252</pages><volume>34</volume><number>3</number><dates><year>2007</year></dates><accession-num>350276267</accession-num><label>YY</label><urls><related-urls><url>
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ADDIN EN.CITE.DATA 27,432??1 ADDIN EN.CITE <EndNote><Cite><Author>Keck</Author><Year>2003</Year><RecNum>441</RecNum><DisplayText><style face="superscript">433</style></DisplayText><record><rec-number>441</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755050">441</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Keck, P. E.</author><author>McElroy, S. L.</author></authors></contributors><auth-address>Division of Clinical Neuroscience, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0559, USA. Paul.Keck@UC.edu</auth-address><titles><title>Bipolar disorder, obesity, and pharmacotherapy-associated weight gain</title><secondary-title>J Clin Psychiatry</secondary-title><alt-title>The Journal of clinical psychiatry</alt-title></titles><periodical><full-title>J Clin Psychiatry</full-title></periodical><alt-periodical><full-title>The Journal of clinical psychiatry</full-title></alt-periodical><pages>1426-35</pages><volume>64</volume><number>12</number><edition>2004/01/20</edition><keywords><keyword>Antimanic Agents/*adverse effects/therapeutic use</keyword><keyword>Bipolar Disorder/drug therapy/*epidemiology</keyword><keyword>Comorbidity</keyword><keyword>Humans</keyword><keyword>Long-Term Care</keyword><keyword>Obesity/chemically induced/*epidemiology/prevention & control</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Risk Factors</keyword><keyword>Weight Gain/*drug effects</keyword></keywords><dates><year>2003</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>0160-6689 (Print)
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ADDIN EN.CITE.DATA 32,434,435??1 ADDIN EN.CITE <EndNote><Cite><Author>Gerlach</Author><Year>2016</Year><RecNum>18</RecNum><DisplayText><style face="superscript">33</style></DisplayText><record><rec-number>18</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754962">18</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gerlach, G.</author><author>Loeber, S.</author><author>Herpertz, S.</author></authors></contributors><titles><title>Personality disorders and obesity: a systematic review</title><secondary-title>Obesity Reviews</secondary-title></titles><periodical><full-title>Obesity Reviews</full-title></periodical><pages>691-723</pages><volume>17</volume><number>8</number><dates><year>2016</year></dates><accession-num>611337194</accession-num><label>YY</label><urls><related-urls><url>
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ADDIN EN.CITE.DATA 436,4379Osteoporosis/bone loss1 ADDIN EN.CITE <EndNote><Cite><Author>Wu</Author><Year>2010</Year><RecNum>445</RecNum><DisplayText><style face="superscript">438</style></DisplayText><record><rec-number>445</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755052">445</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wu, Q.</author><author>Liu, J.</author><author>Gallegos-Orozco, J. F.</author><author>Hentz, J. G.</author></authors></contributors><titles><title>Depression, fracture risk, and bone loss: A meta-analysis of cohort studies</title><secondary-title>Osteoporosis International</secondary-title></titles><periodical><full-title>Osteoporosis International</full-title></periodical><pages>1627-1635</pages><volume>21</volume><number>10</number><dates><year>2010</year></dates><accession-num>50824291</accession-num><label>Osteoporosis</label><urls><related-urls><url>
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ADDIN EN.CITE.DATA 449,4501 ADDIN EN.CITE <EndNote><Cite><Author>Morriss</Author><Year>2005</Year><RecNum>438</RecNum><DisplayText><style face="superscript">430</style></DisplayText><record><rec-number>438</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755050">438</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Morriss, R.</author><author>Mohammed, F. A.</author></authors></contributors><titles><title>Metabolism, lifestyle and bipolar affective disorder</title><secondary-title>Journal of Psychopharmacology</secondary-title></titles><periodical><full-title>Journal of Psychopharmacology</full-title></periodical><pages>94-101</pages><volume>19</volume><number>6 SUPPL.</number><dates><year>2005</year></dates><accession-num>44567863</accession-num><label>YY</label><urls><related-urls><url>
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ADDIN EN.CITE.DATA 30,31 ADHD, ADDIN EN.CITE <EndNote><Cite><Author>Cortese</Author><Year>2016</Year><RecNum>17</RecNum><DisplayText><style face="superscript">32</style></DisplayText><record><rec-number>17</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754961">17</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cortese, S.</author><author>Moreira-Maia, C. R.</author><author>St Fleur, D.</author><author>Morcillo-Penalver, C.</author><author>Rohde, L. A.</author><author>Faraone, S. V.</author></authors></contributors><titles><title>Association between ADHD and obesity: A systematic review and meta-analysis</title><secondary-title>American Journal of Psychiatry</secondary-title></titles><periodical><full-title>American Journal of Psychiatry</full-title></periodical><pages>34-43</pages><volume>173</volume><number>1</number><dates><year>2016</year></dates><accession-num>607755475</accession-num><label>YY</label><urls><related-urls><url> and personality disorders, ADDIN EN.CITE <EndNote><Cite><Author>Gerlach</Author><Year>2016</Year><RecNum>18</RecNum><DisplayText><style face="superscript">33</style></DisplayText><record><rec-number>18</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754962">18</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gerlach, G.</author><author>Loeber, S.</author><author>Herpertz, S.</author></authors></contributors><titles><title>Personality disorders and obesity: a systematic review</title><secondary-title>Obesity Reviews</secondary-title></titles><periodical><full-title>Obesity Reviews</full-title></periodical><pages>691-723</pages><volume>17</volume><number>8</number><dates><year>2016</year></dates><accession-num>611337194</accession-num><label>YY</label><urls><related-urls><url> consistently find evidence of poor cardiometabolic health; with significantly higher rates of obesity, diabetes and metabolic syndrome than the general population (appendix pg. 6-14). In fact, the only inverse relationship between cardiometabolic health and mental disorders is the reduced incidence of diabetes in anorexia nervosa (OR=0.71). ADDIN EN.CITE <EndNote><Cite><Author>Nieto-Martinez</Author><Year>2017</Year><RecNum>19</RecNum><DisplayText><style face="superscript">34</style></DisplayText><record><rec-number>19</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754962">19</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Nieto-Martinez, R.</author><author>Gonzalez-Rivas, J. P.</author><author>Medina-Inojosa, J. R.</author><author>Florez, H.</author></authors></contributors><titles><title>Are Eating Disorders Risk Factors for Type 2 Diabetes? A Systematic Review and Meta-analysis</title><secondary-title>Current Diabetes Reports</secondary-title></titles><periodical><full-title>Current Diabetes Reports</full-title></periodical><volume>17 (12) (no pagination)</volume><number>138</number><dates><year>2017</year></dates><accession-num>619501487</accession-num><label>YY</label><urls><related-urls><url> - anorexia nervosa Due to the physically-damaging behaviours inherent to the condition itself, individuals with this condition face severely elevated risks from other health issues, such as a twelve-fold increase in incidence of osteoporosis, ADDIN EN.CITE <EndNote><Cite><Author>Solmi</Author><Year>2016</Year><RecNum>20</RecNum><DisplayText><style face="superscript">35</style></DisplayText><record><rec-number>20</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754962">20</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Solmi, M.</author><author>Veronese, N.</author><author>Correll, C. U.</author><author>Favaro, A.</author><author>Santonastaso, P.</author><author>Caregaro, L.</author><author>Vancampfort, D.</author><author>Luchini, C.</author><author>De Hert, M.</author><author>Stubbs, B.</author></authors></contributors><titles><title>Bone mineral density, osteoporosis, and fractures among people with eating disorders: A systematic review and meta-analysis</title><secondary-title>Acta Psychiatrica Scandinavica</secondary-title></titles><periodical><full-title>Acta Psychiatrica Scandinavica</full-title></periodical><pages>341-351</pages><volume>133</volume><number>5</number><dates><year>2016</year></dates><accession-num>607767381</accession-num><label>YY</label><urls><related-urls><url> and among the highest rates of premature mortality across all mental disorders. ADDIN EN.CITE <EndNote><Cite><Author>Chesney</Author><Year>2014</Year><RecNum>3</RecNum><IDText>Risks of all-cause and suicide mortality in mental disorders: a meta-review</IDText><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>3</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754959">3</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chesney, E.</author><author>Goodwin, G. M.</author><author>Fazel, S.</author></authors></contributors><auth-address>Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.</auth-address><titles><title>Risks of all-cause and suicide mortality in mental disorders: a meta-review</title><secondary-title>World Psychiatry</secondary-title><alt-title>World psychiatry : official journal of the World Psychiatric Association (WPA)</alt-title></titles><periodical><full-title>World Psychiatry</full-title><abbr-1>World psychiatry : official journal of the World Psychiatric Association (WPA)</abbr-1></periodical><alt-periodical><full-title>World Psychiatry</full-title><abbr-1>World psychiatry : official journal of the World Psychiatric Association (WPA)</abbr-1></alt-periodical><pages>153-60</pages><volume>13</volume><number>2</number><edition>2014/06/04</edition><keywords><keyword>Mortality</keyword><keyword>anorexia nervosa</keyword><keyword>mental disorders</keyword><keyword>meta-review</keyword><keyword>substance use disorders</keyword><keyword>suicide</keyword></keywords><dates><year>2014</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1723-8617 (Print)
1723-8617</isbn><accession-num>24890068</accession-num><urls></urls><custom2>PMC4102288</custom2><electronic-resource-num>10.1002/wps.20128</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>12 Furthermore, other eating disorders, such as bulimia are associated with drastically elevated odds for as diabetes (OR=3.45) ADDIN EN.CITE <EndNote><Cite><Author>Nieto-Martinez</Author><Year>2017</Year><RecNum>19</RecNum><DisplayText><style face="superscript">34</style></DisplayText><record><rec-number>19</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754962">19</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Nieto-Martinez, R.</author><author>Gonzalez-Rivas, J. P.</author><author>Medina-Inojosa, J. R.</author><author>Florez, H.</author></authors></contributors><titles><title>Are Eating Disorders Risk Factors for Type 2 Diabetes? A Systematic Review and Meta-analysis</title><secondary-title>Current Diabetes Reports</secondary-title></titles><periodical><full-title>Current Diabetes Reports</full-title></periodical><volume>17 (12) (no pagination)</volume><number>138</number><dates><year>2017</year></dates><accession-num>619501487</accession-num><label>YY</label><urls><related-urls><url> - anorexia nervosa , which is even higher than other psychiatric conditions. The relationships between mental disorders and cancer risk is more equivocal. While some reviews have found that mental illnesses are associated with a small increase in risk of cancer overall, ADDIN EN.CITE <EndNote><Cite><Author>Jia</Author><Year>2017</Year><RecNum>21</RecNum><DisplayText><style face="superscript">36</style></DisplayText><record><rec-number>21</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754962">21</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Jia, Y.</author><author>Li, F.</author><author>Liu, Y. F.</author><author>Zhao, J. P.</author><author>Leng, M. M.</author><author>Chen, L.</author></authors></contributors><titles><title>Depression and cancer risk: a systematic review and meta-analysis</title><secondary-title>Public Health</secondary-title></titles><periodical><full-title>Public Health</full-title></periodical><pages>138-148</pages><volume>149</volume><dates><year>2017</year></dates><accession-num>618571178</accession-num><label>Cancer</label><urls><related-urls><url> others have found no relationships or even decreased cancer risk.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MaTwvQXV0aG9yPjxZZWFyPjIwMTg8L1llYXI+PFJlY051
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ADDIN EN.CITE.DATA 36,37 This could be partly due to other causes of death occurring at younger ages reducing the lifetime rates of cancer in people with mental illnesses, although further research is required to fully understand these relationships. Another area requiring further large-scale investigation is the relationship between psychiatric and neurological disorders, as the categorical separation between these two overlapping types of illness may result in underestimations of the true burden of mental illness on a global level. ADDIN EN.CITE <EndNote><Cite><Author>Vigo</Author><Year>2016</Year><RecNum>24</RecNum><DisplayText><style face="superscript">39</style></DisplayText><record><rec-number>24</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754963">24</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Vigo, Daniel</author><author>Thornicroft, Graham</author><author>Atun, Rifat</author></authors></contributors><titles><title>Estimating the true global burden of mental illness</title><secondary-title>The Lancet Psychiatry</secondary-title></titles><periodical><full-title>The Lancet Psychiatry</full-title></periodical><pages>171-178</pages><volume>3</volume><number>2</number><dates><year>2016</year></dates><isbn>2215-0366</isbn><urls></urls></record></Cite></EndNote>39 Although a recent meta-analysis has shown that people with depression face a doubled risk of developing Parkinson’s disease, ADDIN EN.CITE <EndNote><Cite><Author>Wang</Author><Year>2018</Year><RecNum>25</RecNum><DisplayText><style face="superscript">40</style></DisplayText><record><rec-number>25</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754963">25</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wang, S.</author><author>Mao, S.</author><author>Xiang, D.</author><author>Fang, C.</author></authors></contributors><titles><title>Association between depression and the subsequent risk of Parkinson's disease: A meta-analysis</title><secondary-title>Progress in Neuro-Psychopharmacology and Biological Psychiatry</secondary-title></titles><periodical><full-title>Progress in Neuro-Psychopharmacology and Biological Psychiatry</full-title></periodical><pages>186-192</pages><volume>86</volume><dates><year>2018</year></dates><accession-num>2000836089</accession-num><label>Parkinsons</label><urls><related-urls><url> the relationships between other psychiatric and neurological disorders has yet to be established. Remaining Gaps in the Meta-Research Of note, there was an absence of meta-analyses on Chronic Obstructive Pulmonary Disease (COPD) in people with mental disorders, although individual health database studies have convincingly demonstrated that the increased prevalence of COPD is a important risk factor for the premature mortality observed in people with mental illness. ADDIN EN.CITE <EndNote><Cite><Author>England</Author><Year>2018</Year><RecNum>26</RecNum><DisplayText><style face="superscript">19,41</style></DisplayText><record><rec-number>26</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754963">26</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Public Health England</author></authors></contributors><titles><title>Severe mental illness (SMI) and physical health inequalities: briefing</title></titles><pages> </pages><dates><year>2018</year></dates><urls></urls></record></Cite><Cite><Author>Reilly</Author><Year>2015</Year><RecNum>27</RecNum><record><rec-number>27</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754963">27</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Reilly, Siobhan</author><author>Olier, Ivan</author><author>Planner, Claire</author><author>Doran, Tim</author><author>Reeves, David</author><author>Ashcroft, Darren M</author><author>Gask, Linda</author><author>Kontopantelis, Evangelos</author></authors></contributors><titles><title>Inequalities in physical comorbidity: a longitudinal comparative cohort study of people with severe mental illness in the UK</title><secondary-title>BMJ open</secondary-title></titles><periodical><full-title>BMJ open</full-title></periodical><pages>e009010</pages><volume>5</volume><number>12</number><dates><year>2015</year></dates><isbn>2044-6055</isbn><urls></urls></record></Cite></EndNote>19,41 Perhaps also underestimated is the deleterious impact of infectious diseases on physical health in people with mental disorders, as this is largely unexplored in mental health conditions other than SMI (Table 2). The reviews we identified on infectious diseases in SMI populations found that the average incidence (across multiple countries) for hepatitis B, C and HIV was 15.63%, 7.21% and 7.59% respectively, ADDIN EN.CITE <EndNote><Cite><Author>Ayano</Author><Year>2018</Year><RecNum>28</RecNum><DisplayText><style face="superscript">42</style></DisplayText><record><rec-number>28</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754963">28</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ayano, G.</author><author>Tulu, M.</author><author>Haile, K.</author><author>Assefa, D.</author><author>Habtamu, Y.</author><author>Araya, G.</author><author>Yohannis, Z.</author></authors></contributors><titles><title>A systematic review and meta-analysis of gender difference in epidemiology of HIV, hepatitis B, and hepatitis C infections in people with severe mental illness</title><secondary-title>Annals of General Psychiatry</secondary-title></titles><periodical><full-title>Annals of General Psychiatry</full-title></periodical><volume>17 (1) (no pagination)</volume><number>16</number><dates><year>2018</year></dates><accession-num>621978220</accession-num><label>YY</label><urls><related-urls><url> - *bipolar disorder and 1.1% to 7.6% for syphilis. ADDIN EN.CITE <EndNote><Cite><Author>Campos</Author><Year>2008</Year><RecNum>29</RecNum><DisplayText><style face="superscript">43</style></DisplayText><record><rec-number>29</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754963">29</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Campos, L. N.</author><author>Guimaraes, M. D. C.</author><author>Carmo, R. A.</author><author>Melo, A. P. S.</author><author>De Oliveira, H. N.</author><author>Elkington, K.</author><author>McKinnon, K.</author></authors></contributors><titles><title>HIV, syphilis, and hepatitis B and C prevalence among patients with mental illness: A review of the literature</title><secondary-title>Cadernos de Saude Publica</secondary-title></titles><periodical><full-title>Cadernos de Saude Publica</full-title></periodical><pages>S607-S620</pages><volume>24</volume><number>SUPPL.4</number><dates><year>2008</year></dates><accession-num>352439225</accession-num><label>YY</label><urls><related-urls><url> Although these global estimates are useful, other recent studies examining the prevalence of infectious diseases in SMI samples within a specific setting/country provide further insights into how individuals with mental illness experience a disproportionate risk. For instance, in the United States, the prevalence rates of hepatitis B and hepatitis C in patients with SMI is around 20% (for both), whereas the relative prevalence of these conditions in the general U.S. population is 0.3% and >2% respectively ADDIN EN.CITE <EndNote><Cite><Author>Janssen</Author><Year>2015</Year><RecNum>30</RecNum><DisplayText><style face="superscript">44,45</style></DisplayText><record><rec-number>30</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754963">30</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Janssen, Ellen M</author><author>McGinty, Emma E</author><author>Azrin, Susan T</author><author>Juliano-Bult, Denise</author><author>Daumit, Gail L</author></authors></contributors><titles><title>Review of the evidence: prevalence of medical conditions in the United States population with serious mental illness</title><secondary-title>General hospital psychiatry</secondary-title></titles><periodical><full-title>General hospital psychiatry</full-title></periodical><pages>199-222</pages><volume>37</volume><number>3</number><dates><year>2015</year></dates><isbn>0163-8343</isbn><urls></urls></record></Cite><Cite><Author>Rosenberg</Author><Year>2001</Year><RecNum>31</RecNum><record><rec-number>31</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754964">31</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rosenberg, Stanley D</author><author>Goodman, Lisa A</author><author>Osher, Fred C</author><author>Swartz, Marvin S</author><author>Essock, Susan M</author><author>Butterfield, Marian I</author><author>Constantine, Niel T</author><author>Wolford, George L</author><author>Salyers, Michelle P</author></authors></contributors><titles><title>Prevalence of HIV, hepatitis B, and hepatitis C in people with severe mental illness</title><secondary-title>American journal of public health</secondary-title></titles><periodical><full-title>American journal of public health</full-title></periodical><pages>31</pages><volume>91</volume><number>1</number><dates><year>2001</year></dates><urls></urls></record></Cite></EndNote>44,45. Similarly, the median prevalence of HIV among people with SMI in the U.S. is 1.8%; almost 4 times greater than the general U.S. population ADDIN EN.CITE <EndNote><Cite><Author>Janssen</Author><Year>2015</Year><RecNum>30</RecNum><DisplayText><style face="superscript">44</style></DisplayText><record><rec-number>30</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754963">30</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Janssen, Ellen M</author><author>McGinty, Emma E</author><author>Azrin, Susan T</author><author>Juliano-Bult, Denise</author><author>Daumit, Gail L</author></authors></contributors><titles><title>Review of the evidence: prevalence of medical conditions in the United States population with serious mental illness</title><secondary-title>General hospital psychiatry</secondary-title></titles><periodical><full-title>General hospital psychiatry</full-title></periodical><pages>199-222</pages><volume>37</volume><number>3</number><dates><year>2015</year></dates><isbn>0163-8343</isbn><urls></urls></record></Cite></EndNote>44. In LMIC settings, infectious diseases are a major cause of mortality inTable 2. The prevalence of various behavioural risk factors across different mental health diagnoses. AlcoholTobacco usePhysical ActivitySedentary BehaviourPoor DietPoor SleepMajor DepressionAround 30% have/had alcohol use disorder. ADDIN EN.CITE <EndNote><Cite><Author>Sullivan</Author><Year>2005</Year><RecNum>458</RecNum><DisplayText><style face="superscript">451</style></DisplayText><record><rec-number>458</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755055">458</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sullivan, Lynn E.</author><author>Fiellin, David A.</author><author>O’Connor, Patrick G.</author></authors></contributors><titles><title>The prevalence and impact of alcohol problems in major depression: A systematic review</title><secondary-title>The American Journal of Medicine</secondary-title></titles><periodical><full-title>The American Journal of Medicine</full-title></periodical><pages>330-341</pages><volume>118</volume><number>4</number><dates><year>2005</year><pub-dates><date>2005/04</date></pub-dates></dates><publisher>Elsevier BV</publisher><isbn>0002-9343</isbn><urls><related-urls><url> likely to smoke, be nicotine dependent, less likely to quit, and more likely to relapse ADDIN EN.CITE <EndNote><Cite><Author>Weinberger</Author><Year>2017</Year><RecNum>459</RecNum><DisplayText><style face="superscript">452</style></DisplayText><record><rec-number>459</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755056">459</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Weinberger, Andrea H</author><author>Kashan, Rachel S</author><author>Shpigel, Danielle M</author><author>Esan, Hannah</author><author>Taha, Farah</author><author>Lee, Christine J</author><author>Funk, Allison P</author><author>Goodwin, Renee D</author></authors></contributors><titles><title>Depression and cigarette smoking behavior: a critical review of population-based studies</title><secondary-title>The American journal of drug and alcohol abuse</secondary-title></titles><periodical><full-title>The American journal of drug and alcohol abuse</full-title></periodical><pages>416-431</pages><volume>43</volume><number>4</number><dates><year>2017</year></dates><isbn>0095-2990</isbn><urls></urls></record></Cite></EndNote>452 Around 60-70% do not meet physical activity guidelines.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5WYW5jYW1wZm9ydDwvQXV0aG9yPjxZZWFyPjIwMTc8L1ll
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ADDIN EN.CITE.DATA 455Heightened risk of regular smoking (+41%) and nicotine dependence (+58%). ADDIN EN.CITE <EndNote><Cite><Author>Jiang</Author><Year>2014</Year><RecNum>463</RecNum><DisplayText><style face="superscript">456</style></DisplayText><record><rec-number>463</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755057">463</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Jiang, Fan</author><author>Li, Suyun</author><author>Pan, Lulu</author><author>Zhang, Nan</author><author>Jia, Chongqi</author></authors></contributors><titles><title>Association of anxiety disorders with the risk of smoking behaviors: A meta-analysis of prospective observational studies</title><secondary-title>Drug and Alcohol Dependence</secondary-title></titles><periodical><full-title>Drug and alcohol dependence</full-title></periodical><pages>69-76</pages><volume>145</volume><dates><year>2014</year><pub-dates><date>2014/12</date></pub-dates></dates><publisher>Elsevier BV</publisher><isbn>0376-8716</isbn><urls><related-urls><url> with panic disorders, social phobia and agrophobia report significantly less activity. ADDIN EN.CITE <EndNote><Cite><Author>Goodwin</Author><Year>2003</Year><RecNum>464</RecNum><DisplayText><style face="superscript">457</style></DisplayText><record><rec-number>464</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755057">464</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Goodwin, R. D.</author></authors></contributors><auth-address>Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. rdg66@columbia.edu</auth-address><titles><title>Association between physical activity and mental disorders among adults in the United States</title><secondary-title>Prev Med</secondary-title><alt-title>Preventive medicine</alt-title></titles><periodical><full-title>Prev Med</full-title><abbr-1>Preventive medicine</abbr-1></periodical><alt-periodical><full-title>Prev Med</full-title><abbr-1>Preventive medicine</abbr-1></alt-periodical><pages>698-703</pages><volume>36</volume><number>6</number><edition>2003/05/15</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Anxiety Disorders/epidemiology/physiopathology</keyword><keyword>Depressive Disorder, Major/epidemiology/physiopathology</keyword><keyword>Exercise/*psychology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Mental Disorders/classification/*epidemiology/physiopathology</keyword><keyword>Middle Aged</keyword><keyword>Prevalence</keyword><keyword>United States/epidemiology</keyword></keywords><dates><year>2003</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>0091-7435 (Print)
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1600-0447</isbn><urls><related-urls><url> higher rates of current smoking, heavy smoking and nicotine dependence. ADDIN EN.CITE <EndNote><Cite><Author>de Leon</Author><Year>2005</Year><RecNum>72</RecNum><DisplayText><style face="superscript">84</style></DisplayText><record><rec-number>72</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754970">72</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>de Leon, J.</author><author>Diaz, F. J.</author></authors></contributors><auth-address>Mental Health Research Center at Eastern State Hospital, 627 West Fourth St., Lexington, KY 40508, USA. jdeleon@uky.edu</auth-address><titles><title>A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors</title><secondary-title>Schizophr Res</secondary-title></titles><periodical><full-title>Schizophr Res</full-title></periodical><pages>135-57</pages><volume>76</volume><number>2-3</number><keywords><keyword>Comorbidity</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Schizophrenia/*epidemiology</keyword><keyword>Smoking/*epidemiology/prevention & control</keyword><keyword>Smoking Cessation/methods</keyword><keyword>Tobacco Use Disorder/*epidemiology/prevention & control</keyword></keywords><dates><year>2005</year><pub-dates><date>Jul 15</date></pub-dates></dates><isbn>0920-9964 (Print)</isbn><accession-num>15949648</accession-num><urls><related-urls><url> do not meet physical activity guidelines.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5WYW5jYW1wZm9ydDwvQXV0aG9yPjxZZWFyPjIwMTc8L1ll
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ADDIN EN.CITE.DATA 454,459First-Episode Psychosis27% have/had alcohol abuse/dependence. ADDIN EN.CITE <EndNote><Cite><Author>Wisdom</Author><Year>2011</Year><RecNum>474</RecNum><DisplayText><style face="superscript">465</style></DisplayText><record><rec-number>474</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755059">474</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wisdom, J. P.</author><author>Manuel, J. I.</author></authors></contributors><auth-address>a Columbia University and New York State Psychiatric Institute , New York , New York , USA.</auth-address><titles><title>Prevalence of Substance Use in People With First-Episode Psychosis</title><secondary-title>J Dual Diagn</secondary-title><alt-title>Journal of dual diagnosis</alt-title></titles><periodical><full-title>J Dual Diagn</full-title><abbr-1>Journal of dual diagnosis</abbr-1></periodical><alt-periodical><full-title>J Dual Diagn</full-title><abbr-1>Journal of dual diagnosis</abbr-1></alt-periodical><pages>39-49</pages><volume>7</volume><number>1-2</number><edition>2011/01/01</edition><keywords><keyword>co-occurring disorders</keyword><keyword>first-episode psychosis</keyword><keyword>schizophrenia</keyword><keyword>systematic review</keyword></keywords><dates><year>2011</year></dates><isbn>1550-4263 (Print)
1550-4271</isbn><accession-num>26954911</accession-num><urls></urls><electronic-resource-num>10.1080/15504263.2011.569876</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>46558% are tobacco users, significantly higher than matched controls ADDIN EN.CITE <EndNote><Cite><Author>Myles</Author><Year>2012</Year><RecNum>475</RecNum><DisplayText><style face="superscript">466</style></DisplayText><record><rec-number>475</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755060">475</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Myles, Nicholas</author><author>Newall, Hannah D.</author><author>Curtis, Jackie</author><author>Nielssen, Olav</author><author>Shiers, David</author><author>Large, Matthew</author></authors></contributors><titles><title>Tobacco Use Before, At, and After First-Episode Psychosis</title><secondary-title>The Journal of Clinical Psychiatry</secondary-title></titles><periodical><full-title>The Journal of clinical psychiatry</full-title></periodical><pages>468-475</pages><volume>73</volume><number>04</number><dates><year>2012</year><pub-dates><date>2012/04/15</date></pub-dates></dates><publisher>Physicians Postgraduate Press, Inc</publisher><isbn>0160-6689</isbn><urls><related-urls><url> active than long-term schizophrenia. ADDIN EN.CITE <EndNote><Cite><Author>Stubbs</Author><Year>2016</Year><RecNum>20</RecNum><DisplayText><style face="superscript">35</style></DisplayText><record><rec-number>20</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754962">20</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Solmi, M.</author><author>Veronese, N.</author><author>Correll, C. U.</author><author>Favaro, A.</author><author>Santonastaso, P.</author><author>Caregaro, L.</author><author>Vancampfort, D.</author><author>Luchini, C.</author><author>De Hert, M.</author><author>Stubbs, B.</author></authors></contributors><titles><title>Bone mineral density, osteoporosis, and fractures among people with eating disorders: A systematic review and meta-analysis</title><secondary-title>Acta Psychiatrica Scandinavica</secondary-title></titles><periodical><full-title>Acta Psychiatrica Scandinavica</full-title></periodical><pages>341-351</pages><volume>133</volume><number>5</number><dates><year>2016</year></dates><accession-num>607767381</accession-num><label>YY</label><urls><related-urls><url> evidence on sedentary behaviour in early psychosis.Insufficient evidence on diet in early psychosis.Significantly reduced sleep time & quality of sleep. ADDIN EN.CITE <EndNote><Cite><Author>Benca</Author><Year>1992</Year><RecNum>466</RecNum><DisplayText><style face="superscript">459</style></DisplayText><record><rec-number>466</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755057">466</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Benca, R. M.</author><author>Obermeyer, W. H.</author><author>Thisted, R. A.</author><author>Gillin, J. C.</author></authors></contributors><auth-address>Department of Psychiatry, University of Chicago, IL 60637.</auth-address><titles><title>Sleep and psychiatric disorders. A meta-analysis</title><secondary-title>Arch Gen Psychiatry</secondary-title><alt-title>Archives of general psychiatry</alt-title></titles><periodical><full-title>Arch Gen Psychiatry</full-title><abbr-1>Archives of general psychiatry</abbr-1></periodical><alt-periodical><full-title>Arch Gen Psychiatry</full-title><abbr-1>Archives of general psychiatry</abbr-1></alt-periodical><pages>651-68; discussion 669-70</pages><volume>49</volume><number>8</number><edition>1992/08/01</edition><keywords><keyword>Adult</keyword><keyword>Age Factors</keyword><keyword>Depressive Disorder/diagnosis</keyword><keyword>Diagnosis, Differential</keyword><keyword>Electroencephalography</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Mental Disorders/*diagnosis</keyword><keyword>Meta-Analysis as Topic</keyword><keyword>Middle Aged</keyword><keyword>Narcolepsy/diagnosis</keyword><keyword>Schizophrenia/diagnosis</keyword><keyword>Sleep/*physiology</keyword><keyword>Sleep Wake Disorders/diagnosis</keyword><keyword>Sleep, REM/physiology</keyword></keywords><dates><year>1992</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>0003-990X (Print)
0003-990x</isbn><accession-num>1386215</accession-num><urls></urls><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>459 Post-Traumatic Stress DisorderElevated rates of comorbid alcohol misuse compared to general population (10-61%). ADDIN EN.CITE <EndNote><Cite><Author>Debell</Author><Year>2014</Year><RecNum>476</RecNum><DisplayText><style face="superscript">467</style></DisplayText><record><rec-number>476</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755060">476</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Debell, Frances</author><author>Fear, Nicola T</author><author>Head, Marc</author><author>Batt-Rawden, Samantha</author><author>Greenberg, Neil</author><author>Wessely, Simon</author><author>Goodwin, Laura</author></authors></contributors><titles><title>A systematic review of the comorbidity between PTSD and alcohol misuse</title><secondary-title>Social psychiatry and psychiatric epidemiology</secondary-title></titles><periodical><full-title>Soc Psychiatry Psychiatr Epidemiol</full-title><abbr-1>Social psychiatry and psychiatric epidemiology</abbr-1></periodical><pages>1401-1425</pages><volume>49</volume><number>9</number><dates><year>2014</year></dates><isbn>0933-7954</isbn><urls></urls></record></Cite></EndNote>46722% more likely to be current smokers than general population. ADDIN EN.CITE <EndNote><Cite><Author>van den Berk-Clark</Author><Year>2018</Year><RecNum>12601</RecNum><DisplayText><style face="superscript">468</style></DisplayText><record><rec-number>12601</rec-number><foreign-keys><key app="EN" db-id="0tpsw9zfo5z2wuex0fkvwsr6pewsdxxrsrx5" timestamp="1539262764">12601</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>van den Berk-Clark, Carissa</author><author>Secrest, Scott</author><author>Walls, Jesse</author><author>Hallberg, Ellen</author><author>Lustman, Patrick J</author><author>Schneider, F David</author><author>Scherrer, Jeffrey F</author></authors></contributors><titles><title>Association between posttraumatic stress disorder and lack of exercise, poor diet, obesity, and co-occuring smoking: A systematic review and meta-analysis</title><secondary-title>Health Psychology</secondary-title></titles><periodical><full-title>Health Psychology</full-title><abbr-1>Health Psychol.</abbr-1><abbr-2>Health Psychol</abbr-2></periodical><pages>407</pages><volume>37</volume><number>5</number><dates><year>2018</year></dates><isbn>1930-7810</isbn><urls></urls></record></Cite></EndNote>4689% less likely to be physically active than general population. ADDIN EN.CITE <EndNote><Cite><Author>van den Berk-Clark</Author><Year>2018</Year><RecNum>12601</RecNum><DisplayText><style face="superscript">468</style></DisplayText><record><rec-number>12601</rec-number><foreign-keys><key app="EN" db-id="0tpsw9zfo5z2wuex0fkvwsr6pewsdxxrsrx5" timestamp="1539262764">12601</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>van den Berk-Clark, Carissa</author><author>Secrest, Scott</author><author>Walls, Jesse</author><author>Hallberg, Ellen</author><author>Lustman, Patrick J</author><author>Schneider, F David</author><author>Scherrer, Jeffrey F</author></authors></contributors><titles><title>Association between posttraumatic stress disorder and lack of exercise, poor diet, obesity, and co-occuring smoking: A systematic review and meta-analysis</title><secondary-title>Health Psychology</secondary-title></titles><periodical><full-title>Health Psychology</full-title><abbr-1>Health Psychol.</abbr-1><abbr-2>Health Psychol</abbr-2></periodical><pages>407</pages><volume>37</volume><number>5</number><dates><year>2018</year></dates><isbn>1930-7810</isbn><urls></urls></record></Cite></EndNote>468Insufficient evidence on sedentary behaviour in PTSD.5% less likely to have a healthy diet than general populations. ADDIN EN.CITE <EndNote><Cite><Author>van den Berk-Clark</Author><Year>2018</Year><RecNum>12601</RecNum><DisplayText><style face="superscript">468</style></DisplayText><record><rec-number>12601</rec-number><foreign-keys><key app="EN" db-id="0tpsw9zfo5z2wuex0fkvwsr6pewsdxxrsrx5" timestamp="1539262764">12601</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>van den Berk-Clark, Carissa</author><author>Secrest, Scott</author><author>Walls, Jesse</author><author>Hallberg, Ellen</author><author>Lustman, Patrick J</author><author>Schneider, F David</author><author>Scherrer, Jeffrey F</author></authors></contributors><titles><title>Association between posttraumatic stress disorder and lack of exercise, poor diet, obesity, and co-occuring smoking: A systematic review and meta-analysis</title><secondary-title>Health Psychology</secondary-title></titles><periodical><full-title>Health Psychology</full-title><abbr-1>Health Psychol.</abbr-1><abbr-2>Health Psychol</abbr-2></periodical><pages>407</pages><volume>37</volume><number>5</number><dates><year>2018</year></dates><isbn>1930-7810</isbn><urls></urls></record></Cite></EndNote>468Significant poorer continuity of sleep and reduced sleep depth compared to healthy controls ADDIN EN.CITE <EndNote><Cite><Author>Baglioni</Author><Year>2016</Year><RecNum>461</RecNum><DisplayText><style face="superscript">454</style></DisplayText><record><rec-number>461</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755056">461</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Baglioni, Chiara</author><author>Nanovska, Svetoslava</author><author>Regen, Wolfram</author><author>Spiegelhalder, Kai</author><author>Feige, Bernd</author><author>Nissen, Christoph</author><author>Reynolds III, Charles F</author><author>Riemann, Dieter</author></authors></contributors><titles><title>Sleep and mental disorders: A meta-analysis of polysomnographic research</title><secondary-title>Psychological bulletin</secondary-title></titles><periodical><full-title>Psychological bulletin</full-title></periodical><pages>969</pages><volume>142</volume><number>9</number><dates><year>2016</year></dates><isbn>1939-1455</isbn><urls></urls></record></Cite></EndNote>454Red = Multi-national meta-analysisPurple = Systematic review of case-controlled, clinical and/or epidemiological researchBlue = Large-scale epidemiological studiesNote: ‘Significantly’ refers to p<0.05 compared to general population.people with SMI. For example, in a 10-year follow-up study in Ethiopia, individuals with SMI died 30 years prematurely compared to the general population, with half of all these deaths due to infectious diseases ADDIN EN.CITE <EndNote><Cite><Author>Fekadu</Author><Year>2015</Year><RecNum>32</RecNum><DisplayText><style face="superscript">46</style></DisplayText><record><rec-number>32</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754964">32</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Fekadu, Abebaw</author><author>Medhin, Girmay</author><author>Kebede, Derege</author><author>Alem, Atalay</author><author>Cleare, Anthony J</author><author>Prince, Martin</author><author>Hanlon, Charlotte</author><author>Shibre, Teshome</author></authors></contributors><titles><title>Excess mortality in severe mental illness: 10-year population-based cohort study in rural Ethiopia</title><secondary-title>The British Journal of Psychiatry</secondary-title></titles><periodical><full-title>The British Journal of Psychiatry</full-title></periodical><pages>289-296</pages><volume>206</volume><number>4</number><dates><year>2015</year></dates><isbn>0007-1250</isbn><urls></urls></record></Cite></EndNote>46. Overall however, the prevalence and outcomes of infectious diseases among people with mental illness in LMIC settings is currently underrepresented in the literature, and further scientific and governmental attention should be turned towards this; particularly given that this is where rates of infection are highest, and inequalities for people with mental illness are most pronounced. ADDIN EN.CITE <EndNote><Cite><Author>Organization</Author><Year>2017</Year><RecNum>33</RecNum><DisplayText><style face="superscript">47</style></DisplayText><record><rec-number>33</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754964">33</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>World Health Organization</author></authors></contributors><titles><title>Helping people with severe mental disorders live longer and healthier lives: policy brief</title></titles><dates><year>2017</year></dates><publisher>World Health Organization</publisher><urls></urls></record></Cite></EndNote>47 Furthermore, despite the compelling evidence for increased risk of infectious diseases in adults with SMI, the prevalence of infectious diseases in other mental disorders, and the extent to which this applies to young people with mental illness, is not widely established. Future research should investigate this matter, while also determining the underlying factors which account for the increased incidence of infectious diseases among people with mental illnesses, in order to develop more appropriate and targeted solutions for tackling this (as discussed in Part 2). It should also be noted that much of the literature assessing physical health in mental illness to date has examined the incidence of specific health outcomes or conditions in isolation. Currently, there is a gap in understanding around the prevalence and impact of physical multimorbidity (i.e. the presence of more than 1 chronic physical condition) in people with mental illness. Nonetheless, some recent large scale multi-national studies have demonstrated that people with SMIPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TdHViYnM8L0F1dGhvcj48WWVhcj4yMDE2PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 18,51 are at greatly increased risk of physical multimorbidity, right from illness onset. ADDIN EN.CITE <EndNote><Cite><Author>Lambert</Author><Year>2018</Year><RecNum>39</RecNum><DisplayText><style face="superscript">52</style></DisplayText><record><rec-number>39</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754965">39</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lambert, Martin</author><author>Ruppelt, Friederike</author><author>Siem, Anna-Katharina</author><author>Rohenkohl, Anja Christine</author><author>Kraft, Vivien</author><author>Luedecke, Daniel</author><author>Sengutta, Mary</author><author>Schr?ter, Romy</author><author>Daubmann, Anne</author><author>Correll, Christoph U</author></authors></contributors><titles><title>Comorbidity of chronic somatic diseases in patients with psychotic disorders and their influence on 4-year outcomes of integrated care treatment (ACCESS II study)</title><secondary-title>Schizophrenia research</secondary-title></titles><periodical><full-title>Schizophrenia research</full-title></periodical><pages>377-383</pages><volume>193</volume><dates><year>2018</year></dates><isbn>0920-9964</isbn><urls></urls></record></Cite></EndNote>52 Multimorbidity occurs from a relatively young age in people with mental illness ADDIN EN.CITE <EndNote><Cite><Author>Lambert</Author><Year>2018</Year><RecNum>39</RecNum><DisplayText><style face="superscript">41,52</style></DisplayText><record><rec-number>39</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754965">39</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lambert, Martin</author><author>Ruppelt, Friederike</author><author>Siem, Anna-Katharina</author><author>Rohenkohl, Anja Christine</author><author>Kraft, Vivien</author><author>Luedecke, Daniel</author><author>Sengutta, Mary</author><author>Schr?ter, Romy</author><author>Daubmann, Anne</author><author>Correll, Christoph U</author></authors></contributors><titles><title>Comorbidity of chronic somatic diseases in patients with psychotic disorders and their influence on 4-year outcomes of integrated care treatment (ACCESS II study)</title><secondary-title>Schizophrenia research</secondary-title></titles><periodical><full-title>Schizophrenia research</full-title></periodical><pages>377-383</pages><volume>193</volume><dates><year>2018</year></dates><isbn>0920-9964</isbn><urls></urls></record></Cite><Cite><Author>England</Author><Year>2018</Year><RecNum>26</RecNum><record><rec-number>26</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754963">26</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Public Health England</author></authors></contributors><titles><title>Severe mental illness (SMI) and physical health inequalities: briefing</title></titles><pages> </pages><dates><year>2018</year></dates><urls></urls></record></Cite></EndNote>41,52, and greatly increases personal and economic burden associated with chronic conditions, while also reducing life expectancy.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CYXJuZXR0PC9BdXRob3I+PFllYXI+MjAxMjwvWWVhcj48
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ADDIN EN.CITE.DATA 13,14 there is a need for further research to examine if the psychological distress associated with mental illness itself is in anyway compounded by the additional burden of these chronic conditions. For instance, in the general population, diabetes is commonly associated with distress, which can have a profound impact on the person’s quality of life and ability to manage their overall health. ADDIN EN.CITE <EndNote><Cite><Author>Perrin</Author><Year>2017</Year><RecNum>43</RecNum><DisplayText><style face="superscript">55</style></DisplayText><record><rec-number>43</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754966">43</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Perrin, NE</author><author>Davies, MJ</author><author>Robertson, N</author><author>Snoek, FJ</author><author>Khunti, K</author></authors></contributors><titles><title>The prevalence of diabetes‐specific emotional distress in people with Type 2 diabetes: a systematic review and meta‐analysis</title><secondary-title>Diabetic Medicine</secondary-title></titles><periodical><full-title>Diabetic Medicine</full-title></periodical><pages>1508-1520</pages><volume>34</volume><number>11</number><dates><year>2017</year></dates><isbn>0742-3071</isbn><urls></urls></record></Cite></EndNote>55 Nascent evidence increasingly shows that diabetes-related distress also affects people with CMDs, ADDIN EN.CITE <EndNote><Cite><Author>Perrin</Author><Year>2017</Year><RecNum>43</RecNum><DisplayText><style face="superscript">55</style></DisplayText><record><rec-number>43</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754966">43</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Perrin, NE</author><author>Davies, MJ</author><author>Robertson, N</author><author>Snoek, FJ</author><author>Khunti, K</author></authors></contributors><titles><title>The prevalence of diabetes‐specific emotional distress in people with Type 2 diabetes: a systematic review and meta‐analysis</title><secondary-title>Diabetic Medicine</secondary-title></titles><periodical><full-title>Diabetic Medicine</full-title></periodical><pages>1508-1520</pages><volume>34</volume><number>11</number><dates><year>2017</year></dates><isbn>0742-3071</isbn><urls></urls></record></Cite></EndNote>55, SMI ADDIN EN.CITE <EndNote><Cite><Author>Balhara</Author><Year>2011</Year><RecNum>44</RecNum><DisplayText><style face="superscript">56</style></DisplayText><record><rec-number>44</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754966">44</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Balhara, Yatan Pal Singh</author></authors></contributors><titles><title>Diabetes and psychiatric disorders</title><secondary-title>Indian journal of endocrinology and metabolism</secondary-title></titles><periodical><full-title>Indian journal of endocrinology and metabolism</full-title></periodical><pages>274</pages><volume>15</volume><number>4</number><dates><year>2011</year></dates><urls></urls></record></Cite></EndNote>56 and substance use disorders ADDIN EN.CITE <EndNote><Cite><Author>Sorsdahl</Author><Year>2018</Year><RecNum>45</RecNum><DisplayText><style face="superscript">57</style></DisplayText><record><rec-number>45</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754966">45</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sorsdahl, Katherine</author><author>Sewpaul, Ronel</author><author>Evans, Meredith</author><author>Naidoo, Pamela</author><author>Myers, Bronwyn</author><author>Stein, Dan J</author></authors></contributors><titles><title>The association between psychological distress, alcohol use and physical non-communicable diseases in a nationally representative sample of South Africans</title><secondary-title>Journal of health psychology</secondary-title></titles><periodical><full-title>Journal of health psychology</full-title></periodical><pages>618-628</pages><volume>23</volume><number>4</number><dates><year>2018</year></dates><isbn>1359-1053</isbn><urls></urls></record></Cite></EndNote>57. Relatedly, the incidence of obesity is significantly elevated across most classes of mental disorders (appendix pg.6-14), even when compared to the alarmingly high rates of obesity in the general population. Weight gain is often distressing and negatively impacts an individual’s QOL, self-esteem, and may impede treatment seeking behaviour in fear of further weight gain ADDIN EN.CITE <EndNote><Cite><Author>Rajan</Author><Year>2017</Year><RecNum>46</RecNum><IDText>Psychiatric disorders and obesity: A review of association studies</IDText><DisplayText><style face="superscript">58</style></DisplayText><record><rec-number>46</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754966">46</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rajan, T. M.</author><author>Menon, V.</author></authors></contributors><auth-address>Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.</auth-address><titles><title>Psychiatric disorders and obesity: A review of association studies</title><secondary-title>J Postgrad Med</secondary-title><alt-title>Journal of postgraduate medicine</alt-title></titles><periodical><full-title>J Postgrad Med</full-title><abbr-1>Journal of postgraduate medicine</abbr-1></periodical><alt-periodical><full-title>J Postgrad Med</full-title><abbr-1>Journal of postgraduate medicine</abbr-1></alt-periodical><pages>182-190</pages><volume>63</volume><number>3</number><edition>2017/07/12</edition><dates><year>2017</year><pub-dates><date>Jul-Sep</date></pub-dates></dates><isbn>0022-3859</isbn><accession-num>28695871</accession-num><urls></urls><custom2>PMC5525483</custom2><electronic-resource-num>10.4103/jpgm.JPGM_712_16</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>58. 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ADDIN EN.CITE.DATA 60, which are themselves associated with the hallmarks of many mental disorders, and also key risk factors for worsening cardiometabolic healthPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5XaWxtb3Q8L0F1dGhvcj48WWVhcj4yMDEyPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 62,63 The reasons for this are unclear, but one biological pathway which could explain this relationship is the inflammatory effects of abdominal obesity; as heightened inflammation has also been associated with worsen mental health ADDIN EN.CITE <EndNote><Cite><Author>Najjar</Author><Year>2013</Year><RecNum>52</RecNum><DisplayText><style face="superscript">64</style></DisplayText><record><rec-number>52</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754967">52</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Najjar, Souhel</author><author>Pearlman, Daniel M</author><author>Alper, Kenneth</author><author>Najjar, Amanda</author><author>Devinsky, Orrin</author></authors></contributors><titles><title>Neuroinflammation and psychiatric illness</title><secondary-title>Journal of neuroinflammation</secondary-title></titles><periodical><full-title>Journal of neuroinflammation</full-title></periodical><pages>816</pages><volume>10</volume><number>1</number><dates><year>2013</year></dates><isbn>1742-2094</isbn><urls></urls></record></Cite></EndNote>64 and even increased suicidality ADDIN EN.CITE <EndNote><Cite><Author>Serafini</Author><Year>2013</Year><RecNum>53</RecNum><DisplayText><style face="superscript">65</style></DisplayText><record><rec-number>53</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754967">53</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Serafini, Gianluca</author><author>Pompili, Maurizio</author><author>Seretti, Maria Elena</author><author>Stefani, Henry</author><author>Palermo, Mario</author><author>Coryell, William</author><author>Girardi, Paolo</author></authors></contributors><titles><title>The role of inflammatory cytokines in suicidal behavior: a systematic review</title><secondary-title>European Neuropsychopharmacology</secondary-title></titles><periodical><full-title>European Neuropsychopharmacology</full-title></periodical><pages>1672-1686</pages><volume>23</volume><number>12</number><dates><year>2013</year></dates><isbn>0924-977X</isbn><urls></urls></record></Cite></EndNote>65. Beyond the personal burden, further research is also needed to establish the financial implications of physical comorbidities in people with mental illness, as discussed in Panel 1.In conclusion, to fully tackle physical health inequalities in people with mental illness, we must focus not only on ‘adding years to life’, but also on ‘adding life to years’ – specifically by preventing and reducing the incidence and impact of chronic health conditions across the life course. In particular, the evidence to date presents cardiometabolic diseases as a highly relevant and transdiagnostic target for improving physical health outcomes across a broad spectrum of mental illnesses. Although schizophrenia is typically associated with the greatest degree of cardiovascular risk (partly due to the side-effects of antipsychotic medications), there is now compelling evidence that obesity, metabolic syndrome, diabetes and cardiometabolic disease are similarly elevated in other mental disorders, including CMDs.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TbWl0aDwvQXV0aG9yPjxZZWFyPjIwMTg8L1llYXI+PFJl
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ADDIN EN.CITE.DATA 26-29,66-73 Given the higher prevalence of these mental disorders across the population, developing transdiagnostically-applicable strategies for improving cardiometabolic health outcomes in these populations (along with SMIs) could considerably reduce the premature mortality and lifelong burden of poor physical health which affects people with mental illness across the globe. Within this, the impact and prevalence of other NCDs and infectious diseases, in both high income and LMIC setting, cannot be neglected. Indeed, understanding the epidemiology of mental-physical comorbidity in LMICs, ADDIN EN.CITE <EndNote><Cite><Author>Mendenhall</Author><Year>2017</Year><RecNum>54</RecNum><DisplayText><style face="superscript">74</style></DisplayText><record><rec-number>54</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754967">54</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mendenhall, Emily</author><author>Kohrt, Brandon A</author><author>Norris, Shane A</author><author>Ndetei, David</author><author>Prabhakaran, Dorairaj</author></authors></contributors><titles><title>Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations</title><secondary-title>The Lancet</secondary-title></titles><periodical><full-title>The Lancet</full-title></periodical><pages>951-963</pages><volume>389</volume><number>10072</number><dates><year>2017</year></dates><isbn>0140-6736</isbn><urls></urls></record></Cite></EndNote>74 and developing evidence-based interventions integrating mental and physical healthcare in these settings, ADDIN EN.CITE <EndNote><Cite><Author>Thornicroft</Author><Year>2018</Year><RecNum>55</RecNum><DisplayText><style face="superscript">75</style></DisplayText><record><rec-number>55</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754968">55</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Thornicroft, Graham</author><author>Ahuja, Shalini</author><author>Barber, Sarah</author><author>Chisholm, Daniel</author><author>Collins, Pamela Y</author><author>Docrat, Sumaiyah</author><author>Fairall, Lara</author><author>Lempp, Heidi</author><author>Niaz, Unaiza</author><author>Ngo, Vicky</author></authors></contributors><titles><title>Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries</title><secondary-title>The Lancet Psychiatry</secondary-title></titles><periodical><full-title>The Lancet Psychiatry</full-title></periodical><dates><year>2018</year></dates><isbn>2215-0366</isbn><urls></urls></record></Cite></EndNote>75 is increasingly recognised a major research priority for global health. The following parts of the Commission aim to identify the key modifiable factors driving mental and physical health comorbidities, discuss strategies for improving the management and prevention of these conditions, and present directions for both immediate clinical action and future research aiming to reduce the physical health inequalities experienced by people with mental illness (as displayed in Figure 1). Panel 1. What is the cost of physical comorbidities in people with mental illness?‘Cost of Illness’ (COI) studies estimate the costs attributable to a diagnosis or group of diagnoses. Such studies have convincingly demonstrated that medical and psychiatric comorbidity is associated with higher hospital costs and increased readmission rates. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYW51PC9BdXRob3I+PFllYXI+MjAxNDwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA 76-78 Although this highlights additional costs of comorbidities, these studies are limited in scope since they only account for the cost of one health care resource (hospitalisation). To capture the full economic burden of physical comorbidities in mental illnesses, analyses should include the direct costs of medical care (hospitalisation, medication, outpatient consultations etc. including both government and private costs), along with costs related to accessing medical care (i.e. transportation) and indirect costs associated with lost productivity for both patients and carers. For instance, data from the United States found that the majority of total costs from people treated for depression in was attributable to comorbid conditions (both mental health and non-mental health related). ADDIN EN.CITE <EndNote><Cite><Author>Greenberg</Author><Year>2015</Year><RecNum>58</RecNum><DisplayText><style face="superscript">79</style></DisplayText><record><rec-number>58</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754968">58</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Greenberg, P. E.</author><author>Fournier, A. A.</author><author>Sisitsky, T.</author><author>Pike, C. T.</author><author>Kessler, R. C.</author></authors></contributors><auth-address>Analysis Group, Inc, 111 Huntington Ave, 10th Floor, Boston, MA 02199 paul.greenberg@.</auth-address><titles><title>The economic burden of adults with major depressive disorder in the United States (2005 and 2010)</title><secondary-title>J Clin Psychiatry</secondary-title><alt-title>The Journal of clinical psychiatry</alt-title></titles><periodical><full-title>J Clin Psychiatry</full-title></periodical><alt-periodical><full-title>The Journal of clinical psychiatry</full-title></alt-periodical><pages>155-62</pages><volume>76</volume><number>2</number><edition>2015/03/06</edition><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Comorbidity</keyword><keyword>*Cost of Illness</keyword><keyword>Cross-Sectional Studies</keyword><keyword>Depressive Disorder, Major/*economics/epidemiology</keyword><keyword>Female</keyword><keyword>Health Care Costs/*trends</keyword><keyword>Health Surveys</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Mental Disorders/economics/epidemiology</keyword><keyword>Middle Aged</keyword><keyword>United States</keyword><keyword>Young Adult</keyword></keywords><dates><year>2015</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0160-6689</isbn><accession-num>25742202</accession-num><urls></urls><electronic-resource-num>10.4088/JCP.14m09298</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>79 However, few studies to date have been able to report specifically on the contribution of comorbid physical conditions to total costs - although there is economic data showing that a large proportion of total costs from people with bipolar disorders are attributed non-mental health treatment,PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CcnlhbnQtQ29tc3RvY2s8L0F1dGhvcj48WWVhcj4yMDAy
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ADDIN EN.CITE.DATA 81Given the complex picture of mental health and physical comorbidities, future COI studies will require robust methods and integrated data sources (administrative, survey and/or registry data) to provide comprehensive estimates of the cost attributable to physical comorbidities in mental illness. Finally, while COI are important from a burden viewpoint, other types of economic evaluation are required to determine the cost-effectiveness of investing in specific physical health interventions/services for people with mental illness.Part 2: Key Modifiable Factors in Health Behaviours and Health ServicesIntroductionPart 1 identified cardiometabolic diseases as a category of physical comorbidities that are particularly pervasive and impactful on well-being, morbidity and mortality, across many mental disorders.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5QZXJyaW48L0F1dGhvcj48WWVhcj4yMDE3PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 26-29,55-57,66-73,82 Along with side-effects of psychotropic medications (covered in Part 3), reasons for the increased cardiometabolic morbidity and mortality in people with mental illness can be divided into patient-related and provider/system-level factors. ADDIN EN.CITE <EndNote><Cite><Author>Liu</Author><Year>2017</Year><RecNum>10</RecNum><DisplayText><style face="superscript">25</style></DisplayText><record><rec-number>10</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754960">10</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Liu, Nancy H</author><author>Daumit, Gail L</author><author>Dua, Tarun</author><author>Aquila, Ralph</author><author>Charlson, Fiona</author><author>Cuijpers, Pim</author><author>Druss, Benjamin</author><author>Dudek, Kenn</author><author>Freeman, Melvyn</author><author>Fujii, Chiyo</author></authors></contributors><titles><title>Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas</title><secondary-title>World psychiatry</secondary-title></titles><periodical><full-title>World Psychiatry</full-title><abbr-1>World psychiatry : official journal of the World Psychiatric Association (WPA)</abbr-1></periodical><pages>30-40</pages><volume>16</volume><number>1</number><dates><year>2017</year></dates><isbn>1723-8617</isbn><urls></urls></record></Cite></EndNote>25 Clear modifiable patient-related factors known to heavily influence cardiometabolic diseases are ‘lifestyle risk factors’ such as smoking, poor diet, and inactivity PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5GaXJ0aDwvQXV0aG9yPjxZZWFyPjIwMTg8L1llYXI+PFJl
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ADDIN EN.CITE.DATA 26-29,66-73 However, the extent to which lifestyle-related risk factors across various mental disorders differs from the general population across is not fully established. This may result in an imprecision in current lifestyle interventions for people with mental illness, or even an over-focus on one specific behavioral modification at the expense of neglecting other important risk factors (e.g. increasing exercise at expense of diet, or focusing on smoking over alcohol intake, etc.). Therefore, we applied a systematic hierarchical approach (described in appendix, pg. 15-16) in order to identifying the latest top-tier evidence on lifestyle-related risk factors for non-communicable diseases (NCDs) in people with mental illness. In doing this, we focused on behaviour risk factors in affective and psychotic conditions, rather than mental health conditions which are characterized by physically-damaging behaviours, such as eating disorders and substance/alcohol abuse (as in these cases, the greatest behavioural risks to physical health are clearly just those behaviours which define the conditions themselves). The findings from recent meta-analyses, systematic reviews and population-scale studies on lifestyle risk factors in various mental health populations are summarized in Table 2.Overview of the Evidence: Lifestyle risk factors across various diagnoses The initial aim of our hierarchal evidence synthesis was to determine the key behavioural/lifestyle risk factors associated with individual mental disorders. However, the bulk of the literature shows that all psychiatric diagnoses are associated with an entire spectrum of lifestyle risk factors (see Table 2). However, although mental disorders were associated with unhealthy lifestyles compared to the general population, comparisons between disorders indicate that an even higher risk in people with schizophrenia of smoking, sedentary behaviour and diet.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5GaXJ0aDwvQXV0aG9yPjxZZWFyPjIwMTg8L1llYXI+PFJl
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ADDIN EN.CITE.DATA 83,85-87 This may be partially mediated by socio-economic factors, as the incidence of schizophrenia is higher in socially deprived communities, ADDIN EN.CITE <EndNote><Cite><Author>Croudace</Author><Year>2000</Year><RecNum>19</RecNum><DisplayText><style face="superscript">88</style></DisplayText><record><rec-number>19</rec-number><foreign-keys><key app="EN" db-id="zs9050fzqvvfzuezsvlpzfwar0wtafxwetav" timestamp="1553758503">19</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author><style face="normal" font="default" size="12">Croudace, T.J.</style></author><author><style face="normal" font="default" size="12">Kayne, R.</style></author><author><style face="normal" font="default" size="12">Jones, P.B.</style></author><author><style face="normal" font="default" size="12">Harrison, G.L. </style></author></authors></contributors><titles><title><style face="normal" font="default" size="12">Non-linear relationship between an index of social deprivation, psychiatric admission prevalence and the incidence of psychosis</style></title><secondary-title><style face="normal" font="default" size="12">Psychol Med</style></secondary-title></titles><pages><style face="normal" font="default" size="12">177–185</style></pages><volume><style face="normal" font="default" size="12">30</style></volume><dates><year><style face="normal" font="default" size="12">2000</style></year></dates><urls></urls></record></Cite></EndNote>88 that also have higher rates of behavioural risk factors. ADDIN EN.CITE <EndNote><Cite><Author>Marmot</Author><Year>2005</Year><RecNum>298</RecNum><DisplayText><style face="superscript">89</style></DisplayText><record><rec-number>298</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755016">298</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Marmot, Michael</author></authors></contributors><titles><title>Social determinants of health inequalities</title><secondary-title>The lancet</secondary-title></titles><periodical><full-title>The Lancet</full-title></periodical><pages>1099-1104</pages><volume>365</volume><number>9464</number><dates><year>2005</year></dates><isbn>0140-6736</isbn><urls></urls></record></Cite></EndNote>89 However, behavioural risk factors are still greater in schizophrenia than other disorders even when controlling for socio-economic factors. For instance, a recent population-scale study of the U.K. Biobank ADDIN EN.CITE <EndNote><Cite><Author>Firth</Author><Year>2018</Year><RecNum>61</RecNum><DisplayText><style face="superscript">83</style></DisplayText><record><rec-number>61</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754969">61</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Firth, Joseph</author><author>Stubbs, Brendon</author><author>Teasdale, Scott B</author><author>Ward, Philip B</author><author>Veronese, Nicola</author><author>Shivappa, Nitin</author><author>Hebert, James R</author><author>Berk, Michael</author><author>Yung, Alison R</author><author>Sarris, Jerome</author></authors></contributors><titles><title>Diet as a hot topic in psychiatry: a population‐scale study of nutritional intake and inflammatory potential in severe mental illness</title><secondary-title>World Psychiatry</secondary-title></titles><periodical><full-title>World Psychiatry</full-title><abbr-1>World psychiatry : official journal of the World Psychiatric Association (WPA)</abbr-1></periodical><pages>365-367</pages><volume>17</volume><number>3</number><dates><year>2018</year></dates><isbn>1723-8617</isbn><urls></urls></record></Cite></EndNote>83 found that individuals with severe mental illness ate more obesogenic food than the general population, particularly those with schizophrenia (see Figure 2). Importantly, these differences persisted after adjusting for social deprivation and education. ADDIN EN.CITE <EndNote><Cite><Author>Firth</Author><Year>2018</Year><RecNum>61</RecNum><DisplayText><style face="superscript">83</style></DisplayText><record><rec-number>61</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754969">61</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Firth, Joseph</author><author>Stubbs, Brendon</author><author>Teasdale, Scott B</author><author>Ward, Philip B</author><author>Veronese, Nicola</author><author>Shivappa, Nitin</author><author>Hebert, James R</author><author>Berk, Michael</author><author>Yung, Alison R</author><author>Sarris, Jerome</author></authors></contributors><titles><title>Diet as a hot topic in psychiatry: a population‐scale study of nutritional intake and inflammatory potential in severe mental illness</title><secondary-title>World Psychiatry</secondary-title></titles><periodical><full-title>World Psychiatry</full-title><abbr-1>World psychiatry : official journal of the World Psychiatric Association (WPA)</abbr-1></periodical><pages>365-367</pages><volume>17</volume><number>3</number><dates><year>2018</year></dates><isbn>1723-8617</isbn><urls></urls></record></Cite></EndNote>83 One contributor may be the use of second generation antipsychotics (SGAs) (see Part 3), as even trials in healthy volunteers show that SGAs Figure 2. 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ADDIN EN.CITE.DATA 90, lethargy and sedation.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5MaW5kYmVyZzwvQXV0aG9yPjxZZWFyPjIwMDI8L1llYXI+
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ADDIN EN.CITE.DATA 91-93 The implications of this for early intervention strategies are presented in Panel 2. However, although certain SGAs such as olanzapine can have the most immediate cardiometabolic side-effects, this should not detract from potential side-effects of other psychotropic medications, which although not as pronounced, are more widely prescribed. Further discussion around the side-effects of SGAs and other more broadly prescribed psychotropic medications (such as antidepressants) is presented in Part 3.Health Behaviours and Mental Illness in Low and Middle Income SettingsWhereas much of the data presented in Table 2 is derived from high-income countries, recent studies have shown similar relationships in low and middle income countries (LMICs). PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TdHViYnM8L0F1dGhvcj48WWVhcj4yMDE4PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 84,86,97-99 Given the different sociocultural factors affecting mental and physical health in LMICs, the persistence of associations between various lifestyle factors in multiple mental health conditions further confirms the robustness of the link and the need for intervention . Furthermore, as LMICs continue to develop, inhabitants are faced with novel changes to health behaviour, such as reduced need for physical activity, and the availability of tobacco and “fast-food”. As these factors disproportionately affect people with mental illness, further efforts are needed to translate lifestyle interventions and screening into LMIC health services. Potential approaches for this are discussed in Part 5.Whereas Table 2 most considers risk factors for NCDs, other behavioural risk factors such as intravenous drug use and risky sexual practices are also overrepresented in people with severe mental illness, leading to infectious disease in both LMIC and high-income settings (as described in Part 1). Most evidence is restricted to adults with SMI and may underestimate the prevalence in other ages and diagnoses. For instance, a recent meta-analysis of 3,029 adolescents with a range of psychiatric diagnoses reported a 15% lifetime prevalence of sexually transmitted illnesses (95% CI = 3-50%) and that 40% engaged in risky behaviour at their last encounter (95 CI = 23-78%) ADDIN EN.CITE <EndNote><Cite><Author>Cunningham</Author><Year>2017</Year><RecNum>74</RecNum><DisplayText><style face="superscript">100</style></DisplayText><record><rec-number>74</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754971">74</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cunningham, Karlene</author><author>Martinez, David A</author><author>Scott-Sheldon, Lori AJ</author><author>Carey, Kate B</author><author>Carey, Michael P</author></authors></contributors><titles><title>Alcohol Use and Sexual Risk Behaviors Among Adolescents With Psychiatric Disorders: A Systematic Review and Meta-Analysis</title><secondary-title>Journal of child & adolescent substance abuse</secondary-title></titles><periodical><full-title>Journal of child & adolescent substance abuse</full-title></periodical><pages>353-366</pages><volume>26</volume><number>5</number><dates><year>2017</year></dates><isbn>1067-828X</isbn><urls></urls></record></Cite></EndNote>100. Furthermore, these risky behaviours interacted with other lifestyle factors with recent alcohol use increasing the likelihood of unprotected sex (OR = 1.66, 95% CI = 1.09, 2.52) ADDIN EN.CITE <EndNote><Cite><Author>Cunningham</Author><Year>2017</Year><RecNum>74</RecNum><DisplayText><style face="superscript">100</style></DisplayText><record><rec-number>74</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754971">74</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cunningham, Karlene</author><author>Martinez, David A</author><author>Scott-Sheldon, Lori AJ</author><author>Carey, Kate B</author><author>Carey, Michael P</author></authors></contributors><titles><title>Alcohol Use and Sexual Risk Behaviors Among Adolescents With Psychiatric Disorders: A Systematic Review and Meta-Analysis</title><secondary-title>Journal of child & adolescent substance abuse</secondary-title></titles><periodical><full-title>Journal of child & adolescent substance abuse</full-title></periodical><pages>353-366</pages><volume>26</volume><number>5</number><dates><year>2017</year></dates><isbn>1067-828X</isbn><urls></urls></record></Cite></EndNote>100. The clustering of risk factors for both NCDs and infectious diseases should not be overlooked, and again suggests that screening for multiple lifestyle factors will provide the most efficient methods for improving health outcomes in people with mental illness.Conceptualizing and Intervening for Health Behaviours ‘Across the Board’ in Mental IllnessIn summary, although our evidence synthesis process was designed to identify key behavioural risk factors for specific mental disorders, the overall evidence suggests that simultaneously considering multiple lifestyle factors across diagnoses more appropriate in understanding and managing risk factors. However, transdiagnostic multi-factorial approaches are not widely reflected in the literature to date, which generally focuses on specific factors for individual disorders. Furthermore, there is an absence of suitable tools for clinicians to comprehensively assess lifestyle factors as part of standard care. Basing physical health assessment entirely on biological markers (such as >7% increase in bodyweight, high blood pressure and lipid profile) could potentially tilt screening methods towards been ‘too late’ for interventions for protecting metabolic health and preventing obesity to be applied preemptively (see Panel 2). This concept is now reflected in clinical guidelines, which are increasingly recommending that assessments of diet, physical activity and health risk behaviours are be used alongside the anthropomorphic/blood markers of metabolic status, ADDIN EN.CITE <EndNote><Cite><Author>NHS-England</Author><Year>2018</Year><RecNum>75</RecNum><DisplayText><style face="superscript">101</style></DisplayText><record><rec-number>75</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754971">75</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>NHS-England</author></authors></contributors><titles><title>CCG data collection for people with severe mental illness receiving a
full physical health check and follow-up interventions in primary care:
Technical guidance</title></titles><dates><year>2018</year></dates><urls></urls></record></Cite></EndNote>101 to more fully capture current physical health and future risk. To facilitate the shift towards more comprehensive health promotion in mental illness, a positive first step would be developing ‘brief but broad’ tools for lifestyle screening. These could be used transdiagnostically, in various settings or services, to assess a range of behavioural risk factors (e.g. exercise, diet, substance use and sleep) at once, and thus identify key drivers of poor physical health on a case-by-case basis. In addition to providing more clear information on individual’s specific risk factors for prescribers and practitioners to address, comprehensive lifestyle assessment would also present patients with more ‘actionable’ physical health information than that which is typically provided based on biological markers of metabolic screening. Whereas self-report questionnaires may be too burdensome and inaccurate, digital technologies (including smartphones and wearables) may ultimately present a feasible and accurate method of broad lifestyle assessment ADDIN EN.CITE <EndNote><Cite><Author>Firth</Author><Year>2018</Year><RecNum>76</RecNum><DisplayText><style face="superscript">102,103</style></DisplayText><record><rec-number>76</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754971">76</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Firth, Joseph</author><author>Stubbs, Brendon</author><author>Vancampfort, Davy</author><author>Schuch, Felipe B</author><author>Rosenbaum, Simon</author><author>Ward, Philip B</author><author>Firth, Josh A</author><author>Sarris, Jerome</author><author>Yung, Alison R</author></authors></contributors><titles><title>The Validity and Value of Self-reported Physical Activity and Accelerometry in People With Schizophrenia: A Population-Scale Study of the UK Biobank</title><secondary-title>Schizophrenia Bulletin</secondary-title></titles><periodical><full-title>Schizophr Bull</full-title><abbr-1>Schizophrenia bulletin</abbr-1></periodical><pages>1293-1300</pages><volume>44</volume><number>6</number><dates><year>2018</year></dates><urls></urls></record></Cite><Cite><Author>Naslund</Author><Year>2018</Year><RecNum>77</RecNum><record><rec-number>77</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754972">77</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Naslund, John A</author><author>Aschbrenner, Kelly A</author></authors></contributors><titles><title>Digital technology for health promotion: opportunities to address excess mortality in persons living with severe mental disorders</title><secondary-title>Evidence-based mental health</secondary-title></titles><periodical><full-title>Evidence-based mental health</full-title></periodical><pages>ebmental-2018-300034</pages><dates><year>2018</year></dates><isbn>1362-0347</isbn><urls></urls></record></Cite></EndNote>102,103. Along with developing suitable assessment tools, more efficient pathways should be provided for helping people with mental illness to overcome their behavioural risk factors (see Part 4). This could include developing multidisciplinary referral pathways (available through both primary and secondary care) which can provide access to specialized physical activity, smoking cessation, dietician or other allied health services - depending on individuals’ specific behavioural profiles and health goals, in order to provide more personalized lifestyle interventions. A further urgent challenge is the dissemination of risk behaviour interventions in LMIC settings, where individuals with mental illness are disproportionately affected by risk for infectious diseases and NCDs. Alongside this, LMICs are increasingly faced with new challenges towards maintaining a healthy lifestyle, due to the spread of fast-food services, new technologies facilitating physical inactivity, and tobacco promotion and legislation.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYWxpazwvQXV0aG9yPjxZZWFyPjIwMTM8L1llYXI+PFJl
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ADDIN EN.CITE.DATA 104-106 Promising emerging approaches, ideal content, and factors affecting implementation of the necessary interventions across various settings are discussed in Part 4 and Part 5.Looking Beyond Lifestyle: Health Provider and System-Level FactorsAlthough important, lifestyle- related factors are unlikely to be the only explanations for poor physical health outcomes in people with mental illness. ADDIN EN.CITE <EndNote><Cite><Author>Liu</Author><Year>2017</Year><RecNum>10</RecNum><DisplayText><style face="superscript">25</style></DisplayText><record><rec-number>10</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754960">10</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Liu, Nancy H</author><author>Daumit, Gail L</author><author>Dua, Tarun</author><author>Aquila, Ralph</author><author>Charlson, Fiona</author><author>Cuijpers, Pim</author><author>Druss, Benjamin</author><author>Dudek, Kenn</author><author>Freeman, Melvyn</author><author>Fujii, Chiyo</author></authors></contributors><titles><title>Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas</title><secondary-title>World psychiatry</secondary-title></titles><periodical><full-title>World Psychiatry</full-title><abbr-1>World psychiatry : official journal of the World Psychiatric Association (WPA)</abbr-1></periodical><pages>30-40</pages><volume>16</volume><number>1</number><dates><year>2017</year></dates><isbn>1723-8617</isbn><urls></urls></record></Cite></EndNote>25 For SMI in particular, mortality remains high even after adjusting for behavioural risk factors such as smoking, physical activity and body mass index. ADDIN EN.CITE <EndNote><Cite><Author>Hamer</Author><Year>2008</Year><RecNum>81</RecNum><DisplayText><style face="superscript">107</style></DisplayText><record><rec-number>81</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754972">81</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hamer, Mark</author><author>Stamatakis, Emmanuel</author><author>Steptoe, Andrew</author></authors></contributors><titles><title>Psychiatric hospital admissions, behavioral risk factors, and all-cause mortality: the Scottish health survey</title><secondary-title>Archives of Internal Medicine</secondary-title></titles><periodical><full-title>Archives of Internal Medicine</full-title></periodical><pages>2474-2479</pages><volume>168</volume><number>22</number><dates><year>2008</year></dates><isbn>0003-9926</isbn><urls></urls></record></Cite></EndNote>107 Increasingly strong evidence suggests this is due to issues at the health provider or system level. From the outset, people with SMI are less able to access sufficient health care. In the United States, they are twice as likely as those without mental disorders to have been denied medical insurance because of a pre-existing condition. ADDIN EN.CITE <EndNote><Cite><Author>Druss</Author><Year>1998</Year><RecNum>82</RecNum><DisplayText><style face="superscript">108</style></DisplayText><record><rec-number>82</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754973">82</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Druss, Benjamin G</author><author>Rosenheck, Robert A</author></authors></contributors><titles><title>Mental disorders and access to medical care in the United States</title><secondary-title>American Journal of Psychiatry</secondary-title></titles><periodical><full-title>American Journal of Psychiatry</full-title></periodical><pages>1775-1777</pages><volume>155</volume><number>12</number><dates><year>1998</year></dates><isbn>0002-953X</isbn><urls></urls></record></Cite></EndNote>108 These disparities extend across all levels of health services. In primary care, people with schizophrenia are less likely to have had a physical examination (e.g. weight, blood pressure), ADDIN EN.CITE <EndNote><Cite><Author>Burns</Author><Year>1998</Year><RecNum>83</RecNum><DisplayText><style face="superscript">109</style></DisplayText><record><rec-number>83</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754973">83</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Burns, Tom</author><author>Cohen, Alan</author></authors></contributors><titles><title>Item-of-service payments for general practitioner care of severely mentally ill persons: does the money matter?</title><secondary-title>Br J Gen Pract</secondary-title></titles><periodical><full-title>Br J Gen Pract</full-title></periodical><pages>1415-1416</pages><volume>48</volume><number>432</number><dates><year>1998</year></dates><isbn>0960-1643</isbn><urls></urls></record></Cite></EndNote>109 or to be assessed and treated for hyperlipidaemia. ADDIN EN.CITE <EndNote><Cite><Author>Hippisley-Cox</Author><Year>2007</Year><RecNum>84</RecNum><DisplayText><style face="superscript">110,111</style></DisplayText><record><rec-number>84</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754973">84</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hippisley-Cox, Julia</author><author>Parker, Chris</author><author>Coupland, Carol A</author><author>Vinogradova, Yana</author></authors></contributors><titles><title>Inequalities in the primary care of coronary heart disease patients with serious mental health problems: cross-sectional study</title><secondary-title>Heart</secondary-title></titles><periodical><full-title>Heart</full-title></periodical><dates><year>2007</year></dates><isbn>1355-6037</isbn><urls></urls></record></Cite><Cite><Author>Howard</Author><Year>2010</Year><RecNum>85</RecNum><record><rec-number>85</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754973">85</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Howard, Louise M</author><author>Barley, Elizabeth A</author><author>Davies, Elizabeth</author><author>Rigg, Anne</author><author>Lempp, Heidi</author><author>Rose, Diana</author><author>Taylor, David</author><author>Thornicroft, Graham</author></authors></contributors><titles><title>Cancer diagnosis in people with severe mental illness: practical and ethical issues</title><secondary-title>The lancet oncology</secondary-title></titles><periodical><full-title>The lancet oncology</full-title></periodical><pages>797-804</pages><volume>11</volume><number>8</number><dates><year>2010</year></dates><isbn>1470-2045</isbn><urls></urls></record></Cite></EndNote>110,111 They also have more emergency department visits, and experience avoidable admissions to hospital for physical conditions ADDIN EN.CITE <EndNote><Cite><Author>Kisely</Author><Year>2015</Year><RecNum>86</RecNum><DisplayText><style face="superscript">112</style></DisplayText><record><rec-number>86</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754973">86</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kisely, Steve</author><author>Ehrlich, Carolyn</author><author>Kendall, Elizabeth</author><author>Lawrence, David</author></authors></contributors><titles><title>Using avoidable admissions to measure quality of care for cardiometabolic and other physical comorbidities of psychiatric disorders: a population-based, record-linkage analysis</title><secondary-title>The Canadian Journal of Psychiatry</secondary-title></titles><periodical><full-title>The Canadian Journal of Psychiatry</full-title></periodical><pages>497-506</pages><volume>60</volume><number>11</number><dates><year>2015</year></dates><isbn>0706-7437</isbn><urls></urls></record></Cite></EndNote>112 which, with appropriate primary care, should not require inpatient treatment. In the area of oral health, there is also evidence of decreased access to appropriate care in a range of psychiatric diagnoses including depression, anxiety, substance use disorder and severe mental illness. ADDIN EN.CITE <EndNote><Cite><Author>Kisely</Author><Year>2015</Year><RecNum>89</RecNum><DisplayText><style face="superscript">113,114</style></DisplayText><record><rec-number>89</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754974">89</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kisely, Steve</author><author>Baghaie, Hooman</author><author>Lalloo, Ratilal</author><author>Siskind, Dan</author><author>Johnson, Newell W</author></authors></contributors><titles><title>A systematic review and meta-analysis of the association between poor oral health and severe mental illness</title><secondary-title>Psychosomatic Medicine</secondary-title></titles><periodical><full-title>Psychosomatic Medicine</full-title></periodical><pages>83-92</pages><volume>77</volume><number>1</number><dates><year>2015</year></dates><isbn>0033-3174</isbn><urls></urls></record></Cite><Cite><Author>Kisely</Author><Year>2016</Year><RecNum>87</RecNum><record><rec-number>87</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754973">87</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kisely, Steve</author><author>Sawyer, Emily</author><author>Siskind, Dan</author><author>Lalloo, Ratilal</author></authors></contributors><titles><title>The oral health of people with anxiety and depressive disorders–a systematic review and meta-analysis</title><secondary-title>Journal of affective disorders</secondary-title></titles><periodical><full-title>J Affect Disord</full-title><abbr-1>Journal of affective disorders</abbr-1></periodical><pages>119-132</pages><volume>200</volume><dates><year>2016</year></dates><isbn>0165-0327</isbn><urls></urls></record></Cite></EndNote>113,114Management of physical health in secondary health services may be no better than in primary care. ADDIN EN.CITE <EndNote><Cite><Author>Robson</Author><Year>2007</Year><RecNum>90</RecNum><DisplayText><style face="superscript">115</style></DisplayText><record><rec-number>90</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754974">90</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Robson, Debbie</author><author>Gray, Richard</author></authors></contributors><titles><title>Serious mental illness and physical health problems: a discussion paper</title><secondary-title>International journal of nursing studies</secondary-title></titles><periodical><full-title>International journal of nursing studies</full-title></periodical><pages>457-466</pages><volume>44</volume><number>3</number><dates><year>2007</year></dates><isbn>0020-7489</isbn><urls></urls></record></Cite></EndNote>115 Of particular concern is that people with mental illness are less likely to receive medical or surgical interventions commonly received by the general community. 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ADDIN EN.CITE.DATA 116-118 They are also less likely to receive appropriate medications, such as b-blockers and statins, on discharge following myocardial infarction. ADDIN EN.CITE <EndNote><Cite><Author>Kisely</Author><Year>2013</Year><RecNum>94</RecNum><DisplayText><style face="superscript">119</style></DisplayText><record><rec-number>94</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754975">94</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kisely, Stephen</author><author>Crowe, Elizabeth</author><author>Lawrence, David</author></authors></contributors><titles><title>Cancer-related mortality in people with mental illness</title><secondary-title>JAMA psychiatry</secondary-title></titles><periodical><full-title>JAMA Psychiatry</full-title></periodical><pages>209-217</pages><volume>70</volume><number>2</number><dates><year>2013</year></dates><isbn>2168-622X</isbn><urls></urls></record></Cite></EndNote>119 In the case of cancer, the incidence of cancer in psychiatric patients is no higher than that of the general population (see Part 1), although mortality is higher. ADDIN EN.CITE <EndNote><Cite><Author>Lawrence</Author><Year>2000</Year><RecNum>95</RecNum><DisplayText><style face="superscript">120,121</style></DisplayText><record><rec-number>95</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754975">95</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lawrence, D</author><author>D'Arcy, C</author><author>Holman, J</author><author>Jablensky, AV</author><author>Threfall, TJ</author><author>Fuller, SA</author></authors></contributors><titles><title>Excess cancer mortality in Western Australian psychiatric patients due to higher case fatality rates</title><secondary-title>Acta Psychiatrica Scandinavica</secondary-title></titles><periodical><full-title>Acta Psychiatrica Scandinavica</full-title></periodical><pages>382-388</pages><volume>101</volume><number>5</number><dates><year>2000</year></dates><isbn>0001-690X</isbn><urls></urls></record></Cite><Cite><Author>Kisely</Author><Year>2008</Year><RecNum>96</RecNum><record><rec-number>96</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754975">96</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kisely, Stephen</author><author>Sadek, Joseph</author><author>MacKenzie, Adrian</author><author>Lawrence, David</author><author>Campbell, Leslie Anne</author></authors></contributors><titles><title>Excess cancer mortality in psychiatric patients</title><secondary-title>The Canadian Journal of Psychiatry</secondary-title></titles><periodical><full-title>The Canadian Journal of Psychiatry</full-title></periodical><pages>753-761</pages><volume>53</volume><number>11</number><dates><year>2008</year></dates><isbn>0706-7437</isbn><urls></urls></record></Cite></EndNote>120,121 This again appears to be driven by disparities at health service level, as people with mental illness are less likely to be offered cancer screening, ADDIN EN.CITE <EndNote><Cite><Author>Tuesley</Author><Year>2018</Year><RecNum>25</RecNum><DisplayText><style face="superscript">122</style></DisplayText><record><rec-number>25</rec-number><foreign-keys><key app="EN" db-id="zs9050fzqvvfzuezsvlpzfwar0wtafxwetav" timestamp="1553758504">25</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Tuesley, K. M.</author><author>Jordan, S. J.</author><author>Siskind, D. J.</author><author>Kendall, B. J.</author><author>Kisely, S.</author></authors></contributors><auth-address>1 Population Health Department, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.
2 School of Public Health, The University of Queensland, Herston, QLD, Australia.
3 School of Medicine, The University of Queensland, Brisbane, QLD, Australia.
4 Metro South Addiction and Mental Health Service, Brisbane, Metro South Health, QLD, Australia.
5 Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia.
6 Departments of Psychiatry and Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada.</auth-address><titles><title>Colorectal, cervical and prostate cancer screening in Australians with severe mental illness: Retrospective nation-wide cohort study</title><secondary-title>Aust N Z J Psychiatry</secondary-title><alt-title>The Australian and New Zealand journal of psychiatry</alt-title></titles><pages>4867418814945</pages><edition>2018/12/07</edition><keywords><keyword>Severe mental illness</keyword><keyword>cancer screening</keyword><keyword>cervical cancer</keyword><keyword>colorectal cancer</keyword><keyword>prostate cancer</keyword></keywords><dates><year>2018</year><pub-dates><date>Dec 2</date></pub-dates></dates><isbn>0004-8674</isbn><accession-num>30501394</accession-num><urls></urls><electronic-resource-num>10.1177/0004867418814945</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>122 have reduced likelihood of surgery for all types of cancer, ADDIN EN.CITE <EndNote><Cite><Author>Kisely</Author><Year>2016</Year><RecNum>97</RecNum><DisplayText><style face="superscript">123</style></DisplayText><record><rec-number>97</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754975">97</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kisely, Steve</author><author>Forsyth, Simon</author><author>Lawrence, David</author></authors></contributors><titles><title>Why do psychiatric patients have higher cancer mortality rates when cancer incidence is the same or lower?</title><secondary-title>Australian & New Zealand Journal of Psychiatry</secondary-title></titles><periodical><full-title>Australian & New Zealand Journal of Psychiatry</full-title></periodical><pages>254-263</pages><volume>50</volume><number>3</number><dates><year>2016</year></dates><isbn>0004-8674</isbn><urls></urls></record></Cite></EndNote>123 and wait longer for their operations. ADDIN EN.CITE <EndNote><Cite><Author>Kisely</Author><Year>2016</Year><RecNum>97</RecNum><DisplayText><style face="superscript">123</style></DisplayText><record><rec-number>97</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754975">97</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kisely, Steve</author><author>Forsyth, Simon</author><author>Lawrence, David</author></authors></contributors><titles><title>Why do psychiatric patients have higher cancer mortality rates when cancer incidence is the same or lower?</title><secondary-title>Australian & New Zealand Journal of Psychiatry</secondary-title></titles><periodical><full-title>Australian & New Zealand Journal of Psychiatry</full-title></periodical><pages>254-263</pages><volume>50</volume><number>3</number><dates><year>2016</year></dates><isbn>0004-8674</isbn><urls></urls></record></Cite></EndNote>123 One explanation for these disparities in care is that clinicians may attribute emerging somatic symptoms to the underlying psychiatric disorder resulting in missed diagnoses, sometimes termed ‘diagnostic overshadowing’. ADDIN EN.CITE <EndNote><Cite><Author>Psychiatrists</Author><Year>2015</Year><RecNum>98</RecNum><DisplayText><style face="superscript">124,125</style></DisplayText><record><rec-number>98</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754975">98</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>The Royal Australian and New Zealand College of Psychiatrists</author></authors></contributors><titles><title>Improving the physical health and life expectancy of people with serious mental illness</title></titles><dates><year>2015</year></dates><urls></urls></record></Cite><Cite><Author>Viron</Author><Year>2010</Year><RecNum>99</RecNum><record><rec-number>99</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754975">99</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Viron, Mark J</author><author>Stern, Theodore A</author></authors></contributors><titles><title>The impact of serious mental illness on health and healthcare</title><secondary-title>Psychosomatics</secondary-title></titles><periodical><full-title>Psychosomatics</full-title></periodical><pages>458-465</pages><volume>51</volume><number>6</number><dates><year>2010</year></dates><isbn>0033-3182</isbn><urls></urls></record></Cite></EndNote>124,125 In addition, people with a mental illness may be have difficulties with: reporting medical complaints; interpreting physical symptoms and distinguishing them from symptoms of their mental illness; and staying engaged with psychiatric and primary care services (i.e. by attending follow-up appointments). ADDIN EN.CITE <EndNote><Cite><Author>Psychiatrists</Author><Year>2015</Year><RecNum>98</RecNum><DisplayText><style face="superscript">124,126</style></DisplayText><record><rec-number>98</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754975">98</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>The Royal Australian and New Zealand College of Psychiatrists</author></authors></contributors><titles><title>Improving the physical health and life expectancy of people with serious mental illness</title></titles><dates><year>2015</year></dates><urls></urls></record></Cite><Cite><Author>Ayerbe</Author><Year>2018</Year><RecNum>100</RecNum><record><rec-number>100</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754976">100</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ayerbe, Luis</author><author>Forgnone, Ivo</author><author>Foguet-Boreu, Quintí</author><author>González, Esteban</author><author>Addo, Juliet</author><author>Ayis, Salma</author></authors></contributors><titles><title>Disparities in the management of cardiovascular risk factors in patients with psychiatric disorders: a systematic review and meta-analysis</title><secondary-title>Psychological medicine</secondary-title></titles><periodical><full-title>Psychol Med</full-title><abbr-1>Psychological medicine</abbr-1></periodical><pages>2693-2701</pages><volume>48</volume><number>16</number><dates><year>2018</year></dates><isbn>0033-2917</isbn><urls></urls></record></Cite></EndNote>124,126Other factors explaining why physicians may be reluctant to offer some medical procedures because of the ensuing psychological stress, along with concerns about capacity, informed consent or compliance with postoperative care, or the presence of contra-indications such as substance abuse and smoking. ADDIN EN.CITE <EndNote><Cite><Author>Ayerbe</Author><Year>2018</Year><RecNum>100</RecNum><DisplayText><style face="superscript">126</style></DisplayText><record><rec-number>100</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754976">100</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ayerbe, Luis</author><author>Forgnone, Ivo</author><author>Foguet-Boreu, Quintí</author><author>González, Esteban</author><author>Addo, Juliet</author><author>Ayis, Salma</author></authors></contributors><titles><title>Disparities in the management of cardiovascular risk factors in patients with psychiatric disorders: a systematic review and meta-analysis</title><secondary-title>Psychological medicine</secondary-title></titles><periodical><full-title>Psychol Med</full-title><abbr-1>Psychological medicine</abbr-1></periodical><pages>2693-2701</pages><volume>48</volume><number>16</number><dates><year>2018</year></dates><isbn>0033-2917</isbn><urls></urls></record></Cite></EndNote>126 However, contra-indications to specialized interventions, such as smoking or problems with informed consent, are less relevant to the prescription of vascular drugs such as ACE inhibitors, beta-blockers, or statins known to reduce subsequent morbidity and mortality. ADDIN EN.CITE <EndNote><Cite><Author>Kugathasan</Author><Year>2018</Year><RecNum>101</RecNum><DisplayText><style face="superscript">127</style></DisplayText><record><rec-number>101</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754976">101</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kugathasan, Pirathiv</author><author>Horsdal, Henriette Thisted</author><author>Aagaard, J?rgen</author><author>Jensen, Svend Eggert</author><author>Laursen, Thomas Munk</author><author>Nielsen, René Ernst</author></authors></contributors><titles><title>Association of secondary preventive cardiovascular treatment after myocardial infarction with mortality among patients with schizophrenia</title><secondary-title>JAMA psychiatry</secondary-title></titles><periodical><full-title>JAMA Psychiatry</full-title></periodical><dates><year>2018</year></dates><urls></urls></record></Cite></EndNote>127 Furthermore, recent data have shown that people with schizophrenia are equally adherent to diabetes medication as the general population, thus further supporting the need for healthcare providers to remain optimistic about prescribing cardiometabolic medications in people with mental illness. ADDIN EN.CITE <EndNote><Cite><Author>Gorczynski</Author><Year>2017</Year><RecNum>102</RecNum><DisplayText><style face="superscript">128</style></DisplayText><record><rec-number>102</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754976">102</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gorczynski, Paul</author><author>Firth, Joseph</author><author>Stubbs, Brendon</author><author>Rosenbaum, Simon</author><author>Vancampfort, Davy</author></authors></contributors><titles><title>Are people with schizophrenia adherent to diabetes medication? A comparative meta-analysis</title><secondary-title>Psychiatry research</secondary-title></titles><periodical><full-title>Psychiatry Research</full-title></periodical><pages>17-24</pages><volume>250</volume><dates><year>2017</year></dates><isbn>0165-1781</isbn><urls></urls></record></Cite></EndNote>128 Finally, access may be compromised by financial costs, fragmentation of care and stigma.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TYXJ0b3JpdXM8L0F1dGhvcj48WWVhcj4yMDA3PC9ZZWFy
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ADDIN EN.CITE.DATA 124,126,129 Although health care should be the one sector where challenging behaviour might be recognized as a symptom of illness, there is evidence that various healthcare providers have stigmatised views on people with mental illness. ADDIN EN.CITE <EndNote><Cite><Author>Psychiatrists</Author><Year>2015</Year><RecNum>98</RecNum><DisplayText><style face="superscript">124,125</style></DisplayText><record><rec-number>98</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754975">98</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>The Royal Australian and New Zealand College of Psychiatrists</author></authors></contributors><titles><title>Improving the physical health and life expectancy of people with serious mental illness</title></titles><dates><year>2015</year></dates><urls></urls></record></Cite><Cite><Author>Viron</Author><Year>2010</Year><RecNum>99</RecNum><record><rec-number>99</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754975">99</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Viron, Mark J</author><author>Stern, Theodore A</author></authors></contributors><titles><title>The impact of serious mental illness on health and healthcare</title><secondary-title>Psychosomatics</secondary-title></titles><periodical><full-title>Psychosomatics</full-title></periodical><pages>458-465</pages><volume>51</volume><number>6</number><dates><year>2010</year></dates><isbn>0033-3182</isbn><urls></urls></record></Cite></EndNote>124,125 Nonetheless, there are increasing calls for health services to routinely offer health screening and lifestyle interventions to people with psychiatric disorders as they would with a chronic physical condition. ADDIN EN.CITE <EndNote><Cite><Author>Saxena</Author><Year>2017</Year><RecNum>104</RecNum><DisplayText><style face="superscript">130</style></DisplayText><record><rec-number>104</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754976">104</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Saxena, Shekhar</author><author>Maj, Mario</author></authors></contributors><titles><title>Physical health of people with severe mental disorders: leave no one behind</title><secondary-title>World Psychiatry</secondary-title></titles><periodical><full-title>World Psychiatry</full-title><abbr-1>World psychiatry : official journal of the World Psychiatric Association (WPA)</abbr-1></periodical><pages>1-2</pages><volume>16</volume><number>1</number><dates><year>2017</year></dates><isbn>1723-8617</isbn><urls></urls></record></Cite></EndNote>130In conclusion, people with mental illness are less likely to receive the same level of health care as others in the community with the same level of physical health problems. Given the complexity of the problem, interventions should be targeted at both providers and the overall health system (see Part 5). Greater integration of physical-mental healthcare in primary care settings is a fundamental recommendation for improving the management of physical comorbidities in people with mental illness, as discussed extensively in Part 5. For mental health clinicians, it is important not to attribute emerging somatic symptoms solely to the underlying mental illness, and there should be refresher training in mental health services in the detection, management and prevention of chronic medical conditions. ADDIN EN.CITE <EndNote><Cite><Author>Sartorius</Author><Year>2007</Year><RecNum>103</RecNum><DisplayText><style face="superscript">129</style></DisplayText><record><rec-number>103</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754976">103</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sartorius, Norman</author></authors></contributors><titles><title>Physical illness in people with mental disorders</title><secondary-title>World Psychiatry</secondary-title></titles><periodical><full-title>World Psychiatry</full-title><abbr-1>World psychiatry : official journal of the World Psychiatric Association (WPA)</abbr-1></periodical><pages>3</pages><volume>6</volume><number>1</number><dates><year>2007</year></dates><urls></urls></record></Cite></EndNote>129 Furthermore, developing (i) clinical tools for comprehensive lifestyle assessment, and improving referral pathways to targeted interventions, will enable practitioners to identify and manage cardiometabolic risk factors in a timely manner. 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ADDIN EN.CITE.DATA 134 Thus, if proactive lifestyle interventions in mental illness are provided only after sizeable changes in biological or clinical markers of adverse metabolic health are noted from screening, the window of opportunity to maximize effective prevention may be missed. As shown in Table 2, individuals with first episode psychosis (FEP) are at considerable lifestyle risk right from illness onset, as they are less physically active and have higher rates of alcohol use disorders than even those with long-term schizophrenia, while also displaying similar nutrient deficits and astonishingly high rates of smoking (at around 60% in both groups – which greatly exceeds prevalence in the general population). Indeed, many behavioural risk factors appear to precede, rather than accompany, the onset of psychotic disorders, ADDIN EN.CITE <EndNote><Cite><Author>Carney</Author><Year>2016</Year><RecNum>106</RecNum><DisplayText><style face="superscript">135</style></DisplayText><record><rec-number>106</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754977">106</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Carney, R.</author><author>Cotter, J.</author><author>Bradshaw, T.</author><author>Firth, J.</author><author>Yung, A. R.</author></authors></contributors><auth-address>(Carney, Cotter, Firth, Yung) Institute of Brain, Behaviour and Mental Health, University of Manchester M13 9PL, United Kingdom (Bradshaw) School of Nursing, Midwifery and Social Work, University of Manchester M13 9PL, United Kingdom</auth-address><titles><title>Cardiometabolic risk factors in young people at ultra-high risk for psychosis: A systematic review and meta-analysis</title><secondary-title>Schizophrenia Research</secondary-title></titles><periodical><full-title>Schizophrenia research</full-title></periodical><pages>290-300</pages><volume>170</volume><number>2-3</number><dates><year>2016</year><pub-dates><date>01 Feb</date></pub-dates></dates><accession-num>607754577</accession-num><work-type>Review</work-type><urls><related-urls><url> Technologies</remote-database-provider></record></Cite></EndNote>135 and metabolic disturbance may be present from illness onset. ADDIN EN.CITE <EndNote><Cite><Author>Pillinger</Author><Year>2017</Year><RecNum>107</RecNum><DisplayText><style face="superscript">136</style></DisplayText><record><rec-number>107</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754977">107</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Pillinger, T.</author><author>Beck, K.</author><author>Gobjila, C.</author><author>Donocik, J.</author><author>Jauhar, S.</author><author>Howes, O.</author></authors></contributors><auth-address>(Pillinger, Beck, Gobjila, Donocik, Jauhar, Howes) King's College London, United Kingdom</auth-address><titles><title>Impaired glucose homeostasis in first-episode schizophrenia: A meta-analysis</title><secondary-title>Schizophrenia Bulletin</secondary-title></titles><periodical><full-title>Schizophr Bull</full-title><abbr-1>Schizophrenia bulletin</abbr-1></periodical><pages>S80</pages><volume>43 (Supplement 1)</volume><dates><year>2017</year><pub-dates><date>March</date></pub-dates></dates><isbn>1745-1701</isbn><accession-num>616524665</accession-num><work-type>Conference Abstract</work-type><urls><related-urls><url> Technologies</remote-database-provider><language>English</language></record></Cite></EndNote>136 Then, upon treatment initiation, SGAs (whilst important to stabilize mental health) further increase metabolic risk (see Part 3). Given the high likelihood of physical health deterioration under these conditions, it could be considered a ‘duty of care’ to ensure that all individuals prescribed SGAs are not only screened but also provided with access to evidence-based lifestyle interventions (as detailed in Part 4) from the very initiation of treatment - even for those with currently intact metabolic health. Whereas health screening should clearly continue, rethinking our preventative approaches, and intervening on the basis of lifestyle plus pharmacological risk (rather than waiting for visible weight-gain and metabolic dysfunction to arise) could produce more timely and effective strategies for improving physical health outcomes.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DdXJ0aXM8L0F1dGhvcj48WWVhcj4yMDE2PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 137Part 3: The interplay between psychiatric medications and physical healthIntroductionAs discussed in Part 1, a broad range of psychiatric diagnoses are associated with high rates of comorbid physical conditions (particularly cardiometabolic diseases). Whereas lifestyle risk factors for chronic illness seem to apply transdiagnostically, across the spectrum of mental illnesses (Part 2), the specific physical health risks associated with individual diagnoses are modified by the types of psychotropic medications used to treat these conditions. This Part aims to present the latest understanding on the interaction between psychotropic medications and physical health across a range of conditions, and to discuss pharmacological strategies for attenuating and managing the physical health risks associated with mental illness and psychotropic adverse drug reactions (ADRs). ADRs associated with psychotropic medicationsAntipsychotic medicationsAntipsychotic medications are the cornerstone of treatment for people with psychotic disorders, leading to reduced acute symptoms ADDIN EN.CITE <EndNote><Cite><Author>Leucht</Author><Year>2017</Year><RecNum>110</RecNum><DisplayText><style face="superscript">138</style></DisplayText><record><rec-number>110</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754977">110</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Leucht, Stefan</author><author>Leucht, Claudia</author><author>Huhn, Maximilian</author><author>Chaimani, Anna</author><author>Mavridis, Dimitris</author><author>Helfer, Bartosz</author><author>Samara, Myrto</author><author>Rabaioli, Matteo</author><author>B?cher, Susanne</author><author>Cipriani, Andrea %J American journal of psychiatry</author></authors></contributors><titles><title>Sixty years of placebo-controlled antipsychotic drug trials in acute schizophrenia: systematic review, Bayesian meta-analysis, and meta-regression of efficacy predictors</title></titles><pages>927-942</pages><volume>174</volume><number>10</number><dates><year>2017</year></dates><isbn>0002-953X</isbn><urls></urls></record></Cite></EndNote>138, relapses ADDIN EN.CITE <EndNote><Cite><Author>Leucht</Author><Year>2012</Year><RecNum>111</RecNum><DisplayText><style face="superscript">139</style></DisplayText><record><rec-number>111</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754978">111</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Leucht, S.</author><author>Tardy, M.</author><author>Komossa, K.</author><author>Heres, S.</author><author>Kissling, W.</author><author>Salanti, G.</author><author>Davis, J. M.</author></authors></contributors><auth-address>Department of Psychiatry and Psychotherapy, Technische Universitat Munchen, Klinikum rechts der Isar, Munich, Germany. stefan.leucht@lrz.tum.de</auth-address><titles><title>Antipsychotic drugs versus placebo for relapse prevention in schizophrenia: a systematic review and meta-analysis</title><secondary-title>Lancet</secondary-title></titles><periodical><full-title>Lancet</full-title><abbr-1>Lancet (London, England)</abbr-1></periodical><pages>2063-71</pages><volume>379</volume><number>9831</number><edition>2012/05/09</edition><keywords><keyword>Antipsychotic Agents/adverse effects/*therapeutic use</keyword><keyword>Humans</keyword><keyword>Patient Dropouts/statistics & numerical data</keyword><keyword>Patient Readmission/statistics & numerical data</keyword><keyword>Placebos/therapeutic use</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Research Design</keyword><keyword>Schizophrenia/*prevention & control</keyword><keyword>Secondary Prevention</keyword><keyword>Sensitivity and Specificity</keyword></keywords><dates><year>2012</year><pub-dates><date>Jun 2</date></pub-dates></dates><isbn>1474-547X (Electronic)
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ADDIN EN.CITE.DATA 22,143. They are also used in bipolar affective disorder (BPAD) ADDIN EN.CITE <EndNote><Cite><Author>Lindstr?m</Author><Year>2017</Year><RecNum>117</RecNum><DisplayText><style face="superscript">144</style></DisplayText><record><rec-number>117</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754979">117</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lindstr?m, Leif</author><author>Lindstr?m, Eva</author><author>Nilsson, Mikael</author><author>H?istad, Malin %J Journal of affective disorders</author></authors></contributors><titles><title>Maintenance therapy with second generation antipsychotics for bipolar disorder–a systematic review and meta-analysis</title></titles><pages>138-150</pages><volume>213</volume><dates><year>2017</year></dates><isbn>0165-0327</isbn><urls></urls></record></Cite></EndNote>144 ADDIN EN.CITE <EndNote><Cite><Author>Spielmans</Author><Year>2013</Year><RecNum>118</RecNum><DisplayText><style face="superscript">145</style></DisplayText><record><rec-number>118</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754979">118</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Spielmans, Glen I</author><author>Berman, Margit I</author><author>Linardatos, Eftihia</author><author>Rosenlicht, Nicholas Z</author><author>Perry, Angela</author><author>Tsai, Alexander C %J PLoS medicine</author></authors></contributors><titles><title>Adjunctive atypical antipsychotic treatment for major depressive disorder: a meta-analysis of depression, quality of life, and safety outcomes</title></titles><pages>e1001403</pages><volume>10</volume><number>3</number><dates><year>2013</year></dates><isbn>1549-1676</isbn><urls></urls></record></Cite></EndNote>145 . The long-term effects of physical health related ADRs, however, remain a major concern. Such ADRs can be divided broadly into the following categories: cardio-metabolic, endocrine, neuro-motor, and other. Details of ADRs associated with specific antipsychotics are displayed in the appendix (Page 17: Table 3.1).Cardio-metabolic. Weight gain is a particularly important ADR, as it mediates other cardio-metabolic outcomes, such as type 2 diabetes mellitus (T2D) and cardiovascular diseases (CVDs). Weight gain is the most distressing side effect reported by callers to mental health helplines ADDIN EN.CITE <EndNote><Cite><Author>Cooper</Author><Year>2016</Year><RecNum>123</RecNum><DisplayText><style face="superscript">132</style></DisplayText><record><rec-number>123</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754980">123</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cooper, Stephen J</author><author>Reynolds, Gavin P</author><author>With expert co-authors :</author><author>Barnes, TRE</author><author>England, E</author><author>Haddad, PM</author><author>Heald, A</author><author>Holt, RIG</author><author>Lingford-Hughes, A</author><author>Osborn, D</author></authors></contributors><titles><title>BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment</title><secondary-title>Journal of Psychopharmacology</secondary-title></titles><periodical><full-title>Journal of Psychopharmacology</full-title></periodical><pages>717-748</pages><volume>30</volume><number>8</number><dates><year>2016</year></dates><isbn>0269-8811</isbn><urls></urls></record></Cite></EndNote>132 and is associated with poorer quality of life PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bbmdlcm1leWVyPC9BdXRob3I+PFllYXI+MTk5OTwvWWVh
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ADDIN EN.CITE.DATA 146-148 and barriers to social engagement. ADDIN EN.CITE <EndNote><Cite><Author>Young</Author><Year>2017</Year><RecNum>128</RecNum><DisplayText><style face="superscript">149</style></DisplayText><record><rec-number>128</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754981">128</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Young, Sarah J</author><author>Praskova, Anna</author><author>Hayward, Nicky</author><author>Patterson, Sue</author></authors></contributors><titles><title>Attending to physical health in mental health services in A ustralia: a qualitative study of service users’ experiences and expectations</title><secondary-title>Health & social care in the community</secondary-title></titles><periodical><full-title>Health & social care in the community</full-title></periodical><pages>602-611</pages><volume>25</volume><number>2</number><dates><year>2017</year></dates><isbn>0966-0410</isbn><urls></urls></record></Cite></EndNote>149 These factors are associated with compromised adherence with treatment leading to relapse and poor mental health outcomes.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NYW51PC9BdXRob3I+PFllYXI+MjAxNDwvWWVhcj48UmVj
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Tm90ZT4A
ADDIN EN.CITE.DATA 150,151. Multiple aetiological factors drive weight gain in people with psychotic disorders, including lifestyle risk factors (Table 2). Antipsychotic medication induced weight loss pathways include H1, D2, 5HT2c blockade, and dysregulation of GLP-1 ADDIN EN.CITE <EndNote><Cite><Author>Mayfield</Author><Year>2016</Year><RecNum>135</RecNum><DisplayText><style face="superscript">152,153</style></DisplayText><record><rec-number>135</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754982">135</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mayfield, Karla</author><author>Siskind, Dan</author><author>Winckel, Karl</author><author>Russell, Anthony W</author><author>Kisely, Steve</author><author>Smith, Greg</author><author>Hollingworth, Samantha %J Journal of Psychopharmacology</author></authors></contributors><titles><title>Glucagon-like peptide-1 agonists combating clozapine-associated obesity and diabetes</title></titles><pages>227-236</pages><volume>30</volume><number>3</number><dates><year>2016</year></dates><isbn>0269-8811</isbn><urls></urls></record></Cite><Cite><Author>Roerig</Author><Year>2011</Year><RecNum>136</RecNum><record><rec-number>136</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754982">136</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Roerig, James L</author><author>Steffen, Kristine J</author><author>Mitchell, James E %J CNS drugs</author></authors></contributors><titles><title>Atypical antipsychotic-induced weight gain</title></titles><pages>1035-1059</pages><volume>25</volume><number>12</number><dates><year>2011</year></dates><isbn>1172-7047</isbn><urls></urls></record></Cite></EndNote>152,153. A wealth of recent meta-analyses (Table 1) have documented an at least two-fold elevated risk of metabolic syndrome, and T2Din people with schizophrenia, BPAD and major depressive disorder (MDD) relative to the general population (see appendix pages 6 – 13 for details).Endocrine. Antipsychotic-induced hyperprolactinaemia is the most common endocrine ADR ADDIN EN.CITE <EndNote><Cite><Author>Peuskens</Author><Year>2014</Year><RecNum>141</RecNum><DisplayText><style face="superscript">154</style></DisplayText><record><rec-number>141</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754983">141</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Peuskens, Jozef</author><author>Pani, L</author><author>Detraux, Johan</author><author>De Hert, Marc %J CNS drugs</author></authors></contributors><titles><title>The effects of novel and newly approved antipsychotics on serum prolactin levels: a comprehensive review</title></titles><pages>421-453</pages><volume>28</volume><number>5</number><dates><year>2014</year></dates><isbn>1172-7047</isbn><urls></urls></record></Cite></EndNote>154. Antipsychotic medications block dopamine in the tuberoinfundibular pathway, leading to reduction in inhibition of prolactin synthesis and secretion, with hyperprolactinaemia developing most commonly with first generation antipsychotics, as well as risperidone paliperidone and amisulpride. Hyperprolactinaemcan be asymptomatic, or may lead to complications such as menstrual dysturbane and sexual dysfunction (including reduced libido, erectile dysfunction, vaginal dryness and orgasmic dysfunction ADDIN EN.CITE <EndNote><Cite><Author>Peuskens</Author><Year>1998</Year><RecNum>142</RecNum><DisplayText><style face="superscript">155</style></DisplayText><record><rec-number>142</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754983">142</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Peuskens, Joseph</author><author>Sienaert, Pascal</author><author>De Hert, Marc %J European Psychiatry</author></authors></contributors><titles><title>Sexual dysfunction: the unspoken side effect of antipsychotics</title></titles><pages>23s-30s</pages><volume>13</volume><dates><year>1998</year></dates><isbn>0924-9338</isbn><urls></urls></record></Cite></EndNote>155) in the short-term ADDIN EN.CITE <EndNote><Cite><Author>Knegtering</Author><Year>2003</Year><RecNum>143</RecNum><DisplayText><style face="superscript">156</style></DisplayText><record><rec-number>143</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754983">143</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Knegtering, H</author><author>Van Der Moolen, AEGM</author><author>Castelein, Stynke</author><author>Kluiter, Herman</author><author>Van Den Bosch, RJ</author></authors></contributors><titles><title>What are the effects of antipsychotics on sexual dysfunctions and endocrine functioning?</title><secondary-title>Psychoneuroendocrinology</secondary-title></titles><periodical><full-title>Psychoneuroendocrinology</full-title></periodical><pages>109-123</pages><volume>28</volume><dates><year>2003</year></dates><isbn>0306-4530</isbn><urls></urls></record></Cite></EndNote>156, and osteopenia in the long-term. ADDIN EN.CITE <EndNote><Cite><Author>De Hert</Author><Year>2016</Year><RecNum>144</RecNum><DisplayText><style face="superscript">157</style></DisplayText><record><rec-number>144</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754983">144</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>De Hert, Marc</author><author>Detraux, Johan</author><author>Stubbs, Brendon %J Expert Opinion on Drug Safety</author></authors></contributors><titles><title>Relationship between antipsychotic medication, serum prolactin levels and osteoporosis/osteoporotic fractures in patients with schizophrenia: a critical literature review</title></titles><pages>809-823</pages><volume>15</volume><number>6</number><dates><year>2016</year></dates><isbn>1474-0338</isbn><urls></urls></record></Cite></EndNote>157Neuro-motor.Extra-pyramidal side effects (EPSE) are the most common neuro-motor ADR of antipsychotics, can be socially stigmatising and are associated with poor quality of life, treatment dissatisfaction and non-adherence ADDIN EN.CITE <EndNote><Cite><Author>Angermeyer</Author><Year>1999</Year><RecNum>125</RecNum><DisplayText><style face="superscript">146,147</style></DisplayText><record><rec-number>125</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754980">125</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Angermeyer, Matthias C</author><author>Holzinger, Anita</author><author>Matschinger, Herbert %J Psychiatrische Praxis</author></authors></contributors><titles><title>Quality of life--what it means to me... Results of a survey among schizophrenic patients</title></titles><pages>56-60</pages><volume>26</volume><number>2</number><dates><year>1999</year></dates><isbn>0303-4259</isbn><urls></urls></record></Cite><Cite><Author>Briggs</Author><Year>2008</Year><RecNum>126</RecNum><record><rec-number>126</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754980">126</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Briggs, Andrew</author><author>Wild, Diane</author><author>Lees, Michael</author><author>Reaney, Matthew</author><author>Dursun, Serdar</author><author>Parry, David</author><author>Mukherjee, Jayanti %J Health</author><author>quality of life outcomes</author></authors></contributors><titles><title>Impact of schizophrenia and schizophrenia treatment-related adverse events on quality of life: direct utility elicitation</title></titles><pages>105</pages><volume>6</volume><number>1</number><dates><year>2008</year></dates><isbn>1477-7525</isbn><urls></urls></record></Cite></EndNote>146,147. 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ADDIN EN.CITE.DATA 158. The annualised incidence of tardive dyskinesia is lower among second-generation antipsychotic medications compared to first-generation antipsychotic medications ADDIN EN.CITE <EndNote><Cite><Author>Carbon</Author><Year>2018</Year><RecNum>146</RecNum><DisplayText><style face="superscript">159</style></DisplayText><record><rec-number>146</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754984">146</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Carbon, Maren</author><author>Kane, John M</author><author>Leucht, Stefan</author><author>Correll, Christoph U</author></authors></contributors><titles><title>Tardive dyskinesia risk with first‐and second‐generation antipsychotics in comparative randomized controlled trials: a meta‐analysis</title><secondary-title>World Psychiatry</secondary-title></titles><periodical><full-title>World Psychiatry</full-title><abbr-1>World psychiatry : official journal of the World Psychiatric Association (WPA)</abbr-1></periodical><pages>330-340</pages><volume>17</volume><number>3</number><dates><year>2018</year></dates><isbn>1723-8617</isbn><urls></urls></record></Cite></EndNote>159. Neuroleptic malignant syndrome (NMS) is a rare (incidence 1-2 per 10,000/year), but serious condition that can be life-threatening ADDIN EN.CITE <EndNote><Cite><Author>Strawn</Author><Year>2007</Year><RecNum>147</RecNum><DisplayText><style face="superscript">160</style></DisplayText><record><rec-number>147</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754984">147</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Strawn, J. R.</author><author>Keck, P. E., Jr.</author><author>Caroff, S. N.</author></authors></contributors><auth-address>University of Cincinnati, Department of Psychiatry, College of Medicine, Box 670559, Cincinnati, OH 45267-0559, USA. strawnjr@uc.edu</auth-address><titles><title>Neuroleptic malignant syndrome</title><secondary-title>Am J Psychiatry</secondary-title></titles><periodical><full-title>Am J Psychiatry</full-title></periodical><pages>870-6</pages><volume>164</volume><number>6</number><edition>2007/06/02</edition><keywords><keyword>Adult</keyword><keyword>Amantadine</keyword><keyword>Antiparkinson Agents/therapeutic use</keyword><keyword>Antipsychotic Agents/adverse effects/therapeutic use</keyword><keyword>Benzodiazepines/therapeutic use</keyword><keyword>Bromocriptine/therapeutic use</keyword><keyword>Dantrolene/therapeutic use</keyword><keyword>Diagnosis, Differential</keyword><keyword>Dopamine/physiology</keyword><keyword>Electroconvulsive Therapy</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Lorazepam/therapeutic use</keyword><keyword>Muscle Relaxants, Central/therapeutic use</keyword><keyword>Neuroleptic Malignant Syndrome/*diagnosis/drug therapy/physiopathology</keyword><keyword>Risk Factors</keyword></keywords><dates><year>2007</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>0002-953X (Print)
0002-953X (Linking)</isbn><accession-num>17541044</accession-num><urls><related-urls><url>. Its incidence has reduced since the wider use of second-generation antipsychotic medications. NMS is characterized by fever, severe rigidity, autonomic disturbances and confusion ADDIN EN.CITE <EndNote><Cite><Author>Strawn</Author><Year>2007</Year><RecNum>147</RecNum><DisplayText><style face="superscript">160</style></DisplayText><record><rec-number>147</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754984">147</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Strawn, J. R.</author><author>Keck, P. E., Jr.</author><author>Caroff, S. N.</author></authors></contributors><auth-address>University of Cincinnati, Department of Psychiatry, College of Medicine, Box 670559, Cincinnati, OH 45267-0559, USA. strawnjr@uc.edu</auth-address><titles><title>Neuroleptic malignant syndrome</title><secondary-title>Am J Psychiatry</secondary-title></titles><periodical><full-title>Am J Psychiatry</full-title></periodical><pages>870-6</pages><volume>164</volume><number>6</number><edition>2007/06/02</edition><keywords><keyword>Adult</keyword><keyword>Amantadine</keyword><keyword>Antiparkinson Agents/therapeutic use</keyword><keyword>Antipsychotic Agents/adverse effects/therapeutic use</keyword><keyword>Benzodiazepines/therapeutic use</keyword><keyword>Bromocriptine/therapeutic use</keyword><keyword>Dantrolene/therapeutic use</keyword><keyword>Diagnosis, Differential</keyword><keyword>Dopamine/physiology</keyword><keyword>Electroconvulsive Therapy</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Lorazepam/therapeutic use</keyword><keyword>Muscle Relaxants, Central/therapeutic use</keyword><keyword>Neuroleptic Malignant Syndrome/*diagnosis/drug therapy/physiopathology</keyword><keyword>Risk Factors</keyword></keywords><dates><year>2007</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>0002-953X (Print)
0002-953X (Linking)</isbn><accession-num>17541044</accession-num><urls><related-urls><url>. OtherAntipsychotics have been associated with varying degrees of cardiac conduction delays, indicated by prolongation of QTc, which can predispose to torsade de pointes leading to sudden death ADDIN EN.CITE <EndNote><Cite><Author>Solmi</Author><Year>2017</Year><RecNum>120</RecNum><DisplayText><style face="superscript">161</style></DisplayText><record><rec-number>120</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754979">120</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Solmi, Marco</author><author>Murru, Andrea</author><author>Pacchiarotti, Isabella</author><author>Undurraga, Juan</author><author>Veronese, Nicola</author><author>Fornaro, Michele</author><author>Stubbs, Brendon</author><author>Monaco, Francesco</author><author>Vieta, Eduard</author><author>Seeman, Mary V %J Therapeutics</author><author>clinical risk management</author></authors></contributors><titles><title>Safety, tolerability, and risks associated with first-and second-generation antipsychotics: a state-of-the-art clinical review</title></titles><pages>757</pages><volume>13</volume><dates><year>2017</year></dates><urls></urls></record></Cite></EndNote>161 and should be monitored in patients at risk. Anticholinergic effects are also common with antipsychotic medications, especially with chlorpromazine, clozapine, and olanzapine PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5OaXNodGFsYTwvQXV0aG9yPjxZZWFyPjIwMTY8L1llYXI+
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ADDIN EN.CITE.DATA 162. Somnolence, sedation and hypersomnia are also common with antipsychotics ADDIN EN.CITE <EndNote><Cite><Author>Leucht</Author><Year>2013</Year><RecNum>149</RecNum><DisplayText><style face="superscript">163</style></DisplayText><record><rec-number>149</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754985">149</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Leucht, Stefan</author><author>Cipriani, Andrea</author><author>Spineli, Loukia</author><author>Mavridis, Dimitris</author><author>?rey, Deniz</author><author>Richter, Franziska</author><author>Samara, Myrto</author><author>Barbui, Corrado</author><author>Engel, Rolf R</author><author>Geddes, John R %J The Lancet</author></authors></contributors><titles><title>Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis</title></titles><pages>951-962</pages><volume>382</volume><number>9896</number><dates><year>2013</year></dates><isbn>0140-6736</isbn><urls></urls></record></Cite></EndNote>163. Although there may be short term benefits with sedation in the acutely exacerbated/agitated patient, somnolence and sedation can impact upon on physical activity, body weight, concentration, ability to participate in daily activities and psychosocial rehabilitation, and may lead to medication non-adherence ADDIN EN.CITE <EndNote><Cite><Author>Angermeyer</Author><Year>1999</Year><RecNum>125</RecNum><DisplayText><style face="superscript">146</style></DisplayText><record><rec-number>125</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754980">125</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Angermeyer, Matthias C</author><author>Holzinger, Anita</author><author>Matschinger, Herbert %J Psychiatrische Praxis</author></authors></contributors><titles><title>Quality of life--what it means to me... Results of a survey among schizophrenic patients</title></titles><pages>56-60</pages><volume>26</volume><number>2</number><dates><year>1999</year></dates><isbn>0303-4259</isbn><urls></urls></record></Cite></EndNote>146. Most antipsychotic medications can reduce the seizure threshold, but the greatest dose-related risk for seizures is associated with clozapine ADDIN EN.CITE <EndNote><Cite><Author>Solmi</Author><Year>2017</Year><RecNum>120</RecNum><DisplayText><style face="superscript">161</style></DisplayText><record><rec-number>120</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754979">120</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Solmi, Marco</author><author>Murru, Andrea</author><author>Pacchiarotti, Isabella</author><author>Undurraga, Juan</author><author>Veronese, Nicola</author><author>Fornaro, Michele</author><author>Stubbs, Brendon</author><author>Monaco, Francesco</author><author>Vieta, Eduard</author><author>Seeman, Mary V %J Therapeutics</author><author>clinical risk management</author></authors></contributors><titles><title>Safety, tolerability, and risks associated with first-and second-generation antipsychotics: a state-of-the-art clinical review</title></titles><pages>757</pages><volume>13</volume><dates><year>2017</year></dates><urls></urls></record></Cite></EndNote>161.ClozapineClozapine is the only approved antipsychotic medication for people with treatment-resistant schizophrenia ADDIN EN.CITE <EndNote><Cite><Author>Howes</Author><Year>2016</Year><RecNum>150</RecNum><DisplayText><style face="superscript">164</style></DisplayText><record><rec-number>150</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754985">150</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Howes, Oliver D</author><author>McCutcheon, Rob</author><author>Agid, Ofer</author><author>De Bartolomeis, Andrea</author><author>Van Beveren, Nico JM</author><author>Birnbaum, Michael L</author><author>Bloomfield, Michael AP</author><author>Bressan, Rodrigo A</author><author>Buchanan, Robert W</author><author>Carpenter, William T</author></authors></contributors><titles><title>Treatment-resistant schizophrenia: treatment response and resistance in psychosis (TRRIP) working group consensus guidelines on diagnosis and terminology</title><secondary-title>American Journal of Psychiatry</secondary-title></titles><periodical><full-title>American Journal of Psychiatry</full-title></periodical><pages>216-229</pages><volume>174</volume><number>3</number><dates><year>2016</year></dates><isbn>0002-953X</isbn><urls></urls></record></Cite></EndNote>164. It is the most effective antipsychotic medication for reducing positive symptoms ADDIN EN.CITE <EndNote><Cite><Author>Siskind</Author><Year>2016</Year><RecNum>151</RecNum><DisplayText><style face="superscript">165</style></DisplayText><record><rec-number>151</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754985">151</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Siskind, Dan</author><author>McCartney, Lara</author><author>Goldschlager, Romi</author><author>Kisely, Steve</author></authors></contributors><titles><title>Clozapine v. first-and second-generation antipsychotics in treatment-refractory schizophrenia: systematic review and meta-analysis</title><secondary-title>The British Journal of Psychiatry</secondary-title></titles><periodical><full-title>The British Journal of Psychiatry</full-title></periodical><pages>385-392</pages><volume>209</volume><number>5</number><dates><year>2016</year></dates><isbn>0007-1250</isbn><urls></urls></record></Cite></EndNote>165 and hospitalisations ADDIN EN.CITE <EndNote><Cite><Author>Land</Author><Year>2017</Year><RecNum>152</RecNum><DisplayText><style face="superscript">166</style></DisplayText><record><rec-number>152</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754985">152</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Land, Rachel</author><author>Siskind, Dan</author><author>Mcardle, Peter</author><author>Kisely, Steve</author><author>Winckel, Karl</author><author>Hollingworth, Samantha A</author></authors></contributors><titles><title>The impact of clozapine on hospital use: a systematic review and meta‐analysis</title><secondary-title>Acta Psychiatrica Scandinavica</secondary-title></titles><periodical><full-title>Acta Psychiatrica Scandinavica</full-title></periodical><pages>296-309</pages><volume>135</volume><number>4</number><dates><year>2017</year></dates><isbn>0001-690X</isbn><urls></urls></record></Cite></EndNote>166. However, clozapine is associated with severe neutropenia/agranulocytosis (incidence 0.9% 95% CI: 0.7–1.1%) usually in the first month following commencement, rarely leading to death (incidence 0.013% 95% CI: 0.01–0.017%) ADDIN EN.CITE <EndNote><Cite><Author>Myles</Author><Year>2018</Year><RecNum>153</RecNum><DisplayText><style face="superscript">167</style></DisplayText><record><rec-number>153</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754985">153</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Myles, N</author><author>Myles, H</author><author>Xia, S</author><author>Large, M</author><author>Kisely, S</author><author>Galletly, C</author><author>Bird, R</author><author>Siskind, D</author></authors></contributors><titles><title>Meta‐analysis examining the epidemiology of clozapine‐associated neutropenia</title><secondary-title>Acta Psychiatrica Scandinavica</secondary-title></titles><periodical><full-title>Acta Psychiatrica Scandinavica</full-title></periodical><dates><year>2018</year></dates><isbn>0001-690X</isbn><urls></urls></record></Cite></EndNote>167. Cardiac ADRs can be life-threatening and include myocarditis (incidence 0.03%-1%, usually within first month) ADDIN EN.CITE <EndNote><Cite><Author>Rohde</Author><Year>2018</Year><RecNum>154</RecNum><DisplayText><style face="superscript">168,169</style></DisplayText><record><rec-number>154</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754985">154</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rohde, C</author><author>Polcwiartek, C</author><author>Kragholm, K</author><author>Ebdrup, BH</author><author>Siskind, D</author><author>Nielsen, J</author></authors></contributors><titles><title>Adverse cardiac events in out‐patients initiating clozapine treatment: a nationwide register‐based study</title><secondary-title>Acta Psychiatrica Scandinavica</secondary-title></titles><periodical><full-title>Acta Psychiatrica Scandinavica</full-title></periodical><pages>47-53</pages><volume>137</volume><number>1</number><dates><year>2018</year></dates><isbn>0001-690X</isbn><urls></urls></record></Cite><Cite><Author>Ronaldson</Author><Year>2015</Year><RecNum>155</RecNum><record><rec-number>155</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754986">155</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ronaldson, KJ</author><author>Fitzgerald, PB</author><author>McNeil, JJ</author></authors></contributors><titles><title>Clozapine‐induced myocarditis, a widely overlooked adverse reaction</title><secondary-title>Acta Psychiatrica Scandinavica</secondary-title></titles><periodical><full-title>Acta Psychiatrica Scandinavica</full-title></periodical><pages>231-240</pages><volume>132</volume><number>4</number><dates><year>2015</year></dates><isbn>0001-690X</isbn><urls></urls></record></Cite></EndNote>168,169 and cardiomyopathy (incidence 0.06-0.12%, usually after the first year) ADDIN EN.CITE <EndNote><Cite><Author>Rohde</Author><Year>2018</Year><RecNum>154</RecNum><DisplayText><style face="superscript">168,170</style></DisplayText><record><rec-number>154</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754985">154</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rohde, C</author><author>Polcwiartek, C</author><author>Kragholm, K</author><author>Ebdrup, BH</author><author>Siskind, D</author><author>Nielsen, J</author></authors></contributors><titles><title>Adverse cardiac events in out‐patients initiating clozapine treatment: a nationwide register‐based study</title><secondary-title>Acta Psychiatrica Scandinavica</secondary-title></titles><periodical><full-title>Acta Psychiatrica Scandinavica</full-title></periodical><pages>47-53</pages><volume>137</volume><number>1</number><dates><year>2018</year></dates><isbn>0001-690X</isbn><urls></urls></record></Cite><Cite><Author>Alawami</Author><Year>2014</Year><RecNum>156</RecNum><record><rec-number>156</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754986">156</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Alawami, Mohammed</author><author>Wasywich, Cara</author><author>Cicovic, Aleksandar</author><author>Kenedi, Christopher</author></authors></contributors><titles><title>A systematic review of clozapine induced cardiomyopathy</title><secondary-title>International journal of cardiology</secondary-title></titles><periodical><full-title>International journal of cardiology</full-title></periodical><pages>315-320</pages><volume>176</volume><number>2</number><dates><year>2014</year></dates><isbn>0167-5273</isbn><urls></urls></record></Cite></EndNote>168,170. Other ADRs include weight gain, T2D, sedation, sialorrhea, constipation, tachycardia, postural hypotension, gastro-oesophageal reflux, nocturnal enuresis, seizures, and obsessive-compulsive symptoms ADDIN EN.CITE <EndNote><Cite><Author>Nielsen</Author><Year>2011</Year><RecNum>157</RecNum><DisplayText><style face="superscript">171</style></DisplayText><record><rec-number>157</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754986">157</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Nielsen, Jimmi</author><author>Damkier, P</author><author>Lublin, Henrik</author><author>Taylor, D</author></authors></contributors><titles><title>Optimizing clozapine treatment</title><secondary-title>Acta Psychiatrica Scandinavica</secondary-title></titles><periodical><full-title>Acta Psychiatrica Scandinavica</full-title></periodical><pages>411-422</pages><volume>123</volume><number>6</number><dates><year>2011</year></dates><isbn>0001-690X</isbn><urls></urls></record></Cite></EndNote>171.Mood stabilisers Mood stabilisers are used in BPAD ADDIN EN.CITE <EndNote><Cite><Author>Geddes</Author><Year>2004</Year><RecNum>158</RecNum><DisplayText><style face="superscript">172</style></DisplayText><record><rec-number>158</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754986">158</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Geddes, John R</author><author>Burgess, Sally</author><author>Hawton, Keith</author><author>Jamison, Kay</author><author>Goodwin, Guy M</author></authors></contributors><titles><title>Long-term lithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials</title><secondary-title>American Journal of Psychiatry</secondary-title></titles><periodical><full-title>American Journal of Psychiatry</full-title></periodical><pages>217-222</pages><volume>161</volume><number>2</number><dates><year>2004</year></dates><isbn>0002-953X</isbn><urls></urls></record></Cite></EndNote>172 and adjunctively in refractory schizophrenia ADDIN EN.CITE <EndNote><Cite><Author>Siskind</Author><Year>2018</Year><RecNum>161</RecNum><DisplayText><style face="superscript">173</style></DisplayText><record><rec-number>161</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754987">161</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Siskind, Dan J</author><author>Lee, Michael</author><author>Ravindran, Arul</author><author>Zhang, Qichen</author><author>Ma, Evelyn</author><author>Motamarri, Balaji</author><author>Kisely, Steve</author></authors></contributors><titles><title>Augmentation strategies for clozapine refractory schizophrenia: A systematic review and meta-analysis</title><secondary-title>Australian & New Zealand Journal of Psychiatry</secondary-title></titles><periodical><full-title>Australian & New Zealand Journal of Psychiatry</full-title></periodical><pages>0004867418772351</pages><dates><year>2018</year></dates><isbn>0004-8674</isbn><urls></urls></record></Cite></EndNote>173. 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Individuals prescribed lithium have a mean weight gain of 4kg over 2 years ADDIN EN.CITE <EndNote><Cite><Author>Vestergaard</Author><Year>1988</Year><RecNum>163</RecNum><DisplayText><style face="superscript">175</style></DisplayText><record><rec-number>163</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754987">163</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Vestergaard, P</author><author>Poulstrup, I</author><author>Schou, M %J Acta Psychiatrica Scandinavica</author></authors></contributors><titles><title>Prospective studies on a lithium cohort: 3. Tremor, weight gain, diarrhea, psychological complaints</title></titles><pages>434-441</pages><volume>78</volume><number>4</number><dates><year>1988</year></dates><isbn>0001-690X</isbn><urls></urls></record></Cite></EndNote>175. 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ADDIN EN.CITE.DATA 177), hypothyroidism ADDIN EN.CITE <EndNote><Cite><Author>McKnight</Author><Year>2012</Year><RecNum>166</RecNum><DisplayText><style face="superscript">178</style></DisplayText><record><rec-number>166</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754988">166</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>McKnight, R. F.</author><author>Adida, M.</author><author>Budge, K.</author><author>Stockton, S.</author><author>Goodwin, G. M.</author><author>Geddes, J. R.</author></authors></contributors><auth-address>Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.</auth-address><titles><title>Lithium toxicity profile: a systematic review and meta-analysis</title><secondary-title>Lancet</secondary-title><alt-title>Lancet (London, England)</alt-title></titles><periodical><full-title>Lancet</full-title><abbr-1>Lancet (London, England)</abbr-1></periodical><alt-periodical><full-title>Lancet</full-title><abbr-1>Lancet (London, England)</abbr-1></alt-periodical><pages>721-8</pages><volume>379</volume><number>9817</number><edition>2012/01/24</edition><keywords><keyword>Antipsychotic Agents/*adverse effects/therapeutic use</keyword><keyword>Humans</keyword><keyword>Lithium/*adverse effects/therapeutic use</keyword><keyword>Mood Disorders/*drug therapy</keyword></keywords><dates><year>2012</year><pub-dates><date>Feb 25</date></pub-dates></dates><isbn>0140-6736</isbn><accession-num>22265699</accession-num><urls></urls><electronic-resource-num>10.1016/s0140-6736(11)61516-x</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>178), as well as hyperthyroidism. ADDIN EN.CITE <EndNote><Cite><Author>McDermott</Author><Year>1986</Year><RecNum>167</RecNum><DisplayText><style face="superscript">179</style></DisplayText><record><rec-number>167</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754988">167</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>McDermott, M. T.</author><author>Burman, K. D.</author><author>Hofeldt, F. D.</author><author>Kidd, G. S.</author></authors></contributors><titles><title>Lithium-associated thyrotoxicosis</title><secondary-title>Am J Med</secondary-title></titles><periodical><full-title>Am J Med</full-title></periodical><pages>1245-8</pages><volume>80</volume><number>6</number><keywords><keyword>Autoimmune Diseases/chemically induced</keyword><keyword>Female</keyword><keyword>Graves Disease/chemically induced</keyword><keyword>Humans</keyword><keyword>Hyperthyroidism/*chemically induced</keyword><keyword>Hypothyroidism/*chemically induced</keyword><keyword>Lithium/*adverse effects</keyword><keyword>Middle Aged</keyword><keyword>Thyroiditis, Autoimmune/chemically induced</keyword></keywords><dates><year>1986</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>0002-9343 (Print)
0002-9343 (Linking)</isbn><accession-num>3755288</accession-num><urls><related-urls><url> Lithium is also associated with polydipsia, polyuria, diabetes insipidus other forms of renal dysfunction ADDIN EN.CITE <EndNote><Cite><Author>McKnight</Author><Year>2012</Year><RecNum>166</RecNum><DisplayText><style face="superscript">178</style></DisplayText><record><rec-number>166</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754988">166</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>McKnight, R. F.</author><author>Adida, M.</author><author>Budge, K.</author><author>Stockton, S.</author><author>Goodwin, G. M.</author><author>Geddes, J. R.</author></authors></contributors><auth-address>Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.</auth-address><titles><title>Lithium toxicity profile: a systematic review and meta-analysis</title><secondary-title>Lancet</secondary-title><alt-title>Lancet (London, England)</alt-title></titles><periodical><full-title>Lancet</full-title><abbr-1>Lancet (London, England)</abbr-1></periodical><alt-periodical><full-title>Lancet</full-title><abbr-1>Lancet (London, England)</abbr-1></alt-periodical><pages>721-8</pages><volume>379</volume><number>9817</number><edition>2012/01/24</edition><keywords><keyword>Antipsychotic Agents/*adverse effects/therapeutic use</keyword><keyword>Humans</keyword><keyword>Lithium/*adverse effects/therapeutic use</keyword><keyword>Mood Disorders/*drug therapy</keyword></keywords><dates><year>2012</year><pub-dates><date>Feb 25</date></pub-dates></dates><isbn>0140-6736</isbn><accession-num>22265699</accession-num><urls></urls><electronic-resource-num>10.1016/s0140-6736(11)61516-x</electronic-resource-num><remote-database-provider>NLM</remote-database-provider><language>eng</language></record></Cite></EndNote>178. Sodium valproate is also associated with metabolic effects, with at least half of individuals experiencing weight gain in the first three months after initiation PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Hcm9vdGVuczwvQXV0aG9yPjxZZWFyPjIwMTg8L1llYXI+
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ADDIN EN.CITE.DATA 182. Considering that antipsychotic medications are often prescribed concurrently with mood stabilisers, the weight gaining effects of both classes of medication could be additive and therefore additional caution is required ADDIN EN.CITE <EndNote><Cite><Author>Vancampfort</Author><Year>2013</Year><RecNum>171</RecNum><DisplayText><style face="superscript">183</style></DisplayText><record><rec-number>171</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754989">171</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Vancampfort, Davy</author><author>Vansteelandt, Kristof</author><author>Correll, Christoph U</author><author>Mitchell, Alex J</author><author>De Herdt, Amber</author><author>Sienaert, Pascal</author><author>Probst, Michel</author><author>De Hert, Marc</author></authors></contributors><titles><title>Metabolic syndrome and metabolic abnormalities in bipolar disorder: a meta-analysis of prevalence rates and moderators</title><secondary-title>American Journal of Psychiatry</secondary-title></titles><periodical><full-title>American Journal of Psychiatry</full-title></periodical><pages>265-274</pages><volume>170</volume><number>3</number><dates><year>2013</year></dates><isbn>0002-953X</isbn><urls></urls></record></Cite></EndNote>183. While lithium and sodium valproate represent the two most widely prescribed mood stabilising medications, other mood stabilisers, such as carbamazepine have a lower propensity for weight gain PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Hcm9vdGVuczwvQXV0aG9yPjxZZWFyPjIwMTg8L1llYXI+
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ADDIN EN.CITE.DATA 180 and lamotrigine is weight neutral ADDIN EN.CITE <EndNote><Cite><Author>Malhi</Author><Year>2012</Year><RecNum>172</RecNum><DisplayText><style face="superscript">184</style></DisplayText><record><rec-number>172</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754989">172</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Malhi, Gin S</author><author>Bargh, Danielle M</author><author>McIntyre, Roger</author><author>Gitlin, Michael</author><author>Frye, Mark A</author><author>Bauer, Michael</author><author>Berk, Michael %J Bipolar disorders</author></authors></contributors><titles><title>Balanced efficacy, safety, and tolerability recommendations for the clinical management of bipolar disorder</title></titles><pages>1-21</pages><volume>14</volume><dates><year>2012</year></dates><isbn>1398-5647</isbn><urls></urls></record></Cite></EndNote>184. All mood stabilizers have been associated with teratogenic effects and should be avoided in pregnancy and lactation (see Appendix Page 18: Table 3.2).AntidepressantsCommon ADRs with newer generation antidepressant drugs include headache, nausea, agitation, sedation, dizziness, sexual dysfunction, hyponatremia as well as weight gain and metabolic abnormalities. ADDIN EN.CITE <EndNote><Cite><Author>Carvalho</Author><Year>2016</Year><RecNum>174</RecNum><DisplayText><style face="superscript">185</style></DisplayText><record><rec-number>174</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754989">174</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Carvalho, A. F.</author><author>Sharma, M. S.</author><author>Brunoni, A. R.</author><author>Vieta, E.</author><author>Fava, G. A.</author></authors></contributors><auth-address>Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceara, Fortaleza, Brazil.</auth-address><titles><title>The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature</title><secondary-title>Psychother Psychosom</secondary-title><alt-title>Psychotherapy and psychosomatics</alt-title></titles><alt-periodical><full-title>Psychotherapy and psychosomatics</full-title></alt-periodical><pages>270-88</pages><volume>85</volume><number>5</number><edition>2016/08/11</edition><keywords><keyword>Antidepressive Agents/*adverse effects</keyword><keyword>Depressive Disorder, Major/*drug therapy</keyword><keyword>Humans</keyword><keyword>Risk Factors</keyword></keywords><dates><year>2016</year></dates><isbn>0033-3190</isbn><accession-num>27508501</accession-num><urls></urls><electronic-resource-num>10.1159/000447034</electronic-resource-num><remote-database-provider>Nlm</remote-database-provider><language>eng</language></record></Cite></EndNote>185 While gastrointestinal side effects, headache and sexual side effects are a class effect of pro-serotonergic antidepressants, sedation, weight gain and metabolic effects vary across agents. More antihistaminergic agents (e.g., mirtazapine) are more associated with cardiometabolic effects and sedation. Less commonly, antidepressants can be associated with cardiac (e.g. arrhythmias), neurological (e.g., seizures) and hepatic ADRs. ADDIN EN.CITE <EndNote><Cite><Author>Carvalho</Author><Year>2016</Year><RecNum>174</RecNum><DisplayText><style face="superscript">185</style></DisplayText><record><rec-number>174</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754989">174</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Carvalho, A. F.</author><author>Sharma, M. S.</author><author>Brunoni, A. R.</author><author>Vieta, E.</author><author>Fava, G. A.</author></authors></contributors><auth-address>Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceara, Fortaleza, Brazil.</auth-address><titles><title>The Safety, Tolerability and Risks Associated with the Use of Newer Generation Antidepressant Drugs: A Critical Review of the Literature</title><secondary-title>Psychother Psychosom</secondary-title><alt-title>Psychotherapy and psychosomatics</alt-title></titles><alt-periodical><full-title>Psychotherapy and psychosomatics</full-title></alt-periodical><pages>270-88</pages><volume>85</volume><number>5</number><edition>2016/08/11</edition><keywords><keyword>Antidepressive Agents/*adverse effects</keyword><keyword>Depressive Disorder, Major/*drug therapy</keyword><keyword>Humans</keyword><keyword>Risk Factors</keyword></keywords><dates><year>2016</year></dates><isbn>0033-3190</isbn><accession-num>27508501</accession-num><urls></urls><electronic-resource-num>10.1159/000447034</electronic-resource-num><remote-database-provider>Nlm</remote-database-provider><language>eng</language></record></Cite></EndNote>185 Treatment with tricyclic antidepressants (TCAs) is frequently associated with anticholinergic effects, including dry mouth, sedation, blurred vision, xerostomia, constipation, urinary retention, as well as increased appetite, weight gain and also hyponatraemia (especially in older patients). ADDIN EN.CITE <EndNote><Cite><Author>Blackwell</Author><Year>1981</Year><RecNum>175</RecNum><DisplayText><style face="superscript">186</style></DisplayText><record><rec-number>175</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754990">175</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Blackwell, B.</author></authors></contributors><titles><title>Adverse effects of antidepressant drugs. Part 1: monoamine oxidase inhibitors and tricyclics</title><secondary-title>Drugs</secondary-title><alt-title>Drugs</alt-title></titles><periodical><full-title>Drugs</full-title><abbr-1>Drugs</abbr-1></periodical><alt-periodical><full-title>Drugs</full-title><abbr-1>Drugs</abbr-1></alt-periodical><pages>201-19</pages><volume>21</volume><number>3</number><edition>1981/03/01</edition><keywords><keyword>Aged</keyword><keyword>Antidepressive Agents/poisoning</keyword><keyword>Antidepressive Agents, Tricyclic/*adverse effects</keyword><keyword>Cardiovascular System/drug effects</keyword><keyword>Central Nervous System/drug effects</keyword><keyword>Drug Interactions</keyword><keyword>Female</keyword><keyword>Fetus/drug effects</keyword><keyword>Food</keyword><keyword>Humans</keyword><keyword>Monoamine Oxidase Inhibitors/*adverse effects</keyword><keyword>Neurotransmitter Agents/secretion</keyword><keyword>Parasympathetic Nervous System/drug effects</keyword><keyword>Pregnancy</keyword></keywords><dates><year>1981</year><pub-dates><date>Mar</date></pub-dates></dates><isbn>0012-6667 (Print)
0012-6667</isbn><accession-num>6114849</accession-num><urls></urls><remote-database-provider>Nlm</remote-database-provider><language>eng</language></record></Cite></EndNote>186 Furthermore, those drugs carry a risk of orthostatic hypotension and falls. ADDIN EN.CITE <EndNote><Cite><Author>Oderda</Author><Year>2012</Year><RecNum>176</RecNum><DisplayText><style face="superscript">187</style></DisplayText><record><rec-number>176</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754990">176</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Oderda, L. H.</author><author>Young, J. R.</author><author>Asche, C. V.</author><author>Pepper, G. A.</author></authors></contributors><auth-address>Department of Pharmacotherapy, College of Pharmacy, University of Utah, Salt Lake City, USA. lynda.oderda@hsc.utah.edu</auth-address><titles><title>Psychotropic-related hip fractures: meta-analysis of first-generation and second-generation antidepressant and antipsychotic drugs</title><secondary-title>Ann Pharmacother</secondary-title><alt-title>The Annals of pharmacotherapy</alt-title></titles><periodical><full-title>Ann Pharmacother</full-title><abbr-1>The Annals of pharmacotherapy</abbr-1></periodical><alt-periodical><full-title>Ann Pharmacother</full-title><abbr-1>The Annals of pharmacotherapy</abbr-1></alt-periodical><pages>917-28</pages><volume>46</volume><number>7-8</number><edition>2012/07/20</edition><keywords><keyword>Accidental Falls</keyword><keyword>Aged</keyword><keyword>Antidepressive Agents/*adverse effects</keyword><keyword>Antipsychotic Agents/*adverse effects</keyword><keyword>Hip Fractures/*epidemiology</keyword><keyword>Humans</keyword><keyword>Odds Ratio</keyword><keyword>Risk</keyword></keywords><dates><year>2012</year><pub-dates><date>Jul-Aug</date></pub-dates></dates><isbn>1060-0280</isbn><accession-num>22811347</accession-num><urls></urls><electronic-resource-num>10.1345/aph.1Q589</electronic-resource-num><remote-database-provider>Nlm</remote-database-provider><language>eng</language></record></Cite></EndNote>187 Additionally, they have a known arrhythmogenic effect; ECG changes may include PR, QRS and PT prolongation (see Appendix Page 19: Table 3.3).Pharmacological Management of Physical Health Comorbidities in People with Mental IllnessFor the physical comorbidities associated with serious mental illness (SMI) commonly seen in the general population (e.g. CVD), national and international prescribing guidelines developed for non-SMI populations should be followed. Conditions secondary to psychiatric pharmacological treatment (e.g. EPSE) require a more specialized approach. There is a need for greater monitoring of the physical health parameters of people on antipsychotics, and the provision evidence based pharmacological treatments ADDIN EN.CITE <EndNote><Cite><Author>Suetani</Author><Year>2015</Year><RecNum>178</RecNum><DisplayText><style face="superscript">188</style></DisplayText><record><rec-number>178</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754990">178</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Suetani, Shuichi</author><author>Whiteford, Harvey A</author><author>McGrath, John J %J JAMA psychiatry</author></authors></contributors><titles><title>An urgent call to address the deadly consequences of serious mental disorders</title></titles><pages>1166-1167</pages><volume>72</volume><number>12</number><dates><year>2015</year></dates><isbn>2168-622X</isbn><urls></urls></record></Cite></EndNote>188. Where safe and feasible, modifying psychiatric medications (dose reduction or switch) that have been associated with the ADR should be considered, in consultation with the patient. Here, we provide a targeted, evidence-based approach to commonly observed physical health ADRs in SMI. Type 2 diabetes mellitusThe approach to pharmacological management of T2D in SMI should follow guidelines for the general population (Appendix Page 20). First-line pharmacological therapy is metformin monotherapy. Second-line therapies are listed in Appendix (Page 20: Table 3.4.). A summary of the relative risks and benefits of T2D treatments in SMI is presented in Table 3. Metformin reduces the risk of transition from pre-diabetes to T2D ADDIN EN.CITE <EndNote><Cite><Author>Diabetes Prevention Program Research</Author><Year>2002</Year><RecNum>227</RecNum><DisplayText><style face="superscript">189,190</style></DisplayText><record><rec-number>227</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755001">227</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Diabetes Prevention Program Research, Group</author></authors></contributors><titles><title>The Diabetes Prevention Program (DPP) description of lifestyle intervention</title><secondary-title>Diabetes care</secondary-title></titles><periodical><full-title>Diabetes care</full-title></periodical><pages>2165-2171</pages><volume>25</volume><number>12</number><dates><year>2002</year></dates><isbn>0149-5992</isbn><urls></urls></record></Cite><Cite><Author>Knowler</Author><Year>2002</Year><RecNum>229</RecNum><record><rec-number>229</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755001">229</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Knowler, William C</author><author>Barrett-Connor, Elizabeth</author><author>Fowler, Sarah E</author><author>Hamman, Richard F</author><author>Lachin, John M</author><author>Walker, Elizabeth A</author><author>Nathan, David M</author></authors></contributors><titles><title>Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin</title><secondary-title>The New England journal of medicine</secondary-title></titles><periodical><full-title>The New England journal of medicine</full-title></periodical><pages>393-403</pages><volume>346</volume><number>6</number><dates><year>2002</year></dates><isbn>0028-4793</isbn><urls></urls></record></Cite></EndNote>189,190 and should be considered for individuals with SMI and pre-diabetes. GLP-1RAs have also been shown to reduce the transition to T2D, as well as leading to clinically significant weight loss. ADDIN EN.CITE <EndNote><Cite><Author>Siskind</Author><Year>2018</Year><RecNum>181</RecNum><DisplayText><style face="superscript">191</style></DisplayText><record><rec-number>181</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754991">181</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Siskind, D</author><author>Hahn, M</author><author>Correll, C</author><author>Fink-Jensen, A</author><author>Russell, A</author><author>Bak, N</author><author>Broberg, B</author><author>Larsen J</author><author>Ishoy, P</author><author>Vilsboell, T</author><author>Knop, F</author><author>Kisely, S</author><author>Ebdrup, BH</author></authors></contributors><titles><title>Glucagon-like peptide-1 receptor-agonists for antipsychotic- associated cardio-metabolic risk factors: a systematic review and individual participant data meta-analysis</title><secondary-title>Diabetes Obes Metab</secondary-title></titles><periodical><full-title>Diabetes Obes Metab</full-title></periodical><volume>in press</volume><dates><year>2018</year></dates><urls></urls></record></Cite></EndNote>191Weight gainWhen behavioural interventions fail, pharmacological methods for attenuating weight gain in SMI should be considered. Pharmacological agents are described in detail in the appendix (Page 21: Table 3.5.), with the most evidence in antipsychotic-treated individuals existing for metformin and topiramate. (Vancampfort et al., 2019a) Bariatric surgery can also be considered as a last-resort treatment option where behavioural and pharmacological interventions fail. Antipsychotic weight gain tends not to be dose dependent, so dose reduction will not be effective in reducing weight ADDIN EN.CITE <EndNote><Cite><Author>Simon</Author><Year>2009</Year><RecNum>183</RecNum><DisplayText><style face="superscript">192</style></DisplayText><record><rec-number>183</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754991">183</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Simon, Viktoria</author><author>De, M Hert %J The Journal of clinical psychiatry</author></authors></contributors><titles><title>Are weight gain and metabolic side effects of atypical antipsychotics dose dependent? a literature review</title></titles><pages>1041-1050</pages><volume>70</volume><number>7</number><dates><year>2009</year></dates><isbn>0160-6689</isbn><urls></urls></record></Cite></EndNote>192.Arterial HypertensionThe approach to pharmacological management of hypertension in SMI should follow guidelines used in the general population, described in appendix (Page 20: Table 3.4).DyslipidaemiaThere is limited data on treatments for dyslipidaemia specific for people with mental illness. 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ADDIN EN.CITE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IaXBwaXNsZXktQ294PC9BdXRob3I+PFllYXI+MjAxNzwv
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ADDIN EN.CITE.DATA 196 are useful in making decisions about initiation of statin-therapy.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Hb2ZmPC9BdXRob3I+PFllYXI+MjAxNDwvWWVhcj48UmVj
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ADDIN EN.CITE.DATA 197 The approach to pharmacological management of dyslipidaemia in SMI should follow guidelines used in the general population (see Panel 3). There is currently no strong evidence to target hypertriglyceridaemia therapeutically to decrease cardiovascular risk. Sinus tachycardiaSinus tachycardia in patients with SMI may be a feature of the illness, drug withdrawal, or an acute drug reaction (e.g. serotonin syndrome or neuroleptic malignant syndrome). Psychotropic related tachycardia is persistent and usually dose-related. Where dose reduction/medication switch is not feasible, and inappropriate sinus tachycardia has been confirmed (including a 24-hour ECG), first line treatment is a cardioselective beta-blocker, e.g. atenolol 25-100 mg/day with up-titration until heart rate normalizes (60-100bpm). If beta-blockers are not tolerated (e.g., postural hypotension), or are ineffective, ivabradine (5-7.5mg twice daily), can be introduced. ADDIN EN.CITE <EndNote><Cite><Author>Ptaszynski</Author><Year>2013</Year><RecNum>195</RecNum><DisplayText><style face="superscript">198</style></DisplayText><record><rec-number>195</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754994">195</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ptaszynski, P.</author><author>Kaczmarek, K.</author><author>Ruta, J.</author><author>Klingenheben, T.</author><author>Wranicz, J. K.</author></authors></contributors><auth-address>Department of Electrocardiology, Medical University Lodz, Regional Sterling Heart Disease Center, Sterling 1/3, 91-425, Lodz, Poland. pawel_ptaszynski@wp.pl</auth-address><titles><title>Metoprolol succinate vs. ivabradine in the treatment of inappropriate sinus tachycardia in patients unresponsive to previous pharmacological therapy</title><secondary-title>Europace</secondary-title></titles><periodical><full-title>Europace</full-title></periodical><pages>116-21</pages><volume>15</volume><number>1</number><keywords><keyword>Adrenergic beta-Antagonists/therapeutic use</keyword><keyword>Adult</keyword><keyword>Anti-Arrhythmia Agents/therapeutic use</keyword><keyword>Benzazepines/*therapeutic use</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Metoprolol/*analogs & derivatives/therapeutic use</keyword><keyword>Tachycardia, Sinus/*diagnosis/*drug therapy</keyword><keyword>Treatment Failure</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>2013</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>1532-2092 (Electronic)
1099-5129 (Linking)</isbn><accession-num>22772053</accession-num><urls><related-urls><url> There is evidence for efficacy and tolerability of ivabradine in clozapine-induced tachycardia. ADDIN EN.CITE <EndNote><Cite><Author>Lally</Author><Year>2014</Year><RecNum>196</RecNum><DisplayText><style face="superscript">199</style></DisplayText><record><rec-number>196</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754994">196</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lally, J.</author><author>Brook, J.</author><author>Dixon, T.</author><author>Gaughran, F.</author><author>Shergill, S.</author><author>Melikian, N.</author><author>MacCabe, J. H.</author></authors></contributors><auth-address>Department of Psychosis Studies, King's College London and National Psychosis Service, South London and Maudsley NHS Foundation Trust, London SE5 8AF, UK.
National Psychosis Services, South London and Maudsley NHS Foundation Trust, London, UK.
National Psychosis Services, South London and Maudsley NHS Foundation Trust, and Department of Psychosis Studies, Institute of Psychiatry, Kings College London, London, UK.
Cardiology Unit, King's College Hospital, London, UK.</auth-address><titles><title>Ivabradine, a novel treatment for clozapine-induced sinus tachycardia: a case series</title><secondary-title>Ther Adv Psychopharmacol</secondary-title></titles><periodical><full-title>Ther Adv Psychopharmacol</full-title></periodical><pages>117-22</pages><volume>4</volume><number>3</number><keywords><keyword>clozapine</keyword><keyword>ivabradine</keyword><keyword>tachycardia</keyword><keyword>treatment-resistant schizophrenia</keyword><keyword>beta blockers</keyword></keywords><dates><year>2014</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>2045-1253 (Print)
2045-1253 (Linking)</isbn><accession-num>25057344</accession-num><urls><related-urls><url> Table 3. Risks, Benefits and Evidence base for diabetes treatments in SMIDrug ClassMechanism RiskBenefitEvidence base in SMI BiguanideMetformin Increases insulin sensitivity, reduces hepatic synthesis and release of glucose, increases peripheral glucose uptake-Lactic acidosis -B12 deficiency-If GI upset try modified release formulation-Contraindicated in eGFR < 30ml/min/1.73m3-Weight loss (3kg)-Low risk of hypoglycaemia-Good evidence for use in SMI, and should be considered 1st line.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5KYXJza29nPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48
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ADDIN EN.CITE.DATA 471 - GLP-1RAs have been shown to reduce the transition to T2D ADDIN EN.CITE <EndNote><Cite><Author>Siskind</Author><Year>2018</Year><RecNum>181</RecNum><DisplayText><style face="superscript">191</style></DisplayText><record><rec-number>181</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754991">181</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Siskind, D</author><author>Hahn, M</author><author>Correll, C</author><author>Fink-Jensen, A</author><author>Russell, A</author><author>Bak, N</author><author>Broberg, B</author><author>Larsen J</author><author>Ishoy, P</author><author>Vilsboell, T</author><author>Knop, F</author><author>Kisely, S</author><author>Ebdrup, BH</author></authors></contributors><titles><title>Glucagon-like peptide-1 receptor-agonists for antipsychotic- associated cardio-metabolic risk factors: a systematic review and individual participant data meta-analysis</title><secondary-title>Diabetes Obes Metab</secondary-title></titles><periodical><full-title>Diabetes Obes Metab</full-title></periodical><volume>in press</volume><dates><year>2018</year></dates><urls></urls></record></Cite></EndNote>191Sulphonylureae.g. gliclazideIncreases endogenous production of insulin -Weight gain -HypoglycaemiaInsufficient trial data in SMI.Sodium glucose transporter 2 (SGLT2) inhibitore.g. dapagliflozinInhibit SGLT2 in the proximal renal tubule thereby reducing glucose reabsorption of glucose promoting glucosuria-Polyuria-Postural -hypotension-Urinary tract infection-DKA can occur in stress settings-Mild fracture risk-Weight loss (2-3kg)-Low risk of hypoglycaemia-Empagliflozin FDA approved to reduce CV mortality. Canagliflozin reduces cardiac events. Insufficient trial data in SMI.Thiazolidinediones(glitazones)e.g. pioglitazoneImprove insulin sensitivity by promoting adipogenesis and reducing circulating fatty acid and lipid availability.Weight gainHeart failureOedema Bone fractures-May reduce stroke risk-Low risk of hypoglycaemiaInsufficient trial data in SMI.InsulinSupplements insufficient endogenous production of insulinWeight gain Hypoglycaemia-In acute setting/poorly controlled T2D may be only effective treatment in stabilizing sugarsInsufficient trial data in SMIPostural HypotensionBeyond causes seen in the general population, postural hypotension may be related to psychotropic medication, notably clozapine and quetiapine ADDIN EN.CITE <EndNote><Cite><Author>Stroup</Author><Year>2018</Year><RecNum>197</RecNum><DisplayText><style face="superscript">200</style></DisplayText><record><rec-number>197</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754994">197</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Stroup, T Scott</author><author>Gray, Neil</author></authors></contributors><titles><title>Management of common adverse effects of antipsychotic medications</title><secondary-title>World Psychiatry</secondary-title></titles><periodical><full-title>World Psychiatry</full-title><abbr-1>World psychiatry : official journal of the World Psychiatric Association (WPA)</abbr-1></periodical><pages>341-356</pages><volume>17</volume><number>3</number><dates><year>2018</year></dates><isbn>1723-8617</isbn><urls></urls></record></Cite></EndNote>200. If increased fluid intake and salt consumption are ineffective, dose adjustment of switch of the responsible psychiatric medication should first be considered, followed by non-pharmacological therapy (appendix page 22: Table 3.6) with regular blood pressure monitoring. Nicotine and Smoking CessationSmoking and resultant physical morbidity plays a central role in the excess mortality of individuals with mental illness ADDIN EN.CITE <EndNote><Cite><Author>Prochaska</Author><Year>2017</Year><RecNum>255</RecNum><DisplayText><style face="superscript">201,202</style></DisplayText><record><rec-number>255</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755007">255</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Prochaska, Judith J</author><author>Das, Smita</author><author>Young-Wolff, Kelly C</author></authors></contributors><titles><title>Smoking, mental illness, and public health</title><secondary-title>Annual review of public health</secondary-title></titles><periodical><full-title>Annual review of public health</full-title></periodical><pages>165-185</pages><volume>38</volume><dates><year>2017</year></dates><isbn>0163-7525</isbn><urls></urls></record></Cite><Cite><Author>Callaghan</Author><Year>2014</Year><RecNum>259</RecNum><record><rec-number>259</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755008">259</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Callaghan, Russell C</author><author>Veldhuizen, Scott</author><author>Jeysingh, Trincy</author><author>Orlan, Chloe</author><author>Graham, Candida</author><author>Kakouris, Gwen</author><author>Remington, Gary</author><author>Gatley, Jodi</author></authors></contributors><titles><title>Patterns of tobacco-related mortality among individuals diagnosed with schizophrenia, bipolar disorder, or depression</title><secondary-title>Journal of psychiatric research</secondary-title></titles><periodical><full-title>J Psychiatr Res</full-title><abbr-1>Journal of psychiatric research</abbr-1></periodical><pages>102-110</pages><volume>48</volume><number>1</number><dates><year>2014</year></dates><isbn>0022-3956</isbn><urls></urls></record></Cite></EndNote>201,202, therefore reducing smoking rates is a priority that cannot be underestimated. 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ADDIN EN.CITE.DATA 203 NRTs should be used for approximately 8-12 weeks. Different preparations are available, including sublingual tablets, gum, patches, nasal spray, inhalators, lozenges, and e-Cigarettes. Bupropion and Varenicline can increase the likelihood of successful smoking cessation without increasing the risk of neuropsychiatric events in people with SMI. ADDIN EN.CITE <EndNote><Cite><Author>Roberts</Author><Year>2016</Year><RecNum>260</RecNum><DisplayText><style face="superscript">204</style></DisplayText><record><rec-number>260</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755008">260</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Roberts, Emmert</author><author>Eden Evins, A</author><author>McNeill, Ann</author><author>Robson, Debbie</author></authors></contributors><titles><title>Efficacy and tolerability of pharmacotherapy for smoking cessation in adults with serious mental illness: a systematic review and network meta‐analysis</title><secondary-title>Addiction</secondary-title></titles><periodical><full-title>Addiction</full-title></periodical><pages>599-612</pages><volume>111</volume><number>4</number><dates><year>2016</year></dates><isbn>0965-2140</isbn><urls></urls></record></Cite></EndNote>204Extrapyramidal Side EffectsAcute dystonias are seen in up to 10% of individuals, ADDIN EN.CITE <EndNote><Cite><Author>Rose</Author><Year>1997</Year><RecNum>200</RecNum><DisplayText><style face="superscript">205</style></DisplayText><record><rec-number>200</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754995">200</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rose, V. L.</author></authors></contributors><titles><title>APA practice guideline for the treatment of patients with schizophrenia</title><secondary-title>American Family Physician</secondary-title><alt-title>Am Fam Physician</alt-title></titles><periodical><full-title>American Family Physician</full-title><abbr-1>Am Fam Physician</abbr-1></periodical><alt-periodical><full-title>American Family Physician</full-title><abbr-1>Am Fam Physician</abbr-1></alt-periodical><pages>1217-&</pages><volume>56</volume><number>4</number><dates><year>1997</year><pub-dates><date>Sep 15</date></pub-dates></dates><isbn>0002-838x</isbn><accession-num>WOS:A1997XX30800024</accession-num><urls><related-urls><url><Go to ISI>://WOS:A1997XX30800024</url></related-urls></urls><language>English</language></record></Cite></EndNote>205 are more common in antipsychotic-na?ve individuals, and can occur rapidly after initiation of antipsychotics. Treatment is with an anticholinergic medication (e.g., benztropine), given orally, intramuscularly or intravenously dependent on urgency. Parkinsonism is seen in approximately 20% of individuals, ADDIN EN.CITE <EndNote><Cite><Author>Bollini</Author><Year>1994</Year><RecNum>201</RecNum><DisplayText><style face="superscript">206</style></DisplayText><record><rec-number>201</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754995">201</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bollini, P.</author><author>Pampallona, S.</author><author>Orza, M. J.</author><author>Adams, M. E.</author><author>Chalmers, T. C.</author></authors></contributors><auth-address>Harvard Univ,Sch Publ Hlth,Technol Assessment Grp,Boston,Ma 02115</auth-address><titles><title>Antipsychotic-Drugs - Is More Worse - a Metaanalysis of the Published Randomized Control Trials</title><secondary-title>Psychological Medicine</secondary-title><alt-title>Psychol Med</alt-title></titles><periodical><full-title>Psychol Med</full-title><abbr-1>Psychological medicine</abbr-1></periodical><alt-periodical><full-title>Psychol Med</full-title><abbr-1>Psychological medicine</abbr-1></alt-periodical><pages>307-316</pages><volume>24</volume><number>2</number><keywords><keyword>symptom-free schizophrenics</keyword><keyword>high dosage haloperidol</keyword><keyword>neuroleptic treatment</keyword><keyword>clinical research</keyword><keyword>publication bias</keyword><keyword>dose-response</keyword><keyword>fluphenazine</keyword><keyword>standard</keyword><keyword>therapy</keyword><keyword>excitement</keyword></keywords><dates><year>1994</year><pub-dates><date>May</date></pub-dates></dates><isbn>0033-2917</isbn><accession-num>WOS:A1994NQ05300004</accession-num><urls><related-urls><url><Go to ISI>://WOS:A1994NQ05300004</url></related-urls></urls><electronic-resource-num>Doi 10.1017/S003329170002729x</electronic-resource-num><language>English</language></record></Cite></EndNote>206 and other than changing medication or reducing the dose of medication, treatment is with an anticholinergic medication. The risk of akathisia varies dependent on the antipsychotic medication prescribed, but is estimated to occur in 25% of individuals on first-generation antipsychotics. ADDIN EN.CITE <EndNote><Cite><Author>Halstead</Author><Year>1994</Year><RecNum>202</RecNum><DisplayText><style face="superscript">207</style></DisplayText><record><rec-number>202</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754995">202</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Halstead, S. M.</author><author>Barnes, T. R. E.</author><author>Speller, J. C.</author></authors></contributors><auth-address>Charing Cross & Westminster Med Sch,London W6 8rp,England
Graylingwell Hosp,Chichester Po14 4pq,England
Nuffield Clin,Plymouth Community Unit,Plymouth Pl4 8nq,Devon,England</auth-address><titles><title>Akathisia - Prevalence and Associated Dysphoria in an Inpatient Population with Chronic-Schizophrenia</title><secondary-title>British Journal of Psychiatry</secondary-title><alt-title>Brit J Psychiat</alt-title></titles><periodical><full-title>British Journal of Psychiatry</full-title><abbr-1>Brit J Psychiat</abbr-1></periodical><alt-periodical><full-title>British Journal of Psychiatry</full-title><abbr-1>Brit J Psychiat</abbr-1></alt-periodical><pages>177-183</pages><volume>164</volume><keywords><keyword>tardive-dyskinesia</keyword><keyword>scale</keyword></keywords><dates><year>1994</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0007-1250</isbn><accession-num>WOS:A1994MX18800008</accession-num><urls><related-urls><url><Go to ISI>://WOS:A1994MX18800008</url></related-urls></urls><electronic-resource-num>DOI 10.1192/bjp.164.2.177</electronic-resource-num><language>English</language></record></Cite></EndNote>207 If dose reduction of the causative medication is unsuccessful, a switch to quetiapine, olanzapine or clozapine can be considered.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5LdW1hcjwvQXV0aG9yPjxZZWFyPjIwMDk8L1llYXI+PFJl
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ADDIN EN.CITE.DATA 208,209 Other treatments include beta-blockers (e.g. propranolol 30-90mg/day), ADDIN EN.CITE <EndNote><Cite><Author>Miller</Author><Year>2000</Year><RecNum>205</RecNum><DisplayText><style face="superscript">210</style></DisplayText><record><rec-number>205</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754996">205</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Miller, C. H.</author><author>Fleischhacker, W. W.</author></authors></contributors><auth-address>Department of Biological Psychiatry, Innsbruck University Clinics Innsbruck, Austria.</auth-address><titles><title>Managing antipsychotic-induced acute and chronic akathisia</title><secondary-title>Drug Saf</secondary-title></titles><periodical><full-title>Drug Saf</full-title></periodical><pages>73-81</pages><volume>22</volume><number>1</number><keywords><keyword>Acute Disease</keyword><keyword>Akathisia, Drug-Induced/*drug therapy</keyword><keyword>Amantadine/therapeutic use</keyword><keyword>Antipsychotic Agents/*adverse effects</keyword><keyword>Benzodiazepines/therapeutic use</keyword><keyword>Cholinergic Antagonists/therapeutic use</keyword><keyword>Chronic Disease</keyword><keyword>Clonidine/therapeutic use</keyword><keyword>Humans</keyword></keywords><dates><year>2000</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0114-5916 (Print)
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ADDIN EN.CITE.DATA 210-212 antimuscarinics (e.g. benztropine 6mg/day), ADDIN EN.CITE <EndNote><Cite><Author>Rathbone</Author><Year>2006</Year><RecNum>208</RecNum><DisplayText><style face="superscript">213</style></DisplayText><record><rec-number>208</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754996">208</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rathbone, J.</author><author>Soares-Weiser, K.</author></authors></contributors><auth-address>Univ Leeds, Dept Psychiat, Leeds LS2 9LT, W Yorkshire, England</auth-address><titles><title>Anticholinergics for neuroleptic-induced acute akathisia</title><secondary-title>Cochrane Database of Systematic Reviews</secondary-title><alt-title>Cochrane Db Syst Rev</alt-title></titles><periodical><full-title>Cochrane Database of Systematic Reviews</full-title><abbr-1>Cochrane Db Syst Rev</abbr-1></periodical><alt-periodical><full-title>Cochrane Database of Systematic Reviews</full-title><abbr-1>Cochrane Db Syst Rev</abbr-1></alt-periodical><number>4</number><keywords><keyword>randomized trials</keyword><keyword>statistics notes</keyword><keyword>propranolol</keyword><keyword>schizophrenia</keyword><keyword>benztropine</keyword><keyword>quality</keyword><keyword>bias</keyword><keyword>metaanalysis</keyword><keyword>drugs</keyword></keywords><dates><year>2006</year></dates><isbn>1469-493x</isbn><accession-num>WOS:000241386000150</accession-num><urls><related-urls><url><Go to ISI>://WOS:000241386000150</url></related-urls></urls><electronic-resource-num>ARTN CD003727
10.1002/14651858.CD003727.pub3</electronic-resource-num><language>English</language></record></Cite></EndNote>213 and benzodiazepines (e.g. clonazepam 0.5-3mg/day). ADDIN EN.CITE <EndNote><Cite><Author>Miller</Author><Year>2000</Year><RecNum>205</RecNum><DisplayText><style face="superscript">210</style></DisplayText><record><rec-number>205</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754996">205</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Miller, C. H.</author><author>Fleischhacker, W. W.</author></authors></contributors><auth-address>Department of Biological Psychiatry, Innsbruck University Clinics Innsbruck, Austria.</auth-address><titles><title>Managing antipsychotic-induced acute and chronic akathisia</title><secondary-title>Drug Saf</secondary-title></titles><periodical><full-title>Drug Saf</full-title></periodical><pages>73-81</pages><volume>22</volume><number>1</number><keywords><keyword>Acute Disease</keyword><keyword>Akathisia, Drug-Induced/*drug therapy</keyword><keyword>Amantadine/therapeutic use</keyword><keyword>Antipsychotic Agents/*adverse effects</keyword><keyword>Benzodiazepines/therapeutic use</keyword><keyword>Cholinergic Antagonists/therapeutic use</keyword><keyword>Chronic Disease</keyword><keyword>Clonidine/therapeutic use</keyword><keyword>Humans</keyword></keywords><dates><year>2000</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>0114-5916 (Print)
0114-5916 (Linking)</isbn><accession-num>10647977</accession-num><urls><related-urls><url> Tardive dyskinesia occurs in 5% of patients per year of antipsychotic exposure ADDIN EN.CITE <EndNote><Cite><Author>Carbon</Author><Year>2018</Year><RecNum>146</RecNum><DisplayText><style face="superscript">159</style></DisplayText><record><rec-number>146</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754984">146</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Carbon, Maren</author><author>Kane, John M</author><author>Leucht, Stefan</author><author>Correll, Christoph U</author></authors></contributors><titles><title>Tardive dyskinesia risk with first‐and second‐generation antipsychotics in comparative randomized controlled trials: a meta‐analysis</title><secondary-title>World Psychiatry</secondary-title></titles><periodical><full-title>World Psychiatry</full-title><abbr-1>World psychiatry : official journal of the World Psychiatric Association (WPA)</abbr-1></periodical><pages>330-340</pages><volume>17</volume><number>3</number><dates><year>2018</year></dates><isbn>1723-8617</isbn><urls></urls></record></Cite></EndNote>159. It is recommended that anticholinergics should be stopped, and treatment rationalized (stopping the causative drug or reducing the dose), with clozapine most likely to provide symptomatic relief ADDIN EN.CITE <EndNote><Cite><Author>Mentzel</Author><Year>2018</Year><RecNum>209</RecNum><DisplayText><style face="superscript">214</style></DisplayText><record><rec-number>209</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754997">209</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mentzel, Thierry Q</author><author>Lieverse, R</author><author>Oorschot, M</author><author>Viechtbauer, W</author><author>Bloemen, O %J The Journal of clinical psychiatry</author></authors></contributors><titles><title>Clozapine Monotherapy as a Treatment for Antipsychotic-Induced Tardive Dyskinesia: A Meta-Analysis</title></titles><volume>79</volume><number>6</number><dates><year>2018</year></dates><isbn>0160-6689</isbn><urls></urls></record></Cite></EndNote>214. Adjunctive treatments include tetrabenazine, ADDIN EN.CITE <EndNote><Cite><Author>Leung</Author><Year>2011</Year><RecNum>210</RecNum><DisplayText><style face="superscript">215</style></DisplayText><record><rec-number>210</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754997">210</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Leung, J. G.</author><author>Breden, E. L.</author></authors></contributors><auth-address>Virginia Commonwealth Univ Hlth Syst, Richmond, VA USA
Univ Pittsburgh, Western Psychiat Inst & Clin, Med Ctr, Pittsburgh, PA 15213 USA</auth-address><titles><title>Tetrabenazine for the Treatment of Tardive Dyskinesia</title><secondary-title>Annals of Pharmacotherapy</secondary-title><alt-title>Ann Pharmacother</alt-title></titles><alt-periodical><full-title>Ann Pharmacother</full-title><abbr-1>The Annals of pharmacotherapy</abbr-1></alt-periodical><pages>525-531</pages><volume>45</volume><number>4</number><keywords><keyword>movement disorders</keyword><keyword>tardive dyskinesia</keyword><keyword>tetrabenazine</keyword><keyword>hyperkinetic movement-disorders</keyword><keyword>antipsychotic-drugs</keyword><keyword>therapy</keyword><keyword>schizophrenia</keyword><keyword>combination</keyword><keyword>olanzapine</keyword><keyword>dystonia</keyword></keywords><dates><year>2011</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1060-0280</isbn><accession-num>WOS:000290137400011</accession-num><urls><related-urls><url><Go to ISI>://WOS:000290137400011</url></related-urls></urls><electronic-resource-num>10.1345/aph.1P312</electronic-resource-num><language>English</language></record></Cite></EndNote>215 as well as FDA -approved novel VMAT-2 inhibitors, such as valbenazine, and deutetrabenazine. ADDIN EN.CITE <EndNote><Cite><Author>Solmi</Author><Year>2018</Year><RecNum>211</RecNum><DisplayText><style face="superscript">216</style></DisplayText><record><rec-number>211</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754997">211</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Solmi, Marco</author><author>Pigato, Giorgio</author><author>Kane, John M</author><author>Correll, Christoph U %J Drug Design, Development</author><author>Therapy</author></authors></contributors><titles><title>Treatment of tardive dyskinesia with VMAT-2 inhibitors: a systematic review and meta-analysis of randomized controlled trials</title></titles><pages>1215</pages><volume>12</volume><dates><year>2018</year></dates><urls></urls></record></Cite></EndNote>216.Anticholinergic EffectsThe first line management of anticholinergic ADRs of antipsychotics is dose reduction, if feasible. ADDIN EN.CITE <EndNote><Cite><Author>Stroup</Author><Year>2018</Year><RecNum>197</RecNum><DisplayText><style face="superscript">200</style></DisplayText><record><rec-number>197</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754994">197</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Stroup, T Scott</author><author>Gray, Neil</author></authors></contributors><titles><title>Management of common adverse effects of antipsychotic medications</title><secondary-title>World Psychiatry</secondary-title></titles><periodical><full-title>World Psychiatry</full-title><abbr-1>World psychiatry : official journal of the World Psychiatric Association (WPA)</abbr-1></periodical><pages>341-356</pages><volume>17</volume><number>3</number><dates><year>2018</year></dates><isbn>1723-8617</isbn><urls></urls></record></Cite></EndNote>200 For constipation, due to anticholinergic-related reductions in gastric motilityPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CdXJnZXI8L0F1dGhvcj48WWVhcj4yMDA2PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 217, stool softeners, including macrogol or docusate, and a stimulant laxative, such as senna, may be effective. ADDIN EN.CITE <EndNote><Cite><Author>Every-Palmer</Author><Year>2017</Year><RecNum>213</RecNum><DisplayText><style face="superscript">218</style></DisplayText><record><rec-number>213</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754997">213</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Every-Palmer, Susanna</author><author>Ellis, Pete M</author><author>Nowitz, Mike</author><author>Stanley, James</author><author>Grant, Eve</author><author>Huthwaite, Mark</author><author>Dunn, Helen</author></authors></contributors><titles><title>The porirua protocol in the treatment of clozapine-induced gastrointestinal hypomotility and constipation: a pre-and post-treatment study</title><secondary-title>CNS drugs</secondary-title></titles><periodical><full-title>CNS drugs</full-title></periodical><pages>75-85</pages><volume>31</volume><number>1</number><dates><year>2017</year></dates><isbn>1172-7047</isbn><urls></urls></record></Cite></EndNote>218 Sialorrhea is common with clozapine. Augmentation with diphenhydramine or benzamide antipsychotics (including amisulpride) have been shown in a recent meta-analysis to ameliorate sialorrhea ADDIN EN.CITE <EndNote><Cite><Author>Chen</Author><Year>2019</Year><RecNum>215</RecNum><DisplayText><style face="superscript">219</style></DisplayText><record><rec-number>215</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754998">215</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chen, SY</author><author>Ravindran, G</author><author>Zhang, Q</author><author>Kisely, S</author><author>Siskind, D</author></authors></contributors><titles><title>Treatment strategies for clozapine-induced sialorrhea: a systematic review and meta-analysis.</title><secondary-title>CNS Drugs</secondary-title></titles><periodical><full-title>CNS drugs</full-title></periodical><volume>in press</volume><dates><year>2019</year></dates><urls></urls></record></Cite></EndNote>219.Sexual Side EffectsPatients with sexual side effects (including, reduced libido, delayed or blocked ejaculation, erectile dysfunction, decreased orgasm, persistent genital arousal, lactation, numbness in vagina / nipples) should be assessed, examining prolactin levels, concomitant medications and comorbid causes (which may be psychological or physical e.g. diabetes mellitus, cardiometabolic disease). ADDIN EN.CITE <EndNote><Cite><Author>Stroup</Author><Year>2018</Year><RecNum>197</RecNum><DisplayText><style face="superscript">200</style></DisplayText><record><rec-number>197</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754994">197</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Stroup, T Scott</author><author>Gray, Neil</author></authors></contributors><titles><title>Management of common adverse effects of antipsychotic medications</title><secondary-title>World Psychiatry</secondary-title></titles><periodical><full-title>World Psychiatry</full-title><abbr-1>World psychiatry : official journal of the World Psychiatric Association (WPA)</abbr-1></periodical><pages>341-356</pages><volume>17</volume><number>3</number><dates><year>2018</year></dates><isbn>1723-8617</isbn><urls></urls></record></Cite></EndNote>200 Raised prolactin levels may require antipsychotic dose reduction or switching, if feasible, or co-prescription of low dose aripiprazole. ADDIN EN.CITE <EndNote><Cite><Author>Stroup</Author><Year>2018</Year><RecNum>197</RecNum><DisplayText><style face="superscript">200</style></DisplayText><record><rec-number>197</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754994">197</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Stroup, T Scott</author><author>Gray, Neil</author></authors></contributors><titles><title>Management of common adverse effects of antipsychotic medications</title><secondary-title>World Psychiatry</secondary-title></titles><periodical><full-title>World Psychiatry</full-title><abbr-1>World psychiatry : official journal of the World Psychiatric Association (WPA)</abbr-1></periodical><pages>341-356</pages><volume>17</volume><number>3</number><dates><year>2018</year></dates><isbn>1723-8617</isbn><urls></urls></record></Cite></EndNote>200 Patients with sexual dysfunction on SSRIs could be switched to another antidepressant or given a trial of bupropion or sildenafil, if appropriate ADDIN EN.CITE <EndNote><Cite><Author>Taylor</Author><Year>2005</Year><RecNum>216</RecNum><DisplayText><style face="superscript">220</style></DisplayText><record><rec-number>216</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754998">216</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Taylor, Matthew J</author><author>Rudkin, Lisa</author><author>Hawton, Keith</author></authors></contributors><titles><title>Strategies for managing antidepressant-induced sexual dysfunction: systematic review of randomised controlled trials</title><secondary-title>Journal of affective disorders</secondary-title></titles><periodical><full-title>J Affect Disord</full-title><abbr-1>Journal of affective disorders</abbr-1></periodical><pages>241-254</pages><volume>88</volume><number>3</number><dates><year>2005</year></dates><isbn>0165-0327</isbn><urls></urls></record></Cite></EndNote>220. Thyroid Disease Treatment of hyperthyroidism in lithium-treated patients depends on the cause, and may require a pertechnate scan to differentiate the cause (e.g. Graves’ hyperthyroidism or toxic multinodular goitre requiring thionamides/radioiodine/surgery, or lithium induced thyroiditis with consideration of lithium cessation) ADDIN EN.CITE <EndNote><Cite><Author>Fairbrother</Author><Year>2019</Year><RecNum>164</RecNum><DisplayText><style face="superscript">176</style></DisplayText><record><rec-number>164</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754987">164</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Fairbrother, Fiona</author><author>Petzl, Nicola</author><author>Scott, James G</author><author>Kisely, Steve %J Australian</author><author>New Zealand Journal of Psychiatry</author></authors></contributors><titles><title>Lithium can cause hyperthyroidism as well as hypothyroidism: A systematic review of an under-recognised association</title></titles><pages>0004867419833171</pages><dates><year>2019</year></dates><isbn>0004-8674</isbn><urls></urls></record></Cite></EndNote>176. Lithium-induced hypothyroidism may occur in the presence or absence of goitre. When it occurs, treatment with levothyroxine is indicated, according to general guidelines for the management of primary hypothyroidism. ADDIN EN.CITE <EndNote><Cite><Author>Fish</Author><Year>1987</Year><RecNum>217</RecNum><DisplayText><style face="superscript">221</style></DisplayText><record><rec-number>217</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754998">217</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Fish, L. H.</author><author>Schwartz, H. L.</author><author>Cavanaugh, J.</author><author>Steffes, M. W.</author><author>Bantle, J. P.</author><author>Oppenheimer, J. H.</author></authors></contributors><auth-address>Univ Minnesota,Dept Med,Div Endocrinol & Metab,Box 91,Mayo Mem Bldg,Minneapolis,Mn 55455
Univ Minnesota,Dept Lab Med & Pathol,Minneapolis,Mn 55455</auth-address><titles><title>Replacement Dose, Metabolism, and Bioavailability of Levothyroxine in the Treatment of Hypothyroidism - Role of Triiodothyronine in Pituitary Feedback in Humans</title><secondary-title>New England Journal of Medicine</secondary-title><alt-title>New Engl J Med</alt-title></titles><periodical><full-title>New England Journal of Medicine</full-title><abbr-1>New Engl J Med</abbr-1></periodical><alt-periodical><full-title>New England Journal of Medicine</full-title><abbr-1>New Engl J Med</abbr-1></alt-periodical><pages>764-770</pages><volume>316</volume><number>13</number><dates><year>1987</year><pub-dates><date>Mar 26</date></pub-dates></dates><isbn>0028-4793</isbn><accession-num>WOS:A1987G509100002</accession-num><urls><related-urls><url><Go to ISI>://WOS:A1987G509100002</url></related-urls></urls><electronic-resource-num>Doi 10.1056/Nejm198703263161302</electronic-resource-num><language>English</language></record></Cite></EndNote>221 Lithium-induced goitre requires ultrasound examination to assess for diffuse versus nodular enlargement, and where appropriate, fine needle aspiration to guide diagnosis. Levothyroxine (T4) may stabilise or reduce lithium-induced goitre. ADDIN EN.CITE <EndNote><Cite><Author>Lazarus</Author><Year>2009</Year><RecNum>218</RecNum><DisplayText><style face="superscript">222</style></DisplayText><record><rec-number>218</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754999">218</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lazarus, J. H.</author></authors></contributors><auth-address>Cardiff Univ, Sch Med, Ctr Endocrine & Diabet Sci, Univ Wales Hosp, Cardiff CF14 4XN, S Glam, Wales</auth-address><titles><title>Lithium and thyroid</title><secondary-title>Best Practice & Research Clinical Endocrinology & Metabolism</secondary-title><alt-title>Best Pract Res Cl En</alt-title></titles><periodical><full-title>Best Practice & Research Clinical Endocrinology & Metabolism</full-title><abbr-1>Best Pract Res Cl En</abbr-1></periodical><alt-periodical><full-title>Best Practice & Research Clinical Endocrinology & Metabolism</full-title><abbr-1>Best Pract Res Cl En</abbr-1></alt-periodical><pages>723-733</pages><volume>23</volume><number>6</number><keywords><keyword>autoimmunity</keyword><keyword>goitre</keyword><keyword>hyperthyroidism</keyword><keyword>hypothyroidism</keyword><keyword>physiology</keyword><keyword>treated psychiatric-patients</keyword><keyword>bipolar affective-disorder</keyword><keyword>radioiodine therapy</keyword><keyword>follow-up</keyword><keyword>long-term</keyword><keyword>subclinical hypothyroidism</keyword><keyword>parathyroid function</keyword><keyword>molecular-mechanism</keyword><keyword>hormone metabolism</keyword><keyword>controlled trial</keyword></keywords><dates><year>2009</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>1521-690x</isbn><accession-num>WOS:000272928100005</accession-num><urls><related-urls><url><Go to ISI>://WOS:000272928100005</url></related-urls></urls><electronic-resource-num>10.1016/j.beem.2009.06.002</electronic-resource-num><language>English</language></record></Cite></EndNote>222 Because of the relatively high incidence of thyroid disease with lithium, baseline clinical thyroid examination and serological assessment of thyroid function is recommended, followed by at least annual monitoring during treatment. The development of thyroid dysfunction on lithium does not usually necessitate cessation of lithium therapy, and the risks/benefit balance of continuing treatment should always be considered. Renal DiseaseLithium-induced nephrogenic diabetes insipidus, with associated polyuria and polydipsia can be disabling, is usually at least partially reversible with lithium cessation although may be permanent after prolonged therapyPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HYXJvZmVhbnU8L0F1dGhvcj48WWVhcj4yMDA1PC9ZZWFy
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ADDIN EN.CITE.DATA 224 Thiazide diuretics alongside a low-sodium diet have also been observed to have a paradoxical effect of reducing urinary output in nephrogenic diabetes insipidus. ADDIN EN.CITE <EndNote><Cite><Author>Singer</Author><Year>1997</Year><RecNum>221</RecNum><DisplayText><style face="superscript">225</style></DisplayText><record><rec-number>221</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754999">221</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Singer, I.</author><author>Oster, J. R.</author><author>Fishman, L. M.</author></authors></contributors><auth-address>Vet Affairs Med Ctr,Med Serv,Miami,Fl 33125
Vet Affairs Med Ctr,Res Serv,Miami,Fl 33125
Univ Miami,Sch Med,Dept Med,Miami,Fl</auth-address><titles><title>The management of diabetes insipidus in adults</title><secondary-title>Archives of Internal Medicine</secondary-title><alt-title>Arch Intern Med</alt-title></titles><periodical><full-title>Archives of Internal Medicine</full-title></periodical><pages>1293-1301</pages><volume>157</volume><number>12</number><keywords><keyword>lithium-therapy</keyword><keyword>indomethacin</keyword><keyword>hydrochlorothiazide</keyword><keyword>desmopressin</keyword><keyword>pregnancy</keyword><keyword>amiloride</keyword><keyword>polyuria</keyword><keyword>hypernatremia</keyword><keyword>vasopressin</keyword><keyword>thirst</keyword></keywords><dates><year>1997</year><pub-dates><date>Jun 23</date></pub-dates></dates><isbn>0003-9926</isbn><accession-num>WOS:A1997XF54600003</accession-num><urls><related-urls><url><Go to ISI>://WOS:A1997XF54600003</url></related-urls></urls><electronic-resource-num>DOI 10.1001/archinte.157.12.1293</electronic-resource-num><language>English</language></record></Cite></EndNote>225 In the case of chronic kidney disease secondary to chronic interstitial nephritis, lithium cessation may be indicated if renal insufficiency progresses. There may be some recovery of renal function following discontinuation of lithium, although progressive renal failure can occur. ADDIN EN.CITE <EndNote><Cite><Author>Markowitz</Author><Year>2000</Year><RecNum>222</RecNum><DisplayText><style face="superscript">226</style></DisplayText><record><rec-number>222</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755000">222</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Markowitz, G. S.</author><author>Radhakrishnan, J.</author><author>Kambham, N.</author><author>Valeri, A. M.</author><author>Hines, W. H.</author><author>D'Agati, V. D.</author></authors></contributors><auth-address>Columbia Presbyterian Med Ctr, Dept Pathol, New York, NY 10032 USA
Columbia Presbyterian Med Ctr, Dept Med, New York, NY 10032 USA
Stamford Hosp, Dept Med, Stamford, CT USA</auth-address><titles><title>Lithium nephrotoxicity: A progressive combined glomerular and tubulointerstitial nephropathy</title><secondary-title>Journal of the American Society of Nephrology</secondary-title><alt-title>J Am Soc Nephrol</alt-title></titles><periodical><full-title>Journal of the American Society of Nephrology</full-title><abbr-1>J Am Soc Nephrol</abbr-1></periodical><alt-periodical><full-title>Journal of the American Society of Nephrology</full-title><abbr-1>J Am Soc Nephrol</abbr-1></alt-periodical><pages>1439-1448</pages><volume>11</volume><number>8</number><keywords><keyword>segmental glomerulosclerosis</keyword><keyword>biopsy findings</keyword><keyword>tubular lesion</keyword><keyword>kidney</keyword><keyword>therapy</keyword><keyword>pathogenesis</keyword></keywords><dates><year>2000</year><pub-dates><date>Aug</date></pub-dates></dates><isbn>1046-6673</isbn><accession-num>WOS:000088340900008</accession-num><urls><related-urls><url><Go to ISI>://WOS:000088340900008</url></related-urls></urls><language>English</language></record></Cite></EndNote>226 Regular monitoring of renal function is required, as is monitoring of other risk factors for renal failure (e.g. hypertension and diabetes mellitus) is important. SummaryThe burden of ADRs associated with psychotropic medications is important to consider in the context of treatment effectiveness and patient acceptability. Antipsychotics remain the best evidence based treatments for psychotic disorders, and leads to lower all-cause mortality in schizophrenia than no treatment ADDIN EN.CITE <EndNote><Cite><Author>Vermeulen</Author><Year>2018</Year><RecNum>223</RecNum><DisplayText><style face="superscript">227</style></DisplayText><record><rec-number>223</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755000">223</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Vermeulen, Jentien M</author><author>van Rooijen, Geeske</author><author>van de Kerkhof, Marita PJ</author><author>Sutterland, Arjen L</author><author>Correll, Christoph U</author><author>de Haan, Lieuwe %J Schizophrenia bulletin</author></authors></contributors><titles><title>Clozapine and Long-Term Mortality Risk in Patients With Schizophrenia: A Systematic Review and Meta-analysis of Studies Lasting 1.1–12.5 Years</title></titles><dates><year>2018</year></dates><urls></urls></record></Cite></EndNote>227. Mood stabilisers are the most effective treatment for BPAD ADDIN EN.CITE <EndNote><Cite><Author>Geddes</Author><Year>2004</Year><RecNum>158</RecNum><DisplayText><style face="superscript">172</style></DisplayText><record><rec-number>158</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754986">158</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Geddes, John R</author><author>Burgess, Sally</author><author>Hawton, Keith</author><author>Jamison, Kay</author><author>Goodwin, Guy M</author></authors></contributors><titles><title>Long-term lithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials</title><secondary-title>American Journal of Psychiatry</secondary-title></titles><periodical><full-title>American Journal of Psychiatry</full-title></periodical><pages>217-222</pages><volume>161</volume><number>2</number><dates><year>2004</year></dates><isbn>0002-953X</isbn><urls></urls></record></Cite></EndNote>172, while antidepressants have a key role in treatment of depression ADDIN EN.CITE <EndNote><Cite><Author>Cipriani</Author><Year>2018</Year><RecNum>224</RecNum><DisplayText><style face="superscript">228</style></DisplayText><record><rec-number>224</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755000">224</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cipriani, Andrea</author><author>Furukawa, Toshi A</author><author>Salanti, Georgia</author><author>Chaimani, Anna</author><author>Atkinson, Lauren Z</author><author>Ogawa, Yusuke</author><author>Leucht, Stefan</author><author>Ruhe, Henricus G</author><author>Turner, Erick H</author><author>Higgins, Julian PT %J The Lancet</author></authors></contributors><titles><title>Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis</title></titles><pages>1357-1366</pages><volume>391</volume><number>10128</number><dates><year>2018</year></dates><isbn>0140-6736</isbn><urls></urls></record></Cite></EndNote>228. Careful and regular monitoring of laboratory and clinical parameters may help in early identification of ADRs and prevent development of iatrogenic comorbidities. We would counsel against ceasing or switching psychotropic treatments to modalities that are less effective without careful consideration of the risk of relapse. Involvement of the patient as part of shared decision making is important when balancing medication effectiveness with ADRs. ADDIN EN.CITE <EndNote><Cite><Author>Slade</Author><Year>2017</Year><RecNum>225</RecNum><DisplayText><style face="superscript">229</style></DisplayText><record><rec-number>225</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755000">225</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Slade, Mike</author></authors></contributors><titles><title>Implementing shared decision making in routine mental health care</title><secondary-title>World Psychiatry</secondary-title></titles><periodical><full-title>World Psychiatry</full-title><abbr-1>World psychiatry : official journal of the World Psychiatric Association (WPA)</abbr-1></periodical><pages>146-153</pages><volume>16</volume><number>2</number><dates><year>2017</year></dates><isbn>1723-8617</isbn><urls></urls></record></Cite></EndNote>229Panel 3. General principles when prescribing anti-hypertensives and statins for people with SMI.Anti-hypertensivesIf there are no specific indications for a particular medication, then any of the following 4 medication classes can be used first-line: ADDIN EN.CITE <EndNote><Cite><Author>Reboussin</Author><Year>2018</Year><RecNum>226</RecNum><DisplayText><style face="superscript">230</style></DisplayText><record><rec-number>226</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755001">226</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Reboussin, D. M.</author><author>Allen, N. B.</author><author>Griswold, M. E.</author><author>Guallar, E.</author><author>Hong, Y.</author><author>Lackland, D. T.</author><author>Miller, E. R.</author><author>Polonsky, T.</author><author>Thompson-Paul, A. M.</author><author>Vupputuri, S.</author></authors></contributors><titles><title>Systematic Review for the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines (vol 71, pg 2176, 2018)</title><secondary-title>Journal of the American College of Cardiology</secondary-title><alt-title>J Am Coll Cardiol</alt-title></titles><periodical><full-title>Journal of the American College of Cardiology</full-title><abbr-1>J Am Coll Cardiol</abbr-1></periodical><alt-periodical><full-title>Journal of the American College of Cardiology</full-title><abbr-1>J Am Coll Cardiol</abbr-1></alt-periodical><pages>2272-2272</pages><volume>71</volume><number>19</number><dates><year>2018</year><pub-dates><date>May 15</date></pub-dates></dates><isbn>0735-1097</isbn><accession-num>WOS:000432367700015</accession-num><urls><related-urls><url><Go to ISI>://WOS:000432367700015</url></related-urls></urls><electronic-resource-num>10.1016/j.jacc.2018.03.018</electronic-resource-num><language>English</language></record></Cite></EndNote>230 thiazide diuretics, long acting calcium channel blockers (e.g. amlodipine), ACE inhibitors, or angiotensin II receptor (ARB) blockers. 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ADDIN EN.CITE.DATA 196 to guide introduction of a statin. Measure both total and high density lipoprotein (HDL) cholesterol to achieve the best estimate of CVD risk ADDIN EN.CITE <EndNote><Cite><Author>NICE</Author><RecNum>193</RecNum><DisplayText><style face="superscript">232</style></DisplayText><record><rec-number>193</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754993">193</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>NICE</author></authors></contributors><titles><title>Cardiovascular disease: risk assessment and reduction, including lipid modification. CG181.</title><secondary-title>National Institute for Health and Care Excellence</secondary-title></titles><periodical><full-title>National Institute for Health and Care Excellence</full-title></periodical><dates></dates><urls></urls></record></Cite></EndNote>232Before offering statins for primary prevention of cardiovascular disease, discuss benefits of lifestyle modification and optimise the management of other modifiable CVD risk factors if possible.Offer statin therapy (e.g. atorvastatin 20mg once daily) for primary prevention of cardiovascular disease if QRISK3 assessment tool determines the individual has a ≥10% 10-year risk of developing cardiovascular disease ADDIN EN.CITE <EndNote><Cite><Author>NICE</Author><RecNum>193</RecNum><DisplayText><style face="superscript">232</style></DisplayText><record><rec-number>193</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754993">193</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>NICE</author></authors></contributors><titles><title>Cardiovascular disease: risk assessment and reduction, including lipid modification. CG181.</title><secondary-title>National Institute for Health and Care Excellence</secondary-title></titles><periodical><full-title>National Institute for Health and Care Excellence</full-title></periodical><dates></dates><urls></urls></record></Cite></EndNote>232 Part 4: Multi-Disciplinary approaches to Multi-MorbidityLifestyle Interventions: What works (and when)? Modifiable lifestyle factors such as physical activity, dietary habits and smoking are increasingly recognised as fundamental to both physical and mental health. Interventions targeting these modifiable risk-factors, delivered by practitioners with specific expertise, are referred to as ‘multidisciplinary lifestyle interventions’. The efficacy of such multidisciplinary lifestyle interventions in reducing the risk of cardiometabolic-related morbidity in the general population is well established. ADDIN EN.CITE <EndNote><Cite><Author>Diabetes Prevention Program Research</Author><Year>2002</Year><RecNum>227</RecNum><DisplayText><style face="superscript">189</style></DisplayText><record><rec-number>227</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755001">227</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Diabetes Prevention Program Research, Group</author></authors></contributors><titles><title>The Diabetes Prevention Program (DPP) description of lifestyle intervention</title><secondary-title>Diabetes care</secondary-title></titles><periodical><full-title>Diabetes care</full-title></periodical><pages>2165-2171</pages><volume>25</volume><number>12</number><dates><year>2002</year></dates><isbn>0149-5992</isbn><urls></urls></record></Cite></EndNote>189 Accordingly, the 2018 WHO Guidelines ADDIN EN.CITE <EndNote><Cite><Author>World Health Organization</Author><Year>2018</Year><RecNum>228</RecNum><DisplayText><style face="superscript">233</style></DisplayText><record><rec-number>228</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755001">228</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>World Health Organization,</author></authors></contributors><titles><title>Guidelines for the management of physical health conditions in adults with severe mental disorders</title></titles><number>Licence: CC BY-NC-SA 3.0 IGO</number><dates><year>2018</year></dates><pub-location>Geneva</pub-location><urls></urls></record></Cite></EndNote>233 recommend that lifestyle interventions are considered as first line strategies for the management of physical health (including weight management, cardiovascular disease and cardiovascular risk reduction and diabetes treatment and prevention) for adults with SMI (severe mental illness). However, this commission puts forth that a broad spectrum of mental disorders, beyond just SMI, have elevated rates of cardiometabolic diseases (Part 1) and lifestyle risk-factors (Part 2) which are further compounded by medications commonly used to treat mental illnesses (Part 3). Thus, a first step in reducing the physical health disparities facing people with mental illness is ensuring the adoption, translation, and routine provision of evidence-based lifestyle interventions as a standard component of mental health care. However, not all lifestyle interventions are created equal. Therefore, we aim to explain here how the efficacy and effectiveness of multidisciplinary lifestyle interventions are impacted by both their content and timing. Some key considerations for individual components of multidisciplinary interventions are presented in Panel 4. Whereas it may seem counter-intuitive to dedicate intensive resources to individuals with relatively ‘intact’ metabolic health, focusing on cardiometabolic protection in at-risk populations may present the optimal approach for lifestyle interventions (see also Panel 2). An example of gold-standard lifestyle intervention in the general population is the Diabetes Prevention Program (DPP) developed and evaluated in the USA. ADDIN EN.CITE <EndNote><Cite><Author>Diabetes Prevention Program Research</Author><Year>2002</Year><RecNum>227</RecNum><DisplayText><style face="superscript">189</style></DisplayText><record><rec-number>227</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755001">227</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Diabetes Prevention Program Research, Group</author></authors></contributors><titles><title>The Diabetes Prevention Program (DPP) description of lifestyle intervention</title><secondary-title>Diabetes care</secondary-title></titles><periodical><full-title>Diabetes care</full-title></periodical><pages>2165-2171</pages><volume>25</volume><number>12</number><dates><year>2002</year></dates><isbn>0149-5992</isbn><urls></urls></record></Cite></EndNote>189 The key features of the DPP’s lifestyle intervention are detailed in Table 4, and include individual case managers, frequent face-to-face contact with participants, a structured educational component including behavioural self-management strategies, supervised physical activity sessions, a maintenance intervention combining group and individual approaches, motivational strategies, and individualization through a “toolbox” of adherence strategies, tailoring of materials and strategies to address ethnic diversity; and an extensive network of training, feedback, and clinical support. ADDIN EN.CITE <EndNote><Cite><Author>Diabetes Prevention Program Research</Author><Year>2002</Year><RecNum>227</RecNum><DisplayText><style face="superscript">189</style></DisplayText><record><rec-number>227</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755001">227</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Diabetes Prevention Program Research, Group</author></authors></contributors><titles><title>The Diabetes Prevention Program (DPP) description of lifestyle intervention</title><secondary-title>Diabetes care</secondary-title></titles><periodical><full-title>Diabetes care</full-title></periodical><pages>2165-2171</pages><volume>25</volume><number>12</number><dates><year>2002</year></dates><isbn>0149-5992</isbn><urls></urls></record></Cite></EndNote>189 The primary study of the DPP recruited 3,234 nondiabetic adults at elevated risk for developing type-2 diabetes (established via multiple risk factors); aiming to achieve a minimum of 7% weight loss/weight maintenance and at least 150 min of physical activity per week. The lifestyle intervention resulted in a 58% reduction in the development of type-2 diabetes over the three year study, with only 4.8 cases of diabetes per 100 person-years observed the lifestyle intervention group, compared to 11.0 cases in the control condition. ADDIN EN.CITE <EndNote><Cite><Author>Diabetes Prevention Program Research</Author><Year>2002</Year><RecNum>227</RecNum><DisplayText><style face="superscript">189,190</style></DisplayText><record><rec-number>227</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755001">227</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Diabetes Prevention Program Research, Group</author></authors></contributors><titles><title>The Diabetes Prevention Program (DPP) description of lifestyle intervention</title><secondary-title>Diabetes care</secondary-title></titles><periodical><full-title>Diabetes care</full-title></periodical><pages>2165-2171</pages><volume>25</volume><number>12</number><dates><year>2002</year></dates><isbn>0149-5992</isbn><urls></urls></record></Cite><Cite><Author>Knowler</Author><Year>2002</Year><RecNum>229</RecNum><record><rec-number>229</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755001">229</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Knowler, William C</author><author>Barrett-Connor, Elizabeth</author><author>Fowler, Sarah E</author><author>Hamman, Richard F</author><author>Lachin, John M</author><author>Walker, Elizabeth A</author><author>Nathan, David M</author></authors></contributors><titles><title>Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin</title><secondary-title>The New England journal of medicine</secondary-title></titles><periodical><full-title>The New England journal of medicine</full-title></periodical><pages>393-403</pages><volume>346</volume><number>6</number><dates><year>2002</year></dates><isbn>0028-4793</isbn><urls></urls></record></Cite></EndNote>189,190 Furthermore, both the clinical benefits and cost-effectiveness of the DPP lifestyle interventions was maintained over a 10-year follow up, even when compared to metformin as a control condition. ADDIN EN.CITE <EndNote><Cite><Author>Group</Author><Year>2013</Year><RecNum>230</RecNum><DisplayText><style face="superscript">234,235</style></DisplayText><record><rec-number>230</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755002">230</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Diabetes Prevention Program Research Group</author></authors></contributors><titles><title>The 10-year cost-effectiveness of lifestyle intervention or metformin for diabetes prevention: an intent-to-treat analysis of the DPP/DPPOS. Diabetes Care 2012; 35: 723–730</title><secondary-title>Diabetes care</secondary-title></titles><periodical><full-title>Diabetes care</full-title></periodical><pages>4172-4175</pages><volume>36</volume><number>12</number><dates><year>2013</year></dates><isbn>0149-5992</isbn><urls></urls></record></Cite><Cite><Author>Group</Author><Year>2009</Year><RecNum>231</RecNum><record><rec-number>231</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755002">231</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Diabetes Prevention Program Research Group</author></authors></contributors><titles><title>10-year follow-up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study</title><secondary-title>The Lancet</secondary-title></titles><periodical><full-title>The Lancet</full-title></periodical><pages>1677-1686</pages><volume>374</volume><number>9702</number><dates><year>2009</year></dates><isbn>0140-6736</isbn><urls></urls></record></Cite></EndNote>234,235 This shows that lifestyle interventions containing beneficial components (Table 4) can reduce the incidence and burden of Table 4. Key components of lifestyle interventions (adapted from the Diabetes Prevention Program, 2002) ADDIN EN.CITE <EndNote><Cite><Author>Diabetes Prevention Program Research</Author><Year>2002</Year><RecNum>227</RecNum><DisplayText><style face="superscript">189</style></DisplayText><record><rec-number>227</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755001">227</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Diabetes Prevention Program Research, Group</author></authors></contributors><titles><title>The Diabetes Prevention Program (DPP) description of lifestyle intervention</title><secondary-title>Diabetes care</secondary-title></titles><periodical><full-title>Diabetes care</full-title></periodical><pages>2165-2171</pages><volume>25</volume><number>12</number><dates><year>2002</year></dates><isbn>0149-5992</isbn><urls></urls></record></Cite></EndNote>189Measurable and specific goalsUse of case managers or lifestyle coaches with university (or equivalent) training in nutrition and dietetics, exercise prescription, and/or behavioural changeFrequent contact and ongoing interventionIndividualisation through a toolbox of adherence strategies Adapted for culturally and ethnically diverse groups Local and national network of training, feedback and clinical supportAchieve body weight maintenance or a reduction of between 5-7% total body weightReduce caloric intake (500-1,000kcal/day below calories needed for weight maintenance and a maximum of 25% of calories from fat), and improve diet qualityIncrease minutes of physical activity (achieve recommendations of 150 minutes per week of moderate-vigorous physical activity)Replace sedentary behaviour with light intensity activity as often as possibleIncrease cardiorespiratory fitnessSmoking cessation Facilitate individualised program design and delivery Offer combination of group and one-on-one based sessions Provide supervised exercise and nutrition sessions at least two times per week (for example community centres, neighbourhood group walks or one-on-one personal training) Conduct relevant assessments at regular intervalsEnsure lifestyle coaches have training in psychopathology and basic principles of working with people living with mental illnessDeliver core curriculum on topics including nutrition (modifying energy intake), physical activity (and sedentary behaviour) and behavioural self-management (barrier identification and problem solving)Provide flexible maintenance program with supplemental group classesMotivation campaigns and restart opportunitiesSelf-monitoring outcomes and behaviours for example weight, physical activity, sedentary behaviour and dietary intake (fat and caloric intake).Barrier identification Translation of documentation to local languages Identification of culturally appropriate resources and intervention approachesCooking groups accounting for dietary restrictions or religious requirementsAppropriate training and upskilling of relevant staffClear referral pathways and integration of lifestyle coaches within standard multi-disciplinary mental health teamMonitoring and evaluation of effectiveness and attendance / engagementcardiometabolic diseases when used as a preventative strategy in at-risk populations. Importantly, the DPP has also been adapted and delivered successfully through primary care settings. ADDIN EN.CITE <EndNote><Cite><Author>Ma</Author><Year>2013</Year><RecNum>232</RecNum><DisplayText><style face="superscript">236</style></DisplayText><record><rec-number>232</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755002">232</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ma, Jun</author><author>Yank, Veronica</author><author>Xiao, Lan</author><author>Lavori, Philip W</author><author>Wilson, Sandra R</author><author>Rosas, Lisa G</author><author>Stafford, Randall S</author></authors></contributors><titles><title>Translating the Diabetes Prevention Program lifestyle intervention for weight loss into primary care: a randomized trial</title><secondary-title>JAMA internal medicine</secondary-title></titles><periodical><full-title>JAMA internal medicine</full-title></periodical><pages>113-121</pages><volume>173</volume><number>2</number><dates><year>2013</year></dates><isbn>2168-6106</isbn><urls></urls></record></Cite></EndNote>236 Considering the raised metabolic and lifestyle risk observed across multiple classes of mental disorders (Parts 1 and 2), the DPP could be adapted for people with mental illness to be made available through primary care, on a referral basis. 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ADDIN EN.CITE.DATA 237-239 - thus indicating that integrating the DPP principles into mental health care may confer benefits even beyond metabolic health, to improve overall recovery. However, it is important to note that the majority of DPP studies to date have allowed the exclusion of individuals with “major psychiatric disorders which, in opinion of clinic staff, would impede conduct of the DPP”. Thus, the DPP now requires replication as a transdiagnostic lifestyle intervention for people with mental illness through primary care services and specialised mental health services. While maintaining the core principles of the DPP is imperative to the design and delivery of such lifestyle interventions, it should be acknowledged that the level of support required by people with SMI is likely to be more intensive than what is required to affect change in the general population. Indeed, an RCT of an adapted versions of the DPP for people with SMI observed significant reductions in obesity and other metabolic risk markers associated with antipsychotic treatment. ADDIN EN.CITE <EndNote><Cite><Author>Erickson</Author><Year>2016</Year><RecNum>236</RecNum><DisplayText><style face="superscript">240</style></DisplayText><record><rec-number>236</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755003">236</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Erickson, Zachary D</author><author>Mena, Shirley J</author><author>Pierre, Joseph M</author><author>Blum, Lisa H</author><author>Martin, Eda</author><author>Hellemann, Gerhard S</author><author>Aragaki, Dixie R</author><author>Firestone, Lisa</author><author>Lee, Catherine</author><author>Lee, Paul</author></authors></contributors><titles><title>Behavioral interventions for antipsychotic medication-associated obesity: a randomized, controlled clinical trial</title><secondary-title>The Journal of clinical psychiatry</secondary-title></titles><periodical><full-title>The Journal of clinical psychiatry</full-title></periodical><pages>e183-9</pages><volume>77</volume><number>2</number><dates><year>2016</year></dates><isbn>0160-6689</isbn><urls></urls></record></Cite></EndNote>240 Conversely, undesirable adaptation of such evidence-based programs, including the insufficient dosage of the interventional components due to conflicting demands and diagnostic overshadowing, ADDIN EN.CITE <EndNote><Cite><Author>Thornicroft</Author><Year>2011</Year><RecNum>5</RecNum><DisplayText><style face="superscript">20</style></DisplayText><record><rec-number>5</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754960">5</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Thornicroft, Graham</author></authors></contributors><titles><title>Physical health disparities and mental illness: the scandal of premature mortality</title><secondary-title>The British Journal of Psychiatry</secondary-title></titles><periodical><full-title>The British Journal of Psychiatry</full-title></periodical><pages>441-442</pages><volume>199</volume><number>6</number><dates><year>2011</year></dates><isbn>0007-1250</isbn><urls></urls></record></Cite></EndNote>20 is a threat to the effectiveness of lifestyle interventions in mental healthcare. Ultimately, the challenge for policy makers, clinicians and service delivery is applying these established, effective principles of behaviour change to people living with mental illness, particularly with regards to adopting an early intervention and prevention framework.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HYXRlczwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+PFJl
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ADDIN EN.CITE.DATA 134Adapting and implementing lifestyle interventions for severe mental illnessA 2019 meta-review aggregated data from 27 different meta-analyses of physical health interventions for people with schizophrenia; ADDIN EN.CITE <EndNote><Cite><Author>Vancampfort</Author><Year>2019</Year><RecNum>237</RecNum><DisplayText><style face="superscript">241</style></DisplayText><record><rec-number>237</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755003">237</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Vancampfort, Davy</author><author>Firth, Joseph</author><author>Correll, Christoph U</author><author>Solmi, Marco</author><author>Siskind, Dan</author><author>De Hert, Marc</author><author>Carney, Rebekah</author><author>Koyanagi, Ai</author><author>Carvalho, André F</author><author>Gaughran, Fiona</author></authors></contributors><titles><title>The impact of pharmacological and non‐pharmacological interventions to improve physical health outcomes in people with schizophrenia: a meta‐review of meta‐analyses of randomized controlled trials</title><secondary-title>World Psychiatry</secondary-title></titles><periodical><full-title>World Psychiatry</full-title><abbr-1>World psychiatry : official journal of the World Psychiatric Association (WPA)</abbr-1></periodical><pages>53-66</pages><volume>18</volume><number>1</number><dates><year>2019</year></dates><isbn>1723-8617</isbn><urls></urls></record></Cite></EndNote>241 showing that exercise, diet and broader lifestyle interventions conferred significant benefits across multiple cardiometabolic outcomes (including bodyweight, waist circumference, blood pressure, and glucose/lipid markers), with comparable efficacy to pharmacological management of metabolic health (which are discussed in Part 3). However, the inclusion criteria and recruitment strategies of the clinical trials from which this efficacy data is predominantly derived may reduce the generalisability and external validity of their findings. ADDIN EN.CITE <EndNote><Cite><Author>Lally</Author><Year>2018</Year><RecNum>238</RecNum><DisplayText><style face="superscript">242</style></DisplayText><record><rec-number>238</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755003">238</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lally, John</author><author>Watkins, Rochelle</author><author>Nash, Sarah</author><author>Shetty, Hitesh</author><author>Gardner-Sood, Poonam</author><author>Smith, Shubulade</author><author>Murray, Robin M</author><author>Gaughran, Fiona</author></authors></contributors><titles><title>The Representativeness of Participants With Severe Mental Illness in a Psychosocial Clinical Trial</title><secondary-title>Frontiers in psychiatry</secondary-title></titles><periodical><full-title>Frontiers in psychiatry</full-title></periodical><volume>9</volume><dates><year>2018</year></dates><urls></urls></record></Cite></EndNote>242 Currently, there is a shortage of effectiveness studies, and pragmatic implementation and sustainability research guiding the routine implementation of lifestyle interventions in people with mental illness. ADDIN EN.CITE <EndNote><Cite><Author>Czosnek</Author><Year>2018</Year><RecNum>239</RecNum><DisplayText><style face="superscript">243</style></DisplayText><record><rec-number>239</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755003">239</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Czosnek, Louise</author><author>Lederman, Oscar</author><author>Cormie, Prue</author><author>Zopf, Eva</author><author>Stubbs, Brendon</author><author>Rosenbaum, Simon</author></authors></contributors><titles><title>Health benefits, safety and cost of physical activity interventions for mental health conditions: A meta-review to inform translation efforts</title><secondary-title>Mental Health and Physical Activity</secondary-title></titles><periodical><full-title>Mental Health and Physical Activity</full-title></periodical><dates><year>2018</year></dates><isbn>1755-2966</isbn><urls></urls></record></Cite></EndNote>243 Furthermore, there has been a number of null findings in recent years from large-scale clinical trials in people with mental illness. In order to provide guidance regarding best-practice implementation of lifestyle interventions within mental health services, it is important to consider intervention factors associated with negative and positive outcomes of trials. As detailed in appendix (page 23: Table 4.1) trials of lifestyle interventions in mental healthcare often fail to meet all of the principles of programs such as the DPP. Specific aspects of the DPP that are poorly endorsed from the extant literature are (i) utilising qualified exercise professionals / dietician staff to deliver lifestyle interventions, (ii) providing sufficient access to supervised exercise services, (iii) ensuring existing mental health staff are appropriately familiarised with the lifestyle interventions. Individual summaries of large-scale clinical trials of broad lifestyle interventions addressing multiple risk factors in people living with mental illness, and discussions of the ‘lessons learnt’ from each of these, are presented in the appendix (Pages 24-30: Table 4.2.).The high acceptability of lifestyle interventions offers a novel method by which to engage typically disengaged service users in more traditional mental health treatment. For example, the provision of gym-based resistance exercise may offer a clinical pathway to care for young people with early psychosis,PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5GaXJ0aDwvQXV0aG9yPjxZZWFyPjIwMTY8L1llYXI+PFJl
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ADDIN EN.CITE.DATA 244 or veterans with posttraumatic stress disorder ADDIN EN.CITE <EndNote><Cite><Author>Rosenbaum</Author><Year>2015</Year><RecNum>241</RecNum><DisplayText><style face="superscript">245</style></DisplayText><record><rec-number>241</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755004">241</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rosenbaum, S.</author><author>Vancampfort, D.</author><author>Steel, Z.</author><author>Newby, Jill M.</author><author>Ward, P. B</author><author>Stubbs, B</author></authors></contributors><titles><title>Physical activity in the treatment of posttraumatic stress disorder: A systematic review and meta-analysis</title><secondary-title>Psychiatry Res</secondary-title></titles><periodical><full-title>Psychiatry Res</full-title></periodical><pages>130–136</pages><volume>230</volume><dates><year>2015</year></dates><urls></urls></record></Cite></EndNote>245. However, an important consideration is how such programs are applied across different clinical and broader public health settings. Flexibility in delivery, a focus on ‘practical’ exercise and dietary instruction and involvement, and support to integrate the lifestyle measures into daily life, are highly recommended.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CYXJ0ZWxzPC9BdXRob3I+PFllYXI+MjAxNTwvWWVhcj48
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ADDIN EN.CITE.DATA 246,247 Further research is needed on how interventions are delivered, with greater emphasis on a mixed model involving online delivery and practical face-to-face being a potentially balanced and cost-effective way forward. ADDIN EN.CITE <EndNote><Cite><Author>Naslund</Author><Year>2018</Year><RecNum>77</RecNum><DisplayText><style face="superscript">103</style></DisplayText><record><rec-number>77</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754972">77</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Naslund, John A</author><author>Aschbrenner, Kelly A</author></authors></contributors><titles><title>Digital technology for health promotion: opportunities to address excess mortality in persons living with severe mental disorders</title><secondary-title>Evidence-based mental health</secondary-title></titles><periodical><full-title>Evidence-based mental health</full-title></periodical><pages>ebmental-2018-300034</pages><dates><year>2018</year></dates><isbn>1362-0347</isbn><urls></urls></record></Cite></EndNote>103 The potential benefits of implementing multidisciplinary lifestyle interventions as a preventative strategy for metabolic health in people with SMI is provided by the “Keeping the Body in Mind” (KBIM) study (detailed elsewherePEVuZE5vdGU+PENpdGU+PEF1dGhvcj5DdXJ0aXM8L0F1dGhvcj48WWVhcj4yMDE2PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 137). The KBIM study, along with other examples from studies of lifestyle interventions across different settings/contexts for people with mental illness are provided in the appendix (Pages 31-34: Table 4.3).4.3. Training health professionals for a culture shiftConsideration of potential core health professionals in multidisciplinary teams in mental health settings is rapidly evolving to include allied health professionals with expertise in nutrition, physical activity, behaviour change, and other aspects such as general lifestyle psychoeducation and mindfulness training. The success of this transition relies on a number of factors.First, allied health practitioners should receive at least introductory training in psychopathology and in the principles of working with patients experiencing mental illness. This can be achieved by ensuring that the curriculum for health professionals including dietitians, physiotherapists and exercise physiologists is updated to reflect the increasing role for such professionals within mental health teams. ADDIN EN.CITE <EndNote><Cite><Author>Rosenbaum</Author><Year>2018</Year><RecNum>244</RecNum><DisplayText><style face="superscript">248</style></DisplayText><record><rec-number>244</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755004">244</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rosenbaum, Simon</author><author>Hobson-Powell, Anita</author><author>Davison, Kade</author><author>Stanton, Robert</author><author>Craft, Lynette L</author><author>Duncan, Michael</author><author>Elliot, Catherine</author><author>Ward, Philip B</author></authors></contributors><titles><title>The Role of Sport, Exercise, and Physical Activity in Closing the Life Expectancy Gap for People with Mental Illness: An International Consensus Statement by Exercise and Sports Science Australia, American College of Sports Medicine, British Association of Sport and Exercise Science, and Sport and Exercise Science New Zealand</title><secondary-title>Translational Journal of the American College of Sports Medicine</secondary-title></titles><periodical><full-title>Translational Journal of the American College of Sports Medicine</full-title></periodical><pages>72-73</pages><volume>3</volume><number>10</number><dates><year>2018</year></dates><isbn>2379-2868</isbn><urls></urls></record></Cite></EndNote>248 Second, medical and mental health professionals should receive training on (i) working with allied health professionals in an integrated manner, (ii) understanding the principles of lifestyle interventions. The importance of training medical students in ‘lifestyle medicine’ is increasingly being recognised globally. ADDIN EN.CITE <EndNote><Cite><Author>Strong</Author><Year>2017</Year><RecNum>245</RecNum><DisplayText><style face="superscript">249</style></DisplayText><record><rec-number>245</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755005">245</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Strong, Abigail</author><author>Stoutenberg, Mark</author><author>Hobson-Powell, Anita</author><author>Hargreaves, Mark</author><author>Beeler, Halle</author><author>Stamatakis, Emmanuel</author></authors></contributors><titles><title>An evaluation of physical activity training in Australian medical school curricula</title><secondary-title>Journal of Science and Medicine in Sport</secondary-title></titles><periodical><full-title>Journal of Science and Medicine in Sport</full-title></periodical><pages>534-538</pages><volume>20</volume><number>6</number><dates><year>2017</year></dates><isbn>1440-2440</isbn><urls></urls></record></Cite></EndNote>249 Efforts towards integrating lifestyle interventions within routine mental healthcare should also avoid an isolated focus on individual level behaviour change, in the absence of facilitating adaptations in service structure, delivery and culture (see Part 5). This approach builds on existing evidence that medical and nursing practitioners who engage in healthy lifestyle behaviours themselves are more likely to recommend and endorse such behaviours for patients. ADDIN EN.CITE <EndNote><Cite><Author>Lobelo</Author><Year>2016</Year><RecNum>246</RecNum><DisplayText><style face="superscript">250</style></DisplayText><record><rec-number>246</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755005">246</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lobelo, Felipe</author><author>de Quevedo, Isabel Garcia</author></authors></contributors><titles><title>The evidence in support of physicians and health care providers as physical activity role models</title><secondary-title>American journal of lifestyle medicine</secondary-title></titles><periodical><full-title>American journal of lifestyle medicine</full-title></periodical><pages>36-52</pages><volume>10</volume><number>1</number><dates><year>2016</year></dates><isbn>1559-8276</isbn><urls></urls></record></Cite></EndNote>250 Drawing on advances in implementation science will also make lifestyle interventions more likely to meaningfully impact patient outcomes. ADDIN EN.CITE <EndNote><Cite><Author>Czosnek</Author><Year>2018</Year><RecNum>239</RecNum><DisplayText><style face="superscript">243</style></DisplayText><record><rec-number>239</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755003">239</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Czosnek, Louise</author><author>Lederman, Oscar</author><author>Cormie, Prue</author><author>Zopf, Eva</author><author>Stubbs, Brendon</author><author>Rosenbaum, Simon</author></authors></contributors><titles><title>Health benefits, safety and cost of physical activity interventions for mental health conditions: A meta-review to inform translation efforts</title><secondary-title>Mental Health and Physical Activity</secondary-title></titles><periodical><full-title>Mental Health and Physical Activity</full-title></periodical><dates><year>2018</year></dates><isbn>1755-2966</isbn><urls></urls></record></Cite></EndNote>243 Barriers, Opportunities and Future ResearchSome of the current issues, emerging solutions and research priorities for smoking cessation, physical activity and dietary interventions for people with mental illness are presented in Panel 4. For all aspects of lifestyle interventions, further consideration for a gradient of intervention intensity, or ‘stepped care’, is required; especially with regards to varying the intensity to individual participants, treatment setting, culture and readiness to provide lifestyle interventions, particularly in low-resource settings. Even in high-resource settings, providing intensive lifestyle interventions solely through mental health services may cause issues for individuals who attend their mental health centres infrequently, and those who are discharged may struggle to stay engaged with lifestyle changes. A potential solution is the use of primary care referral schemes to facilitate sustained engagement with health behaviour interventions. 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ADDIN EN.CITE.DATA 251,252 However, preliminary data indicates community exercise can be beneficial and engaging for young people with mental illness, even for those with severe conditions. ADDIN EN.CITE <EndNote><Cite><Author>Firth</Author><Year>2016</Year><RecNum>249</RecNum><DisplayText><style face="superscript">253,254</style></DisplayText><record><rec-number>249</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755005">249</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Firth, Joseph</author><author>Carney, Rebekah</author><author>Elliott, Rebecca</author><author>French, Paul</author><author>Parker, Sophie</author><author>McIntyre, Rebecca</author><author>McPhee, Jamie S</author><author>Yung, Alison R</author></authors></contributors><titles><title>Exercise as an intervention for first‐episode psychosis: a feasibility study</title><secondary-title>Early Intervention in Psychiatry</secondary-title></titles><periodical><full-title>Early Interv Psychiatry</full-title><abbr-1>Early intervention in psychiatry</abbr-1></periodical><dates><year>2016</year></dates><isbn>1751-7893</isbn><urls></urls></record></Cite><Cite><Author>Firth</Author><Year>2016</Year><RecNum>250</RecNum><record><rec-number>250</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755006">250</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Firth, Joseph</author><author>Carney, Rebekah</author><author>Jerome, Lauren</author><author>Elliott, Rebecca</author><author>French, Paul</author><author>Yung, Alison R.</author></authors></contributors><titles><title>The effects and determinants of exercise participation in first-episode psychosis: a qualitative study</title><secondary-title>BMC psychiatry</secondary-title></titles><periodical><full-title>BMC Psychiatry</full-title><abbr-1>BMC psychiatry</abbr-1></periodical><pages>1-9</pages><volume>16</volume><number>1</number><dates><year>2016</year></dates><isbn>1471-244X</isbn><urls></urls></record></Cite></EndNote>253,254 Community-based diet programmes, such as ‘Weight Watchers’ have been found to provide cost effective weight-loss interventions when delivered via primary care to obese individuals. Research is now warranted to determine the suitability and effectiveness of such schemes for psychiatric populations.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5GdWxsZXI8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 255,256 Mobile health (or ‘mhealth’) technologies may also provide new options for applying adapted versions of programs such as the DPP in mental illness. For example, a pilot study found that ‘FitBit’ activity trackers could potentially be used alongside fitness apps in people with schizophrenia to deliver DPP-based interventions,PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bc2NoYnJlbm5lcjwvQXV0aG9yPjxZZWFyPjIwMTY8L1ll
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ADDIN EN.CITE.DATA 257 using added features such as daily prompts/motivational messages and self-determined ‘step count’ goals. Participants in this initial study found this to be engaging, motivating and empowering,PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bc2NoYnJlbm5lcjwvQXV0aG9yPjxZZWFyPjIwMTY8L1ll
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ADDIN EN.CITE.DATA 257 although small sample size (n=25) makes it difficult to determine efficacy. Although only explored in small scale pilot studies so far, mHealth technologies present a myriad of potential opportunities for delivering novel, scalable and sustainable lifestyle interventions for people with mental illness. Given the potential of such interventions for dissemination even in low-resource settings, more research focusing on the development and evaluation of evidence-based mHealth interventions for improving physical health in people experiencing mental illness is warranted. In conclusion, the overarching principles of existing gold-standard diabetes prevention programs are advised to be used as a benchmark in the implementation and maintenance of lifestyle interventions as an integrated, routine component of mental healthcare (Table 4). However, adaptions may be required to translate such an approach to specific care settings, and for particular patient needs. Thus, efforts to translate these principles into both (i) preventative, transdiagnostic lifestyle interventions available through primary care, and (ii) intensive interventions for specialist services, is likely to bridge the implementation gap and present new, effective programs for protecting the cardiometabolic health of people living with mental illness.Panel 4 Key Components of Lifestyle Interventions: Smoking Cessation, Exercise and DietSMOKING CESSATIONIssue: General population approaches have not worked for people with mental illness Although smoking rates have dramatically decreased for the general population they have remained high for people with mental illness, ADDIN EN.CITE <EndNote><Cite><Author>Weinberger</Author><Year>2018</Year><RecNum>254</RecNum><DisplayText><style face="superscript">258</style></DisplayText><record><rec-number>254</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755007">254</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Weinberger, Andrea H</author><author>Streck, Joanna M</author><author>Pacek, Lauren R</author><author>Goodwin, Renee D</author></authors></contributors><titles><title>Nondaily Cigarette Smoking Is Increasing Among People With Common Mental Health and Substance Use Problems in the United States: Data From Representative Samples of US Adults, 2005-2014</title><secondary-title>The Journal of clinical psychiatry</secondary-title></titles><periodical><full-title>The Journal of clinical psychiatry</full-title></periodical><volume>79</volume><number>5</number><dates><year>2018</year></dates><isbn>0160-6689</isbn><urls></urls></record></Cite></EndNote>258 even in young people (see Table 2). Resultantly, people with mental illness now consume around half of all cigarettes sold. ADDIN EN.CITE <EndNote><Cite><Author>Prochaska</Author><Year>2017</Year><RecNum>255</RecNum><DisplayText><style face="superscript">201,259</style></DisplayText><record><rec-number>255</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755007">255</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Prochaska, Judith J</author><author>Das, Smita</author><author>Young-Wolff, Kelly C</author></authors></contributors><titles><title>Smoking, mental illness, and public health</title><secondary-title>Annual review of public health</secondary-title></titles><periodical><full-title>Annual review of public health</full-title></periodical><pages>165-185</pages><volume>38</volume><dates><year>2017</year></dates><isbn>0163-7525</isbn><urls></urls></record></Cite><Cite><Author>England</Author><Year>2018</Year><RecNum>256</RecNum><record><rec-number>256</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755007">256</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Public Health England</author></authors></contributors><titles><title>Health matters: reducing health inequalities in mental illness</title><secondary-title> </secondary-title></titles><periodical><full-title> may because although people with mental illness are just as motivated to stop smoking, they are more nicotine dependent and less likely to seek out and receive appropriate interventions tailored to their needsPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Bc2h0b248L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 260,261Smoking-related deaths disproportionality affect people with mental illness, and smoking is a leading cause of the premature mortality observed in this population. ADDIN EN.CITE <EndNote><Cite><Author>Prochaska</Author><Year>2017</Year><RecNum>255</RecNum><DisplayText><style face="superscript">201,202</style></DisplayText><record><rec-number>255</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755007">255</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Prochaska, Judith J</author><author>Das, Smita</author><author>Young-Wolff, Kelly C</author></authors></contributors><titles><title>Smoking, mental illness, and public health</title><secondary-title>Annual review of public health</secondary-title></titles><periodical><full-title>Annual review of public health</full-title></periodical><pages>165-185</pages><volume>38</volume><dates><year>2017</year></dates><isbn>0163-7525</isbn><urls></urls></record></Cite><Cite><Author>Callaghan</Author><Year>2014</Year><RecNum>259</RecNum><record><rec-number>259</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755008">259</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Callaghan, Russell C</author><author>Veldhuizen, Scott</author><author>Jeysingh, Trincy</author><author>Orlan, Chloe</author><author>Graham, Candida</author><author>Kakouris, Gwen</author><author>Remington, Gary</author><author>Gatley, Jodi</author></authors></contributors><titles><title>Patterns of tobacco-related mortality among individuals diagnosed with schizophrenia, bipolar disorder, or depression</title><secondary-title>Journal of psychiatric research</secondary-title></titles><periodical><full-title>J Psychiatr Res</full-title><abbr-1>Journal of psychiatric research</abbr-1></periodical><pages>102-110</pages><volume>48</volume><number>1</number><dates><year>2014</year></dates><isbn>0022-3956</isbn><urls></urls></record></Cite></EndNote>201,202Emerging Solutions: Bespoke cessation interventionsPharmacological Interventions; have strong efficacy evidence. For instance, a recent meta-analysis showed bupropion and varencicline were the most effective interventions for smoking cessation for people with SMI; both producing a 5-fold odds of smoking cessation compared to placebo treatments. ADDIN EN.CITE <EndNote><Cite><Author>Roberts</Author><Year>2016</Year><RecNum>260</RecNum><DisplayText><style face="superscript">204</style></DisplayText><record><rec-number>260</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755008">260</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Roberts, Emmert</author><author>Eden Evins, A</author><author>McNeill, Ann</author><author>Robson, Debbie</author></authors></contributors><titles><title>Efficacy and tolerability of pharmacotherapy for smoking cessation in adults with serious mental illness: a systematic review and network meta‐analysis</title><secondary-title>Addiction</secondary-title></titles><periodical><full-title>Addiction</full-title></periodical><pages>599-612</pages><volume>111</volume><number>4</number><dates><year>2016</year></dates><isbn>0965-2140</isbn><urls></urls></record></Cite></EndNote>204 Non-pharmacological Interventions: must take into account the additional barriers people with mental illness face (e.g. cognitive impairments) to be effective ADDIN EN.CITE <EndNote><Cite><Author>Rüther</Author><Year>2014</Year><RecNum>261</RecNum><DisplayText><style face="superscript">262</style></DisplayText><record><rec-number>261</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755008">261</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rüther, T</author><author>Bobes, Julio</author><author>De Hert, Marc</author><author>Svensson, TH</author><author>Mann, K</author><author>Batra, A</author><author>Gorwood, P</author><author>M?ller, HJ</author></authors></contributors><titles><title>EPA guidance on tobacco dependence and strategies for smoking cessation in people with mental illness</title><secondary-title>European Psychiatry</secondary-title></titles><periodical><full-title>European Psychiatry</full-title><abbr-1>Eur Psychiat</abbr-1></periodical><pages>65-82</pages><volume>29</volume><number>2</number><dates><year>2014</year></dates><isbn>0924-9338</isbn><urls></urls></record></Cite></EndNote>262. For instance, the SCIMITAR pilot study was developed with service users, and resulted in a 3-fold increased quit rate compared with usual care. ADDIN EN.CITE <EndNote><Cite><Author>Gilbody</Author><Year>2015</Year><RecNum>262</RecNum><DisplayText><style face="superscript">263</style></DisplayText><record><rec-number>262</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755008">262</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gilbody, Simon</author><author>Peckham, Emily</author><author>Man, Mei-See</author><author>Mitchell, Natasha</author><author>Li, Jinshuo</author><author>Becque, Taeko</author><author>Hewitt, Catherine</author><author>Knowles, Sarah</author><author>Bradshaw, Tim</author><author>Planner, Claire</author></authors></contributors><titles><title>Bespoke smoking cessation for people with severe mental ill health (SCIMITAR): a pilot randomised controlled trial</title><secondary-title>The Lancet Psychiatry</secondary-title></titles><periodical><full-title>The Lancet Psychiatry</full-title></periodical><pages>395-402</pages><volume>2</volume><number>5</number><dates><year>2015</year></dates><isbn>2215-0366</isbn><urls></urls></record></Cite></EndNote>263 National / policy level intervention: can also be implemented. For instance, the recent move to ‘Smokefree’ environments by NHS England includes banning smoking on mental health wards and hospital premises while promoting cessation on a service-level throughout community care. ADDIN EN.CITE <EndNote><Cite><Author>Public Health England</Author><Year>2016</Year><RecNum>263</RecNum><DisplayText><style face="superscript">264</style></DisplayText><record><rec-number>263</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755008">263</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Public Health England, UK</author></authors></contributors><titles><title>Smokefree mental health services in England: Implementation document for providers of mental health services</title><secondary-title>available online: </secondary-title></titles><periodical><full-title>available online: Initial data suggests that implementing smoking bans and bespoke smoking cessation programs are well-received in inpatient settings, and may even have broader benefits for service culture. ADDIN EN.CITE <EndNote><Cite><Author>Robson</Author><Year>2017</Year><RecNum>264</RecNum><DisplayText><style face="superscript">265</style></DisplayText><record><rec-number>264</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755009">264</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Robson, Debbie</author><author>Spaducci, Gilda</author><author>McNeill, Ann</author><author>Stewart, Duncan</author><author>Craig, Tom JK</author><author>Yates, Mary</author><author>Szatkowski, Lisa</author></authors></contributors><titles><title>Effect of implementation of a smoke-free policy on physical violence in a psychiatric inpatient setting: an interrupted time series analysis</title><secondary-title>The Lancet Psychiatry</secondary-title></titles><periodical><full-title>The Lancet Psychiatry</full-title></periodical><pages>540-546</pages><volume>4</volume><number>7</number><dates><year>2017</year></dates><isbn>2215-0366</isbn><urls></urls></record></Cite></EndNote>265Future Research Priorities: Improving access and timing of cessation interventionsSmoking cessation training in now freely available for healthcare professionals; which may increase the likelihood of service users receiving access to evidence-based interventions. One such example is the ‘Very Brief Advice on Smoking’ e-learning from NHS England / Public Health England, ADDIN EN.CITE <EndNote><Cite><Author>Public Health England</Author><Year>2018</Year><RecNum>265</RecNum><DisplayText><style face="superscript">266</style></DisplayText><record><rec-number>265</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755009">265</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Public Health England, UK</author></authors></contributors><titles><title>Health matters: reducing health inequalities in mental illness</title><secondary-title>Available online: </secondary-title></titles><periodical><full-title>Available online: which may be useful for supporting the delivery of smoking cessation advice by frontline mental health staff. E-cigarettes are already widely used across a wide range of mental health populations, ADDIN EN.CITE <EndNote><Cite><Author>Bianco</Author><Year>2019</Year><RecNum>266</RecNum><DisplayText><style face="superscript">267</style></DisplayText><record><rec-number>266</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755009">266</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bianco, Cynthia L</author></authors></contributors><titles><title>Rates of electronic cigarette use among adults with a chronic mental illness</title><secondary-title>Addictive behaviors</secondary-title></titles><periodical><full-title>Addict Behav</full-title><abbr-1>Addictive behaviors</abbr-1></periodical><pages>1-4</pages><volume>89</volume><dates><year>2019</year></dates><isbn>0306-4603</isbn><urls></urls></record></Cite></EndNote>267 may present a novel method to reduce smoking-related deaths. Indeed, the Science and Technology Committee in England, have advised mental health trusts to allow e-cigarette use on their premises. However, e-cigarettes are not authorized or available in many countries, and further research is required to establish the health outcomes of this approach. ADDIN EN.CITE <EndNote><Cite><Author>Hickling</Author><Year>2018</Year><RecNum>267</RecNum><DisplayText><style face="superscript">268</style></DisplayText><record><rec-number>267</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755009">267</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hickling, Lauren M</author><author>Perez-Iglesias, Rocio</author><author>McNeill, Ann</author><author>Dawkins, Lynne</author><author>Moxham, John</author><author>Ruffell, Tamatha</author><author>Sendt, Kyra-Verena</author><author>McGuire, Philip</author></authors></contributors><titles><title>A pre-post pilot study of electronic cigarettes to reduce smoking in people with severe mental illness</title><secondary-title>Psychological medicine</secondary-title></titles><periodical><full-title>Psychol Med</full-title><abbr-1>Psychological medicine</abbr-1></periodical><pages>1-8</pages><dates><year>2018</year></dates><isbn>0033-2917</isbn><urls></urls></record></Cite></EndNote>268 Early intervention for smoking is feasible, ADDIN EN.CITE <EndNote><Cite><Author>Curtis</Author><Year>2018</Year><RecNum>268</RecNum><DisplayText><style face="superscript">269</style></DisplayText><record><rec-number>268</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755009">268</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Curtis, Jackie</author><author>Zhang, Charry</author><author>McGuigan, Bernadette</author><author>Pavel-Wood, Esther</author><author>Morell, Rachel</author><author>Ward, Philip B</author><author>Watkins, Andrew</author><author>Lappin, Julia M</author></authors></contributors><titles><title>y-QUIT: Smoking Prevalence, Engagement and Effectiveness of an Individualized Smoking Cessation Intervention in Youth with Severe Mental Illness</title><secondary-title>Frontiers in psychiatry</secondary-title></titles><periodical><full-title>Frontiers in psychiatry</full-title></periodical><pages>683</pages><volume>9</volume><dates><year>2018</year></dates><isbn>1664-0640</isbn><urls></urls></record></Cite></EndNote>269 may improve quit rates, and long-term physical health outcomes. ADDIN EN.CITE <EndNote><Cite><Author>Harker</Author><Year>2016</Year><RecNum>269</RecNum><DisplayText><style face="superscript">270</style></DisplayText><record><rec-number>269</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755010">269</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Harker, Katy</author><author>Cheeseman, Hazel</author></authors></contributors><titles><title>Shifting culture and taking action to reduce smoking and premature death among people with a mental health condition</title><secondary-title>Journal of Public Mental Health</secondary-title></titles><periodical><full-title>Journal of Public Mental Health</full-title></periodical><pages>184-187</pages><volume>15</volume><number>4</number><dates><year>2016</year></dates><isbn>1746-5729</isbn><urls></urls></record></Cite></EndNote>270 [Continuation of Panel 4]PHYSICAL ACTIVITYDIETIssue: Staying MotivatedWeight loss is often the people’s primary motivation factor for physical activity, ADDIN EN.CITE <EndNote><Cite><Author>Firth</Author><Year>2016</Year><RecNum>270</RecNum><DisplayText><style face="superscript">271</style></DisplayText><record><rec-number>270</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755010">270</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Firth, Joseph</author><author>Rosenbaum, Simon</author><author>Stubbs, Brendon</author><author>Gorczynski, Paul</author><author>Yung, AR</author><author>Vancampfort, Davy</author></authors></contributors><titles><title>Motivating factors and barriers towards exercise in severe mental illness: a systematic review and meta-analysis</title><secondary-title>Psychological medicine</secondary-title></titles><periodical><full-title>Psychol Med</full-title><abbr-1>Psychological medicine</abbr-1></periodical><pages>1-13</pages><dates><year>2016</year></dates><isbn>1469-8978</isbn><urls></urls></record></Cite></EndNote>271 but exercise alone is insufficient to reliably reduce bodyweight, particularly over the short term.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5GaXJ0aDwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+PFJl
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ADDIN EN.CITE.DATA 272 Although exercise can attenuate further weight gain, weight maintenance may not be a strong enough motivator for people with mental illness (particularly if they are overweight beforehand) - resulting in disengagement with exercise.Issue: Additive effect of medication and dietDietary risks are collectively a leading risk factor for the global burden of disease ADDIN EN.CITE <EndNote><Cite><Author>Gakidou</Author><Year>2017</Year><RecNum>272</RecNum><DisplayText><style face="superscript">273</style></DisplayText><record><rec-number>272</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755010">272</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gakidou, Emmanuela</author><author>Afshin, Ashkan</author><author>Abajobir, Amanuel Alemu</author><author>Abate, Kalkidan Hassen</author><author>Abbafati, Cristiana</author><author>Abbas, Kaja M</author><author>Abd-Allah, Foad</author><author>Abdulle, Abdishakur M</author><author>Abera, Semaw Ferede</author><author>Aboyans, Victor</author></authors></contributors><titles><title>Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016</title><secondary-title>The Lancet</secondary-title></titles><periodical><full-title>The Lancet</full-title></periodical><pages>1345-1422</pages><volume>390</volume><number>10100</number><dates><year>2017</year></dates><isbn>0140-6736</isbn><urls></urls></record></Cite></EndNote>273 with the risk exacerbated for people with mental illness,PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5GaXJ0aDwvQXV0aG9yPjxZZWFyPjIwMTg8L1llYXI+PFJl
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ADDIN EN.CITE.DATA 87,274 due to a combination of psychotropic medication side-effects, ADDIN EN.CITE <EndNote><Cite><Author>Fountaine</Author><Year>2010</Year><RecNum>12677</RecNum><DisplayText><style face="superscript">275</style></DisplayText><record><rec-number>12677</rec-number><foreign-keys><key app="EN" db-id="0tpsw9zfo5z2wuex0fkvwsr6pewsdxxrsrx5" timestamp="1544082400">12677</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Fountaine, Robert J</author><author>Taylor, Ann E</author><author>Mancuso, James P</author><author>Greenway, Frank L</author><author>Byerley, Lauri O</author><author>Smith, Steven R</author><author>Most, Marlene M</author><author>Fryburg, David A</author></authors></contributors><titles><title>Increased food intake and energy expenditure following administration of olanzapine to healthy men</title><secondary-title>Obesity</secondary-title></titles><periodical><full-title>Obesity</full-title><abbr-1>Obesity</abbr-1><abbr-2>Obesity</abbr-2></periodical><pages>1646-1651</pages><volume>18</volume><number>8</number><dates><year>2010</year></dates><isbn>1930-7381</isbn><urls></urls></record></Cite></EndNote>275,PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BbGJhdWdoPC9BdXRob3I+PFllYXI+MjAxMTwvWWVhcj48
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ADDIN EN.CITE.DATA 90,276 insensitive reward system and poor cognitive control ADDIN EN.CITE <EndNote><Cite><Author>Elman</Author><Year>2006</Year><RecNum>276</RecNum><DisplayText><style face="superscript">277</style></DisplayText><record><rec-number>276</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755011">276</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Elman, Igor</author><author>Borsook, David</author><author>Lukas, Scott E</author></authors></contributors><titles><title>Food intake and reward mechanisms in patients with schizophrenia: implications for metabolic disturbances and treatment with second-generation antipsychotic agents</title><secondary-title>Neuropsychopharmacology</secondary-title></titles><periodical><full-title>Neuropsychopharmacology</full-title></periodical><pages>2091</pages><volume>31</volume><number>10</number><dates><year>2006</year></dates><isbn>1740-634X</isbn><urls></urls></record></Cite></EndNote>277 and food insecurity and financial constraints. ADDIN EN.CITE <EndNote><Cite><Author>Mangurian</Author><Year>2013</Year><RecNum>277</RecNum><DisplayText><style face="superscript">278</style></DisplayText><record><rec-number>277</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755011">277</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mangurian, Christina</author><author>Sreshta, Nina</author><author>Seligman, Hilary</author></authors></contributors><titles><title>Food insecurity among adults with severe mental illness</title><secondary-title>Psychiatric Services</secondary-title></titles><periodical><full-title>Psychiatric Services</full-title></periodical><pages>931-932</pages><volume>64</volume><number>9</number><dates><year>2013</year></dates><isbn>1075-2730</isbn><urls></urls></record></Cite></EndNote>278Emerging Solutions: Fitness Goals, by Fitness ProfessionalsImproving fitness may offer a similarly-motivating ADDIN EN.CITE <EndNote><Cite><Author>Firth</Author><Year>2016</Year><RecNum>270</RecNum><DisplayText><style face="superscript">271</style></DisplayText><record><rec-number>270</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755010">270</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Firth, Joseph</author><author>Rosenbaum, Simon</author><author>Stubbs, Brendon</author><author>Gorczynski, Paul</author><author>Yung, AR</author><author>Vancampfort, Davy</author></authors></contributors><titles><title>Motivating factors and barriers towards exercise in severe mental illness: a systematic review and meta-analysis</title><secondary-title>Psychological medicine</secondary-title></titles><periodical><full-title>Psychol Med</full-title><abbr-1>Psychological medicine</abbr-1></periodical><pages>1-13</pages><dates><year>2016</year></dates><isbn>1469-8978</isbn><urls></urls></record></Cite></EndNote>271, but more achievable,PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TdHViYnM8L0F1dGhvcj48WWVhcj4yMDE2PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 237,282,283 Qualified exercise professionals embedded within mental health services can ensure existing mental health staff are upskilled and equipped to ensure coherent exercise advice regardless of clinical discipline.Emerging Solutions: Dietary SupportImproving diet quality ADDIN EN.CITE <EndNote><Cite><Author>Sotos-Prieto</Author><Year>2017</Year><RecNum>283</RecNum><DisplayText><style face="superscript">284</style></DisplayText><record><rec-number>283</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755013">283</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sotos-Prieto, Mercedes</author><author>Bhupathiraju, Shilpa N</author><author>Mattei, Josiemer</author><author>Fung, Teresa T</author><author>Li, Yanping</author><author>Pan, An</author><author>Willett, Walter C</author><author>Rimm, Eric B</author><author>Hu, Frank B</author></authors></contributors><titles><title>Association of changes in diet quality with total and cause-specific mortality</title><secondary-title>New England Journal of Medicine</secondary-title></titles><periodical><full-title>New England Journal of Medicine</full-title><abbr-1>New Engl J Med</abbr-1></periodical><pages>143-153</pages><volume>377</volume><number>2</number><dates><year>2017</year></dates><isbn>0028-4793</isbn><urls></urls></record></Cite></EndNote>284 and weight reduction ADDIN EN.CITE <EndNote><Cite><Author>Ma</Author><Year>2017</Year><RecNum>284</RecNum><DisplayText><style face="superscript">285</style></DisplayText><record><rec-number>284</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755013">284</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ma, Chenhan</author><author>Avenell, Alison</author><author>Bolland, Mark</author><author>Hudson, Jemma</author><author>Stewart, Fiona</author><author>Robertson, Clare</author><author>Sharma, Pawana</author><author>Fraser, Cynthia</author><author>MacLennan, Graeme</author></authors></contributors><titles><title>Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: systematic review and meta-analysis</title><secondary-title>bmj</secondary-title></titles><periodical><full-title>BMJ</full-title></periodical><pages>j4849</pages><volume>359</volume><dates><year>2017</year></dates><isbn>0959-8138</isbn><urls></urls></record></Cite></EndNote>285 are both associated with a decreased mortality rates in the general population.Dietary interventions in people with mental illness are more effective if delivered: i) by specialist clinicians such as a dieticians, and ii) early in course of treatment ADDIN EN.CITE <EndNote><Cite><Author>Teasdale</Author><Year>2017</Year><RecNum>285</RecNum><DisplayText><style face="superscript">286</style></DisplayText><record><rec-number>285</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755013">285</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Teasdale, Scott B</author><author>Ward, Philip B</author><author>Rosenbaum, Simon</author><author>Samaras, Katherine</author><author>Stubbs, Brendon</author></authors></contributors><titles><title>Solving a weighty problem: systematic review and meta-analysis of nutrition interventions in severe mental illness</title><secondary-title>The British Journal of Psychiatry</secondary-title></titles><periodical><full-title>The British Journal of Psychiatry</full-title></periodical><pages>110-118</pages><volume>210</volume><number>2</number><dates><year>2017</year></dates><isbn>0007-1250</isbn><urls></urls></record></Cite></EndNote>286. Cardiometabolic care and subsequent dietary intervention should be implemented within a multidisciplinary framework. ADDIN EN.CITE <EndNote><Cite><Author>Teasdale</Author><Year>2018</Year><RecNum>286</RecNum><DisplayText><style face="superscript">287</style></DisplayText><record><rec-number>286</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755013">286</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Teasdale, Scott B</author><author>Latimer, Geogina</author><author>Byron, Annette</author><author>Schuldt, Vanessa</author><author>Pizzinga, Josephine</author><author>Plain, Janice</author><author>Buttenshaw, Kerryn</author><author>Forsyth, Adrienne</author><author>Parker, Elizabeth</author><author>Soh, Nerissa</author></authors></contributors><titles><title>Expanding collaborative care: integrating the role of dietitians and nutrition interventions in services for people with mental illness</title><secondary-title>Australasian Psychiatry</secondary-title></titles><periodical><full-title>Australasian Psychiatry</full-title></periodical><pages>47-49</pages><volume>26</volume><number>1</number><dates><year>2018</year></dates><isbn>1039-8562</isbn><urls></urls></record></Cite></EndNote>287Future Research Priorities: Personalised Pathways to Health and FitnessWhereas much of the research has been conducted on aerobic exercise, increasing amounts of evidence from the general population indicates that strength and resistance training or ‘high intensity interval training can produce a multitude of beneficial effects, for both metabolic and mental health.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Db2RlbGxhPC9BdXRob3I+PFllYXI+MjAxODwvWWVhcj48
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ADDIN EN.CITE.DATA 288-290 Given that enjoyment and satisfaction are central determinants of exercise adherence ADDIN EN.CITE <EndNote><Cite><Author>Krogh</Author><Year>2014</Year><RecNum>297</RecNum><DisplayText><style face="superscript">291</style></DisplayText><record><rec-number>297</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755016">297</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Krogh, Jesper</author><author>Lorentzen, Anne Kathrine</author><author>Subhi, Yousif</author><author>Nordentoft, Merete</author></authors></contributors><titles><title>Predictors of adherence to exercise interventions in patients with clinical depression – A pooled analysis from two clinical trials</title><secondary-title>Mental Health and Physical Activity</secondary-title></titles><periodical><full-title>Mental Health and Physical Activity</full-title></periodical><pages>50-54</pages><volume>7</volume><number>1</number><keywords><keyword>Exercise</keyword><keyword>Depression</keyword><keyword>Adherance</keyword><keyword>Participation</keyword><keyword>Attrition</keyword><keyword>Predictors</keyword></keywords><dates><year>2014</year></dates><isbn>1755-2966</isbn><urls><related-urls><url>, providing a range of exercise options, which can accommodate patient preference and goals, is the key to building sustainable and engaging exercise routines. As with exercise, the best dietary regime in people with mental illness is ultimately the one that the person can sustain. Future research may be able to better find strategies to combat the obesogenic effects of psychotropic medications, insensitive reward system and poor cognitive control. The growing understanding surrounding the link between dietary intake, microbiome, inflammation and obesity may signify a viable target to improve physical outcomes in people with mental illness.Part 5: Innovations in Integration for Physical-Mental HealthcareIntroductionSocial determinants including poverty, poor education, unemployment, homelessness and childhood abuse increase the risk for both mental and physical disorders. ADDIN EN.CITE <EndNote><Cite><Author>Marmot</Author><Year>2005</Year><RecNum>298</RecNum><DisplayText><style face="superscript">89,292</style></DisplayText><record><rec-number>298</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755016">298</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Marmot, Michael</author></authors></contributors><titles><title>Social determinants of health inequalities</title><secondary-title>The lancet</secondary-title></titles><periodical><full-title>The Lancet</full-title></periodical><pages>1099-1104</pages><volume>365</volume><number>9464</number><dates><year>2005</year></dates><isbn>0140-6736</isbn><urls></urls></record></Cite><Cite><Author>Bj?rkenstam</Author><Year>2016</Year><RecNum>299</RecNum><record><rec-number>299</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755016">299</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bj?rkenstam, Emma</author><author>Burstr?m, Bo</author><author>Vinnerljung, Bo</author><author>Kosidou, Kyriaki</author></authors></contributors><titles><title>Childhood adversity and psychiatric disorder in young adulthood: An analysis of 107,704 Swedes</title><secondary-title>Journal of psychiatric research</secondary-title></titles><periodical><full-title>J Psychiatr Res</full-title><abbr-1>Journal of psychiatric research</abbr-1></periodical><pages>67-75</pages><volume>77</volume><dates><year>2016</year></dates><isbn>0022-3956</isbn><urls></urls></record></Cite></EndNote>89,292 Relationships between adversity, physical health and mental health are complex, and can operate synergistically to reinforce disadvantage and disability. 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ADDIN EN.CITE.DATA 89,293,294 A 2017 series in The Lancet (focusing on the co-occurrence of chronic health conditions) articulated how ‘syndemic frameworks’ can be used to conceptualise how health risks and comorbidities interact with one another within the broader environmental context. ADDIN EN.CITE <EndNote><Cite><Author>Sharma</Author><Year>2017</Year><RecNum>303</RecNum><DisplayText><style face="superscript">295</style></DisplayText><record><rec-number>303</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755017">303</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sharma, A</author></authors></contributors><titles><title>Syndemics: health in context</title><secondary-title>The Lancet</secondary-title></titles><periodical><full-title>The Lancet</full-title></periodical><pages>10072</pages><volume>389</volume><dates><year>2017</year></dates><urls></urls></record></Cite></EndNote>295 For instance, epidemiological research has applied syndemic frameworks to characterise the pervasive relationships between poverty and diabetes with mental illness and infectious diseases in low-income settings. ADDIN EN.CITE <EndNote><Cite><Author>Mendenhall</Author><Year>2017</Year><RecNum>54</RecNum><DisplayText><style face="superscript">74</style></DisplayText><record><rec-number>54</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754967">54</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mendenhall, Emily</author><author>Kohrt, Brandon A</author><author>Norris, Shane A</author><author>Ndetei, David</author><author>Prabhakaran, Dorairaj</author></authors></contributors><titles><title>Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations</title><secondary-title>The Lancet</secondary-title></titles><periodical><full-title>The Lancet</full-title></periodical><pages>951-963</pages><volume>389</volume><number>10072</number><dates><year>2017</year></dates><isbn>0140-6736</isbn><urls></urls></record></Cite></EndNote>74 This approach sheds new insights into how national and local conditions influence the interface between physical-mental health, and emphasizes the importance of accounting for social, political and economic factors when designing public health interventions, or implementing health service change. Further discussion around the potential application of syndemics for understanding the reciprocal associations between chronic physical and mental disorders is provided elsewhere. ADDIN EN.CITE <EndNote><Cite><Author>Thornicroft</Author><Year>2018</Year><RecNum>55</RecNum><DisplayText><style face="superscript">75</style></DisplayText><record><rec-number>55</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754968">55</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Thornicroft, Graham</author><author>Ahuja, Shalini</author><author>Barber, Sarah</author><author>Chisholm, Daniel</author><author>Collins, Pamela Y</author><author>Docrat, Sumaiyah</author><author>Fairall, Lara</author><author>Lempp, Heidi</author><author>Niaz, Unaiza</author><author>Ngo, Vicky</author></authors></contributors><titles><title>Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries</title><secondary-title>The Lancet Psychiatry</secondary-title></titles><periodical><full-title>The Lancet Psychiatry</full-title></periodical><dates><year>2018</year></dates><isbn>2215-0366</isbn><urls></urls></record></Cite></EndNote>75While the complexity and magnitude of these issues appears daunting, numerous national and international healthcare and advisory bodies have now turned their attention to these issues, and produced an array of resources on the topic of health inequalities in people with mental illnesses (see Table 5 and Supplement 5.1.). These documents present new ideas and best practice approaches for improving the integration of physical and mental healthcare at the individual, health service and societal levels. Brief details for key recommended resources are presented in Table 5. Additional information and key messages from each resource is detailed in Supplement 5.1. Several key health organisation guidelinesPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Pcmdhbml6YXRpb248L0F1dGhvcj48WWVhcj4yMDE3PC9Z
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ADDIN EN.CITE.DATA 47,259,296 and academic articles ADDIN EN.CITE <EndNote><Cite><Author>Thornicroft</Author><Year>2018</Year><RecNum>55</RecNum><DisplayText><style face="superscript">75</style></DisplayText><record><rec-number>55</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754968">55</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Thornicroft, Graham</author><author>Ahuja, Shalini</author><author>Barber, Sarah</author><author>Chisholm, Daniel</author><author>Collins, Pamela Y</author><author>Docrat, Sumaiyah</author><author>Fairall, Lara</author><author>Lempp, Heidi</author><author>Niaz, Unaiza</author><author>Ngo, Vicky</author></authors></contributors><titles><title>Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries</title><secondary-title>The Lancet Psychiatry</secondary-title></titles><periodical><full-title>The Lancet Psychiatry</full-title></periodical><dates><year>2018</year></dates><isbn>2215-0366</isbn><urls></urls></record></Cite></EndNote>75 have included ‘real world’ examples of how new local and national initiatives (which take into account the surrounding environmental conditions) can be implemented to improve the integration of physical and mental health care. Along with detailing required improvements in healthcare for existing patients, several of these guidelines also discuss approaches to preventing chronic physical and mental health conditions. ADDIN EN.CITE <EndNote><Cite><Author>Naylor</Author><Year>2016</Year><RecNum>304</RecNum><DisplayText><style face="superscript">259,296</style></DisplayText><record><rec-number>304</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755018">304</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Naylor, Chris</author><author>Das, Preety</author><author>Ross, Shilpa</author><author>Honeyman, Matthew</author><author>Thompson, James</author><author>Gilburt, Helen</author></authors></contributors><titles><title>Bringing together physical and mental health</title><secondary-title>King's Fund</secondary-title></titles><periodical><full-title>King's Fund</full-title></periodical><dates><year>2016</year></dates><urls></urls></record></Cite><Cite><Author>England</Author><Year>2018</Year><RecNum>256</RecNum><record><rec-number>256</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755007">256</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Public Health England</author></authors></contributors><titles><title>Health matters: reducing health inequalities in mental illness</title><secondary-title> </secondary-title></titles><periodical><full-title> Wide-scale adoption and implementation of strategies which aim to prevent chronic conditions (physical or mental), multi-morbidity and risk of premature mortality is required if we hope to reduce the magnitude of health inequalities for future patients and generations. Some examples and considerations for prevention at primary, secondary and tertiary levels are presented in Panel 5. Table 5. Key Resources on the Integration of Physical and Mental Health TitleYearPublished ByConditionsOutcomesAccessible at:Management of physical health conditions in adults with severe mental disorders: WHO Guidelines2018World Health OrganisationSMIMorbidity and Premature Mortality matters: reducing health inequalities in mental illness2018Public Health EnglandSMIMorbidity and Premature Mortality together physical and mental health A new frontier for integrated care2016The Kings FundAll mental illnessCardiometabolic Health physical healthcare for people living with severe mental illness (SMI) in primary care: Guidance for CCGs2018NHS EnglandSMIPremature Mortality Well: The physical health of people with mental health conditions and/or addiction2017Te PouSMIMortality and Morbidity mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas2017World Psychiatric AssociationSMIPremature Mortality peoplewith severe mental disorders live longer and healthier lives2017World Health OrganizationSMIPremature Mortality the physical health of adults with severe mental illness: essential actions2017Academy of Medical Royal CollegesSMIPremature Mortality integrated care for people with mental illnessEffective management of multimorbidity requires integrated care to be provided in a holistic way; ADDIN EN.CITE <EndNote><Cite><Author>Sciences</Author><Year>2018</Year><RecNum>305</RecNum><DisplayText><style face="superscript">297</style></DisplayText><record><rec-number>305</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755018">305</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Academy of Medical Sciences</author></authors></contributors><titles><title>Multimorbidity: a priority for global health research</title><secondary-title>available from: from: so that common risk factors and the bi-directional interaction between physical and mental health and their treatment can be addressed together. ADDIN EN.CITE <EndNote><Cite><Author>Naylor</Author><Year>2016</Year><RecNum>304</RecNum><DisplayText><style face="superscript">296</style></DisplayText><record><rec-number>304</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755018">304</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Naylor, Chris</author><author>Das, Preety</author><author>Ross, Shilpa</author><author>Honeyman, Matthew</author><author>Thompson, James</author><author>Gilburt, Helen</author></authors></contributors><titles><title>Bringing together physical and mental health</title><secondary-title>King's Fund</secondary-title></titles><periodical><full-title>King's Fund</full-title></periodical><dates><year>2016</year></dates><urls></urls></record></Cite></EndNote>296 There is international agreement that primary care is the optimal setting for addressing and coordinating management of multimorbity. ADDIN EN.CITE <EndNote><Cite><Author>Excellence</Author><Year>2016</Year><RecNum>306</RecNum><DisplayText><style face="superscript">298,299</style></DisplayText><record><rec-number>306</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755018">306</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>National Institute for Clinical Excellence</author></authors></contributors><titles><title>Multimorbidity: clinical assessment and management</title><secondary-title>This is a report . nice. org. uk/guidance/ng56</secondary-title></titles><periodical><full-title>This is a report . nice. org. uk/guidance/ng56</full-title></periodical><dates><year>2016</year></dates><urls></urls></record></Cite><Cite><Author>Health</Author><Year>2010</Year><RecNum>307</RecNum><record><rec-number>307</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755018">307</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>US Department of Health</author><author>Human Services</author></authors></contributors><titles><title>Multiple chronic conditions—a strategic framework: optimum health and quality of life for individuals with multiple chronic conditions</title><secondary-title>Washington, DC: US Department of Health and Human Services</secondary-title></titles><periodical><full-title>Washington, DC: US Department of Health and Human Services</full-title></periodical><volume>2</volume><dates><year>2010</year></dates><urls></urls></record></Cite></EndNote>298,299 In many countries, most people with mental illness first present to the health system through primary care, and most mental health care is delivered in primary care. ADDIN EN.CITE <EndNote><Cite><Author>Thornicroft</Author><Year>2018</Year><RecNum>55</RecNum><DisplayText><style face="superscript">75</style></DisplayText><record><rec-number>55</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754968">55</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Thornicroft, Graham</author><author>Ahuja, Shalini</author><author>Barber, Sarah</author><author>Chisholm, Daniel</author><author>Collins, Pamela Y</author><author>Docrat, Sumaiyah</author><author>Fairall, Lara</author><author>Lempp, Heidi</author><author>Niaz, Unaiza</author><author>Ngo, Vicky</author></authors></contributors><titles><title>Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries</title><secondary-title>The Lancet Psychiatry</secondary-title></titles><periodical><full-title>The Lancet Psychiatry</full-title></periodical><dates><year>2018</year></dates><isbn>2215-0366</isbn><urls></urls></record></Cite></EndNote>75 Even patients requiring specialist mental health services need ongoing engagement with primary care to deliver and coordinate other aspects of their health care, including prevention and management of comorbid physical illness. Primary care aspires to provide equitable, accessible, safe, effective, comprehensive, person-centred care, meeting the needs of individuals, families and communities throughout life. ADDIN EN.CITE <EndNote><Cite><Author>Starfield</Author><Year>2005</Year><RecNum>308</RecNum><DisplayText><style face="superscript">300</style></DisplayText><record><rec-number>308</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755019">308</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Starfield, Barbara</author><author>Shi, Leiyu</author><author>Macinko, James</author></authors></contributors><titles><title>Contribution of primary care to health systems and health</title><secondary-title>The milbank quarterly</secondary-title></titles><periodical><full-title>The milbank quarterly</full-title></periodical><pages>457-502</pages><volume>83</volume><number>3</number><dates><year>2005</year></dates><isbn>1468-0009</isbn><urls></urls></record></Cite></EndNote>300 This presents an ideal environment for managing multimorbidity, which requires an individualised approach towards care provision, not only dealing with the increased burden incurred by multimorbidity, but also managing competing/conflicting treatment needs informed by individuals’ preferences and treatment priorities. ADDIN EN.CITE <EndNote><Cite><Author>Excellence</Author><Year>2016</Year><RecNum>306</RecNum><DisplayText><style face="superscript">298</style></DisplayText><record><rec-number>306</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755018">306</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>National Institute for Clinical Excellence</author></authors></contributors><titles><title>Multimorbidity: clinical assessment and management</title><secondary-title>This is a report . nice. org. uk/guidance/ng56</secondary-title></titles><periodical><full-title>This is a report . nice. org. uk/guidance/ng56</full-title></periodical><dates><year>2016</year></dates><urls></urls></record></Cite></EndNote>298 Further discussion on how primary care settings should provide physical healthcare for people with mental illness are presented in the 2018 guidelines from NHS England (see Table 5 and Supplement 5.1). At a minimum, frequent and timely communication between providers is necessary to ensure safety and effectiveness of treatment. Ideally, services should seek a greater degree of integration, aiming for multi-disciplinary team based care that is structured, comprehensive and proactive. However, this usually requires overcoming certain bureaucratic barriers which can impede integration at the service level, such as difficulties in sharing medical records, along with governance and funding issue limiting the provision of coordinated health care (Figure 3). The 2016 report ADDIN EN.CITE <EndNote><Cite><Author>Naylor</Author><Year>2016</Year><RecNum>304</RecNum><DisplayText><style face="superscript">296</style></DisplayText><record><rec-number>304</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755018">304</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Naylor, Chris</author><author>Das, Preety</author><author>Ross, Shilpa</author><author>Honeyman, Matthew</author><author>Thompson, James</author><author>Gilburt, Helen</author></authors></contributors><titles><title>Bringing together physical and mental health</title><secondary-title>King's Fund</secondary-title></titles><periodical><full-title>King's Fund</full-title></periodical><dates><year>2016</year></dates><urls></urls></record></Cite></EndNote>296 from The Kings Fund (UK) puts forth an aspirational approach towards improving integrated care across a broad spectrum of physical and mental health conditions, providing advice for overcoming common barriers towards implementation of integrated care (See Table 5, Supplement 5.1. and Naylor et al. ADDIN EN.CITE <EndNote><Cite><Author>Naylor</Author><Year>2016</Year><RecNum>304</RecNum><DisplayText><style face="superscript">296</style></DisplayText><record><rec-number>304</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755018">304</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Naylor, Chris</author><author>Das, Preety</author><author>Ross, Shilpa</author><author>Honeyman, Matthew</author><author>Thompson, James</author><author>Gilburt, Helen</author></authors></contributors><titles><title>Bringing together physical and mental health</title><secondary-title>King's Fund</secondary-title></titles><periodical><full-title>King's Fund</full-title></periodical><dates><year>2016</year></dates><urls></urls></record></Cite></EndNote>296). Examples of different integrated care models, and their evaluated outcomes, are provided in Panel 6.Managing Substance Comorbidity and Promoting Smoking CessationAcross the spectrum of mental disorders, alcohol, tobacco and illicit drug use is more prevalent than in the general population and are associated with poorer physical and mental health outcomesPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Td2FydHo8L0F1dGhvcj48WWVhcj4xOTk4PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 301-303. The prevalence of comorbidity is detailed in Table 2. There is a bidirectional relationship between substance abuse and mental illnesses, as substance abuse can cause and exacerbate mental illness, and are often used as a means to reduce symptoms or combat dysphoria. ADDIN EN.CITE <EndNote><Cite><Author>Patel</Author><Year>2018</Year><RecNum>319</RecNum><DisplayText><style face="superscript">304</style></DisplayText><record><rec-number>319</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755021">319</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Patel, Vikram</author><author>Saxena, Shekhar</author><author>Lund, Crick</author><author>Thornicroft, Graham</author><author>Baingana, Florence</author><author>Bolton, Paul</author><author>Chisholm, Dan</author><author>Collins, Pamela Y</author><author>Cooper, Janice L</author><author>Eaton, Julian</author></authors></contributors><titles><title>The Lancet Commission on global mental health and sustainable development</title><secondary-title>The Lancet</secondary-title></titles><periodical><full-title>The Lancet</full-title></periodical><pages>1553-1598</pages><volume>392</volume><number>10157</number><dates><year>2018</year></dates><isbn>0140-6736</isbn><urls></urls></record></Cite></EndNote>304 Genetic risk factors for schizophrenia also appear to predispose individuals towards illicit drug use ADDIN EN.CITE <EndNote><Cite><Author>Power</Author><Year>2014</Year><RecNum>318</RecNum><DisplayText><style face="superscript">305</style></DisplayText><record><rec-number>318</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755021">318</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Power, Robert A</author><author>Verweij, Karin JH</author><author>Zuhair, Mohamed</author><author>Montgomery, Grant W</author><author>Henders, Anjali K</author><author>Heath, Andrew C</author><author>Madden, Pamela AF</author><author>Medland, Sarah E</author><author>Wray, Naomi R</author><author>Martin, Nicholas G</author></authors></contributors><titles><title>Genetic predisposition to schizophrenia associated with increased use of cannabis</title><secondary-title>Molecular psychiatry</secondary-title></titles><periodical><full-title>Molecular psychiatry</full-title></periodical><pages>1201</pages><volume>19</volume><number>11</number><dates><year>2014</year></dates><isbn>1476-5578</isbn><urls></urls></record></Cite></EndNote>305. Improving the focus on combating substance abuse within mental health services is undoubtedly a high priority. ADDIN EN.CITE <EndNote><Cite><Author>Patel</Author><Year>2018</Year><RecNum>319</RecNum><DisplayText><style face="superscript">304</style></DisplayText><record><rec-number>319</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755021">319</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Patel, Vikram</author><author>Saxena, Shekhar</author><author>Lund, Crick</author><author>Thornicroft, Graham</author><author>Baingana, Florence</author><author>Bolton, Paul</author><author>Chisholm, Dan</author><author>Collins, Pamela Y</author><author>Cooper, Janice L</author><author>Eaton, Julian</author></authors></contributors><titles><title>The Lancet Commission on global mental health and sustainable development</title><secondary-title>The Lancet</secondary-title></titles><periodical><full-title>The Lancet</full-title></periodical><pages>1553-1598</pages><volume>392</volume><number>10157</number><dates><year>2018</year></dates><isbn>0140-6736</isbn><urls></urls></record></Cite></EndNote>304 Despite this, many services have no standardized screening for substance use, and mental health clinicians are often not trained to address substance abuse.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Nb3JvamVsZTwvQXV0aG9yPjxZZWFyPjIwMTI8L1llYXI+
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ADDIN EN.CITE.DATA 307 853237161275683602000036-5343905935988Figure 3. Aspirational model of Collaborative Care for improving continuity and comprehensiveness of care for people living with physical-mental comorbidities.020000Figure 3. Aspirational model of Collaborative Care for improving continuity and comprehensiveness of care for people living with physical-mental comorbidities.Due to the complexity of comorbid mental health and substance abuse disorders consumers require individualized treatment developed with an emphasis on overcoming barriers imposed by mental illness and enhancing engagement with evidence-based treatments. This would take into account readiness to change, cognitive ability and cognitive distortions resulting from the mental illness. Treatments with evidence include motivational interviewing (MI), cognitive-behavioural therapy (CBT) and family interventions/therapy. ADDIN EN.CITE <EndNote><Cite><Author>Patel</Author><Year>2018</Year><RecNum>319</RecNum><DisplayText><style face="superscript">304</style></DisplayText><record><rec-number>319</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755021">319</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Patel, Vikram</author><author>Saxena, Shekhar</author><author>Lund, Crick</author><author>Thornicroft, Graham</author><author>Baingana, Florence</author><author>Bolton, Paul</author><author>Chisholm, Dan</author><author>Collins, Pamela Y</author><author>Cooper, Janice L</author><author>Eaton, Julian</author></authors></contributors><titles><title>The Lancet Commission on global mental health and sustainable development</title><secondary-title>The Lancet</secondary-title></titles><periodical><full-title>The Lancet</full-title></periodical><pages>1553-1598</pages><volume>392</volume><number>10157</number><dates><year>2018</year></dates><isbn>0140-6736</isbn><urls></urls></record></Cite></EndNote>304 Evidence based interventions can be a challenge to implement in already stretched mental health services. Keeping this in mind, it is important to note that there is a paucity of evidence to recommend integrated interventions compared to sequential or parallel treatment programs, particularly in alcohol use disorders.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5CZW5uZXR0PC9BdXRob3I+PFllYXI+MjAxNzwvWWVhcj48
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ADDIN EN.CITE.DATA 308 Each approach provides advantages and disadvantages. The advantage of an integrated approach is that the consumer does not need to receive care from two services. The disadvantage is that provision of care requires intensive resources and investment from within the mental health system to upskill mental health clinicians in the treatment of substance use. The advantage of sequential or parallel treatments are that the interventions are delivered within a highly specialised substance use program. However the disadvantage is that this approach requires seamless coordination and information-sharing between agencies. A clear referral policy between mental health and substance use treatment services (including those in primary care) should be developed so that services can be held accountable when consumers slip through the gaps.The considerations around smoking cessation interventions for people with mental illness are presented in Panel 4. However, regardless of how the interventions are provided, and investment in training for screening within mental health services is a priority. Mental health clinicians should be trained to perform regular assessments of co-morbid substance use, assess people`s readiness to change and provide motivational interviewing. In high income countries with mature services, an emphasis on a “no wrong door” for accessing substance abuse treatments and developing clear referral policies between mental health and substance use treatment services should be a priority. ADDIN EN.CITE <EndNote><Cite><Author>England</Author><Year>2018</Year><RecNum>256</RecNum><DisplayText><style face="superscript">259</style></DisplayText><record><rec-number>256</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755007">256</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Public Health England</author></authors></contributors><titles><title>Health matters: reducing health inequalities in mental illness</title><secondary-title> </secondary-title></titles><periodical><full-title> cessation isn’t possible, harm minimisation strategies should be adopted. This is achieved by switching to alternative, safer forms of the drug (e.g. e-cigarettes, methadone and suboxone) or providing access to safe injecting facilities. As an example for smoking in particular, the Royal College of Physicians (RCP) has recently published a reports on harm minimisation to support smokers who are unable or find it difficult to quit. ADDIN EN.CITE <EndNote><Cite><Author>London</Author><Year>2016</Year><RecNum>325</RecNum><DisplayText><style face="superscript">309</style></DisplayText><record><rec-number>325</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755023">325</key></foreign-keys><ref-type name="Book">6</ref-type><contributors><authors><author>Royal College of Physicians of London</author></authors></contributors><titles><title>Nicotine Without Smoke Tobacco Harm Reduction</title></titles><dates><year>2016</year></dates><publisher>Royal College of Physicians of London</publisher><isbn>1860166008</isbn><urls></urls></record></Cite></EndNote>309Innovations in Integration for Low- and middle income countries (LMICs) The importance of integrated care in LMICSIn most LMICs, less than 1% of the health budget is spent on mental health. ADDIN EN.CITE <EndNote><Cite><Author>Mackenzie</Author><Year>2016</Year><RecNum>326</RecNum><DisplayText><style face="superscript">310</style></DisplayText><record><rec-number>326</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755023">326</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>Mackenzie, J</author><author>Kesner, C</author></authors></contributors><titles><title>Mental health funding and the SDGs: what now and who pays</title></titles><dates><year>2016</year></dates><publisher>London: Overseas Development Institute</publisher><urls></urls></record></Cite></EndNote>310 This includes government mental health expenditure on specialist mental health services, general health services and social care services. ADDIN EN.CITE <EndNote><Cite><Author>Mackenzie</Author><Year>2016</Year><RecNum>326</RecNum><DisplayText><style face="superscript">310</style></DisplayText><record><rec-number>326</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755023">326</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>Mackenzie, J</author><author>Kesner, C</author></authors></contributors><titles><title>Mental health funding and the SDGs: what now and who pays</title></titles><dates><year>2016</year></dates><publisher>London: Overseas Development Institute</publisher><urls></urls></record></Cite></EndNote>310 Hence mental health services are poorly resourced with 90% of people needing treatment not receiving any care. ADDIN EN.CITE <EndNote><Cite><Author>Lund</Author><Year>2015</Year><RecNum>327</RecNum><DisplayText><style face="superscript">311</style></DisplayText><record><rec-number>327</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755023">327</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lund, C</author><author>Alem, A</author><author>Schneider, M</author><author>Hanlon, C</author><author>Ahrens, J</author><author>Bandawe, C</author><author>Bass, J</author><author>Bhana, A</author><author>Burns, J</author><author>Chibanda, D</author></authors></contributors><titles><title>Generating evidence to narrow the treatment gap for mental disorders in sub-Saharan Africa: rationale, overview and methods of AFFIRM</title><secondary-title>Epidemiology and psychiatric sciences</secondary-title></titles><periodical><full-title>Epidemiology and psychiatric sciences</full-title></periodical><pages>233-240</pages><volume>24</volume><number>3</number><dates><year>2015</year></dates><isbn>2045-7960</isbn><urls></urls></record></Cite></EndNote>311 Mental health services rely predominantly on expensive psychotropic drugs, which are seldom available, and are associated with a myriad of side-effects which require close management (see Part 3). ADDIN EN.CITE <EndNote><Cite><Author>Mugisha</Author><Year>2016</Year><RecNum>328</RecNum><DisplayText><style face="superscript">312</style></DisplayText><record><rec-number>328</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755024">328</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mugisha, James</author><author>Ssebunnya, Joshua</author><author>Kigozi, Fred N</author></authors></contributors><titles><title>Towards understanding governance issues in integration of mental health into primary health care in Uganda</title><secondary-title>International journal of mental health systems</secondary-title></titles><periodical><full-title>International journal of mental health systems</full-title></periodical><pages>25</pages><volume>10</volume><number>1</number><dates><year>2016</year></dates><isbn>1752-4458</isbn><urls></urls></record></Cite></EndNote>312 Until very recently, little attention has been given to the complex bi-directional relationship between physical and mental health and the relevance of screening in LMIC settings. ADDIN EN.CITE <EndNote><Cite><Author>Mugisha</Author><Year>2016</Year><RecNum>328</RecNum><DisplayText><style face="superscript">312</style></DisplayText><record><rec-number>328</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755024">328</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mugisha, James</author><author>Ssebunnya, Joshua</author><author>Kigozi, Fred N</author></authors></contributors><titles><title>Towards understanding governance issues in integration of mental health into primary health care in Uganda</title><secondary-title>International journal of mental health systems</secondary-title></titles><periodical><full-title>International journal of mental health systems</full-title></periodical><pages>25</pages><volume>10</volume><number>1</number><dates><year>2016</year></dates><isbn>1752-4458</isbn><urls></urls></record></Cite></EndNote>312, ADDIN EN.CITE <EndNote><Cite><Author>Mugisha</Author><Year>2017</Year><RecNum>329</RecNum><DisplayText><style face="superscript">313</style></DisplayText><record><rec-number>329</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755024">329</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mugisha, James</author><author>De Hert, Marc</author><author>Stubbs, Brendon</author><author>Basangwa, David</author><author>Vancampfort, Davy</author></authors></contributors><titles><title>Physical health policies and metabolic screening in mental health care systems of sub-Saharan African countries: a systematic review</title><secondary-title>International journal of mental health systems</secondary-title></titles><periodical><full-title>International journal of mental health systems</full-title></periodical><pages>31</pages><volume>11</volume><number>1</number><dates><year>2017</year></dates><isbn>1752-4458</isbn><urls></urls></record></Cite></EndNote>313 The 2018 WHO guideline on “Management of physical health conditions in adults with severe mental disorders” asserted that health inequalities for people with SMI are greatest in LMICs, where ‘the resources are inadequate, the institutions are not well managed and access to quality mental health care and physical care is limited’. Indeed, the largest gaps in life expectancy for people with SMI are observed in low-income settings. ADDIN EN.CITE <EndNote><Cite><Author>Organization</Author><Year>2017</Year><RecNum>33</RecNum><DisplayText><style face="superscript">47,314</style></DisplayText><record><rec-number>33</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754964">33</key></foreign-keys><ref-type name="Report">27</ref-type><contributors><authors><author>World Health Organization</author></authors></contributors><titles><title>Helping people with severe mental disorders live longer and healthier lives: policy brief</title></titles><dates><year>2017</year></dates><publisher>World Health Organization</publisher><urls></urls></record></Cite><Cite><Author>Hjorth?j</Author><Year>2017</Year><RecNum>330</RecNum><record><rec-number>330</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755024">330</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hjorth?j, Carsten</author><author>Stürup, Anne Emilie</author><author>McGrath, John J</author><author>Nordentoft, Merete</author></authors></contributors><titles><title>Years of potential life lost and life expectancy in schizophrenia: a systematic review and meta-analysis</title><secondary-title>The Lancet Psychiatry</secondary-title></titles><periodical><full-title>The Lancet Psychiatry</full-title></periodical><pages>295-301</pages><volume>4</volume><number>4</number><dates><year>2017</year></dates><isbn>2215-0366</isbn><urls></urls></record></Cite></EndNote>47,314 There is a clear need to re-orient current mental health care systems in LMICs and focus on a more integrated model. However, an important challenge in many LMICs is the lack of integrated physical-mental health services, and poorly developed community-based services, resulting in an overreliance on institutional psychiatric care. ADDIN EN.CITE <EndNote><Cite><Author>Mugisha</Author><Year>2016</Year><RecNum>328</RecNum><DisplayText><style face="superscript">312</style></DisplayText><record><rec-number>328</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755024">328</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mugisha, James</author><author>Ssebunnya, Joshua</author><author>Kigozi, Fred N</author></authors></contributors><titles><title>Towards understanding governance issues in integration of mental health into primary health care in Uganda</title><secondary-title>International journal of mental health systems</secondary-title></titles><periodical><full-title>International journal of mental health systems</full-title></periodical><pages>25</pages><volume>10</volume><number>1</number><dates><year>2016</year></dates><isbn>1752-4458</isbn><urls></urls></record></Cite></EndNote>312 This is mainly due to outdated mental health legislation and policies. ADDIN EN.CITE <EndNote><Cite><Author>Mugisha</Author><Year>2017</Year><RecNum>329</RecNum><DisplayText><style face="superscript">313</style></DisplayText><record><rec-number>329</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755024">329</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mugisha, James</author><author>De Hert, Marc</author><author>Stubbs, Brendon</author><author>Basangwa, David</author><author>Vancampfort, Davy</author></authors></contributors><titles><title>Physical health policies and metabolic screening in mental health care systems of sub-Saharan African countries: a systematic review</title><secondary-title>International journal of mental health systems</secondary-title></titles><periodical><full-title>International journal of mental health systems</full-title></periodical><pages>31</pages><volume>11</volume><number>1</number><dates><year>2017</year></dates><isbn>1752-4458</isbn><urls></urls></record></Cite></EndNote>313 Specific barriers towards an integrated mental and physical health policy development and implementation include insufficient coordination across different government levels, shortage of human resources and competences at all levels of care, a need for buy-in, irrelevance of policies to local actors, governmental bureaucracy and shortage of finances and accountability, alongside differing streams of funding - all making shared decisions and shared responsibility more challenging. ADDIN EN.CITE <EndNote><Cite><Author>Thornicroft</Author><Year>2018</Year><RecNum>55</RecNum><DisplayText><style face="superscript">75</style></DisplayText><record><rec-number>55</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754968">55</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Thornicroft, Graham</author><author>Ahuja, Shalini</author><author>Barber, Sarah</author><author>Chisholm, Daniel</author><author>Collins, Pamela Y</author><author>Docrat, Sumaiyah</author><author>Fairall, Lara</author><author>Lempp, Heidi</author><author>Niaz, Unaiza</author><author>Ngo, Vicky</author></authors></contributors><titles><title>Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries</title><secondary-title>The Lancet Psychiatry</secondary-title></titles><periodical><full-title>The Lancet Psychiatry</full-title></periodical><dates><year>2018</year></dates><isbn>2215-0366</isbn><urls></urls></record></Cite></EndNote>75 As a consequence, in daily clinical practice mental health providers in community settings do not ask about medical issues or test for them because of insufficient consideration of the physical health needs, or shortage or time/ resources. ADDIN EN.CITE <EndNote><Cite><Author>Ludwick</Author><Year>2009</Year><RecNum>331</RecNum><DisplayText><style face="superscript">315</style></DisplayText><record><rec-number>331</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755024">331</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ludwick, JJ</author><author>Oosthuizen, PP</author></authors></contributors><titles><title>Screening for and monitoring of cardio-metabolic risk factors in outpatients with severe mental illness in a primary care setting</title><secondary-title>African journal of psychiatry</secondary-title></titles><periodical><full-title>African journal of psychiatry</full-title></periodical><volume>12</volume><number>4</number><dates><year>2009</year></dates><isbn>1994-8220</isbn><urls></urls></record></Cite></EndNote>315 In LMICs, there is an urgent need to increase awareness of the importance of considering the physical health needs of patients with mental health problems and vice versa. ADDIN EN.CITE <EndNote><Cite><Author>Mugisha</Author><Year>2016</Year><RecNum>328</RecNum><DisplayText><style face="superscript">312</style></DisplayText><record><rec-number>328</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755024">328</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mugisha, James</author><author>Ssebunnya, Joshua</author><author>Kigozi, Fred N</author></authors></contributors><titles><title>Towards understanding governance issues in integration of mental health into primary health care in Uganda</title><secondary-title>International journal of mental health systems</secondary-title></titles><periodical><full-title>International journal of mental health systems</full-title></periodical><pages>25</pages><volume>10</volume><number>1</number><dates><year>2016</year></dates><isbn>1752-4458</isbn><urls></urls></record></Cite></EndNote>312 For example, awareness of the links between chronic physical and mental conditions through public health awareness campaigns might be one strategy. A 2016 review exploring the efficacy and effectiveness of interventions at population- and community-levels for mental, disorders in LMICs concluded that mass public awareness campaigns are recommended as “good practice”; but more research in LMICs is needed. Also increasing awareness of chronic conditions via school-based programmes is considered a “good practice” strategy in LMICs. ADDIN EN.CITE <EndNote><Cite><Author>Petersen</Author><Year>2016</Year><RecNum>332</RecNum><DisplayText><style face="superscript">316</style></DisplayText><record><rec-number>332</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755025">332</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Petersen, Inge</author><author>Evans-Lacko, Sara</author><author>Semrau, Maya</author><author>Barry, Margaret M</author><author>Chisholm, Dan</author><author>Gronholm, Petra</author><author>Egbe, Catherine O</author><author>Thornicroft, Graham</author></authors></contributors><titles><title>Promotion, prevention and protection: interventions at the population-and community-levels for mental, neurological and substance use disorders in low-and middle-income countries</title><secondary-title>International journal of mental health systems</secondary-title></titles><periodical><full-title>International journal of mental health systems</full-title></periodical><pages>30</pages><volume>10</volume><number>1</number><dates><year>2016</year></dates><isbn>1752-4458</isbn><urls></urls></record></Cite></EndNote>316Another system level approach would involve augmenting the competences of the existing work staff at all levels of care. Although education about the link between chronic physical and mental health conditions is an important tool to support changes in clinical practice, it is rarely a one-off solution to altering knowledge and behaviours. Multiple sessions and top ups are usually required alongside rolling programmes to support staff turnover. ADDIN EN.CITE <EndNote><Cite><Author>Docherty</Author><Year>2017</Year><RecNum>333</RecNum><DisplayText><style face="superscript">317</style></DisplayText><record><rec-number>333</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755025">333</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Docherty, Mary</author><author>Shaw, Kate</author><author>Goulding, Lucy</author><author>Parke, Hannah</author><author>Eassom, Erica</author><author>Ali, Farnoosh</author><author>Thornicroft, Graham</author></authors></contributors><titles><title>Evidence-based guideline implementation in low and middle income countries: lessons for mental health care</title><secondary-title>International journal of mental health systems</secondary-title></titles><periodical><full-title>International journal of mental health systems</full-title></periodical><pages>8</pages><volume>11</volume><number>1</number><dates><year>2017</year></dates><isbn>1752-4458</isbn><urls></urls></record></Cite></EndNote>317 Next to increasing awareness, changing the current mental health policies in LMICs, by making an integrated care model a central focus in mental health care action plans is essential. A review of integrated care across high, middle, and lower-income settings presents clear evidence for the rationale and effectiveness. ADDIN EN.CITE <EndNote><Cite><Author>Thornicroft</Author><Year>2018</Year><RecNum>55</RecNum><DisplayText><style face="superscript">75</style></DisplayText><record><rec-number>55</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754968">55</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Thornicroft, Graham</author><author>Ahuja, Shalini</author><author>Barber, Sarah</author><author>Chisholm, Daniel</author><author>Collins, Pamela Y</author><author>Docrat, Sumaiyah</author><author>Fairall, Lara</author><author>Lempp, Heidi</author><author>Niaz, Unaiza</author><author>Ngo, Vicky</author></authors></contributors><titles><title>Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries</title><secondary-title>The Lancet Psychiatry</secondary-title></titles><periodical><full-title>The Lancet Psychiatry</full-title></periodical><dates><year>2018</year></dates><isbn>2215-0366</isbn><urls></urls></record></Cite></EndNote>75 The review describes a strong theoretical basis along with multiple ‘real-world’ examples and practical steps towards implementing integrated care in LMIC settings; identifying the ‘Practical Approach to Care Kit’ (PACK) as a particularly successful example of a best-practice approach towards the provision of universal integrated primary health care. ADDIN EN.CITE <EndNote><Cite><Author>Fairall</Author><Year>2016</Year><RecNum>334</RecNum><DisplayText><style face="superscript">318</style></DisplayText><record><rec-number>334</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755025">334</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Fairall, Lara R</author><author>Folb, Naomi</author><author>Timmerman, Venessa</author><author>Lombard, Carl</author><author>Steyn, Krisela</author><author>Bachmann, Max O</author><author>Bateman, Eric D</author><author>Lund, Crick</author><author>Cornick, Ruth</author><author>Faris, Gill</author></authors></contributors><titles><title>Educational outreach with an integrated clinical tool for nurse-led non-communicable chronic disease management in primary care in South Africa: a pragmatic cluster randomised controlled trial</title><secondary-title>PLoS medicine</secondary-title></titles><periodical><full-title>PLoS medicine</full-title></periodical><pages>e1002178</pages><volume>13</volume><number>11</number><dates><year>2016</year></dates><isbn>1549-1676</isbn><urls></urls></record></Cite></EndNote>318 PACK has been successfully implemented in several LMICs, including South-Africa, Botswana, Brazil, Nigeria and Ethiopia. ADDIN EN.CITE <EndNote><Cite><Author>Cornick</Author><Year>2018</Year><RecNum>335</RecNum><DisplayText><style face="superscript">319</style></DisplayText><record><rec-number>335</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755025">335</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cornick, Ruth</author><author>Wattrus, Camilla</author><author>Eastman, Tracy</author><author>Ras, Christy Joy</author><author>Awotiwon, Ajibola</author><author>Anderson, Lauren</author><author>Bateman, Eric</author><author>Zepeda, Jorge</author><author>Zwarenstein, Merrick</author><author>Doherty, Tanya</author></authors></contributors><titles><title>Crossing borders: the PACK experience of spreading a complex health system intervention across low-income and middle-income countries</title><secondary-title>BMJ global health</secondary-title></titles><periodical><full-title>BMJ global health</full-title></periodical><pages>e001088</pages><volume>3</volume><number>Suppl 5</number><dates><year>2018</year></dates><isbn>2059-7908</isbn><urls></urls></record></Cite></EndNote>319 Development of clinical practice guidelines including best practice examples such as PACK and with consideration of the local context, including staff attitudes and available resources, is crucial in encouraging policy uptake in LMIC settings. In particular, the local context including prevalent knowledge, behaviours and attitudes towards mental health conditions strongly predicts the success of implementing a clinical practice change. ADDIN EN.CITE <EndNote><Cite><Author>Docherty</Author><Year>2017</Year><RecNum>333</RecNum><DisplayText><style face="superscript">317</style></DisplayText><record><rec-number>333</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755025">333</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Docherty, Mary</author><author>Shaw, Kate</author><author>Goulding, Lucy</author><author>Parke, Hannah</author><author>Eassom, Erica</author><author>Ali, Farnoosh</author><author>Thornicroft, Graham</author></authors></contributors><titles><title>Evidence-based guideline implementation in low and middle income countries: lessons for mental health care</title><secondary-title>International journal of mental health systems</secondary-title></titles><periodical><full-title>International journal of mental health systems</full-title></periodical><pages>8</pages><volume>11</volume><number>1</number><dates><year>2017</year></dates><isbn>1752-4458</isbn><urls></urls></record></Cite></EndNote>317 Harnessing Collaborations and Task SharingClinical practice guidelines should also incorporate strategies aimed at fostering collaboration between formal primary care and mental health services and key community-based providers such as traditional healers. Approximately half of individuals seeking formal health care for mental disorders in LMICs, choose traditional and religious healers as their first care provider, and this choice is associated with delays in accessing formal mental health services. ADDIN EN.CITE <EndNote><Cite><Author>Burns</Author><Year>2015</Year><RecNum>336</RecNum><DisplayText><style face="superscript">320</style></DisplayText><record><rec-number>336</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755026">336</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Burns, Jonathan K</author><author>Tomita, Andrew</author></authors></contributors><titles><title>Traditional and religious healers in the pathway to care for people with mental disorders in Africa: a systematic review and meta-analysis</title><secondary-title>Social psychiatry and psychiatric epidemiology</secondary-title></titles><periodical><full-title>Soc Psychiatry Psychiatr Epidemiol</full-title><abbr-1>Social psychiatry and psychiatric epidemiology</abbr-1></periodical><pages>867-877</pages><volume>50</volume><number>6</number><dates><year>2015</year></dates><isbn>0933-7954</isbn><urls></urls></record></Cite></EndNote>320 Based on lessons from Uganda, ADDIN EN.CITE <EndNote><Cite><Author>Akol</Author><Year>2018</Year><RecNum>337</RecNum><DisplayText><style face="superscript">321</style></DisplayText><record><rec-number>337</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755026">337</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Akol, Angela</author><author>Moland, Karen Marie</author><author>Babirye, Juliet N</author><author>Engebretsen, Ingunn Marie S</author></authors></contributors><titles><title>“We are like co-wives”: Traditional healers' views on collaborating with the formal Child and Adolescent Mental Health System in Uganda</title><secondary-title>BMC health services research</secondary-title></titles><periodical><full-title>BMC health services research</full-title></periodical><pages>258</pages><volume>18</volume><number>1</number><dates><year>2018</year></dates><isbn>1472-6963</isbn><urls></urls></record></Cite></EndNote>321 strategies should involve, among others, improving clinicians’ understanding of traditional healers’ explanatory models for illness, and vice versa. Secondly, trust between the two categories of providers needs to be enhanced to improve interaction between the two sectors, which currently operate in isolation. In particular, clinicians’ negative attitudes towards traditional healers needs to be addressed. Thirdly, quality of care by traditional healers needs to be addressed to improve hygiene and eliminate unethical practices.Task sharing involving key community-based providers might be a promising implementation strategy in low resource settings. Task sharing refers to the process of transferring a task usually delivered by a scarce resource such as a physician to a rapidly trained and less scarce resource such as a health care worker (e.g.sPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5QZXRlcnNlbjwvQXV0aG9yPjxZZWFyPjIwMTE8L1llYXI+
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ADDIN EN.CITE.DATA 324-326 Case studies from non-governmental organisations indicate that inefficient health system structures can present barriers to successful task-sharing; indicating a need for more CC services. ADDIN EN.CITE <EndNote><Cite><Author>Hanlon</Author><Year>2017</Year><RecNum>340</RecNum><DisplayText><style face="superscript">324</style></DisplayText><record><rec-number>340</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755027">340</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hanlon, C</author></authors></contributors><titles><title>Next steps for meeting the needs of people with severe mental illness in low-and middle-income countries</title><secondary-title>Epidemiology and psychiatric sciences</secondary-title></titles><periodical><full-title>Epidemiology and psychiatric sciences</full-title></periodical><pages>348-354</pages><volume>26</volume><number>4</number><dates><year>2017</year></dates><isbn>2045-7960</isbn><urls></urls></record></Cite></EndNote>324 However, whether such approaches will be successful in reducing premature mortality, improving wellbeing and achieving better social outcomes in LMIC settings has yet to be fully established. ADDIN EN.CITE <EndNote><Cite><Author>Hanlon</Author><Year>2017</Year><RecNum>340</RecNum><DisplayText><style face="superscript">324</style></DisplayText><record><rec-number>340</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755027">340</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hanlon, C</author></authors></contributors><titles><title>Next steps for meeting the needs of people with severe mental illness in low-and middle-income countries</title><secondary-title>Epidemiology and psychiatric sciences</secondary-title></titles><periodical><full-title>Epidemiology and psychiatric sciences</full-title></periodical><pages>348-354</pages><volume>26</volume><number>4</number><dates><year>2017</year></dates><isbn>2045-7960</isbn><urls></urls></record></Cite></EndNote>324 Addressing these evidence gaps is essential if task-sharing?CC is going to deliver on its promise of improving the mental and physical quality of life of people with mental health problems in low resource settings.5.5. Digital Technologies for People with Mental IllnessDigital technology plays an increasing role in promoting health, addressing risk factors and managing physical disease, with growing evidence for its effectiveness. Mobile phones provide a particularly convenient platform for digital health care delivery (mobile health or ‘mhealth’). The WHO estimates that 95% of the world population lives in an area covered by mobile networks, and there are over 7 billion mobile subscriptions – one for almost every person on the planet. ADDIN EN.CITE <EndNote><Cite ExcludeYear="1"><Author>Organization</Author><RecNum>8962</RecNum><DisplayText><style face="superscript">327</style></DisplayText><record><rec-number>8962</rec-number><foreign-keys><key app="EN" db-id="p59d0ad2rr502se09wtptvxjs5s000edw9zx" timestamp="1547686902">8962</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>World Health Organization</author></authors></contributors><titles><title>Be He@ lthy Be Mobile.[Internet][cited January 2014] Available from: . itu. int/en/ITU-D/ICT-Applications/eHEALTH/Be_healthy/Pages</title><secondary-title>Be_Healthy. aspx</secondary-title></titles><periodical><full-title>Be_Healthy. aspx</full-title></periodical><dates></dates><urls></urls></record></Cite></EndNote>327 Smartphone technologies are closing the ‘digital divide’ previously found in LMIC settings. ADDIN EN.CITE <EndNote><Cite><Author>Kay</Author><Year>2011</Year><RecNum>344</RecNum><DisplayText><style face="superscript">328</style></DisplayText><record><rec-number>344</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755027">344</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kay, Misha</author><author>Santos, Jonathan</author><author>Takane, Marina</author></authors></contributors><titles><title>mHealth: New horizons for health through mobile technologies</title><secondary-title>World Health Organization</secondary-title></titles><periodical><full-title>World Health Organization</full-title></periodical><pages>66-71</pages><volume>64</volume><number>7</number><dates><year>2011</year></dates><urls></urls></record></Cite></EndNote>328 Digital technology is available at a time and place that suit the client, unlike traditional health services which require the person to attend at a set time and location.Research has demonstrated the effectiveness of simple text messaging to support lifestyle improvement. One important example is the TEXT ME RCT which involved 710 patients with coronary heart disease. ADDIN EN.CITE <EndNote><Cite><Author>Chow</Author><Year>2015</Year><RecNum>345</RecNum><DisplayText><style face="superscript">329</style></DisplayText><record><rec-number>345</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755028">345</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chow, Clara K</author><author>Redfern, Julie</author><author>Hillis, Graham S</author><author>Thakkar, Jay</author><author>Santo, Karla</author><author>Hackett, Maree L</author><author>Jan, Stephen</author><author>Graves, Nicholas</author><author>de Keizer, Laura</author><author>Barry, Tony</author></authors></contributors><titles><title>Effect of lifestyle-focused text messaging on risk factor modification in patients with coronary heart disease: a randomized clinical trial</title><secondary-title>Jama</secondary-title></titles><periodical><full-title>JAMA</full-title></periodical><pages>1255-1263</pages><volume>314</volume><number>12</number><dates><year>2015</year></dates><isbn>0098-7484</isbn><urls></urls></record></Cite></EndNote>329 The intervention comprised four personalised messages per week for six months providing advice, motivation and support to change lifestyle behaviours. At six months follow up, levels of low-density lipoprotein cholesterol were significantly lower in intervention participants, with concurrent reductions in systolic blood pressure and body mass index, significant increases in physical activity, and a significant reduction in self-reported smoking. Further studies to assess sustainability of these positive changes, and the effectiveness of text messaging in participants who have not yet experienced a cardiovascular event are underway. ADDIN EN.CITE <EndNote><Cite><Author>Chow</Author><Year>2016</Year><RecNum>346</RecNum><DisplayText><style face="superscript">330</style></DisplayText><record><rec-number>346</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755028">346</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Chow, Clara K</author><author>Islam, Sheikh Mohammed Shariful</author><author>Farmer, Andrew</author><author>Bobrow, Kirsty</author><author>Maddision, Ralph</author><author>Whittaker, Robyn</author><author>Dale, Leila Pfaeffli</author><author>Lechner, Andreas</author><author>Niessen, Louis</author><author>Lear, Scott A</author></authors></contributors><titles><title>Text2PreventCVD: protocol for a systematic review and individual participant data meta-analysis of text message-based interventions for the prevention of cardiovascular diseases</title><secondary-title>BMJ open</secondary-title></titles><periodical><full-title>BMJ open</full-title></periodical><pages>e012723</pages><volume>6</volume><number>10</number><dates><year>2016</year></dates><isbn>2044-6055</isbn><urls></urls></record></Cite></EndNote>330 Text messaging can support other important health behaviours, such as medication adherence for people with chronic conditions. ADDIN EN.CITE <EndNote><Cite><Author>Thakkar</Author><Year>2016</Year><RecNum>347</RecNum><DisplayText><style face="superscript">331</style></DisplayText><record><rec-number>347</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755028">347</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Thakkar, Jay</author><author>Kurup, Rahul</author><author>Laba, Tracey-Lea</author><author>Santo, Karla</author><author>Thiagalingam, Aravinda</author><author>Rodgers, Anthony</author><author>Woodward, Mark</author><author>Redfern, Julie</author><author>Chow, Clara K</author></authors></contributors><titles><title>Mobile telephone text messaging for medication adherence in chronic disease: a meta-analysis</title><secondary-title>JAMA internal medicine</secondary-title></titles><periodical><full-title>JAMA internal medicine</full-title></periodical><pages>340-349</pages><volume>176</volume><number>3</number><dates><year>2016</year></dates><isbn>2168-6106</isbn><urls></urls></record></Cite></EndNote>331 Smartphone apps may promote healthy lifestyle change, although they vary in quality, as does the quality of reported evaluation research. ADDIN EN.CITE <EndNote><Cite><Author>Covolo</Author><Year>2017</Year><RecNum>348</RecNum><DisplayText><style face="superscript">332</style></DisplayText><record><rec-number>348</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755028">348</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Covolo, L</author><author>Ceretti, E</author><author>Moneda, M</author><author>Castaldi, S</author><author>Gelatti, U</author></authors></contributors><titles><title>Does evidence support the use of mobile phone apps as a driver for promoting healthy lifestyles from a public health perspective? A systematic review of Randomized Control Trials</title><secondary-title>Patient education and counseling</secondary-title></titles><periodical><full-title>Patient education and counseling</full-title></periodical><pages>2231-2243</pages><volume>100</volume><number>12</number><dates><year>2017</year></dates><isbn>0738-3991</isbn><urls></urls></record></Cite></EndNote>332 To date few studies have examined clinical or cost effectiveness. ADDIN EN.CITE <EndNote><Cite><Author>Safavi</Author><Year>2019</Year><RecNum>349</RecNum><DisplayText><style face="superscript">333</style></DisplayText><record><rec-number>349</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755029">349</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Safavi, Kyan</author><author>Mathews, Simon C</author><author>Bates, David W</author><author>Dorsey, E Ray</author><author>Cohen, Adam B</author></authors></contributors><titles><title>Top-Funded Digital Health Companies And Their Impact On High-Burden, High-Cost Conditions</title><secondary-title>Health Affairs</secondary-title></titles><periodical><full-title>Health Affairs</full-title></periodical><pages>115-123</pages><volume>38</volume><number>1</number><dates><year>2019</year></dates><isbn>0278-2715</isbn><urls></urls></record></Cite></EndNote>333 User engagement may be lower in actual clinical care that in trial settings. ADDIN EN.CITE <EndNote><Cite><Author>Torous</Author><Year>2017</Year><RecNum>350</RecNum><DisplayText><style face="superscript">334,335</style></DisplayText><record><rec-number>350</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755029">350</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Torous, J.</author><author>Firth, J.</author></authors></contributors><titles><title>Bridging The Dichotomy of Actual versus Aspirational Digital Health</title><secondary-title>World Psychiatry</secondary-title></titles><periodical><full-title>World Psychiatry</full-title><abbr-1>World psychiatry : official journal of the World Psychiatric Association (WPA)</abbr-1></periodical><volume>in press</volume><dates><year>2017</year></dates><urls></urls></record></Cite><Cite><Author>Fleming</Author><Year>2018</Year><RecNum>351</RecNum><record><rec-number>351</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755029">351</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Fleming, Theresa</author><author>Bavin, Lynda</author><author>Lucassen, Mathijs</author><author>Stasiak, Karolina</author><author>Hopkins, Sarah</author><author>Merry, Sally</author></authors></contributors><titles><title>Beyond the Trial: Systematic Review of Real-World Uptake and Engagement With Digital Self-Help Interventions for Depression, Low Mood, or Anxiety</title><secondary-title>Journal of medical Internet research</secondary-title></titles><periodical><full-title>Journal of medical Internet research</full-title></periodical><pages>e199</pages><volume>20</volume><number>6</number><dates><year>2018</year></dates><urls></urls></record></Cite></EndNote>334,335 Key strategies for effective user engagement include co-designing interventions with consumers, personalization of interventions, and just-in-time adaptation. ADDIN EN.CITE <EndNote><Cite><Author>Partridge</Author><Year>2018</Year><RecNum>352</RecNum><DisplayText><style face="superscript">336</style></DisplayText><record><rec-number>352</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755029">352</key></foreign-keys><ref-type name="Conference Proceedings">10</ref-type><contributors><authors><author>Partridge, Stephanie</author><author>Redfern, Julie</author></authors></contributors><titles><title>Strategies to Engage Adolescents in Digital Health Interventions for Obesity Prevention and Management</title><secondary-title>Healthcare</secondary-title></titles><pages>70</pages><volume>6</volume><number>3</number><dates><year>2018</year></dates><publisher>Multidisciplinary Digital Publishing Institute</publisher><urls></urls></record></Cite></EndNote>336 An example is the Australian FoodSwitch app, which uses a smartphone camera to scan the barcode of a food item, and recommends healthier alternatives based on a crowd-sourced database of nutritional information. ADDIN EN.CITE <EndNote><Cite><Author>Dunford</Author><Year>2014</Year><RecNum>353</RecNum><DisplayText><style face="superscript">337</style></DisplayText><record><rec-number>353</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755029">353</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Dunford, Elizabeth</author><author>Trevena, Helen</author><author>Goodsell, Chester</author><author>Ng, Ka Hung</author><author>Webster, Jacqui</author><author>Millis, Audra</author><author>Goldstein, Stan</author><author>Hugueniot, Orla</author><author>Neal, Bruce</author></authors></contributors><titles><title>FoodSwitch: a mobile phone app to enable consumers to make healthier food choices and crowdsourcing of national food composition data</title><secondary-title>JMIR mHealth and uHealth</secondary-title></titles><periodical><full-title>JMIR mHealth and uHealth</full-title></periodical><volume>2</volume><number>3</number><dates><year>2014</year></dates><urls></urls></record></Cite></EndNote>337 Valuable smartphone functionalities include the ability to receive and analyse data from sensors measuring activity or biological variables; access health information via the internet; and engage with social media to promote lifestyle change. ADDIN EN.CITE <EndNote><Cite><Author>Waring</Author><Year>2018</Year><RecNum>354</RecNum><DisplayText><style face="superscript">338</style></DisplayText><record><rec-number>354</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755030">354</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Waring, Molly E</author><author>Jake-Schoffman, Danielle E</author><author>Holovatska, Marta M</author><author>Mejia, Claudia</author><author>Williams, Jamasia C</author><author>Pagoto, Sherry L</author></authors></contributors><titles><title>Social Media and Obesity in Adults: a Review of Recent Research and Future Directions</title><secondary-title>Current diabetes reports</secondary-title></titles><periodical><full-title>Current Diabetes Reports</full-title></periodical><pages>34</pages><volume>18</volume><number>6</number><dates><year>2018</year></dates><isbn>1534-4827</isbn><urls></urls></record></Cite></EndNote>338 Increasingly, consumers are able to access elements of their electronic health records via their smartphone or other portable device, providing an important opportunity for consumer partnership and empowerment. However, smartphones are more expensive than basic mobiles and require an internet connection, so text messaging may be required to provide broader population access in some low-income settings. ADDIN EN.CITE <EndNote><Cite><Author>Bastawrous</Author><Year>2013</Year><RecNum>355</RecNum><DisplayText><style face="superscript">339</style></DisplayText><record><rec-number>355</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755030">355</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bastawrous, Andrew</author><author>Armstrong, Matthew J</author></authors></contributors><titles><title>Mobile health use in low-and high-income countries: an overview of the peer-reviewed literature</title><secondary-title>Journal of the royal society of medicine</secondary-title></titles><periodical><full-title>Journal of the royal society of medicine</full-title></periodical><pages>130-142</pages><volume>106</volume><number>4</number><dates><year>2013</year></dates><isbn>0141-0768</isbn><urls></urls></record></Cite></EndNote>339To date, most studies using mhealth to promote healthy behaviours have recruited from the general population. An increasing number of individuals with SMI also want to use technology to manage their health. ADDIN EN.CITE <EndNote><Cite><Author>Firth</Author><Year>2015</Year><RecNum>356</RecNum><DisplayText><style face="superscript">340</style></DisplayText><record><rec-number>356</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755030">356</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Firth, Joseph</author><author>Cotter, Jack</author><author>Torous, John</author><author>Bucci, Sandra</author><author>Firth, Josh A</author><author>Yung, Alison R</author></authors></contributors><titles><title>Mobile phone ownership and endorsement of “mHealth” among people with psychosis: a meta-analysis of cross-sectional studies</title><secondary-title>Schizophrenia bulletin</secondary-title></titles><periodical><full-title>Schizophr Bull</full-title><abbr-1>Schizophrenia bulletin</abbr-1></periodical><pages>448-455</pages><volume>42</volume><number>2</number><dates><year>2015</year></dates><isbn>1745-1701</isbn><urls></urls></record></Cite></EndNote>340 Although there are very few evaluations of mHealth for physical health in mental illness, there is emerging evidence that online peer-support platforms, smartphone apps and fitness trackers can successfully increase walking and physical activity in people with SMI.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NdXJhbGlkaGFyYW48L0F1dGhvcj48WWVhcj4yMDE4PC9Z
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ADDIN EN.CITE.DATA 257,341,342 Furthermore, a review of e-Health for people with depression found that online lifestyle interventions can have positive effects on various health behaviours, including alcohol use, sleep, and physical activity. ADDIN EN.CITE <EndNote><Cite><Author>Young</Author><Year>2018</Year><RecNum>359</RecNum><DisplayText><style face="superscript">343</style></DisplayText><record><rec-number>359</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755031">359</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Young, Claire L</author><author>Trapani, Karen</author><author>Dawson, Samantha</author><author>O’Neil, Adrienne</author><author>Kay-Lambkin, Frances</author><author>Berk, Michael</author><author>Jacka, Felice N</author></authors></contributors><titles><title>Efficacy of online lifestyle interventions targeting lifestyle behaviour change in depressed populations: a systematic review</title><secondary-title>Australian & New Zealand Journal of Psychiatry</secondary-title></titles><periodical><full-title>Australian & New Zealand Journal of Psychiatry</full-title></periodical><pages>834-846</pages><volume>52</volume><number>9</number><dates><year>2018</year></dates><isbn>0004-8674</isbn><urls></urls></record></Cite></EndNote>343 Although the current evidence base remains preliminary, mHealth shows promise for tackling the physical health disparities of people with mental illness globally, and is a promising area for future research (see Figure 1). However, adoption of mHealth will depend not only on technological advances, but also on rigorous evaluation and overcoming common limitations for digital health interventions, such as consumer perceptions (particularly around safety, reliability and trustworthiness) and ethical risks, such as the potential for intrusion, coercion, and data privacy concerns.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Ub3JvdXM8L0F1dGhvcj48WWVhcj4yMDE5PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 304,344 Accountabilities and Responsibilities: Turning Ideas into ActionsIn moving from ideas to action, governments, health commissioners, and care providers must acknowledge their respective responsibilities for improving physical health in people with mental illness – and clear accountability must be established. For instance, primary prevention is often regarded as the duty of governments, rather than health services. ADDIN EN.CITE <EndNote><Cite><Author>Godlee</Author><Year>2019</Year><RecNum>9064</RecNum><DisplayText><style face="superscript">345</style></DisplayText><record><rec-number>9064</rec-number><foreign-keys><key app="EN" db-id="p59d0ad2rr502se09wtptvxjs5s000edw9zx" timestamp="1553488778">9064</key></foreign-keys><ref-type name="Generic">13</ref-type><contributors><authors><author>Godlee, Fiona</author></authors></contributors><titles><title>Prevention is the role of governments, not health systems</title></titles><dates><year>2019</year></dates><publisher>British Medical Journal Publishing Group</publisher><isbn>0959-8138</isbn><urls></urls></record></Cite></EndNote>345 The elevated risk factors for physical diseases among people with mental illness, which appear even prior to first diagnoses, could therefore characterise a failure at public health levels – and perhaps even wilful abandonment of educational and health promotion initiatives to reach this marginalized group. Nonetheless, taking action to address socio-environmental factors which contribute towards relationships between deprivation and health, such as shortage of green spaces and walking routes, the affordability and accessibility of fast-foods vs healthy foods, and the targeting of tobacco and alcohol advertising (and associated legislation), could all present feasible actions through which local and nation health policy can begin to improve the physical health of people with mental illness. Furthermore, increasing evidence suggests that obesity, ADDIN EN.CITE <EndNote><Cite><Author>Tyrrell</Author><Year>2018</Year><RecNum>9063</RecNum><DisplayText><style face="superscript">346,347</style></DisplayText><record><rec-number>9063</rec-number><foreign-keys><key app="EN" db-id="p59d0ad2rr502se09wtptvxjs5s000edw9zx" timestamp="1553487520">9063</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Tyrrell, Jessica</author><author>Mulugeta, Anwar</author><author>Wood, Andrew R</author><author>Zhou, Ang</author><author>Beaumont, Robin N</author><author>Tuke, Marcus A</author><author>Jones, Samuel E</author><author>Ruth, Katherine S</author><author>Yaghootkar, Hanieh</author><author>Sharp, Seth</author></authors></contributors><titles><title>Using genetics to understand the causal influence of higher BMI on depression</title></titles><dates><year>2018</year></dates><urls></urls></record></Cite><Cite><Author>Markowitz</Author><Year>2008</Year><RecNum>9062</RecNum><record><rec-number>9062</rec-number><foreign-keys><key app="EN" db-id="p59d0ad2rr502se09wtptvxjs5s000edw9zx" timestamp="1553487466">9062</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Markowitz, Sarah</author><author>Friedman, Michael A</author><author>Arent, Shawn M</author></authors></contributors><titles><title>Understanding the relation between obesity and depression: causal mechanisms and implications for treatment</title><secondary-title>Clinical Psychology: Science and Practice</secondary-title></titles><periodical><full-title>Clinical Psychology: Science and Practice</full-title></periodical><pages>1-20</pages><volume>15</volume><number>1</number><dates><year>2008</year></dates><isbn>0969-5893</isbn><urls></urls></record></Cite></EndNote>346,347 smoking ADDIN EN.CITE <EndNote><Cite><Author>Gurillo</Author><Year>2015</Year><RecNum>9058</RecNum><DisplayText><style face="superscript">348,349</style></DisplayText><record><rec-number>9058</rec-number><foreign-keys><key app="EN" db-id="p59d0ad2rr502se09wtptvxjs5s000edw9zx" timestamp="1553487159">9058</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gurillo, Pedro</author><author>Jauhar, Sameer</author><author>Murray, Robin M</author><author>MacCabe, James H</author></authors></contributors><titles><title>Does tobacco use cause psychosis? Systematic review and meta-analysis</title><secondary-title>The Lancet Psychiatry</secondary-title></titles><periodical><full-title>The Lancet Psychiatry</full-title></periodical><pages>718-725</pages><volume>2</volume><number>8</number><dates><year>2015</year></dates><isbn>2215-0366</isbn><urls></urls></record></Cite><Cite><Author>Wootton</Author><Year>2018</Year><RecNum>9035</RecNum><record><rec-number>9035</rec-number><foreign-keys><key app="EN" db-id="p59d0ad2rr502se09wtptvxjs5s000edw9zx" timestamp="1552341152">9035</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wootton, Robyn E</author><author>Richmond, Rebecca C</author><author>Stuijfzand, Bobby G</author><author>Lawn, Rebecca B</author><author>Sallis, Hannah M</author><author>Taylor, Gemma MJ</author><author>Jones, Hannah J</author><author>Zammit, Stanley</author><author>Smith, George Davey</author><author>Munafo, Marcus R</author></authors></contributors><titles><title>Causal effects of lifetime smoking on risk for depression and schizophrenia: Evidence from a Mendelian randomisation study</title><secondary-title>BioRxiv</secondary-title></titles><periodical><full-title>BioRxiv</full-title></periodical><pages>381301</pages><dates><year>2018</year></dates><urls></urls></record></Cite></EndNote>348,349 and physical inactivity ADDIN EN.CITE <EndNote><Cite><Author>Choi</Author><Year>2019</Year><RecNum>9057</RecNum><DisplayText><style face="superscript">350,351</style></DisplayText><record><rec-number>9057</rec-number><foreign-keys><key app="EN" db-id="p59d0ad2rr502se09wtptvxjs5s000edw9zx" timestamp="1553487066">9057</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Choi, Karmel W</author><author>Chen, Chia-Yen</author><author>Stein, Murray B</author><author>Klimentidis, Yann C</author><author>Wang, Min-Jung</author><author>Koenen, Karestan C</author><author>Smoller, Jordan W</author></authors></contributors><titles><title>Assessment of bidirectional relationships between physical activity and depression among adults: a 2-sample mendelian randomization study</title><secondary-title>JAMA psychiatry</secondary-title></titles><periodical><full-title>JAMA psychiatry</full-title></periodical><dates><year>2019</year></dates><urls></urls></record></Cite><Cite><Author>Schuch</Author><Year>2018</Year><RecNum>9023</RecNum><record><rec-number>9023</rec-number><foreign-keys><key app="EN" db-id="p59d0ad2rr502se09wtptvxjs5s000edw9zx" timestamp="1552023109">9023</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Schuch, Felipe B</author><author>Vancampfort, Davy</author><author>Firth, Joseph</author><author>Rosenbaum, Simon</author><author>Ward, Philip B</author><author>Silva, Edson S</author><author>Hallgren, Mats</author><author>Ponce De Leon, Antonio</author><author>Dunn, Andrea L</author><author>Deslandes, Andrea C</author></authors></contributors><titles><title>Physical activity and incident depression: a meta-analysis of prospective cohort studies</title><secondary-title>American Journal of Psychiatry</secondary-title></titles><periodical><full-title>American Journal of Psychiatry</full-title></periodical><pages>631-648</pages><volume>175</volume><number>7</number><dates><year>2018</year></dates><isbn>0002-953X</isbn><urls></urls></record></Cite></EndNote>350,351 are dual risk-factors not only for chronic physical conditions, but also mental illnesses. As these risk factors cluster together alongside social deprivation, ADDIN EN.CITE <EndNote><Cite><Author>Pampel</Author><Year>2010</Year><RecNum>9056</RecNum><DisplayText><style face="superscript">89,352</style></DisplayText><record><rec-number>9056</rec-number><foreign-keys><key app="EN" db-id="p59d0ad2rr502se09wtptvxjs5s000edw9zx" timestamp="1553485472">9056</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Pampel, Fred C</author><author>Krueger, Patrick M</author><author>Denney, Justin T</author></authors></contributors><titles><title>Socioeconomic disparities in health behaviors</title><secondary-title>Annual review of sociology</secondary-title></titles><periodical><full-title>Annual review of sociology</full-title></periodical><pages>349-370</pages><volume>36</volume><dates><year>2010</year></dates><isbn>0360-0572</isbn><urls></urls></record></Cite><Cite><Author>Marmot</Author><Year>2005</Year><RecNum>298</RecNum><record><rec-number>298</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755016">298</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Marmot, Michael</author></authors></contributors><titles><title>Social determinants of health inequalities</title><secondary-title>The lancet</secondary-title></titles><periodical><full-title>The Lancet</full-title></periodical><pages>1099-1104</pages><volume>365</volume><number>9464</number><dates><year>2005</year></dates><isbn>0140-6736</isbn><urls></urls></record></Cite></EndNote>89,352 greater investment in public health schemes and policy to address these proactively in at-risk groups, particularly in young people, could potentially reduce the onset and incidence of both physical and mental illnesses. However, this has yet to be demonstrated, and should be considered a promising area for future research (Figure 1). The risk factors consequences of physical diseases in people with mental illness are further compounded by the personal-, service- and social-level barriers to healthcare faced by this population. As a priority action, governments must address the stark inequalities in health insurance and access to care, in order to provide a suitable context for adequate medical and lifestyle interventions. Additionally, health commissioners must acknowledge the shortage of resources in mental health services dedicated towards protection of cardiometabolic health, and the broad neglect of physical health risks in the treatment of mental illness. This is a scandalous situation that would not be tolerated in any other area of healthcare. Clinical staff should also reflect on the duty of care that they have to people with mental illness, both at an individual level, and through their national associations. Given the foreseeable nature of poor physical health outcomes, protecting the physical health of people receiving treatment for mental illness should be regarded as within the scope of clinical duty of care. Within sufficiently resourced settings, this duty of care must include (i) measuring and addressing the physical health of the patient; (ii) clearly explaining the risks associated with treatment, and (iii) taking appropriate action to mitigate those risks and protect the physical health of the patient. As demonstrated in this Commission, and evidenced in guidelines documents (appendices pp.35-42), opinion is coalescing that good clinical practice in mental healthcare requires attention to the physical health of service users.Finally, the allocation of research funding presents another pathway through which systemic discrimination impacts on health and well-being of people with mental illness. Major research councils must aspire towards dedicating sufficient funding towards addressing the physical health disparities that affect people with mental illness. As a solely economic justification, the allocation of resources should at least fall in line with demonstrated financial cost of physical-mental comorbidities across the population (see Panel 2). This economic burden must also be considered alongside the so-far unresolved (and in fact worseningPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5IYXllczwvQXV0aG9yPjxZZWFyPjIwMTc8L1llYXI+PFJl
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ADDIN EN.CITE.DATA 21-24) personal burden of lifelong health disparities which affect people with mental illness. Substantial research investment in this area is now required in order to reverse the current inequalities, and develop novel methods for preventing these disparities from arising in future generations.ConclusionsThe large disparities in physical health for those with mental illness have persisted over time, and might even be worsening in some regions. Although this inequity is increasingly gaining attention, further investment, intervention, and research are urgently required to address the premature mortality and lifelong burden of poor physical health associated with mental illness. Nonetheless, our Commission takes an optimistic approach. We have described how disparities could be reduced through evidence-based prescribing and better integration of physical and mental health care. Our priority actions for health policy, clinical services, and future research are presented in Figure 1. Promisingly, multiple national and international guidelines now present feasible actions for improving the integration of physical and mental health, across various health and social care settings. Broader implementation of lifestyle interventions for mental illness is also required to reduce elevated cardiometabolic risk and attenuate medication side-effects. Whenever possible, interventions should maintain the core principles of evidence-based lifestyle programmes (such as DPP) and be made accessible to those who do not have current physical comorbidities, with the aim of protecting cardiometabolic health from the earliest stages of mental-health treatment. From a public health perspective, further exploration of population-scale strategies for primary prevention of co-occurring physical and mental disorders is warranted. Additionally, more government action is required to prevent discrimination and ensure equitable access to all aspects of health care for those with mental illness. Overall, protecting the physical health of people with mental illness should be considered an international priority for reducing the personal, social, and economic burden of these conditions.Table 6. Innovations in Integration: Conclusions and DirectionsConsiderations for:Directions and RationaleActioned bySyndemics & SocietiesExamining how broader societal factors influence the interaction between physical and mental health conditions within a given region can shed new light these comorbidities and the conditions which produce them. This, in turn, can inform the development and implementation of preventative strategies and interventions for tackling chronic health conditions within a given socio-economic setting.Led by public health; developed and implemented by national and local healthcare providersPreventing MultimorbidityMultimorbidity is common among people with long-term mental illness, and highly detrimental to health and well-being. Thus, evidence-based integrated care models (i.e. Supplement 5.1) should made available from illness onset. There are also feasible changes which can be made at primary, secondary and tertiary prevention levels which would reduce the prevalence and impact of physical health conditions in people treated for mental illness (Panel 5)Led by public health; delivered by primary, secondary and tertiary care, community groupsPrimary and Parallel CarePrimary care is a first-point of contact for most patients, and also plays a central role in step-down model of care following discharge from a specialist services. Thus, implementing integrated models of mental and physical health care through primary care services appears effective for efficient for the management of physical health comorbidities in people with mental illness (Panel 6). However, the management of comorbid SUDs may depend upon improving access, referral pathways and the quality of dedicated parallel services.Led by commissioners of healthcare organisations ; developed by culturally sensitizing integrated care models, and implemented by health care practitioners.LMIC ImplementationIncorporating integrated care models within the emerging mental health services of LMICs is crucial for tackling the health inequalities experienced globally by people with mental illness, and may also provide a more cost-effective approach to health care provision in these settings. mHealth SolutionsmHealth and other digital technologies present a myriad of novel methods for promoting physical health and delivering interventions remotely. The low-cost, scalability and global accessibility of such approaches are highly appealing, particularly in LMIC settings. While the evidence-base is still nascent, this can be considered a high-priority area for future research.Led by mental health commissioning, developed with community, researchers and industry, and implemented by health care practitionersPanel 5.1. Levels of Prevention for Physical Health Morbidity and Mortality in Mental DisordersPrimary prevention of physical illness includes helping people avoid unhealthy habits – eg smoking, alcohol and substance abuse, poor diet, and physical inactivity. Ideally, early in the course of mental illness, preventive measures will provide the tools needed for a healthy lifestyle.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HYXRlczwvQXV0aG9yPjxZZWFyPjIwMTU8L1llYXI+PFJl
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ADDIN EN.CITE.DATA 354 Primary prevention strategies need to be adapted for people with mental illness, as public health strategies that are effective in the general population do not always translate effectively for those with mental illness. Although “people with mental illness” is not a homogenous group, separation by individual diagnostic categories (e.g. depression vs. anxiety vs. schizophrenia) is equally unhelpful when developing and implementing primary prevention strategies for physical health. Transdiagnostic approaches which better account for individual-level differences (such as gender, cultural and ethnic identity, specific lifestyle factors, medication usage and social circumstances) will lead to provide more suitably tailored and scalable strategies (See Part 2). Secondary prevention involves screening and preventative treatments, which are often underused in people with mental illness. As covered in Part 1, many people with mental illnesses are affected by co-morbid physical diseases, which are present even from illness onset. Population-scale data from NHS England provides strong rationale that it is ‘never too soon’ for implementing secondary prevention of physical conditions in mental health services, as even from the ages of 11 to 19, children with mental illness are three-times as likely to be obese as their mentally healthy counterparts. ADDIN EN.CITE <EndNote><Cite><Author>Sadler</Author><Year>2018</Year><RecNum>362</RecNum><DisplayText><style face="superscript">355</style></DisplayText><record><rec-number>362</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755032">362</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Sadler, Katharine</author><author>Vizard, Tim</author><author>Ford, Tamsin</author><author>Marchesell, Franziska</author><author>Pearce, Nicola</author><author>Mandalia, Dhriti</author><author>Davis, Jodie</author><author>Brodie, Ellie</author><author>Forbes, Nick</author><author>Goodman, Anna</author></authors></contributors><titles><title>Mental Health of Children and Young People in England, 2017</title></titles><dates><year>2018</year></dates><urls></urls></record></Cite></EndNote>355 Considerations for improving the preventative focus of screening programs is covered in Panel 2. Recommendations for timely intervention are present in Part 3 (pharmacological) and Part 4 (lifestyle). Tertiary prevention encompasses improving treatment and recovery from disease. Engaging and responsive services require flexibility from individual clinicians and service planners. For example, cardiac mortality in severe mental illness is significantly reduced by efficient administration of cardioprotective medications after first cardiac events. ADDIN EN.CITE <EndNote><Cite><Author>Kugathasan</Author><Year>2018</Year><RecNum>8951</RecNum><DisplayText><style face="superscript">356</style></DisplayText><record><rec-number>8951</rec-number><foreign-keys><key app="EN" db-id="p59d0ad2rr502se09wtptvxjs5s000edw9zx" timestamp="1547618133">8951</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kugathasan, Pirathiv</author><author>Horsdal, Henriette Thisted</author><author>Aagaard, J?rgen</author><author>Jensen, Svend Eggert</author><author>Laursen, Thomas Munk</author><author>Nielsen, René Ernst</author></authors></contributors><titles><title>Association of secondary preventive cardiovascular treatment after myocardial infarction with mortality among patients with schizophrenia</title><secondary-title>JAMA psychiatry</secondary-title></titles><periodical><full-title>JAMA psychiatry</full-title></periodical><pages>1234-1240</pages><volume>75</volume><number>12</number><dates><year>2018</year></dates><isbn>2168-622X</isbn><urls></urls></record></Cite></EndNote>356 This confirms assertions in new guidelines (See table 5) and Part 3 that dissemination of tertiary prevention measures in people with mental illness is often overlooked, despite their potential to improve health and reduce premature mortality. Panel 5.2. Examples and Evaluations: Integrated Care for Physical and Mental IllnessWithin the broad category of ‘integrated care’, collaborative care (CC) models are emerging as an effective approach, which can simultaneously reduce costs while improving clinical outcomes and treatment adherence, in the management of both mental illness and chronic physical conditions.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BcmNoZXI8L0F1dGhvcj48WWVhcj4yMDEyPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 357-360 A core component of CC models is the involvement of several health care professionals working together; with CC teams typically including a physician, a case manager, and a mental health clinician. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5BcmNoZXI8L0F1dGhvcj48WWVhcj4yMDEyPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 361-363 After TEAMcare, the COINCIDE trial ADDIN EN.CITE <EndNote><Cite><Author>Coventry</Author><Year>2015</Year><RecNum>365</RecNum><DisplayText><style face="superscript">359</style></DisplayText><record><rec-number>365</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755032">365</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Coventry, Peter</author><author>Lovell, Karina</author><author>Dickens, Chris</author><author>Bower, Peter</author><author>Chew-Graham, Carolyn</author><author>McElvenny, Damien</author><author>Hann, Mark</author><author>Cherrington, Andrea</author><author>Garrett, Charlotte</author><author>Gibbons, Chris J</author></authors></contributors><titles><title>Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease</title><secondary-title>bmj</secondary-title></titles><periodical><full-title>BMJ</full-title></periodical><pages>h638</pages><volume>350</volume><dates><year>2015</year></dates><isbn>1756-1833</isbn><urls></urls></record></Cite></EndNote>359 tested a psychological intervention for people with depression comorbid with diabetes or cardiovascular disease (CVD), using behavioural activation, healthy lifestyle, exercise and diet. This integrated approach produced significant improvements in depression and in patient satisfaction, with benefits sustained at 24 months follow up, and was cost-effective. ADDIN EN.CITE <EndNote><Cite><Author>Camacho</Author><Year>2018</Year><RecNum>370</RecNum><DisplayText><style face="superscript">364</style></DisplayText><record><rec-number>370</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755034">370</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Camacho, Elizabeth M</author><author>Davies, Linda M</author><author>Hann, Mark</author><author>Small, Nicola</author><author>Bower, Peter</author><author>Chew-Graham, Carolyn</author><author>Baguely, Clare</author><author>Gask, Linda</author><author>Dickens, Chris M</author><author>Lovell, Karina</author></authors></contributors><titles><title>Long-term clinical and cost-effectiveness of collaborative care (versus usual care) for people with mental–physical multimorbidity: cluster-randomised trial</title><secondary-title>The British Journal of Psychiatry</secondary-title></titles><periodical><full-title>The British Journal of Psychiatry</full-title></periodical><pages>1-8</pages><dates><year>2018</year></dates><isbn>0007-1250</isbn><urls></urls></record></Cite></EndNote>364 Additionally, new evidence from the RAINBOW trial further supports the use of CC models for improving both physical and mental health outcomes in people with common mental disorders and cardiometabolic comorbidities. ADDIN EN.CITE <EndNote><Cite><Author>Ma</Author><Year>2019</Year><RecNum>371</RecNum><DisplayText><style face="superscript">365</style></DisplayText><record><rec-number>371</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755034">371</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ma, Jun</author><author>Rosas, Lisa Goldman</author><author>Lv, Nan</author><author>Xiao, Lan</author><author>Snowden, Mark B</author><author>Venditti, Elizabeth M</author><author>Lewis, Megan A</author><author>Goldhaber-Fiebert, Jeremy D</author><author>Lavori, Philip W</author></authors></contributors><titles><title>Effect of integrated behavioral weight loss treatment and problem-solving therapy on body mass index and depressive symptoms among patients with obesity and depression: the RAINBOW randomized clinical trial</title><secondary-title>Jama</secondary-title></titles><periodical><full-title>JAMA</full-title></periodical><pages>869-879</pages><volume>321</volume><number>9</number><dates><year>2019</year></dates><isbn>0098-7484</isbn><urls></urls></record></Cite></EndNote>365 However, it is important to note the above evidence pertains to evaluations of CC models in high-income settings. The importance of further development and evaluation of integrated care approaches for LMIC settings are discussed in Part 5.Furthermore, although effective for common mental disorders, the evidence for CC models in people with long-standing SMI is equivocal, and optimal models of integrated care in this group have yet to be refined. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5EcnVzczwvQXV0aG9yPjxZZWFyPjIwMTY8L1llYXI+PFJl
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ADDIN EN.CITE.DATA 366-368 One example of this provided by the PRIMROSE study; ADDIN EN.CITE <EndNote><Cite><Author>Osborn</Author><Year>2018</Year><RecNum>374</RecNum><DisplayText><style face="superscript">368</style></DisplayText><record><rec-number>374</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755035">374</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Osborn, David</author><author>Burton, Alexandra</author><author>Hunter, Rachael</author><author>Marston, Louise</author><author>Atkins, Lou</author><author>Barnes, Thomas</author><author>Blackburn, Ruth</author><author>Craig, Thomas</author><author>Gilbert, Hazel</author><author>Heinkel, Samira</author><author>Holt, Richard</author><author>King, Michael</author><author>Michie, Susan</author><author>Morris, Richard</author><author>Morris, Steve</author><author>Nazareth, Irwin</author><author>Omar, Rumana</author><author>Petersen, Irene</author><author>Peveler, Robert</author><author>Pinfold, Vanessa</author><author>Walters, Kate</author></authors></contributors><titles><title>Clinical and cost-effectiveness of an intervention for reducing cholesterol and cardiovascular risk for people with severe mental illness in English primary care: a cluster randomised controlled trial</title><secondary-title>The Lancet Psychiatry</secondary-title></titles><periodical><full-title>The Lancet Psychiatry</full-title></periodical><pages>145-154</pages><volume>5</volume><number>2</number><section>145</section><dates><year>2018</year></dates><isbn>22150366</isbn><urls></urls><electronic-resource-num>10.1016/s2215-0366(18)30007-5</electronic-resource-num></record></Cite></EndNote>368 which compared integrated primary care to usual care in 327 people with SMI, finding no significant benefits for HDL cholesterol over 12 months. However, The PRIMROSE integrated care did show a 12 month mean health care cost difference of -?824 (95% CI -?568 to ?1079) compare to usual care, and proved to be cost-effective due to fewer of hospital readmissions over a 12-month period; thus indicating the enhanced continuity of care afforded by integrated care approaches can confer important benefits even in the absence of changes in cardiometabolic health. ADDIN EN.CITE <EndNote><Cite><Author>Osborn</Author><Year>2018</Year><RecNum>374</RecNum><DisplayText><style face="superscript">368</style></DisplayText><record><rec-number>374</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755035">374</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Osborn, David</author><author>Burton, Alexandra</author><author>Hunter, Rachael</author><author>Marston, Louise</author><author>Atkins, Lou</author><author>Barnes, Thomas</author><author>Blackburn, Ruth</author><author>Craig, Thomas</author><author>Gilbert, Hazel</author><author>Heinkel, Samira</author><author>Holt, Richard</author><author>King, Michael</author><author>Michie, Susan</author><author>Morris, Richard</author><author>Morris, Steve</author><author>Nazareth, Irwin</author><author>Omar, Rumana</author><author>Petersen, Irene</author><author>Peveler, Robert</author><author>Pinfold, Vanessa</author><author>Walters, Kate</author></authors></contributors><titles><title>Clinical and cost-effectiveness of an intervention for reducing cholesterol and cardiovascular risk for people with severe mental illness in English primary care: a cluster randomised controlled trial</title><secondary-title>The Lancet Psychiatry</secondary-title></titles><periodical><full-title>The Lancet Psychiatry</full-title></periodical><pages>145-154</pages><volume>5</volume><number>2</number><section>145</section><dates><year>2018</year></dates><isbn>22150366</isbn><urls></urls><electronic-resource-num>10.1016/s2215-0366(18)30007-5</electronic-resource-num></record></Cite></EndNote>368 Nonetheless, in aiming to improve physical health outcomes of SMI, future studies must evaluate benefits of earlier implementation of integrated care for SMI (i.e. providing CC from illness onset), along with providing CC referral to evidence-based lifestyle programs based on DPP principles (See Figure 3).AcknowledgementsThe Commission would like to acknowledge the assistance of Melissa Eaton in preparing the tables and appendices for the document.References ADDIN EN.REFLIST 1.Thornicroft G. 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American Journal of Medical Genetics, Part B: Neuropsychiatric Genetics 2015; 168(2): 81-8.441.Hughes E, Bassi S, Gilbody S, Bland M, Martin F. Prevalence of HIV, hepatitis B, and hepatitis C in people with severe mental illness: A systematic review and meta-analysis. The Lancet Psychiatry 2016; 3(1): 40-8.442.Fisher JC, Bang H, Kapiga SH. The association between HIV infection and alcohol use: A systematic review and meta-analysis of African studies. Sexually Transmitted Diseases 2007; 34(11): 856-63.443.Novo-Veleiro I, de la Calle C, Dominguez-Quiben S, Pastor I, Marcos M, Laso FJ. Prevalence of hepatitis C virus infection in alcoholic patients: Cohort study and systematic review. Alcohol and Alcoholism 2013; 48(5): 564-9.444.Rahimi-Movaghar A, Amin-Esmaeili M, Haghdoost AA, Sadeghirad B, Mohraz M. HIV prevalence amongst injecting drug users in Iran: A systematic review of studies conducted during the decade 1998-2007. 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Parts and Contributors #TitleContributors-Executive SummaryJoseph Firth, Najma Siddiqi, Ai Koyanagi, Dan Siskind, Simon Rosenbaum, Cherrie Galletly, Scott Teasdale, Stephanie Allan, Patrick McGorry, Sarah Jackson, Graham Thornicroft, Eoin Killacky, Brendon Stubbs.1It’s more than premature mortalityNajma Siddiqi*, Johanna Taylor, Lee Smith, Nicola Veronese, Marco Solmi, Brendon Stubbs, Joseph Firth.2Modifiable factors in health behaviours and servicesAi Koyanagi*, Steve Kisley, Rebekah Carney, Joseph Firth, Adrian Heald, Alison Yung, Mario Maj.3The interplay between psychiatric medications and physical healthDan Siskind*, Toby Pillinger, Brian O’Donaghue, Shuichi Seutani, Andre F. Carvalho, Fiona Gaughran, Christoph U. Correll.4Going multi-disciplinary on multi-morbiditySimon Rosenbaum*, Scott Teasdale, Stephanie Allan, Erin Hoare, Jacqueline Curtis, Phillip Ward, Jerome Sarris, Felipe B. Schuch, Joseph Firth.5Innovations in integrationCherrie Galletly*, Davy Vancampfort, Tim Usherwood, Constanza Caneo, Joseph Firth, Hannah Myles, Karina Lovell.-Multiple Parts / additional contributionsMary-Lou Chatterton, Jacqueline Curtis, David Shiers, Cathrine Mihalopoulos, Sarah Jackson, John Torous.*Represents lead authorExecutive Summary AppendixPart 1 Appendix: ‘Its more than Premature Mortality’ 514985-36322000Appendix Figure 1. Increases in published research on physical health in mental disorders between 1996-2016. Bars show number of PubMed articles published per year on “Physical Health” in MeSH topic of ‘Mental Disorders’ (updated from earlier article ADDIN EN.CITE <EndNote><Cite><Author>Blanner Kristiansen</Author><Year>2015</Year><RecNum>8912</RecNum><DisplayText><style face="superscript">1</style></DisplayText><record><rec-number>8912</rec-number><foreign-keys><key app="EN" db-id="p59d0ad2rr502se09wtptvxjs5s000edw9zx" timestamp="1547446546">8912</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Blanner Kristiansen, C</author><author>H?strup Vestergaard, C</author></authors></contributors><titles><title>Secular trends in the interest of physical health in patients with mental illness</title><secondary-title>Acta Psychiatrica Scandinavica</secondary-title></titles><periodical><full-title>Acta Psychiatrica Scandinavica</full-title></periodical><pages>408-410</pages><volume>132</volume><number>5</number><dates><year>2015</year></dates><isbn>0001-690X</isbn><urls></urls></record></Cite></EndNote>1). Evidence Synthesis DetailsIn determining the scope and focus of the commission, we sought to examine the prevalence and impact of both non-communicable diseases (e.g. obesity, hypertension, cardiovascular, metabolic syndrome) and infectious diseases (e.g. TB, HIV) across a broad range of mental health conditions (including CMDs, SMIs, SUDs, along with personality and behavioural disorders). We searched Embase to identify meta-analyses, systematic reviews or overviews of systematic reviews of the burden of physical illness in mental illness published in peer-reviewed journals in the English language from 2000 to 2018. Two authors independently screened titles and abstracts, and subsequently full text articles of potentially relevant articles to identify studies for inclusion, resolving disagreements through consensus. Experts in the field were consulted to check for any additional reviews or large seminal studies, particularly where gaps in the literature had been identified. Predetermined selection criteria for studies included: Population: people with mental illness, with, or at risk of physical illness. Controls could include the general population or people without mental illness. Studies without control populations were also included. Reviews that were restricted to studies from a single country were excluded because of limited generalisability.Mental illness: one or more mental illness diagnoses made according to DSM(R) or ICD(R) criteria, or using screening tools based on these, and reporting a cut-off for diagnosis. We excluded studies in which only symptoms or changes in symptoms were reported. We included studies of:?Common mental disorders (CMD) (e.g. mild to moderate depression, anxiety disorders) ?Severe mental illness (SMI) (e.g. schizophrenia, schizoaffective disorder, bipolar disorder, first episode psychosis, major depressive disorder)?Alcohol and substance use disorders?Other (e.g. personality disorders, behavioural disorders, pervasive developmental disorders) We excluded studies of neurological disorders. Physical illness: one or more physical illness diagnoses, including non-communicable diseases (e.g. obesity, hypertension, cardiovascular, metabolic syndrome) and infectious diseases (e.g. TB, HIV). Outcomes: reporting either prevalence or incidence of physical illness, or one or more of the following outcomes: physical health, mental health, quality of life, years lived with disability, mortality, employment, economic and healthcare use.Study design: For prevalence: Systematic reviews of retrospective or prospective cohort (period prevalence) and cross-Partal (point prevalence) studies.For incidence: Systematic reviews of retrospective or prospective cohort studies; control arms of trials.For outcomes: Systematic reviews of cohort studies, case–control studies and controlled trials.Two authors extracted data on type of mental illness, type of physical illness, number of studies and participants, prevalence, incidence and relative risk (or hazard ratios, odds ratios) and outcomes as described above.We organised studies meeting the selection criteria by type of mental disorder and physical disorder, and reported the number of studies and where there were gaps in the evidence for specific mental and physical disorders. Where there were multiple reviews on the same comorbidity or multimorbidity, we selected the most comprehensive and recent (according to search date) meta-analyses with ‘within study’ control populations, and reported data from these. Where meta-analyses were not available, we reported data from systematic reviews, or large population-level epidemiological studies, again selecting the most comprehensive and recent. For each type of mental illness, we reported prevalence, incidence or risk of developing a physical illness compared to the general population or control population without mental illness. Study Flow Diagram-342900121285Articles meeting criteria for the review n = 99(n=48)common mental disorders (n=30)severe mental illness(n=6)alcohol and substance use disorders (n=8)other mental disorders(n=7)mixed mental illness populationsFull-text articles excluded n = 189(n=27)conference abstract (n=2)duplicate (n=8)not in English language (n=47)not systematic review (n=64) not mental illness population (n=16)not physical illness (n=17)not reporting prevalence (n=8)study designFull-text articles assessed for eligibility n = 288Duplicates removed n = 47Records excluded from title and abstract review n = 3524Records identified from database search Classic+Embase (26.11.2018)n = 3843Additional articles located from key reports, literature reviews and topic expertsn = 16Records screened n = 379600Articles meeting criteria for the review n = 99(n=48)common mental disorders (n=30)severe mental illness(n=6)alcohol and substance use disorders (n=8)other mental disorders(n=7)mixed mental illness populationsFull-text articles excluded n = 189(n=27)conference abstract (n=2)duplicate (n=8)not in English language (n=47)not systematic review (n=64) not mental illness population (n=16)not physical illness (n=17)not reporting prevalence (n=8)study designFull-text articles assessed for eligibility n = 288Duplicates removed n = 47Records excluded from title and abstract review n = 3524Records identified from database search Classic+Embase (26.11.2018)n = 3843Additional articles located from key reports, literature reviews and topic expertsn = 16Records screened n = 3796 Systematic Search Terms (# Returned Results in Brackets) -Updated on 26th October 2018 of OVID Embase1 exp mental disease/ (2099410)2 (mental or mentally or psychiatr* or psycho* or depressi* or depressed or MDD or anxi* or phobia or phobic or schizo* or hebephrenic*).ti. (790133)3 (somatoform or somatiz* or somatis* or hysteri* or briquet or multisomat* or multi somat* or MUPs or medically unexplained).ti. (5899)4 ((dissociative adj3 (disorder* or reaction*)) or dissociation).ti. (18958)5 (affective* adj (disorder? or disease? or illness* or symptom?)).ti. (6737)6 (PTSD or post-trauma* or posttrauma* or combat disorder? or war disorder?).ti. (37586)7 ((Cognitive or cognition or personality or impulse control or eating or mood) adj (disorder? or illness* or disease?)).ti. 8 ((bipolar or behavio?ral or obsessive or compulsive or panic or mood or agrophobi* or phobic or delusional) adj (disorder? or illness* or disease?)).ti. (37801)9 (OCD or obsess*-compulsi* or GAD or acute stress or neuros#s or neurotic).ti. (21823)10 exp *drug abuse/ (44635)11 ((Alcohol* or amphetamin* or cannabis or cocaine or heroin or methadone or substance* or drug*1) adj2 (addict* or depend* or disorder* or syndrome*)).ti. (36380)12 or/1-11 [Mental disorders] (2429079)13 *comorbidity/ (12122)14 *multiple chronic conditions/ (540)15 (Comorbid* or co-morbid*).ti. (27353)16 (Multimorbid* or multi-morbid*).ti. (1850)17 (Multidisease? or multi-disease? or (multiple adj (ill* or disease? or condition? or syndrom* or disorder?))).ti. (396)18 ((Cooccur* or co-occur* or coexist* or co-exist* or multipl* or concord* or discord* or long-term or physical*) adj3 (disease? or ill* or care or condition? or disorder* or health* or medication* or symptom* or syndrom*)).ti. (46864)19 exp *asthma/ or asthma*.ti. (165863)20 exp *chronic obstructive lung disease/ (59441)21 ((pulmonar* or lung* or respiratory) adj2 disease*).ti. (65044)22 exp *emphysema/ or emphysema*.ti. (24557)23 exp *bronchitis/ or bronchit*.ti. (30861)24 exp *arthritis/ or arthriti*.ti. (303370)25 exp *diabetes mellitus/ or diabet*.ti. (523983)26 exp *cerebrovascular disorders/ or ((cerebrovascular or vascular or carotoid* or arter*) adj (disorder? or disease?)).ti. 27 exp *bacterial infection/ or (tuberculosis or TB or conjunctivitis).ti. (666673)28 exp *Human immunodeficiency virus infection/ or (hiv or acquired immune* deficiency syndrome? or (aids adj (associated or related or arteritis))).ti. (327226)29 exp *kidney disease/ or (kidney adj (disease? or disorder?)).ti. (492310)30 exp *liver disease/ or (liver adj (disease? or disorder?)).ti. (581784)31 exp *heart disease/ or (((heart or cardiac or cardiovascular or coronary) adj (disease? or disorder? or failure)) or arrythmia?).ti. (1090279)32 exp *hypertension/ or (hypertens* or "high blood pressure?").ti. (367548)33 exp *hyperlipidemia/ or (hyperlipidem* or hypercholesterolemia* or hypertriglyceridemia*).ti. (54084)34 exp *neoplasms/ or (neoplasm? or cancer?).ti. (3534461)35 exp *osteoporosis/ or osteoporosis.ti. (62339)36 exp *thyroid disease/ or ((thyroid adj (disease? or disorder)) or hyperthyroid* or hypothyroid*).ti. (154791)37 exp *Motor Neuron Disease/ or (Motor Neuron Disease or Motor Neurone Disease or amyotrophic lateral sclerosis).ti. 38 exp *Multiple Sclerosis/ or Multiple Sclerosis.ti. (82607)39 exp *Parkinson Disease/ or parkinson*.ti. (106624)40 exp *metabolic disorder/ or metabolic syndrome X/ or (metabolic adj (disorder* or disease* or syndrome*)).ti. (1600405)41 exp *Obesity/ or obes*.ti. (246913)42 exp *pain/ or pain.ti. (435445)43 or/13-42 [Physical conditions or multi-morbidity] (9416770)44 12 and 43 [Mental conditions and physical conditions or multi-morbidity] (431282)45 prevalence/ (614803)46 incidence/ (330147)47 (Prevalen* or incidence*).ti,kw. (308926)48 epidemiology/ (222445)49 Epidemiolog*.ti,kw. (213477)50 Frequency/ (2367)51 Frequency.ti. (102276)52 Risk factor/ (903036)53 Risk factor*.ti. (142622)54 Outcome*.ti. (427782)55 or/45-54 [Prevalence or incidence or outcomes] (2506037)56 44 and 55 [Mental conditions and physical conditions or multi-morbidity and prevalence or incidence or outcomes] (75606)57 "systematic review"/ (181694)58 meta analysis/ (150660)59 (review or meta-analysis or metaanalysis or synthes?s or overview?).ti. (985846)60 or/57-59 [Systematic review or metanalyses] (1094412)61 56 and 60 (4044)62 limit 61 to yr="2000 -Current" (3843)ResultsOur search identified 3796 unique records. Following title and abstract screening, 288 full text articles were retrieved, of which 99 met our selection criteria for reviews of prevalence/incidence of physical illness in mental disorder (see Study flow diagram). We identified 99 reviews, 48 for CMD, 30 for SMI, five for alcohol and one for substance use disorders, and eight for other mental illness. Seven reviews included several categories or did not differentiate between types of mental disorder. Focusing on the most recent reviews, as described above, the majority of the evidence was for cardiovascular (n=30) or metabolic conditions (n=40) in common mental disorder (predominantly in depression) or in schizophrenia. For all other categories of mental and physical illness, there were either only a handful or no reviews. The few reviews examining infectious diseases (n=8) were limited mostly to severe mental illness. Of particular note, given the high prevalence of tobacco use in mental illnress,PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Qcm9jaGFza2E8L0F1dGhvcj48WWVhcj4yMDE3PC9ZZWFy
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ADDIN EN.CITE.DATA 2 we identified no reviews of chronic lung disease meeting our selection criteria. Most studies reported associations or relative risks of developing physical disorders in mental illness. Very few reported physical, emotional or socio-economic outcomes of mental and physical multimorbidity.Tables 2a-e give the prevalence, incidence or risk of developing physical illness for each category of mental illness. Common mental disorderIn depression, the risk of developing all non-communicable diseases- cardiac diseases, hypertension, stroke, diabetes, metabolic syndrome, obesity, cancer, parkinson’s, osteoporosis, is increased compared to the general population. There is most evidence for cardiovascular disorders, with 13 meta-analyses or systematic reviews, followed by diabetes, with seven. As noted above, the magnitude of the increased risk is remarkably similar for most physical health conditions, with around a 40% increase in prevalence (Table 2a). However, for asthma, Jiang et al ADDIN EN.CITE <EndNote><Cite><Author>Jiang</Author><Year>2014</Year><RecNum>376</RecNum><DisplayText><style face="superscript">3</style></DisplayText><record><rec-number>376</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755035">376</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Jiang, M.</author><author>Qin, P.</author><author>Yang, X.</author></authors></contributors><titles><title>Comorbidity between depression and asthma via immune-inflammatory pathways: A meta-analysis</title><secondary-title>Journal of Affective Disorders</secondary-title></titles><periodical><full-title>J Affect Disord</full-title><abbr-1>Journal of affective disorders</abbr-1></periodical><pages>22-29</pages><volume>166</volume><dates><year>2014</year></dates><accession-num>373160347</accession-num><label>Asthma</label><urls><related-urls><url> report a threefold increased prevalence, although incident adult-onset asthma has a more comparable relative risk of 1.4 ADDIN EN.CITE <EndNote><Cite><Author>Gao</Author><Year>2015</Year><RecNum>375</RecNum><DisplayText><style face="superscript">4</style></DisplayText><record><rec-number>375</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755035">375</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gao, Y. H.</author><author>Zhao, H. S.</author><author>Zhang, F. R.</author><author>Gao, Y.</author><author>Shen, P.</author><author>Chen, R.</author><author>Zhang, G. J.</author></authors></contributors><titles><title>The relationship between depression and asthma: A meta-analysis of prospective studies</title><secondary-title>PLoS ONE</secondary-title></titles><periodical><full-title>PLoS One</full-title><abbr-1>PloS one</abbr-1></periodical><volume>10 (7) (no pagination)</volume><number>e0132424</number><dates><year>2015</year></dates><accession-num>605939044</accession-num><label>Asthma</label><urls><related-urls><url> . The risk of Parkinson’s is doubled. ADDIN EN.CITE <EndNote><Cite><Author>Wang</Author><Year>2018</Year><RecNum>25</RecNum><DisplayText><style face="superscript">5</style></DisplayText><record><rec-number>25</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754963">25</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wang, S.</author><author>Mao, S.</author><author>Xiang, D.</author><author>Fang, C.</author></authors></contributors><titles><title>Association between depression and the subsequent risk of Parkinson's disease: A meta-analysis</title><secondary-title>Progress in Neuro-Psychopharmacology and Biological Psychiatry</secondary-title></titles><periodical><full-title>Progress in Neuro-Psychopharmacology and Biological Psychiatry</full-title></periodical><pages>186-192</pages><volume>86</volume><dates><year>2018</year></dates><accession-num>2000836089</accession-num><label>Parkinsons</label><urls><related-urls><url> evidence for cancer risk is more equivocal. Depression is associated with a small increase in overall cancer risk, but there are significant differences by cancer type, with increased risk for lung and liver cancer, but no significant associations found for breast, prostate, or colorectal/colon cancer. ADDIN EN.CITE <EndNote><Cite><Author>Jia</Author><Year>2017</Year><RecNum>21</RecNum><DisplayText><style face="superscript">6</style></DisplayText><record><rec-number>21</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754962">21</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Jia, Y.</author><author>Li, F.</author><author>Liu, Y. F.</author><author>Zhao, J. P.</author><author>Leng, M. M.</author><author>Chen, L.</author></authors></contributors><titles><title>Depression and cancer risk: a systematic review and meta-analysis</title><secondary-title>Public Health</secondary-title></titles><periodical><full-title>Public Health</full-title></periodical><pages>138-148</pages><volume>149</volume><dates><year>2017</year></dates><accession-num>618571178</accession-num><label>Cancer</label><urls><related-urls><url> found no reviews of infectious diseases in common mental disorders.Severe mental illnessNon-communicable diseasesThe 30 reviews of physical illness in severe mental illness again focused predominantly on cardio-metabolic disorders (n=18), with clear evidence of an increased risk across all categories of a magnitude of 1.5 to 2. Asthma and autoimmune disorders are also increased,PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5XdTwvQXV0aG9yPjxZZWFyPjIwMTY8L1llYXI+PFJlY051
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ADDIN EN.CITE.DATA 9 Conversely, a review including 10 studies reported the risk of rheumatoid arthritis in schizophrenia to be half that seen in the general population or controls without schizophrenia. ADDIN EN.CITE <EndNote><Cite><Author>Euesden</Author><Year>2015</Year><RecNum>447</RecNum><DisplayText><style face="superscript">10</style></DisplayText><record><rec-number>447</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755052">447</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Euesden, J.</author><author>Breen, G.</author><author>Farmer, A.</author><author>McGuffin, P.</author><author>Lewis, C. M.</author></authors></contributors><titles><title>The relationship between schizophrenia and rheumatoid arthritis revisited: Genetic and epidemiological analyses</title><secondary-title>American Journal of Medical Genetics, Part B: Neuropsychiatric Genetics</secondary-title></titles><periodical><full-title>American Journal of Medical Genetics, Part B: Neuropsychiatric Genetics</full-title></periodical><pages>81-88</pages><volume>168</volume><number>2</number><dates><year>2015</year></dates><accession-num>602094270</accession-num><label>YY</label><urls><related-urls><url>(ISSN)1552-485X As for common mental disorders, the evidence for the risk of cancer is mixed. Li et al ADDIN EN.CITE <EndNote><Cite><Author>Li</Author><Year>2018</Year><RecNum>22</RecNum><DisplayText><style face="superscript">11</style></DisplayText><record><rec-number>22</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754962">22</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Li, H.</author><author>Li, J.</author><author>Yu, X.</author><author>Zheng, H.</author><author>Sun, X.</author><author>Lu, Y.</author><author>Zhang, Y.</author><author>Li, C.</author><author>Bi, X.</author></authors></contributors><titles><title>The incidence rate of cancer in patients with schizophrenia: A meta-analysis of cohort studies</title><secondary-title>Schizophrenia Research</secondary-title></titles><periodical><full-title>Schizophrenia research</full-title></periodical><pages>519-528</pages><volume>195</volume><dates><year>2018</year></dates><accession-num>618392316</accession-num><label>YY</label><urls><related-urls><url> report a small significant decreased overall risk of cancer incidence among patients with schizophrenia, with decreased risks for colorectal and prostate cancer but a higher risk of lung cancer in women (RR=1.2). Catala-Lopez et al found no association between schizophrenia and cancer risk. Infectious diseasesThree reviews reported the risk of infectious diseases in severe mental disorders, but did not include a control population. Ayano et al reported prevalence of hepatitis B, C and HIV to be 15.63%, 7.21% and 7.59% respectively. ADDIN EN.CITE <EndNote><Cite><Author>Ayano</Author><Year>2018</Year><RecNum>28</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>28</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754963">28</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ayano, G.</author><author>Tulu, M.</author><author>Haile, K.</author><author>Assefa, D.</author><author>Habtamu, Y.</author><author>Araya, G.</author><author>Yohannis, Z.</author></authors></contributors><titles><title>A systematic review and meta-analysis of gender difference in epidemiology of HIV, hepatitis B, and hepatitis C infections in people with severe mental illness</title><secondary-title>Annals of General Psychiatry</secondary-title></titles><periodical><full-title>Annals of General Psychiatry</full-title></periodical><volume>17 (1) (no pagination)</volume><number>16</number><dates><year>2018</year></dates><accession-num>621978220</accession-num><label>YY</label><urls><related-urls><url> - *bipolar disorder and Campos et al ADDIN EN.CITE <EndNote><Cite><Author>Campos</Author><Year>2008</Year><RecNum>29</RecNum><DisplayText><style face="superscript">13</style></DisplayText><record><rec-number>29</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754963">29</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Campos, L. N.</author><author>Guimaraes, M. D. C.</author><author>Carmo, R. A.</author><author>Melo, A. P. S.</author><author>De Oliveira, H. N.</author><author>Elkington, K.</author><author>McKinnon, K.</author></authors></contributors><titles><title>HIV, syphilis, and hepatitis B and C prevalence among patients with mental illness: A review of the literature</title><secondary-title>Cadernos de Saude Publica</secondary-title></titles><periodical><full-title>Cadernos de Saude Publica</full-title></periodical><pages>S607-S620</pages><volume>24</volume><number>SUPPL.4</number><dates><year>2008</year></dates><accession-num>352439225</accession-num><label>YY</label><urls><related-urls><url> reported the prevalence of syphilis to range from 1.1% to 7.6% in 4 studies. Alcohol and substance use disordersThe limited number of reviews examining physical illness in alcohol or substance use disorders nevertheless showed a similar pattern of increased risk. 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ADDIN EN.CITE.DATA 16,17 Risk of asthma is also increased in autism. ADDIN EN.CITE <EndNote><Cite><Author>Zheng</Author><Year>2016</Year><RecNum>379</RecNum><DisplayText><style face="superscript">18</style></DisplayText><record><rec-number>379</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755036">379</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Zheng, Z.</author><author>Zhang, L.</author><author>Zhu, T.</author><author>Huang, J.</author><author>Qu, Y.</author><author>Mu, D.</author></authors></contributors><titles><title>Association between asthma and autism spectrum disorder: A meta-analysis</title><secondary-title>PLoS ONE</secondary-title></titles><periodical><full-title>PLoS One</full-title><abbr-1>PloS one</abbr-1></periodical><volume>11 (6) (no pagination)</volume><number>e0156662</number><dates><year>2016</year></dates><accession-num>610615594</accession-num><label>YY</label><urls><related-urls><url> In bulimia, there is a marked increase in risk of diabetes (OR 3.45) and in anorexia, the risk is significantly decreased (OR 0.71). ADDIN EN.CITE <EndNote><Cite><Author>Nieto-Martinez</Author><Year>2017</Year><RecNum>19</RecNum><DisplayText><style face="superscript">19</style></DisplayText><record><rec-number>19</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754962">19</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Nieto-Martinez, R.</author><author>Gonzalez-Rivas, J. P.</author><author>Medina-Inojosa, J. R.</author><author>Florez, H.</author></authors></contributors><titles><title>Are Eating Disorders Risk Factors for Type 2 Diabetes? A Systematic Review and Meta-analysis</title><secondary-title>Current Diabetes Reports</secondary-title></titles><periodical><full-title>Current Diabetes Reports</full-title></periodical><volume>17 (12) (no pagination)</volume><number>138</number><dates><year>2017</year></dates><accession-num>619501487</accession-num><label>YY</label><urls><related-urls><url> - anorexia nervosa The risk of osteoporosis is increased over twelve-fold in the latter. ADDIN EN.CITE <EndNote><Cite><Author>Solmi</Author><Year>2016</Year><RecNum>20</RecNum><DisplayText><style face="superscript">20</style></DisplayText><record><rec-number>20</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754962">20</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Solmi, M.</author><author>Veronese, N.</author><author>Correll, C. U.</author><author>Favaro, A.</author><author>Santonastaso, P.</author><author>Caregaro, L.</author><author>Vancampfort, D.</author><author>Luchini, C.</author><author>De Hert, M.</author><author>Stubbs, B.</author></authors></contributors><titles><title>Bone mineral density, osteoporosis, and fractures among people with eating disorders: A systematic review and meta-analysis</title><secondary-title>Acta Psychiatrica Scandinavica</secondary-title></titles><periodical><full-title>Acta Psychiatrica Scandinavica</full-title></periodical><pages>341-351</pages><volume>133</volume><number>5</number><dates><year>2016</year></dates><accession-num>607767381</accession-num><label>YY</label><urls><related-urls><url> Finally, people with personality disorder are at twice the risk of obesity. ADDIN EN.CITE <EndNote><Cite><Author>Gerlach</Author><Year>2016</Year><RecNum>18</RecNum><DisplayText><style face="superscript">21</style></DisplayText><record><rec-number>18</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754962">18</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gerlach, G.</author><author>Loeber, S.</author><author>Herpertz, S.</author></authors></contributors><titles><title>Personality disorders and obesity: a systematic review</title><secondary-title>Obesity Reviews</secondary-title></titles><periodical><full-title>Obesity Reviews</full-title></periodical><pages>691-723</pages><volume>17</volume><number>8</number><dates><year>2016</year></dates><accession-num>611337194</accession-num><label>YY</label><urls><related-urls><url> Appendix Table 2a Common mental disordersPhysical illnessStudySetting /populationPrevalence/incidence/relative risk AsthmaDepression ADDIN EN.CITE <EndNote><Cite><Author>Gao</Author><Year>2015</Year><RecNum>375</RecNum><DisplayText><style face="superscript">4</style></DisplayText><record><rec-number>375</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755035">375</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gao, Y. H.</author><author>Zhao, H. S.</author><author>Zhang, F. R.</author><author>Gao, Y.</author><author>Shen, P.</author><author>Chen, R.</author><author>Zhang, G. J.</author></authors></contributors><titles><title>The relationship between depression and asthma: A meta-analysis of prospective studies</title><secondary-title>PLoS ONE</secondary-title></titles><periodical><full-title>PLoS One</full-title><abbr-1>PloS one</abbr-1></periodical><volume>10 (7) (no pagination)</volume><number>e0132424</number><dates><year>2015</year></dates><accession-num>605939044</accession-num><label>Asthma</label><urls><related-urls><url> with and without depression in the general population; 2334 incident cases of asthmaDepression predicted incident adult-onset asthma RR= 1.43 (95% CI, 1.28–1.61, P<0.001) N=6; n=83,684 ADDIN EN.CITE <EndNote><Cite><Author>Jiang</Author><Year>2014</Year><RecNum>376</RecNum><DisplayText><style face="superscript">3</style></DisplayText><record><rec-number>376</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755035">376</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Jiang, M.</author><author>Qin, P.</author><author>Yang, X.</author></authors></contributors><titles><title>Comorbidity between depression and asthma via immune-inflammatory pathways: A meta-analysis</title><secondary-title>Journal of Affective Disorders</secondary-title></titles><periodical><full-title>J Affect Disord</full-title><abbr-1>Journal of affective disorders</abbr-1></periodical><pages>22-29</pages><volume>166</volume><dates><year>2014</year></dates><accession-num>373160347</accession-num><label>Asthma</label><urls><related-urls><url> with and without depression in the general populationPrevalence of asthma in depressed people higher than in the general population OR 3.17 (95% CI, 2.82–3.56, p<0.00001) N=3; n=20,001Cardiovascular diseaseDepressionHeart disease ADDIN EN.CITE <EndNote><Cite><Author>Shi</Author><Year>2016</Year><RecNum>390</RecNum><DisplayText><style face="superscript">22</style></DisplayText><record><rec-number>390</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755038">390</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shi, S.</author><author>Liu, T.</author><author>Liang, J.</author><author>Hu, D.</author><author>Yang, B.</author></authors></contributors><titles><title>The relationship between depression and risk of sudden cardiac death and arrhythmias: A meta-analysis</title><secondary-title>Heart Rhythm</secondary-title></titles><periodical><full-title>Heart Rhythm</full-title></periodical><pages>S502-S503</pages><volume>1)</volume><dates><year>2016</year></dates><accession-num>72283991</accession-num><label>CVD Heart disease</label><urls><related-urls><url> population with and without pre-existing cardiovascular disease Risk of sudden cardiovascular death in depression RR= 1.62 (95% CI, 1.37– 1.92, p < .001) N=4; n= 83,659VT/VF RR=1.47 (95% CI, 1.23– 1.76; p < .001) N=8; n= 4,048AF RR=1.43 (95% CI, 0.99– 2.05; p = .056) N=5; n=31,247Hypertension ADDIN EN.CITE <EndNote><Cite><Author>Meng</Author><Year>2012</Year><RecNum>393</RecNum><DisplayText><style face="superscript">23</style></DisplayText><record><rec-number>393</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755039">393</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Meng, L.</author><author>Chen, D.</author><author>Yang, Y.</author><author>Zheng, Y.</author><author>Hui, R.</author></authors></contributors><titles><title>Depression increases the risk of hypertension incidence: A meta-analysis of prospective cohort studies.</title><secondary-title>Journal of Hypertension.</secondary-title></titles><periodical><full-title>Journal of Hypertension.</full-title></periodical><volume>15</volume><dates><year>2012</year></dates><accession-num>51867823</accession-num><label>CVD hypertension</label><urls><related-urls><url> with depression and healthy controls Pooled RR for incident hypertension = 1.42 (95% CI, 1.09 to 1.86, P. 0.009) N=9; n= 22,367Stroke ADDIN EN.CITE <EndNote><Cite><Author>Li</Author><Year>2015</Year><RecNum>395</RecNum><DisplayText><style face="superscript">24</style></DisplayText><record><rec-number>395</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755040">395</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Li, M.</author><author>Zhang, X. W.</author><author>Hou, W. S.</author><author>Tang, Z. Y.</author></authors></contributors><titles><title>Impact of depression on incident stroke: A meta-analysis</title><secondary-title>International Journal of Cardiology</secondary-title></titles><periodical><full-title>International journal of cardiology</full-title></periodical><pages>103-110</pages><volume>180</volume><dates><year>2015</year></dates><accession-num>601155976</accession-num><label>CVD Stroke</label><urls><related-urls><url> population 11,350 cases of strokeDepression significantly increased risk of stroke RR= 1.45 (95% CI, 1.31–1.61) adjusted for established cardiovascular risk factors. N=36; n=399,791AnxietyHeart disease ADDIN EN.CITE <EndNote><Cite><Author>Emdin</Author><Year>2016</Year><RecNum>14</RecNum><DisplayText><style face="superscript">25</style></DisplayText><record><rec-number>14</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754961">14</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Emdin, C. A.</author><author>Odutayo, A.</author><author>Wong, C. X.</author><author>Tran, J.</author><author>Hsiao, A. J.</author><author>Hunn, B. H. M.</author></authors></contributors><titles><title>Meta-Analysis of Anxiety as a Risk Factor for Cardiovascular Disease</title><secondary-title>American Journal of Cardiology</secondary-title></titles><periodical><full-title>American Journal of Cardiology</full-title></periodical><pages>511-519</pages><volume>118</volume><number>4</number><dates><year>2016</year></dates><accession-num>612620440</accession-num><label>YY</label><urls><related-urls><url> population; 222,253 subjects with anxietyAnxiety significantly increased risk of cardiovascular mortality RR= 1.41 (95% CI,1.13 -1.76); coronary heart disease RR= 1.41 (95% CI, 1.23 -1.61); stroke RR 1.71 (95% CI, 1.18 -2.50); and heart failure RR=1.35 (95% CI, 1.11-1.64). N=46; n=2,017,276Stroke ADDIN EN.CITE <EndNote><Cite><Author>Pan</Author><Year>2015</Year><RecNum>399</RecNum><DisplayText><style face="superscript">26</style></DisplayText><record><rec-number>399</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755041">399</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Pan, Y.</author><author>Cai, W.</author><author>Cheng, Q.</author><author>Dong, W.</author><author>An, T.</author><author>Yan, J.</author></authors></contributors><titles><title>Association between anxiety and hypertension: A systematic review and meta-analysis of epidemiological studies</title><secondary-title>Neuropsychiatric Disease and Treatment</secondary-title></titles><periodical><full-title>Neuropsychiatric Disease and Treatment</full-title></periodical><pages>1121-1130</pages><volume>11</volume><dates><year>2015</year></dates><accession-num>604305033</accession-num><label>YY</label><urls><related-urls><url> population; 2,394 subjects with hypertension Anxiety increased risk of stroke OR= 1.18 (95% CI, 1.02–1.37, P<0.001) N=13 cross Partal studies; n=151,389OR=1.55 (95% CI, 1.24–1.94, P<0.001) N=8 prospective cohort studies; n=80,146CancerDepression? ADDIN EN.CITE <EndNote><Cite><Author>Jia</Author><Year>2017</Year><RecNum>21</RecNum><DisplayText><style face="superscript">6</style></DisplayText><record><rec-number>21</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754962">21</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Jia, Y.</author><author>Li, F.</author><author>Liu, Y. F.</author><author>Zhao, J. P.</author><author>Leng, M. M.</author><author>Chen, L.</author></authors></contributors><titles><title>Depression and cancer risk: a systematic review and meta-analysis</title><secondary-title>Public Health</secondary-title></titles><periodical><full-title>Public Health</full-title></periodical><pages>138-148</pages><volume>149</volume><dates><year>2017</year></dates><accession-num>618571178</accession-num><label>Cancer</label><urls><related-urls><url> population 89,716 incident cases of cancerDepression significantly associated with overall cancer risk RR= 1.15 (95% CI, 1.09-1.22) N=25; n=1,469,179Liver cancer RR= 1.20 (95% CI, 1.01-1.43) Lung cancer RR= 1.33, 95% CI, 1.04-1.72)No significant associations found for breast, prostate, or colorectal/colon cancer.DiabetesDepression ADDIN EN.CITE <EndNote><Cite><Author>Vancampfort</Author><Year>2015b</Year><RecNum>422</RecNum><DisplayText><style face="superscript">27</style></DisplayText><record><rec-number>422</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755046">422</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Vancampfort, D.</author><author>Mitchell, A. J.</author><author>De Hert, M.</author><author>Sienaert, P.</author><author>Probst, M.</author><author>Buys, R.</author><author>Stubbs, B.</author></authors></contributors><titles><title>TYPE 2 DIABETES in PATIENTS with MAJOR DEPRESSIVE DISORDER: A META-ANALYSIS of PREVALENCE ESTIMATES and PREDICTORS</title><secondary-title>Depression and Anxiety</secondary-title></titles><periodical><full-title>Depression and Anxiety</full-title></periodical><pages>763-773</pages><volume>32</volume><number>10</number><dates><year>2015b</year></dates><accession-num>605030841</accession-num><label>Diabetes</label><urls><related-urls><url> population controls Prevalence of T2DM in MDD = 8.7% (95% CI, 7.3–10.2%) Significantly increased risk of diabetes in MDD RR = 1.49 (95% CI, 1.29-1.72; P < .001) N=16; n=158,834Anxiety ADDIN EN.CITE <EndNote><Cite><Author>Smith</Author><Year>2018</Year><RecNum>11</RecNum><DisplayText><style face="superscript">28</style></DisplayText><record><rec-number>11</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754961">11</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Smith, K. J.</author><author>Deschenes, S. S.</author><author>Schmitz, N.</author></authors></contributors><titles><title>Investigating the longitudinal association between diabetes and anxiety: a systematic review and meta-analysis</title><secondary-title>Diabetic Medicine</secondary-title></titles><periodical><full-title>Diabetic Medicine</full-title></periodical><pages>677-693</pages><volume>35</volume><number>6</number><dates><year>2018</year></dates><accession-num>621384372</accession-num><label>YY</label><urls><related-urls><url> study population aged 16 years and aboveBaseline anxiety associated with incident diabetes OR=1.47, 95% CI,1.23–1.75) N=14; n =1 760 800Metabolic syndromeDepression ADDIN EN.CITE <EndNote><Cite><Author>Vancampfort</Author><Year>2014</Year><RecNum>431</RecNum><DisplayText><style face="superscript">29</style></DisplayText><record><rec-number>431</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755048">431</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Vancampfort, D.</author><author>Correll, C. U.</author><author>Wampers, M.</author><author>Sienaert, P.</author><author>Mitchell, A. J.</author><author>De Herdt, A.</author><author>Probst, M.</author><author>Scheewe, T. W.</author><author>De Hert, M.</author></authors></contributors><titles><title>Metabolic syndrome and metabolic abnormalities in patients with major depressive disorder: a meta-analysis of prevalences and moderating variables</title><secondary-title>Psychological medicine</secondary-title></titles><periodical><full-title>Psychol Med</full-title><abbr-1>Psychological medicine</abbr-1></periodical><pages>2017-2028</pages><volume>44</volume><number>10</number><dates><year>2014</year></dates><accession-num>607907384</accession-num><label>Metabolic</label><urls><related-urls><url> defined depression population in any setting (community, outpatient, inpatient)Prevalence of MetS = 30.5% (95% CI, 26.3–35.1) n= 5531Compared with age- and gender-matched control groups (N=5, n=3297), individuals with MDD (N=5, n=3118) had a higher MetS prevalence OR= 1.54, 95% CI 1.21–1.97, p=0.001].Antipsychotic use (p<0.05) significantly explained higher MetS prevalence estimates in MDD but no effect of age, gender, geographical area, smoking, antidepressant use or presence of psychiatric co-morbidity.Anxiety ADDIN EN.CITE <EndNote><Cite><Author>Tang</Author><Year>2017</Year><RecNum>13</RecNum><DisplayText><style face="superscript">30</style></DisplayText><record><rec-number>13</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754961">13</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Tang, F.</author><author>Wang, G.</author><author>Lian, Y.</author></authors></contributors><titles><title>Association between anxiety and metabolic syndrome: A systematic review and meta-analysis of epidemiological studies</title><secondary-title>Psychoneuroendocrinology</secondary-title></titles><periodical><full-title>Psychoneuroendocrinology</full-title></periodical><pages>112-121</pages><volume>77</volume><dates><year>2017</year></dates><accession-num>613825148</accession-num><label>YY</label><urls><related-urls><url> setting.Anxiety associated with MetS OR=1.07 (95% CI, 1.01–1.12). N=18; n=41168Obesity?Anxiety ADDIN EN.CITE <EndNote><Cite><Author>van den Berk-Clark</Author><Year>2018</Year><RecNum>12</RecNum><DisplayText><style face="superscript">31</style></DisplayText><record><rec-number>12</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754961">12</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>van den Berk-Clark, C.</author><author>Secrest, S.</author><author>Walls, J.</author><author>Hallberg, E.</author><author>Lustman, P. J.</author><author>Schneider, F. D.</author><author>Scherrer, J. F.</author></authors></contributors><titles><title>Association between posttraumatic stress disorder and lack of exercise, poor diet, obesity, and co-occuring smoking: A systematic review and meta-analysis</title><secondary-title>Health Psychology</secondary-title></titles><periodical><full-title>Health Psychology</full-title></periodical><pages>407-416</pages><volume>37</volume><number>5</number><dates><year>2018</year></dates><accession-num>621919514</accession-num><label>YY</label><urls><related-urls><url> samples (N=9); veterans (N=10; primary care/health center sample (N=4); clinical (inpatient psychiatric) settings (N=2); military service members or policemen (N=5)Increased risk of obesity, pooled adjusted OR=1.31 (95% CI,1.25 -1.38) N=21; n=973,003Osteoporosis/bone lossDepression ADDIN EN.CITE <EndNote><Cite><Author>Wu</Author><Year>2010</Year><RecNum>445</RecNum><DisplayText><style face="superscript">32</style></DisplayText><record><rec-number>445</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755052">445</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wu, Q.</author><author>Liu, J.</author><author>Gallegos-Orozco, J. F.</author><author>Hentz, J. G.</author></authors></contributors><titles><title>Depression, fracture risk, and bone loss: A meta-analysis of cohort studies</title><secondary-title>Osteoporosis International</secondary-title></titles><periodical><full-title>Osteoporosis International</full-title></periodical><pages>1627-1635</pages><volume>21</volume><number>10</number><dates><year>2010</year></dates><accession-num>50824291</accession-num><label>Osteoporosis</label><urls><related-urls><url> men and women; 9/14 studies in women only; and 2/14 in men only. 10/14 with subjects >50 yearsIncrease in risk of osteoporosis RR= 1.52 (95% CI, 1.26–1.85; P<0.001). May be mediated by antidepressants.N=4; n=33,428Parkinson's diseaseDepression ADDIN EN.CITE <EndNote><Cite><Author>Wang</Author><Year>2018</Year><RecNum>25</RecNum><DisplayText><style face="superscript">5</style></DisplayText><record><rec-number>25</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754963">25</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wang, S.</author><author>Mao, S.</author><author>Xiang, D.</author><author>Fang, C.</author></authors></contributors><titles><title>Association between depression and the subsequent risk of Parkinson's disease: A meta-analysis</title><secondary-title>Progress in Neuro-Psychopharmacology and Biological Psychiatry</secondary-title></titles><periodical><full-title>Progress in Neuro-Psychopharmacology and Biological Psychiatry</full-title></periodical><pages>186-192</pages><volume>86</volume><dates><year>2018</year></dates><accession-num>2000836089</accession-num><label>Parkinsons</label><urls><related-urls><url> with and without depressionDepression increases risk of Parkinson’s disease RR=2.20, (95% CI, 1.87–2.58)N=11; n=483,071Appendix Table 2b Severe mental illnessPhysical diseasesStudySetting/populationPrevalence/incidence/relative riskAsthmaBipolar disorder ADDIN EN.CITE <EndNote><Cite><Author>Wu</Author><Year>2016</Year><RecNum>377</RecNum><DisplayText><style face="superscript">7</style></DisplayText><record><rec-number>377</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755035">377</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wu, M. K.</author><author>Wang, H. Y.</author><author>Chen, Y. W.</author><author>Lin, P. Y.</author><author>Wu, C. K.</author><author>Tseng, P. T.</author></authors></contributors><titles><title>Significantly higher prevalence rate of asthma and bipolar disorder co-morbidity: A meta-analysis and review under PRISMA guidelines</title><secondary-title>Medicine (United States)</secondary-title></titles><periodical><full-title>Medicine (United States)</full-title></periodical><pages>e3217</pages><volume>95</volume><number>13</number><dates><year>2016</year></dates><accession-num>609693584</accession-num><label>YY</label><urls><related-urls><url> with/without bipolar disorderSignificantly higher prevalence of asthma in BD ES=1.86 (95% CI, 1.40–2.47, P<0.001)N=6; n=5750 patients with bipolar disorder and 139,529 healthy controls Autoimmune disordersMixed SMI ADDIN EN.CITE <EndNote><Cite><Author>!!! 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ADDIN EN.CITE.DATA 34People with and without schizophrenia.422,698 CVD outcomesFor incidence of CVD, pooled RR=1.53 (95% CI, 1.27, 1.86)For coronary heart disease RR=1.20 (95% CI, 0.93,1.53)For stroke RR=1.71 (95% CI, 1.19,2.46)N=13; n= 3,549,950Bipolar disorder ADDIN EN.CITE <EndNote><Cite><Author>Prieto</Author><Year>2014</Year><RecNum>406</RecNum><DisplayText><style face="superscript">35</style></DisplayText><record><rec-number>406</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755042">406</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Prieto, M. L.</author><author>Cuellar-Barboza, A. B.</author><author>Bobo, W. V.</author><author>Roger, V. L.</author><author>Bellivier, F.</author><author>Leboyer, M.</author><author>West, C. P.</author><author>Frye, M. A.</author></authors></contributors><titles><title>Differential risk of myocardial infarction and stroke in bipolar disorder: A systematic review and meta-analysis</title><secondary-title>Biological Psychiatry</secondary-title></titles><periodical><full-title>Biological Psychiatry</full-title></periodical><pages>211S-212S</pages><volume>1)</volume><dates><year>2014</year></dates><accession-num>71434473</accession-num><label>YY</label><urls><related-urls><url> with (n=27,092) and without bipolar disorderNo evidence for a significant increase in the risk of myocardial infarction, RR=1.09, 95% CI 0.96– 1.24, p = 0.20)Risk of stroke increased RR= 1.74 (95% CI, 1.29– 2.35, p = 0.0003)N=5 ; n=13 115 911Mixed SMIPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Db3JyZWxsPC9BdXRob3I+PFllYXI+MjAxNzwvWWVhcj48
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ADDIN EN.CITE.DATA 363,211,768 patients with SMI and 113,383,368 controlsCROSS-PARTAL STUDIESPooled CVD prevalence in SMI =9.9% (95% CI, 7.4-13.3) N=38)Adjusted pooled OR for CVD =1.53 (95% CI, 1.27-1.83, p<0.001) N=11LONGITUDINAL STUDIESIncidence of CVD event in SMI= 3.6% (95% CI, 2.7-5.3%) during median follow-up period of 8.4 years (range 1.8-30.0) N=65Increased risk for CVD, HR=1.78 (95% CI, 1.60-1.98) N=31 Hypertension ADDIN EN.CITE <EndNote><Cite><Author>Ayerbe</Author><Year>2018</Year><RecNum>407</RecNum><DisplayText><style face="superscript">37</style></DisplayText><record><rec-number>407</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755042">407</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ayerbe, L.</author><author>Forgnone, I.</author><author>Addo, J.</author><author>Siguero, A.</author><author>Gelati, S.</author><author>Ayis, S.</author></authors></contributors><titles><title>Hypertension risk and clinical care in patients with bipolar disorder or schizophrenia; a systematic review and meta-analysis</title><secondary-title>Journal of Affective Disorders</secondary-title></titles><periodical><full-title>J Affect Disord</full-title><abbr-1>Journal of affective disorders</abbr-1></periodical><pages>665-670</pages><volume>225</volume><dates><year>2018</year></dates><accession-num>618233796</accession-num><label>YY</label><urls><related-urls><url> and healthcare settingsIncreased risk of hypertension, Incidence Rate Ratio =1.27 (95% CI, 1.15–1.40)N=5CancerSchizophrenia ADDIN EN.CITE <EndNote><Cite><Author>Li</Author><Year>2018</Year><RecNum>22</RecNum><DisplayText><style face="superscript">11</style></DisplayText><record><rec-number>22</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754962">22</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Li, H.</author><author>Li, J.</author><author>Yu, X.</author><author>Zheng, H.</author><author>Sun, X.</author><author>Lu, Y.</author><author>Zhang, Y.</author><author>Li, C.</author><author>Bi, X.</author></authors></contributors><titles><title>The incidence rate of cancer in patients with schizophrenia: A meta-analysis of cohort studies</title><secondary-title>Schizophrenia Research</secondary-title></titles><periodical><full-title>Schizophrenia research</full-title></periodical><pages>519-528</pages><volume>195</volume><dates><year>2018</year></dates><accession-num>618392316</accession-num><label>YY</label><urls><related-urls><url> participants with schizophrenia and 41,999 cases of cancerSmall significant decreased overall risk of cancer incidence among patients with schizophrenia (RR = 0.90, 95% CI 0.81–0.99).N=16 Significant decreased incidence risk rates of colorectal cancer, RR = 0.82 (95% CI, 0.69–0.98) andprostate cancer RR = 0.55 (95% CI, 0.42–0.71) colorectal cancer in male patients RR = 0.89 (95%, CI 0.81–0.98)lung cancer increased significantly in female patients RR = 1.12 (95% CI, 1.01–1.25)DiabetesSchizophreniaPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TdHViYnM8L0F1dGhvcj48WWVhcj4yMDE1PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 38145,718 individuals with schizophrenia (22.5– 54.4 years) and 4,343,407 controls Prevalence of T2DM = 9.5% (95% CI, 7.0 -12.8) N=25; n=145 718Pooled RR = 1.82 (95% CI, 1.56– 2.13) n= 4,489,125. Bipolar disorder ADDIN EN.CITE <EndNote><Cite><Author>Vancampfort</Author><Year>2015c</Year><RecNum>427</RecNum><DisplayText><style face="superscript">39</style></DisplayText><record><rec-number>427</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755047">427</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Vancampfort, D.</author><author>Mitchell, A. J.</author><author>De Hert, M.</author><author>Sienaert, P.</author><author>Probst, M.</author><author>Buys, R.</author><author>Stubbs, B.</author></authors></contributors><titles><title>Prevalence and predictors of type 2 diabetes mellitus in people with bipolar disorder: A systematic review and meta-analysis</title><secondary-title>Journal of Clinical Psychiatry</secondary-title></titles><periodical><full-title>Journal of Clinical Psychiatry</full-title><abbr-1>J Clin Psychiat</abbr-1></periodical><pages>1490-1499</pages><volume>76</volume><number>11</number><dates><year>2015c</year></dates><accession-num>608484074</accession-num><label>YY</label><urls><related-urls><url> people with bipolar disorder and 783,049 age and gender matched controls.Prevalence of T2DM = 9.4% (95% CI, 6.5%–12.7%) n = 18,060RR= 1.98 (95% CI, 1.6–2.4, P < .001) N=19 Mixed SMIPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Pc2Jvcm48L0F1dGhvcj48WWVhcj4yMDA4PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 409612 people with SMI (1166 with diabetes) and 3449677 people without SMI (534248 with diabetes).Pooled risk ratio for diabetes in SMI= 1.70 (95% CI, 1.21 to 2.37)N=26Metabolic syndromeSchizophrenia ADDIN EN.CITE <EndNote><Cite><Author>Mitchell</Author><Year>2013a</Year><RecNum>435</RecNum><DisplayText><style face="superscript">41</style></DisplayText><record><rec-number>435</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755049">435</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Mitchell, A. J.</author><author>Vancampfort, D.</author><author>Sweers, K.</author><author>Van Winkel, R.</author><author>Yu, W.</author><author>De Hert, M.</author></authors></contributors><titles><title>Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders-a systematic review and meta-analysis</title><secondary-title>Schizophrenia Bulletin</secondary-title></titles><periodical><full-title>Schizophr Bull</full-title><abbr-1>Schizophrenia bulletin</abbr-1></periodical><pages>306-318</pages><volume>39</volume><number>2</number><dates><year>2013a</year></dates><accession-num>368442005</accession-num><label>YY</label><urls><related-urls><url> with schizophreniaPrevalence of MetS= 32.5% (95% CI, 30.1%- 35.0%)N=77 n=525 692No population rate for comparison.Bipolar disorder ADDIN EN.CITE <EndNote><Cite><Author>Vancampfort</Author><Year>2013</Year><RecNum>127</RecNum><DisplayText><style face="superscript">42</style></DisplayText><record><rec-number>127</rec-number><foreign-keys><key app="EN" db-id="ff0rzwtf2evvtee9r5dvaawdsa22f55deepx" timestamp="1533823778">127</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Vancampfort, D.</author><author>Vansteelandt, K.</author><author>Correll, C. U.</author><author>Mitchell, A. J.</author><author>De Herdt, A.</author><author>Sienaert, P.</author><author>Probst, M.</author><author>De Hert, M.</author></authors></contributors><titles><title>Metabolic syndrome and metabolic abnormalities in bipolar disorder: A meta-analysis of prevalence rates and moderators</title><secondary-title>American Journal of Psychiatry</secondary-title></titles><periodical><full-title>American Journal of Psychiatry</full-title></periodical><pages>265-274</pages><volume>170</volume><number>3</number><dates><year>2013</year></dates><accession-num>368487359</accession-num><label>YY</label><urls><related-urls><url> with bipolar disorder and general populationPrevalence of MetS= 37.3% (95% CI, 36.1–39.0) Higher rate in bipolar disorder, OR= 1.98 (95% CI, 1.74–2.25) N= 37; n=6,983ObesityBipolar disorder ADDIN EN.CITE <EndNote><Cite><Author>Keck</Author><Year>2003</Year><RecNum>441</RecNum><DisplayText><style face="superscript">43</style></DisplayText><record><rec-number>441</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755050">441</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Keck, P. E.</author><author>McElroy, S. L.</author></authors></contributors><auth-address>Division of Clinical Neuroscience, Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0559, USA. Paul.Keck@UC.edu</auth-address><titles><title>Bipolar disorder, obesity, and pharmacotherapy-associated weight gain</title><secondary-title>J Clin Psychiatry</secondary-title><alt-title>The Journal of clinical psychiatry</alt-title></titles><periodical><full-title>J Clin Psychiatry</full-title></periodical><alt-periodical><full-title>The Journal of clinical psychiatry</full-title></alt-periodical><pages>1426-35</pages><volume>64</volume><number>12</number><edition>2004/01/20</edition><keywords><keyword>Antimanic Agents/*adverse effects/therapeutic use</keyword><keyword>Bipolar Disorder/drug therapy/*epidemiology</keyword><keyword>Comorbidity</keyword><keyword>Humans</keyword><keyword>Long-Term Care</keyword><keyword>Obesity/chemically induced/*epidemiology/prevention & control</keyword><keyword>Randomized Controlled Trials as Topic</keyword><keyword>Risk Factors</keyword><keyword>Weight Gain/*drug effects</keyword></keywords><dates><year>2003</year><pub-dates><date>Dec</date></pub-dates></dates><isbn>0160-6689 (Print)
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ADDIN EN.CITE.DATA 9n = 3038 with schizophreniaPrevalence of osteoporosis in schizophrenia= 13.2% (95% CI = 7.8– 21.6%) N=19 Increased risk of osteoporosis OR= 2.86 (95% CI, 1.27– 6.42, p = 0.01) N=8; n= 1824Rheumatoid arthritisSchizophrenia ADDIN EN.CITE <EndNote><Cite><Author>Euesden</Author><Year>2015</Year><RecNum>447</RecNum><DisplayText><style face="superscript">10</style></DisplayText><record><rec-number>447</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755052">447</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Euesden, J.</author><author>Breen, G.</author><author>Farmer, A.</author><author>McGuffin, P.</author><author>Lewis, C. M.</author></authors></contributors><titles><title>The relationship between schizophrenia and rheumatoid arthritis revisited: Genetic and epidemiological analyses</title><secondary-title>American Journal of Medical Genetics, Part B: Neuropsychiatric Genetics</secondary-title></titles><periodical><full-title>American Journal of Medical Genetics, Part B: Neuropsychiatric Genetics</full-title></periodical><pages>81-88</pages><volume>168</volume><number>2</number><dates><year>2015</year></dates><accession-num>602094270</accession-num><label>YY</label><urls><related-urls><url>(ISSN)1552-485X 145901 patients with schizophrenia and 4,485,088 controls (general population or people without schizophrenia)Prevalence of RA in schizophrenia significantly reduced, OR=0.48 (95% CI, 0.34–0.67, p< 0.000) N=10 studies; n=4,630,989Mixed SMI ADDIN EN.CITE <EndNote><Cite><Author>!!! INVALID CITATION !!!</Author><RecNum>0</RecNum><DisplayText><style face="superscript">33</style></DisplayText><record><dates><year>!!! INVALID CITATION !!!</year></dates></record></Cite></EndNote>33Population based and healthcare settingsOR = 0.65 (95% CI, 0.50–0.84) N=4Hepatitis BMixed SMI ADDIN EN.CITE <EndNote><Cite><Author>Ayano</Author><Year>2018</Year><RecNum>28</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>28</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754963">28</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ayano, G.</author><author>Tulu, M.</author><author>Haile, K.</author><author>Assefa, D.</author><author>Habtamu, Y.</author><author>Araya, G.</author><author>Yohannis, Z.</author></authors></contributors><titles><title>A systematic review and meta-analysis of gender difference in epidemiology of HIV, hepatitis B, and hepatitis C infections in people with severe mental illness</title><secondary-title>Annals of General Psychiatry</secondary-title></titles><periodical><full-title>Annals of General Psychiatry</full-title></periodical><volume>17 (1) (no pagination)</volume><number>16</number><dates><year>2018</year></dates><accession-num>621978220</accession-num><label>YY</label><urls><related-urls><url> - *bipolar disorder with severe mental disorderPrevalence of hepatitis B = 15.63% (95% CI, 7.19–30.69) N=4Hepatitis CMixed SMI ADDIN EN.CITE <EndNote><Cite><Author>Ayano</Author><Year>2018</Year><RecNum>28</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>28</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754963">28</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ayano, G.</author><author>Tulu, M.</author><author>Haile, K.</author><author>Assefa, D.</author><author>Habtamu, Y.</author><author>Araya, G.</author><author>Yohannis, Z.</author></authors></contributors><titles><title>A systematic review and meta-analysis of gender difference in epidemiology of HIV, hepatitis B, and hepatitis C infections in people with severe mental illness</title><secondary-title>Annals of General Psychiatry</secondary-title></titles><periodical><full-title>Annals of General Psychiatry</full-title></periodical><volume>17 (1) (no pagination)</volume><number>16</number><dates><year>2018</year></dates><accession-num>621978220</accession-num><label>YY</label><urls><related-urls><url> - *bipolar disorder with severe mental disorderPrevalence of hepatitis C= 7.21% (95% CI, 4.44–11.50)N=5HIVMixed SMI ADDIN EN.CITE <EndNote><Cite><Author>Ayano</Author><Year>2018</Year><RecNum>28</RecNum><DisplayText><style face="superscript">12</style></DisplayText><record><rec-number>28</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754963">28</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Ayano, G.</author><author>Tulu, M.</author><author>Haile, K.</author><author>Assefa, D.</author><author>Habtamu, Y.</author><author>Araya, G.</author><author>Yohannis, Z.</author></authors></contributors><titles><title>A systematic review and meta-analysis of gender difference in epidemiology of HIV, hepatitis B, and hepatitis C infections in people with severe mental illness</title><secondary-title>Annals of General Psychiatry</secondary-title></titles><periodical><full-title>Annals of General Psychiatry</full-title></periodical><volume>17 (1) (no pagination)</volume><number>16</number><dates><year>2018</year></dates><accession-num>621978220</accession-num><label>YY</label><urls><related-urls><url> - *bipolar disorder with severe mental disorderPrevalence of HIV = 7.59% (95% CI, 4.82–11.75) N=13SyphilisMixed SMI ADDIN EN.CITE <EndNote><Cite><Author>Campos</Author><Year>2008</Year><RecNum>29</RecNum><DisplayText><style face="superscript">13</style></DisplayText><record><rec-number>29</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754963">29</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Campos, L. N.</author><author>Guimaraes, M. D. C.</author><author>Carmo, R. A.</author><author>Melo, A. P. S.</author><author>De Oliveira, H. N.</author><author>Elkington, K.</author><author>McKinnon, K.</author></authors></contributors><titles><title>HIV, syphilis, and hepatitis B and C prevalence among patients with mental illness: A review of the literature</title><secondary-title>Cadernos de Saude Publica</secondary-title></titles><periodical><full-title>Cadernos de Saude Publica</full-title></periodical><pages>S607-S620</pages><volume>24</volume><number>SUPPL.4</number><dates><year>2008</year></dates><accession-num>352439225</accession-num><label>YY</label><urls><related-urls><url> inpatients and outpatientsPrevalence rates varied from 1.1% to 7.6%.No pooling of data. N=4Mixed physical illness/comorbiditiesSchizophrenia ADDIN EN.CITE <EndNote><Cite><Author>Leucht</Author><Year>2007</Year><RecNum>456</RecNum><DisplayText><style face="superscript">44</style></DisplayText><record><rec-number>456</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755055">456</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Leucht, S.</author><author>Burkard, T.</author><author>Henderson, J.</author><author>Maj, M.</author><author>Sartorius, N.</author></authors></contributors><titles><title>Physical illness and schizophrenia: A review of the literature</title><secondary-title>Acta Psychiatrica Scandinavica</secondary-title></titles><periodical><full-title>Acta Psychiatrica Scandinavica</full-title></periodical><pages>317-333</pages><volume>116</volume><number>5</number><dates><year>2007</year></dates><accession-num>47537428</accession-num><label>YY</label><urls><related-urls><url> settingsIncreased with good evidence: HIV, CVD, obesity Increased: TB, hepatitis B ? C, osteoporosis, poor dental status, diabetes, MetS, thyroid dysfunction, impaired lung function, sexual dysfunction, obstetric complicationsDecreased: Cancer in general, prostate cancer, rheumatoid arthritisAppendix Table 2c Alcohol disordersPhysical diseasesStudiesSetting/ population Prevalence/Incidence/Relative riskDiabetesPEVuZE5vdGU+PENpdGU+PEF1dGhvcj5WYW5jYW1wZm9ydDwvQXV0aG9yPjxZZWFyPjIwMTY8L1ll
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ADDIN EN.CITE.DATA 143998 people with alcohol use disordersPooled T2DM prevalence = 12.4% (95% CI, 11.8–13.9%) N=7 (No healthy control data, but pooled prevalence similar to people with severe mental illness)Metabolic syndrome ADDIN EN.CITE <EndNote><Cite><Author>!!! INVALID CITATION !!!</Author><RecNum>0</RecNum><DisplayText><style face="superscript">33</style></DisplayText><record><dates><year>!!! INVALID CITATION !!!</year></dates></record></Cite></EndNote>33Hospital inpatient settings (N=3); outpatients and community settings (N=4) outpatient or community settings.The pooled MetS prevalence =21.8% (95% CI, 19.1%–24.8%) N studies = 5; n = 865(Due to the lack of data not able to compare rates with age- and gender-matched healthy controls)Hepatitis C( ADDIN EN.CITE <EndNote><Cite><Author>!!! INVALID CITATION !!!</Author><RecNum>0</RecNum><DisplayText><style face="superscript">33</style></DisplayText><record><dates><year>!!! INVALID CITATION !!!</year></dates></record></Cite></EndNote>33Representative samples from community-based surveys (N= 8); high-risk groups (N=11); mixed group (N=1).HCV prevalence ranging from 2.1 to 51% and an average weighted prevalence of 16.32%.N=24 n= 9,861HIV ADDIN EN.CITE <EndNote><Cite><Author>!!! INVALID CITATION !!!</Author><RecNum>0</RecNum><DisplayText><style face="superscript">33</style></DisplayText><record><dates><year>!!! INVALID CITATION !!!</year></dates></record></Cite></EndNote>33Problem drinkers. Studies only from AfricaAdjusted pooled risk estimate = 1.57 (95% CI, 1.42–1. 72). N=11Tuberculosis ADDIN EN.CITE <EndNote><Cite><Author>Lonnroth</Author><Year>2008</Year><RecNum>455</RecNum><DisplayText><style face="superscript">45</style></DisplayText><record><rec-number>455</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755055">455</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lonnroth, K.</author><author>Williams, B. G.</author><author>Stadlin, S.</author><author>Jaramillo, E.</author><author>Dye, C.</author></authors></contributors><titles><title>Alcohol use as a risk factor for tuberculosis - A systematic review</title><secondary-title>BMC Public Health</secondary-title></titles><periodical><full-title>BMC Public Health</full-title></periodical><volume>8 (no pagination)</volume><number>289</number><dates><year>2008</year></dates><accession-num>352342217</accession-num><label>YY</label><urls><related-urls><url> of community, hospital inpatient and outpatient settings; TB registers and clinics; contacts of TB cases; prison inmates.Pooled RR= 2.9 (95% CI,1.9–4.6 N=21Appendix Table 2d Other mental illnessMental illness/physical illnessStudiesSetting/populationPrevalence/Incidence/Relative rIskADHDAsthma ADDIN EN.CITE <EndNote><Cite><Author>!!! INVALID CITATION !!!</Author><RecNum>0</RecNum><DisplayText><style face="superscript">33</style></DisplayText><record><dates><year>!!! INVALID CITATION !!!</year></dates></record></Cite></EndNote>33Population based and healthcare settings. 210,363 participants with ADHD and 3,115 168 without.Pooled adjusted OR =1.53 (1.41–1.65) N=49Obesity ADDIN EN.CITE <EndNote><Cite><Author>Cortese</Author><Year>2016</Year><RecNum>17</RecNum><DisplayText><style face="superscript">16</style></DisplayText><record><rec-number>17</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754961">17</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Cortese, S.</author><author>Moreira-Maia, C. R.</author><author>St Fleur, D.</author><author>Morcillo-Penalver, C.</author><author>Rohde, L. A.</author><author>Faraone, S. V.</author></authors></contributors><titles><title>Association between ADHD and obesity: A systematic review and meta-analysis</title><secondary-title>American Journal of Psychiatry</secondary-title></titles><periodical><full-title>American Journal of Psychiatry</full-title></periodical><pages>34-43</pages><volume>173</volume><number>1</number><dates><year>2016</year></dates><accession-num>607755475</accession-num><label>YY</label><urls><related-urls><url> ADHD subjects; 679,975 comparison. Adults and children. Population based and clinical studies.OR=1.55 (95% C, 1.32–1.81) in adults with ADHDOR= 1.20 (95% CI, 1.05–1.37) in children with ADHDThe association remained when limited to studies reporting ORs adjusted for possible confounding factors. N=42; n=728,136 AutismAsthma ADDIN EN.CITE <EndNote><Cite><Author>Zheng</Author><Year>2016</Year><RecNum>379</RecNum><DisplayText><style face="superscript">18</style></DisplayText><record><rec-number>379</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755036">379</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Zheng, Z.</author><author>Zhang, L.</author><author>Zhu, T.</author><author>Huang, J.</author><author>Qu, Y.</author><author>Mu, D.</author></authors></contributors><titles><title>Association between asthma and autism spectrum disorder: A meta-analysis</title><secondary-title>PLoS ONE</secondary-title></titles><periodical><full-title>PLoS One</full-title><abbr-1>PloS one</abbr-1></periodical><volume>11 (6) (no pagination)</volume><number>e0156662</number><dates><year>2016</year></dates><accession-num>610615594</accession-num><label>YY</label><urls><related-urls><url> cases of ASDPrevalence of asthma in ASD = 20.4%, and in controls =15.4% (p < 0.001). N=10; n=175,406 Pooled OR= 1.26 (95% CI, 0.98–1.61, p = 0.07) for prevalence of asthma in cross-Partal studies.In case-control studies, pooled OR= 0.98 (95% CI, 0.68–1.43, p = 0.94) Eating disordersDiabetes ADDIN EN.CITE <EndNote><Cite><Author>Nieto-Martinez</Author><Year>2017</Year><RecNum>19</RecNum><DisplayText><style face="superscript">19</style></DisplayText><record><rec-number>19</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754962">19</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Nieto-Martinez, R.</author><author>Gonzalez-Rivas, J. P.</author><author>Medina-Inojosa, J. R.</author><author>Florez, H.</author></authors></contributors><titles><title>Are Eating Disorders Risk Factors for Type 2 Diabetes? A Systematic Review and Meta-analysis</title><secondary-title>Current Diabetes Reports</secondary-title></titles><periodical><full-title>Current Diabetes Reports</full-title></periodical><volume>17 (12) (no pagination)</volume><number>138</number><dates><year>2017</year></dates><accession-num>619501487</accession-num><label>YY</label><urls><related-urls><url> - anorexia nervosa (N=4); population-based (N=3); mixed settings (N=3).In bulimia nervosa, increased risk of diabetes, OR=3.45 (95% CI, 1.92–6.1) in cross Partal studies, N= 2. RR= 1.7 (95% CI, 1.2–2.5), N=1 cohort study.In anorexia nervosa, decreased risk of T2D, RR=0.71 (95% CI, 0.52–0.98) in N=1 cohort sudy.OR= 0.87 (95% CI, 0.40–1.88) in cross-Partal studies, N = 2. Osteoporosis ADDIN EN.CITE <EndNote><Cite><Author>Solmi</Author><Year>2016</Year><RecNum>20</RecNum><DisplayText><style face="superscript">20</style></DisplayText><record><rec-number>20</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754962">20</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Solmi, M.</author><author>Veronese, N.</author><author>Correll, C. U.</author><author>Favaro, A.</author><author>Santonastaso, P.</author><author>Caregaro, L.</author><author>Vancampfort, D.</author><author>Luchini, C.</author><author>De Hert, M.</author><author>Stubbs, B.</author></authors></contributors><titles><title>Bone mineral density, osteoporosis, and fractures among people with eating disorders: A systematic review and meta-analysis</title><secondary-title>Acta Psychiatrica Scandinavica</secondary-title></titles><periodical><full-title>Acta Psychiatrica Scandinavica</full-title></periodical><pages>341-351</pages><volume>133</volume><number>5</number><dates><year>2016</year></dates><accession-num>607767381</accession-num><label>YY</label><urls><related-urls><url> with anorexia and healthy controls. In anorexia nervosa increased risk of osteoporosis, OR = 12.59 (95% CI, 3.30–47.9, p < 0.001) N= 4.Increased risk of fractures, OR =1.84, 95% CI, 1.17–2.89) N=6.Personality disordersObesity ADDIN EN.CITE <EndNote><Cite><Author>Gerlach</Author><Year>2016</Year><RecNum>18</RecNum><DisplayText><style face="superscript">21</style></DisplayText><record><rec-number>18</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754962">18</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gerlach, G.</author><author>Loeber, S.</author><author>Herpertz, S.</author></authors></contributors><titles><title>Personality disorders and obesity: a systematic review</title><secondary-title>Obesity Reviews</secondary-title></titles><periodical><full-title>Obesity Reviews</full-title></periodical><pages>691-723</pages><volume>17</volume><number>8</number><dates><year>2016</year></dates><accession-num>611337194</accession-num><label>YY</label><urls><related-urls><url> and population-based studies.Personality disorder in young adulthood was a significant predictor of obesity (OR=1.95) up to the age of 33 years, even after controlling for age, gender and axis I mental disorders N=1; n=658.Appendix Table 2e Mixed mental illness studiesPhysical illnessStudySetting/populationPrevalence/incidence/relative riskCancer ADDIN EN.CITE <EndNote><Cite><Author>Catala-Lopez</Author><Year>2015</Year><RecNum>416</RecNum><DisplayText><style face="superscript">46</style></DisplayText><record><rec-number>416</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755045">416</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Catala-Lopez, F.</author><author>Suarez-Pinilla, M.</author><author>Suarez-Pinilla, P.</author><author>Valderas, J. M.</author><author>Gomez-Beneyto, M.</author><author>Martinez, S.</author><author>Balanza-Martinez, V.</author><author>Climent, J.</author><author>Valencia, A.</author><author>McGrath, J.</author><author>Crespo-Facorro, B.</author><author>Sanchez-Moreno, J.</author><author>Vieta, E.</author><author>Tabares-Seisdedos, R.</author></authors></contributors><titles><title>Inverse and direct cancer Comorbidity in people with central nervous system disorders: A meta-Analysis of cancer incidence in 577,013 Participants of 50 observational studies</title><secondary-title>Psychotherapy and Psychosomatics</secondary-title></titles><periodical><full-title>Psychotherapy and psychosomatics</full-title></periodical><pages>89-105</pages><volume>83</volume><number>2</number><dates><year>2015</year></dates><accession-num>603918173</accession-num><label>YY</label><urls><related-urls><url> populationand/or health care settings.No association between schizophrenia and cancer (ES = 0.98; 95% CI, 0.90–1.07; with substantial between-study heterogeneity). N= 16; n= 427,843Diabetes type 2 ADDIN EN.CITE <EndNote><Cite><Author>Vancampfort</Author><Year>2016c</Year><RecNum>213</RecNum><DisplayText><style face="superscript">47</style></DisplayText><record><rec-number>213</rec-number><foreign-keys><key app="EN" db-id="ff0rzwtf2evvtee9r5dvaawdsa22f55deepx" timestamp="1535444932">213</key><key app="ENWeb" db-id="">0</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Vancampfort, D.</author><author>Correll, C. U.</author><author>Galling, B.</author><author>Probst, M.</author><author>De Hert, M.</author><author>Ward, P. B.</author><author>Rosenbaum, S.</author><author>Gaughran, F.</author><author>Lally, J.</author><author>Stubbs, B.</author></authors></contributors><titles><title>Diabetes mellitus in people with schizophrenia, bipolar disorder and major depressive disorder: A systematic review and large scale meta-analysis</title><secondary-title>World Psychiatry</secondary-title></titles><periodical><full-title>World Psychiatry</full-title></periodical><pages>166-174</pages><volume>15</volume><number>2</number><dates><year>2016c</year></dates><accession-num>610655310</accession-num><label>YY</label><urls><related-urls><url>(ISSN)2051-5545 with SMI compared with general population.Pooled prevalence in SMI 11.3% (95% CI, 10.0%-12.6%).People with SMI significantly more likely to have T2DM than matched controls RR=1.85 (95% CI, 1.45-2.37; p<0.001) N=118; n=438,245Metabolic syndrome ADDIN EN.CITE <EndNote><Cite><Author>Vancampfort</Author><Year>2015a</Year><RecNum>189</RecNum><DisplayText><style face="superscript">48</style></DisplayText><record><rec-number>189</rec-number><foreign-keys><key app="EN" db-id="ff0rzwtf2evvtee9r5dvaawdsa22f55deepx" timestamp="1535444932">189</key><key app="ENWeb" db-id="">0</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Vancampfort, D.</author><author>Stubbs, B.</author><author>Mitchell, A. J.</author><author>De Hert, M.</author><author>Wampers, M.</author><author>Ward, P. B.</author><author>Rosenbaum, S.</author><author>Correll, C. U.</author></authors></contributors><titles><title>Risk of metabolic syndrome and its components in people with schizophrenia and related psychotic disorders, bipolar disorder and major depressive disorder: A systematic review and meta-analysis</title><secondary-title>World Psychiatry</secondary-title></titles><periodical><full-title>World Psychiatry</full-title></periodical><pages>339-347</pages><volume>14</volume><number>3</number><dates><year>2015a</year></dates><accession-num>606190109</accession-num><label>YY</label><urls><related-urls><url>(ISSN)2051-5545 with SMI compared with general population.Pooled prevalence in SMI 32.6% (95% CI, 30.8%- 34.4%).People with SMI at significantly increased risk for MetS compared with matched control RR=1.58 (95% CI, 1.35-1.86 p<0.001) N=198; n=52,678Obesity ADDIN EN.CITE <EndNote><Cite><Author>Rajan</Author><Year>2017</Year><RecNum>238</RecNum><DisplayText><style face="superscript">49</style></DisplayText><record><rec-number>238</rec-number><foreign-keys><key app="EN" db-id="ff0rzwtf2evvtee9r5dvaawdsa22f55deepx" timestamp="1533823780">238</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Rajan, T. M.</author><author>Menon, V.</author></authors></contributors><titles><title>Psychiatric disorders and obesity: A review of association studies</title><secondary-title>Journal of Postgraduate Medicine</secondary-title></titles><periodical><full-title>Journal of Postgraduate Medicine</full-title></periodical><pages>182-190</pages><volume>63</volume><number>3</number><dates><year>2017</year></dates><accession-num>617433486</accession-num><label>YY</label><urls><related-urls><url> - alcohol consumption with SMI compared with general population.OR for obesity in depression= 1.18–3.76; stronger association observed in women. In anxiety disorders, evidence mostly cross-Partal, OR: 1.27–1.40.In eating disorders, OR: 4.5. N=21HIV ADDIN EN.CITE <EndNote><Cite><Author>Breuer</Author><Year>2011</Year><RecNum>454</RecNum><DisplayText><style face="superscript">50</style></DisplayText><record><rec-number>454</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755054">454</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Breuer, E.</author><author>Myer, L.</author><author>Struthers, H.</author><author>Joska, J. A.</author></authors></contributors><titles><title>HIV/AIDS and mental health research in sub-Saharan Africa: A systematic review</title><secondary-title>African Journal of AIDS Research</secondary-title></titles><periodical><full-title>African Journal of AIDS Research</full-title></periodical><pages>101-122</pages><volume>10</volume><number>2</number><dates><year>2011</year></dates><accession-num>362369616</accession-num><label>YY</label><urls><related-urls><url> in-patients with no comparator population.AfricaPrevalence from 9% to 23%. No pooled estimate. N=15KeyAF: Atrial fibrillationASD: Autism spectrum disordersCVD: cardiovascular diseaseES: Effect sizeMDD: Major depressive disorderMetS: Metabolic syndromeN: Number of studies n: Number of participantsOR: Odds ratioRA: Rheumatoid arthritisRR: Relative riskSMI: Severe mental illnessTB: TuberculosisT2DM: Type 2 diabetes mellitusVT/VF: Ventricular tachycardia/fibrillationAppendix Part 2: Key Modifiable Factors in Health Behaviours and Health ServicesHierarchal Evidence Gathering for Lifestyle Risk Factors in Mental IllnessDue to the broad scope of our research question (in terms of both the different lifestyle factors and mental health conditions covered) it was not feasible to gather all available data from every existing individual study in the field. Therefore, we used a systematic approach towards data gathering, favoring the top-tiers of evidence synthesis (i.e. meta-analyses combined pooled data on lifestyle factors in mental disorders compared to control conditions, followed by systematic reviews aggregating all individual study findings on a specific topic, followed by population-scale epidemiological studies (searched for separately) where no recent meta-analyses/systematic reviews existed. The process is displayed below. The top level of the diagram represents the top-tier of evidence search for (and, where available, used). Subsequent levels were sought, in the following order, only where higher tiers of evidence were not available. Only recent evidence syntheses (meta-analyses and systematic reviews published since 2000 onwards) were used. In cases where an older meta-analysis/systematic review had later been covered by a newer, larger meta-analysis/systematic review on the same topic, the more recent study was used instead. Part 2 - Primary Search (conducted in April 2018)Databases Searched: Cochrane Central Register of Controlled Trials; Cochrane Database of Systematic’ Health Technology Assessment; NHS Economic Evaluation Database’ AMED (Allied and Complementary Medicine); Embase; HMIC Health Management Information Consortium; Ovid MEDLINE; PsycINFO Search Algorithm: [applied to all databases]CategorySearch words used (‘OR’ terms)Populationschizo* OR mental illness OR mental disorder* OR psychiatr* OR depress* OR bipolar OR anxiety OR substance abus* OR eating disorder* OR psychosis OR psychoticStudy type"meta-analys*" OR "systematic review*" OR metaan* [in title]ComparatorRandomised; Randomized; Controlled; Control Group; Intervention; Adjunc*; Adjuvant; Augmentation; Supplement*; open label; single arm; feasibility; pilot; prospective; trial; Outcomes (All)Further searches were also conducted of Google Scholar in September 2018, using similar search terms, to update and supplement the original searches and retrieve any additional articles. Part 3 AppendixAppendix Table 3.1. Side effects risk profile of commonly used antipsychotic medications Weight gainDyslipidaemiaGlucose abnormalitiesQTc prolongation Orthostatic hypotension Hyper-Prolactinemia Anticholinergic side effectExtrapyramidal side effect SedationMechanismH1, D2, 5HT2c blockageWeight gain, over-eating, direct effectsWeight gain, over-eating, direct effectsCardiac ion channel effectsAlpha-1 blockageD2 blockageAnticholinergicD2 blockageH1 blockageDose dependenceLowLowLowModerateHighHighLowModerate/HighHighFirst generationChlorpromazineModerate/HighHighHighModerateHighModerate/HighHighModerateHighFlupenthixolModerateLimited dataModerateLowLowHighModerateModerateLowFluphenazineHighLowModerateLowLowHighLowHighLowHaloperidolLow/ModerateLowLow/ModerateModerateLowHighLowHighLowPericyazineModerateLimited dataLowLimited dataModerateHighHighLowHighZuclopenthixol ModerateLimited dataLowLimited dataLowHighModerateModerateHighSecond generationAmisulprideLowLowLowModerateLowHighLowLowLowAripiprazole*LowLowLowLowLowLowLowLowLowAsenapineLowLowLow/ModerateLowLowLowLowLowLowClozapine**HighHighHighLowHighLowHighLowHighLurasidoneLowLowLowLowLowModerateLowLowLowOlanzapineHighHighHighLow/ModerateLowLowModerateLowModeratePaliperidoneModerateModerateLow/ModerateLowModerateHighLowLowLowQuetiapineModerateModerate/HighModerate/HighModerateModerateLowLowLowModerateRisperidoneModerateModerateModerateLowModerateHighLowLowLowZiprasidoneLowLowLowModerateLowModerateLowLowLow* Increased risk of akathesis** specific ADRs associated with clozapine including agranulocytosis are discussed in the main text Sources: PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5HYWxsZXRseTwvQXV0aG9yPjxZZWFyPjIwMTY8L1llYXI+
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ADDIN EN.CITE.DATA 51-57Appendix Table 3.2 – Mood Stabilisers – Risk of ADRsMetabolicNeurologicalOtherMood StabiliserWeight gainDyslipidaemiaMovementTirednessCognitive impairmentThyroidRenalValproateHighLowModerate for tremorModerateModerateLowModerateLamotrigineLow Low Low LowLowLowLowCarbamazepineModerate Low Dose dependent for akathisia and ataxiaModerateModerate for diplopia?LowModerateLithiumModerate Low Moderate for tremorLowModerateModerateHigh with long term treatmentAdapted from “Malhi GS, Bargh DM, Cashman E, Frye MA, Gitlin M. The clinical management of bipolar disorder complexity using a stratified model. Bipolar Disorders. 2012 May;14:66-89.”Appendix Table 3.3 Adverse Effects associated with Antidepressants (Adapted from "Taylor, D., Young, A. and Barnes, T. (2018). The Maudsley Prescribing Guidelines in Psychiatry. Wiley-Blackwell.AntidepressantGastrointestinalSedationAnticholinergicCardiacSexualPostural hypotensionSSRI/SNRICitalopramModerateLowLowLowHighLowDuloxetineModerateLowLowLowModerateHypertensionEscitalopramModerateLowLowLowHighLowFluoxetineModerateLowLowLowHighLowFluvoxamineHighLowLowLowHighLowLevomilnacipranModerateLowLowLowModerateHypertensionParoxetineModerateLowLowLowHighLowSertralineModerateLowLowLowHighLowVenlafaxineHighLowLowLowHighHypertensionVilazodoneModerateLowLowLowModerateLowVortioxetineModerateLowLowLowLowLowOtherAgomelatineLowLowLowLowLowLowMianserinLowModerateLowLowLowLowMirtazepineLowHighLowLowLowLowReboxetineLowLowLowLowLowLowTrazodoneLowHighLowLowLowLowTCAAmitriptylineLowHighHighHighHighHighClomipramineModerateModerateModerateHighHighHighDoxepinLowHighHighHighLowModerateImpramineLowModerateHighHighLowHighNortriptylineLowLowLowModerateLowModerateTrimipramineLowHighModerateModerateLowHighMAOI/ RIMAIsocarboxazidLowLowModerateLowLowModerateMoclobemideLowLowLowLowLowLowPhenelzineLowLowLowLowLowLowTranylcypromineLowLowLowLowLowLowAppendix Table 3.4 Treatment algorithms for type 2 diabetes mellitus in the general population.GuidelinesSummarized RecommendationsAmerican Diabetes Association ADDIN EN.CITE <EndNote><Cite><Author>Marathe</Author><Year>2017</Year><RecNum>116</RecNum><DisplayText><style face="superscript">58</style></DisplayText><record><rec-number>116</rec-number><foreign-keys><key app="EN" db-id="9e9et9fzi95p00er5v85fdtprrwd5ewa9d9w" timestamp="1552976359">116</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Marathe, P. H.</author><author>Gao, H. X.</author><author>Close, K. L.</author></authors></contributors><auth-address>Close Concerns, San Francisco, CA USA</auth-address><titles><title>American Diabetes Association Standards of Medical Care in Diabetes 2017</title><secondary-title>Journal of Diabetes</secondary-title><alt-title>J Diabetes</alt-title></titles><periodical><full-title>Journal of Diabetes</full-title><abbr-1>J Diabetes</abbr-1></periodical><alt-periodical><full-title>Journal of Diabetes</full-title><abbr-1>J Diabetes</abbr-1></alt-periodical><pages>320-324</pages><volume>9</volume><number>4</number><dates><year>2017</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>1753-0393</isbn><accession-num>WOS:000398157900002</accession-num><urls><related-urls><url><Go to ISI>://WOS:000398157900002</url></related-urls></urls><electronic-resource-num>10.1111/1753-0407.12524</electronic-resource-num><language>English</language></record></Cite></EndNote>581st Line: metformin2nd Line: dual therapy metformin plus one of: DPP4i, TZD, SU, GLP1RA, SGLT2i, or insulin.3rd Line: triple therapy Metformin + SU + TZD/DDP4i/SGLT2i/GLP1RA/insulinMetformin + TZD + SU/DDP4i/SGLT2i/GLP1RA/insulinMetformin + DPP4i + SU/TZD/SGLT2i/InsulinMetformin + SGLT2i + SU/TZD/DPP4i/GLP1RA/insulinMetformin + GLP1RA + SU/TZD/SGLT2i/insulinMetformin + Insulin + TZD/DDP4i/SGLT2i/GLP1RA4th Line: combination insulin therapyNational Institute of Clinical Excellence ADDIN EN.CITE <EndNote><Cite><Author>NICE</Author><Year>2015</Year><RecNum>117</RecNum><DisplayText><style face="superscript">59</style></DisplayText><record><rec-number>117</rec-number><foreign-keys><key app="EN" db-id="9e9et9fzi95p00er5v85fdtprrwd5ewa9d9w" timestamp="1552976359">117</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>NICE</author></authors></contributors><titles><title>Type 2 diabetes in adults: management. NG28</title><secondary-title>National Institute for Health and Care Excellence</secondary-title></titles><periodical><full-title>National Institute for Health and Care Excellence</full-title></periodical><dates><year>2015</year></dates><urls></urls></record></Cite></EndNote>591st Line: metformin2nd Line: dual therapy metformin plus one of: DPP4i/pioglitazone/SU/SGLT2i.3rd Line: triple therapy:Metformin + DPP4i + SUMetformin + TZD (pioglitazone) + SUMetformin + (pioglitazone/SU) + SGLT2i4th Line: Option for introduction of GLP1RA alongside metformin and SU if certain criteria met:-BMI>35kg/m2 and obesity-related medical/psychological complications -BMI <35kg/m2 and insulin therapy has significant occupational implications-If weight loss would benefit obesity-related comorbiditiesAfter exhausting first 4 steps consider insulin therapy SU: sulphonylurea; TZD: thiazolidinedione; DPP4i: dipeptidyl peptidase-4 inhibitor; GLP1RA: glucagon-like peptide-1 receptor agonist; SGLT2i: sodium-glucose cotransporter 2 inhibitor; AGi: ?-glucosidase inhibitor. Appendix Table 3.5 Pharmacological treatments for weight gain in SMIDrugCommentRisk/side effectsMetformin (500mg – 2000mg/day)First-line for psychotropic-induced weight gain. PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5KYXJza29nPC9BdXRob3I+PFllYXI+MjAxMzwvWWVhcj48
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ADDIN EN.CITE.DATA 65,66 ADDIN EN.CITE <EndNote><Cite><Author>Siskind</Author><Year>2018</Year><RecNum>181</RecNum><DisplayText><style face="superscript">67</style></DisplayText><record><rec-number>181</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553754991">181</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Siskind, D</author><author>Hahn, M</author><author>Correll, C</author><author>Fink-Jensen, A</author><author>Russell, A</author><author>Bak, N</author><author>Broberg, B</author><author>Larsen J</author><author>Ishoy, P</author><author>Vilsboell, T</author><author>Knop, F</author><author>Kisely, S</author><author>Ebdrup, BH</author></authors></contributors><titles><title>Glucagon-like peptide-1 receptor-agonists for antipsychotic- associated cardio-metabolic risk factors: a systematic review and individual participant data meta-analysis</title><secondary-title>Diabetes Obes Metab</secondary-title></titles><periodical><full-title>Diabetes Obes Metab</full-title></periodical><volume>in press</volume><dates><year>2018</year></dates><urls></urls></record></Cite></EndNote>67 Weekly formulations available.Nausea/vomiting, possible increased pancreatitis risk.Aripiprazole (5-15mg/day)Evidence for use in conjunction with clozapine or olanzapine.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5NaXp1bm88L0F1dGhvcj48WWVhcj4yMDE0PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 69,70 Theoretical risk of exacerbating psychosis. Buproprion (150mg twice daily)Evidence for use in the general population, including combination therapy with naltrexone. ADDIN EN.CITE <EndNote><Cite><Author>Greig</Author><Year>2015</Year><RecNum>128</RecNum><DisplayText><style face="superscript">71</style></DisplayText><record><rec-number>128</rec-number><foreign-keys><key app="EN" db-id="9e9et9fzi95p00er5v85fdtprrwd5ewa9d9w" timestamp="1552976359">128</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Greig, S. L.</author><author>Keating, G. M.</author></authors></contributors><auth-address>Springer, Private Bag 65901, Mairangi Bay 0754, Auckland, New Zealand, demail@.</auth-address><titles><title>Naltrexone ER/Bupropion ER: A Review in Obesity Management</title><secondary-title>Drugs</secondary-title></titles><periodical><full-title>Drugs</full-title><abbr-1>Drugs</abbr-1></periodical><pages>1269-80</pages><volume>75</volume><number>11</number><keywords><keyword>Adult</keyword><keyword>Animals</keyword><keyword>Anti-Obesity Agents/administration & dosage/adverse effects/*therapeutic use</keyword><keyword>Bupropion/administration & dosage/adverse effects/*therapeutic use</keyword><keyword>Delayed-Action Preparations</keyword><keyword>Drug Combinations</keyword><keyword>Humans</keyword><keyword>Naltrexone/administration & dosage/adverse effects/*therapeutic use</keyword><keyword>Obesity/*drug therapy</keyword><keyword>Overweight/drug therapy</keyword></keywords><dates><year>2015</year><pub-dates><date>Jul</date></pub-dates></dates><isbn>1179-1950 (Electronic)
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ADDIN EN.CITE.DATA 72 GI side effects reported. Potent inhibitor of cytochrome P450 isoenzyme CYP2D6, ADDIN EN.CITE <EndNote><Cite><Author>Kotlyar</Author><Year>2005</Year><RecNum>130</RecNum><DisplayText><style face="superscript">73</style></DisplayText><record><rec-number>130</rec-number><foreign-keys><key app="EN" db-id="9e9et9fzi95p00er5v85fdtprrwd5ewa9d9w" timestamp="1552976359">130</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kotlyar, M.</author><author>Brauer, L. H.</author><author>Tracy, T. S.</author><author>Hatsukami, D. K.</author><author>Harris, J.</author><author>Bronars, C. A.</author><author>Adson, D. E.</author></authors></contributors><auth-address>Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Twin Cities Campus, Minneapolis, MN 55455, USA. kotly001@umn.edu</auth-address><titles><title>Inhibition of CYP2D6 activity by bupropion</title><secondary-title>J Clin Psychopharmacol</secondary-title></titles><periodical><full-title>J Clin Psychopharmacol</full-title></periodical><pages>226-9</pages><volume>25</volume><number>3</number><keywords><keyword>Adult</keyword><keyword>Bupropion/*pharmacology</keyword><keyword>Cytochrome P-450 CYP2D6/metabolism</keyword><keyword>*Cytochrome P-450 CYP2D6 Inhibitors</keyword><keyword>Dextromethorphan/pharmacology/urine</keyword><keyword>Drug Interactions</keyword><keyword>Enzyme Inhibitors/pharmacology</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword></keywords><dates><year>2005</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>0271-0749 (Print)
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ADDIN EN.CITE.DATA 82,83 Sedation, cognitive impairment, paraesthesiaZonisamide (100-600mg/day)Limited evidence for use in in second-generation antipsychotic induced weight gain. ADDIN EN.CITE <EndNote><Cite><Author>Buoli</Author><Year>2017</Year><RecNum>141</RecNum><DisplayText><style face="superscript">84</style></DisplayText><record><rec-number>141</rec-number><foreign-keys><key app="EN" db-id="9e9et9fzi95p00er5v85fdtprrwd5ewa9d9w" timestamp="1552976359">141</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Buoli, M.</author><author>Grassi, S.</author><author>Ciappolino, V.</author><author>Serati, M.</author><author>Altamura, A. C.</author></authors></contributors><auth-address>Department of Psychiatry, University of Milan, Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.</auth-address><titles><title>The Use of Zonisamide for the Treatment of Psychiatric Disorders: A Systematic Review</title><secondary-title>Clin Neuropharmacol</secondary-title></titles><periodical><full-title>Clin Neuropharmacol</full-title></periodical><pages>85-92</pages><volume>40</volume><number>2</number><keywords><keyword>Anticonvulsants/adverse effects/therapeutic use</keyword><keyword>Drug Therapy, Combination</keyword><keyword>Humans</keyword><keyword>Isoxazoles/adverse effects/*therapeutic use</keyword><keyword>Mental Disorders/*drug therapy</keyword><keyword>Obesity/*drug therapy/psychology</keyword><keyword>Smoking Cessation/*methods/psychology</keyword></keywords><dates><year>2017</year><pub-dates><date>Mar/Apr</date></pub-dates></dates><isbn>1537-162X (Electronic)
0362-5664 (Linking)</isbn><accession-num>28195838</accession-num><urls><related-urls><url>, diarrhea, cognitive impairment EPSE: extrapyramidal side effects; GI: gastrointestinal.Appendix Table 3.6 Non-pharmacological and pharmacological interventions for postural hypotensionStrategyLifestyle modificationSitting up slowly in stages from supine to standingMaintain hydrationRaise head of bed 10-20 degrees: this reduces renal perfusion activating the renin-angiotensin-aldosterone system decreasing nocturnal diuresis thereby increasing intravascular volume. ADDIN EN.CITE <EndNote><Cite><Author>Wieling</Author><Year>2009</Year><RecNum>143</RecNum><DisplayText><style face="superscript">85</style></DisplayText><record><rec-number>143</rec-number><foreign-keys><key app="EN" db-id="9e9et9fzi95p00er5v85fdtprrwd5ewa9d9w" timestamp="1552976359">143</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Wieling, W.</author><author>Raj, S. R.</author><author>Thijs, R. D.</author></authors></contributors><titles><title>Are small observational studies sufficient evidence for a recommendation of head-up sleeping in all patients with debilitating orthostatic hypotension? MacLean and Allen revisited after 70 years</title><secondary-title>Clin Auton Res</secondary-title></titles><periodical><full-title>Clin Auton Res</full-title></periodical><pages>8-12</pages><volume>19</volume><number>1</number><keywords><keyword>Humans</keyword><keyword>Hypotension, Orthostatic/*therapy</keyword><keyword>Posture/*physiology</keyword><keyword>*Sleep</keyword></keywords><dates><year>2009</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>1619-1560 (Electronic)
0959-9851 (Linking)</isbn><accession-num>19224325</accession-num><urls><related-urls><url> salt and water intake: a target daily ingestion of 1.5 to 3L of water per day and 6-10g of sodium per day have been recommended.PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5Od2F6dWU8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 86-89 Meal modification may be suggested if there is a clear post-prandial association to hypotensive episodes. Advice includes reducing meal size, reducing/eliminating alcohol intake with meals, and increasing water intake with meals. Anti-embolism elastic stockingsThese should extend to the waist to reduce peripheral blood pooling. ADDIN EN.CITE <EndNote><Cite><Author>Henry</Author><Year>1999</Year><RecNum>148</RecNum><DisplayText><style face="superscript">90</style></DisplayText><record><rec-number>148</rec-number><foreign-keys><key app="EN" db-id="9e9et9fzi95p00er5v85fdtprrwd5ewa9d9w" timestamp="1552976359">148</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Henry, R.</author><author>Rowe, J.</author><author>O'Mahony, D.</author></authors></contributors><titles><title>Haemodynamic analysis of efficacy of compression hosiery in elderly fallers with orthostatic hypotension</title><secondary-title>Lancet</secondary-title></titles><periodical><full-title>Lancet</full-title></periodical><pages>45-6</pages><volume>354</volume><number>9172</number><keywords><keyword>Accidental Falls/*prevention & control</keyword><keyword>Aged</keyword><keyword>Aged, 80 and over</keyword><keyword>*Bandages</keyword><keyword>Female</keyword><keyword>Hemodynamics/*physiology</keyword><keyword>Humans</keyword><keyword>Hypotension, Orthostatic/physiopathology/*therapy</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Tilt-Table Test</keyword><keyword>Treatment Outcome</keyword></keywords><dates><year>1999</year><pub-dates><date>Jul 03</date></pub-dates></dates><isbn>0140-6736 (Print)
0140-6736 (Linking)</isbn><accession-num>10406369</accession-num><urls><related-urls><url>(99)02132-7</electronic-resource-num></record></Cite></EndNote>90 These are contraindicated in patients with peripheral vascular disease: if unsure, an ankle brachial pressure index measurement should be sought first.Physical manoeuvresIsometric handgrip when standing. ADDIN EN.CITE <EndNote><Cite><Author>Clarke</Author><Year>2010</Year><RecNum>149</RecNum><DisplayText><style face="superscript">91</style></DisplayText><record><rec-number>149</rec-number><foreign-keys><key app="EN" db-id="9e9et9fzi95p00er5v85fdtprrwd5ewa9d9w" timestamp="1552976359">149</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Clarke, D. A.</author><author>Medow, M. S.</author><author>Taneja, I.</author><author>Ocon, A. J.</author><author>Stewart, J. M.</author></authors></contributors><auth-address>Department of Pediatrics, The Center for Hypotension, New York Medical College, Valhalla, NY, USA.</auth-address><titles><title>Initial orthostatic hypotension in the young is attenuated by static handgrip</title><secondary-title>J Pediatr</secondary-title></titles><periodical><full-title>J Pediatr</full-title></periodical><pages>1019-22, 1022 e1</pages><volume>156</volume><number>6</number><keywords><keyword>Adolescent</keyword><keyword>Blood Volume</keyword><keyword>Cardiac Output</keyword><keyword>Female</keyword><keyword>*Hand Strength</keyword><keyword>Heart Rate/physiology</keyword><keyword>Humans</keyword><keyword>Hypotension, Orthostatic/*physiopathology</keyword><keyword>Male</keyword><keyword>Posture/physiology</keyword><keyword>Vascular Resistance/physiology</keyword><keyword>Young Adult</keyword></keywords><dates><year>2010</year><pub-dates><date>Jun</date></pub-dates></dates><isbn>1097-6833 (Electronic)
0022-3476 (Linking)</isbn><accession-num>20350727</accession-num><urls><related-urls><url> interventionsFludrocortisone is a synthetic mineralocorticoid, which may be considered for patients whose postural hypotension does not respond to lifestyle modification ADDIN EN.CITE <EndNote><Cite><Author>Campbell</Author><Year>1975</Year><RecNum>150</RecNum><DisplayText><style face="superscript">92</style></DisplayText><record><rec-number>150</rec-number><foreign-keys><key app="EN" db-id="9e9et9fzi95p00er5v85fdtprrwd5ewa9d9w" timestamp="1552976359">150</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Campbell, I. W.</author><author>Ewing, D. J.</author><author>Clarke, B. F.</author></authors></contributors><titles><title>9-Alpha-fluorohydrocortisone in the treatment of postural hypotension in diabetic autonomic neuropathy</title><secondary-title>Diabetes</secondary-title></titles><periodical><full-title>Diabetes</full-title></periodical><pages>381-4</pages><volume>24</volume><number>4</number><keywords><keyword>Adult</keyword><keyword>Autonomic Nervous System</keyword><keyword>Blood</keyword><keyword>Blood Pressure/drug effects</keyword><keyword>Blood Volume/drug effects</keyword><keyword>Body Weight/drug effects</keyword><keyword>Clinical Trials as Topic</keyword><keyword>Diabetic Neuropathies/*drug therapy</keyword><keyword>Edema/chemically induced</keyword><keyword>Fludrocortisone/adverse effects/pharmacology/*therapeutic use</keyword><keyword>Heart Rate/drug effects</keyword><keyword>Humans</keyword><keyword>Hypotension, Orthostatic/*drug therapy</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Osmolar Concentration</keyword><keyword>Placebos</keyword><keyword>Posture</keyword><keyword>Serum Albumin/metabolism</keyword><keyword>Urine</keyword></keywords><dates><year>1975</year><pub-dates><date>Apr</date></pub-dates></dates><isbn>0012-1797 (Print)
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ADDIN EN.CITE.DATA 96, non-steroidal anti-inflammatories ADDIN EN.CITE <EndNote><Cite><Author>Kochar</Author><Year>1978</Year><RecNum>155</RecNum><DisplayText><style face="superscript">97</style></DisplayText><record><rec-number>155</rec-number><foreign-keys><key app="EN" db-id="9e9et9fzi95p00er5v85fdtprrwd5ewa9d9w" timestamp="1552976359">155</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Kochar, M. S.</author><author>Itskovitz, H. D.</author></authors></contributors><titles><title>Treatment of idiopathic orthostatic hypotension (Shy-Drager syndrome) with indomethacin</title><secondary-title>Lancet</secondary-title></titles><periodical><full-title>Lancet</full-title></periodical><pages>1011-14</pages><volume>1</volume><number>8072</number><keywords><keyword>Administration, Oral</keyword><keyword>Blood Pressure/drug effects</keyword><keyword>Drug Evaluation</keyword><keyword>Fecal Incontinence/drug therapy/physiopathology</keyword><keyword>Female</keyword><keyword>Follow-Up Studies</keyword><keyword>Humans</keyword><keyword>Hypotension, Orthostatic/*drug therapy/physiopathology</keyword><keyword>Indomethacin/administration & dosage/*therapeutic use</keyword><keyword>Male</keyword><keyword>Nervous System Diseases/drug therapy/physiopathology</keyword><keyword>Prostaglandin Antagonists</keyword><keyword>Syndrome</keyword><keyword>Urinary Incontinence/drug therapy/physiopathology</keyword></keywords><dates><year>1978</year><pub-dates><date>May 13</date></pub-dates></dates><isbn>0140-6736 (Print)
0140-6736 (Linking)</isbn><accession-num>76934</accession-num><urls><related-urls><url>, caffeine ADDIN EN.CITE <EndNote><Cite><Author>Onrot</Author><Year>1985</Year><RecNum>156</RecNum><DisplayText><style face="superscript">98</style></DisplayText><record><rec-number>156</rec-number><foreign-keys><key app="EN" db-id="9e9et9fzi95p00er5v85fdtprrwd5ewa9d9w" timestamp="1552976359">156</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Onrot, J.</author><author>Goldberg, M. R.</author><author>Biaggioni, I.</author><author>Hollister, A. S.</author><author>Kingaid, D.</author><author>Robertson, D.</author></authors></contributors><titles><title>Hemodynamic and humoral effects of caffeine in autonomic failure. Therapeutic implications for postprandial hypotension</title><secondary-title>N Engl J Med</secondary-title></titles><periodical><full-title>N Engl J Med</full-title></periodical><pages>549-54</pages><volume>313</volume><number>9</number><keywords><keyword>Aged</keyword><keyword>Autonomic Nervous System Diseases/*drug therapy/physiopathology</keyword><keyword>Blood Pressure/drug effects</keyword><keyword>Caffeine/pharmacology/*therapeutic use</keyword><keyword>*Eating</keyword><keyword>Epinephrine/blood</keyword><keyword>Female</keyword><keyword>Heart Rate/drug effects</keyword><keyword>Hemodynamics/*drug effects</keyword><keyword>Humans</keyword><keyword>Hypotension, Orthostatic/*drug therapy/etiology/physiopathology</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Norepinephrine/blood</keyword><keyword>Renin/blood</keyword><keyword>Vasoconstrictor Agents/therapeutic use</keyword></keywords><dates><year>1985</year><pub-dates><date>Aug 29</date></pub-dates></dates><isbn>0028-4793 (Print)
0028-4793 (Linking)</isbn><accession-num>3894971</accession-num><urls><related-urls><url> and erythropoietin ADDIN EN.CITE <EndNote><Cite><Author>Hoeldtke</Author><Year>1993</Year><RecNum>157</RecNum><DisplayText><style face="superscript">99</style></DisplayText><record><rec-number>157</rec-number><foreign-keys><key app="EN" db-id="9e9et9fzi95p00er5v85fdtprrwd5ewa9d9w" timestamp="1552976360">157</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Hoeldtke, R. D.</author><author>Streeten, D. H.</author></authors></contributors><auth-address>Department of Medicine, Temple University, Philadelphia.</auth-address><titles><title>Treatment of orthostatic hypotension with erythropoietin</title><secondary-title>N Engl J Med</secondary-title></titles><periodical><full-title>N Engl J Med</full-title></periodical><pages>611-5</pages><volume>329</volume><number>9</number><keywords><keyword>Adolescent</keyword><keyword>Adult</keyword><keyword>Aged</keyword><keyword>Autonomic Nervous System Diseases/complications</keyword><keyword>Blood Pressure</keyword><keyword>Diabetic Neuropathies/complications</keyword><keyword>Erythrocyte Volume</keyword><keyword>Erythropoietin/*therapeutic use</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Hypotension, Orthostatic/blood/physiopathology/*therapy</keyword><keyword>Male</keyword><keyword>Middle Aged</keyword><keyword>Plasma Volume</keyword></keywords><dates><year>1993</year><pub-dates><date>Aug 26</date></pub-dates></dates><isbn>0028-4793 (Print)
0028-4793 (Linking)</isbn><accession-num>8341335</accession-num><urls><related-urls><url> as adjunctive agents in patients who remain symptomatic with the above regime.Part 4 Appendix: Multidisciplinary approaches to Multimorbidity Included both exercise and dietary modification? Used BCTs; including specific + measurable behavioural goals, and self-monitoring?Delivered by staff with professional qualifications in exercise or nutrition and dietetics?Offered supervised exercise sessions ≥2 per week?Mental health staff familiarised with the lifestyle intervention?Used Peer-support?Improved primary outcome?IMPaCT ADDIN EN.CITE <EndNote><Cite><Author>Gaughran</Author><Year>2017</Year><RecNum>3729</RecNum><DisplayText><style face="superscript">100</style></DisplayText><record><rec-number>3729</rec-number><foreign-keys><key app="EN" db-id="vztrr2pxoswezaedfpsvdxvvx0wff0paassr" timestamp="1515631652">3729</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gaughran, Fiona</author><author>Stahl, Daniel</author><author>Ismail, Khalida</author><author>Greenwood, Kathryn</author><author>Atakan, Zerrin</author><author>Gardner-Sood, Poonam</author><author>Stubbs, Brendon</author><author>Hopkins, David</author><author>Patel, Anita</author><author>Lally, John</author><author>Lowe, Philippa</author><author>Arbuthnot, Maurice</author><author>Orr, Diana</author><author>Corlett, Sarah</author><author>Eberhard, Jonas</author><author>David, Anthony S.</author><author>Murray, Robin</author><author>Smith, Shubulade</author></authors></contributors><titles><title>Randomised control trial of the effectiveness of an integrated psychosocial health promotion intervention aimed at improving health and reducing substance use in established psychosis (IMPaCT)</title><secondary-title>BMC Psychiatry</secondary-title></titles><periodical><full-title>BMC Psychiatry</full-title></periodical><pages>413</pages><volume>17</volume><number>1</number><dates><year>2017</year><pub-dates><date>December 28</date></pub-dates></dates><isbn>1471-244X</isbn><label>Gaughran2017</label><work-type>journal article</work-type><urls><related-urls><url> PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TcGV5ZXI8L0F1dGhvcj48WWVhcj4yMDE2PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 106YesYesYesYesYesYesYesAppendix Table 4.1. Assessment of recent lifestyle interventions in SMI against key aspects of the DPPAppendix Table 4.2. Large Scale Trials of Lifestyle Interventions in Mental Illness: Lessons from Key Studies IMPaCT ADDIN EN.CITE <EndNote><Cite><Author>Gaughran</Author><Year>2017</Year><RecNum>3729</RecNum><DisplayText><style face="superscript">100</style></DisplayText><record><rec-number>3729</rec-number><foreign-keys><key app="EN" db-id="vztrr2pxoswezaedfpsvdxvvx0wff0paassr" timestamp="1515631652">3729</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gaughran, Fiona</author><author>Stahl, Daniel</author><author>Ismail, Khalida</author><author>Greenwood, Kathryn</author><author>Atakan, Zerrin</author><author>Gardner-Sood, Poonam</author><author>Stubbs, Brendon</author><author>Hopkins, David</author><author>Patel, Anita</author><author>Lally, John</author><author>Lowe, Philippa</author><author>Arbuthnot, Maurice</author><author>Orr, Diana</author><author>Corlett, Sarah</author><author>Eberhard, Jonas</author><author>David, Anthony S.</author><author>Murray, Robin</author><author>Smith, Shubulade</author></authors></contributors><titles><title>Randomised control trial of the effectiveness of an integrated psychosocial health promotion intervention aimed at improving health and reducing substance use in established psychosis (IMPaCT)</title><secondary-title>BMC Psychiatry</secondary-title></titles><periodical><full-title>BMC Psychiatry</full-title></periodical><pages>413</pages><volume>17</volume><number>1</number><dates><year>2017</year><pub-dates><date>December 28</date></pub-dates></dates><isbn>1471-244X</isbn><label>Gaughran2017</label><work-type>journal article</work-type><urls><related-urls><url> DesignResultsLessonsDetermine the effectiveness of a modular health promotion intervention (IMPaCT Therapy) in improving health and reducing cardiovascular risk in psychosisType:Parallel, cluster controlled RCT across 5 sitesSetting & Participants:Community care coordinators were randomly assigned to training and supervision in delivering the intervention or TAU. Intervention:IMPaCT practitioners underwent a 4-day training programme. Therapy involved motivational interviewing, and CBT, drawing key principles from the “Wellbeing Support Program” and the “Managing Mental Health and Drug Use”. IMPaCT was delivered over 9 months.Adherence:Defined as at least 6 sessions each of at least 30 minutes duration in addition to routine care.Primary outcome: Physical and mental health component scores of SF-36. Power calculation:70 care coordinators each with 4 patients (280 patients), allowing for 20% loss of care coordinator and 30% loss of patients to follow up, was needed to detect a reduction of 5 points on both physical (d = 0.5) and mental health scale (d = 0.42) with at least 80% power using an alpha level of 0.05 and two-tailed assumptions.Secondary outcomes: Metabolic biochemistry, CRP, anthropometry, blood pressure, substance use, lifestyle factors and mental health status.Recruitment:104 community care coordinators (with 213 patients) were randomised to either the IMPaCT intervention or TAU.Adherence & Retention:Of 406 patients, 318 (78%) and 301 (74%) completed 12-month and 18-month follow-up respectively. 19 patients (9%) met minimums for adherence (47 patients or 22% reached at least 180 minutes of IMPaCT Therapy irrespective of number of sessions). Primary outcome:No significant difference between IMPaCT and TAU Secondary outcomes:HDL cholesterol improved more in IMPaCT group compared to TAU [effect = 0.085 (0.007 to 0.16), p = 0.034, d = 0.2]. No other between group differences in secondary outcomes Strengths of the IMPaCT trial are that it focused on staff training and indirectly, staff culture. Identified limitations include focusing on existing staff without the provision of additional services or dedicated practitioners. For example, only 17-36% of care-coordinators managed to deliver the minimum dose of IMPaCT therapy.The authors highlight the need for an integrated approach to the provision of lifestyle interventions and provide evidence that in the absence of dedicated practitioners, systemic culture change within services or the provision of additional resources, solely focussing on the training and supervision of front-line mental health workers is insufficient to change therapeutic practice at a level required to reverse cardiometabolic risk indicators in patients with established psychosisAuthors conclude that “it may be that widening mental health teams to include specialists in exercise and nutrition is necessary”CHANGE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5TcGV5ZXI8L0F1dGhvcj48WWVhcj4yMDE2PC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 101AimsStudy DesignResultsLessonsExplore whether a 12-month lifestyle coaching plus care coordination plus TAU, compared to care coordination plus TAU, and TAU alone, can reduce the 10-year risk of CVD in people with SCZ and abdominal obesity.Type:3-arm, randomized, parallel-group superiority trialSetting and population:Participants were obese people with schizophrenia. Coaches were health professionals (occupational therapists, physiotherapists or dieticians)Intervention:Lifestyle coaching plus care coordination:Coaches received training in motivational interviewing (5 days), smoking cessation (5 days), treatment of lifestyle disorders (1 day), and health eating (2 days). Lifestyle coaching included tailored, manual-based intervention targeting physical inactivity, unhealthy dietary habits and smoking, and facilitating contact to the patient’s general practitioner. Lifestyle coaching was based on the theory of the stages of change, motivational interviewing and an assertive approach (adapted from the assertive community treatment), delivered via home visits, of at-least one weekly meeting. Additional support available via text messages, phone calls and email messages. Care coordination plus TAU:Manual-based intervention added to usual care. Care coordinator (psychiatric nurse) facilitated contact to primary care to ensure optimal treatment of physical health problems.Adherence:Intended sessions with coach were 42 per participantPrimary outcome:10-year risk of cardiovascular disease Power calculation: Allowing a power of 90%, we estimated to recruit 150 participants to each intervention group, a total of 450 participants. This calculation was based on a standard deviation of 5.9% of the Copenhagen risk score as found in the Inter99-trialSecondary outcomes: CRF, FEV, WC, BP, metabolic biochemistry, self-reported PAL.Recruitment:428 participants randomised: 138 to CHANGE, 142 to care coordination plus TAU, and 148 to TAU.Adherence/Retention:86% retention in whole program, no difference between groups. Change participants had a mean 24.6 ± 14.5 sessions. 60% of participants attended 21 of the intended 42 sessions.Primary outcome:No difference between CHANGE intervention plus care-coordination, care-coordination plus TAU, or TAU alone. Secondary outcomes:No significant difference was found for secondary outcomes.Within this high-income setting, usual care includes mandatory screening through primary care, and therefore the quality of standard care is considerably higher in comparison to other settings and countries which is likely to have impacted the outcomes.The conclusion from CHANGE is that future interventions should consider the environmental/structural changes necessary to achieve sustainable change, rather than individually anchored health interventions, taking into account the special needs of patients with schizophreniaINTERACT ADDIN EN.CITE <EndNote><Cite><Author>Lovell</Author><Year>2014</Year><RecNum>1185</RecNum><DisplayText><style face="superscript">102</style></DisplayText><record><rec-number>1185</rec-number><foreign-keys><key app="EN" db-id="vztrr2pxoswezaedfpsvdxvvx0wff0paassr" timestamp="1402969561">1185</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lovell, K.</author><author>Wearden, A.</author><author>Bradshaw, T.</author><author>Tomenson, B.</author><author>Pedley, R.</author><author>Davies, L. M.</author><author>Husain, N.</author><author>Woodham, A.</author><author>Escott, D.</author><author>Swarbrick, C. M.</author><author>Femi-Ajao, O.</author><author>Warburton, J.</author><author>Marshall, M.</author></authors></contributors><auth-address>School of Nursing, Midwifery and Social Work, Room 6.322a, Jean McFarlane Bldg, Oxford Rd, University of Manchester, Manchester, M13 9PL United Kingdom karina.lovell@manchester.ac.uk.</auth-address><titles><title>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</title><secondary-title>Journal of Clinical Psychiatry</secondary-title><alt-title>The Journal of clinical psychiatry</alt-title></titles><periodical><full-title>Journal of Clinical Psychiatry</full-title></periodical><alt-periodical><full-title>The Journal of clinical psychiatry</full-title></alt-periodical><pages>498-505</pages><volume>75</volume><number>5</number><section>498</section><dates><year>2014</year><pub-dates><date>Jan 21</date></pub-dates></dates><isbn>1555-2101 (Electronic)
0160-6689 (Linking)</isbn><accession-num>24500028</accession-num><urls><related-urls><url> DesignResultsLessonsTo determine the uptake, adherence, and clinical effectiveness of a 12-month healthy living intervention designed to reduce weight gain in people with a first-episode of psychosis in the last 3 years, who were overweight/obese.Type: RCTSetting and population:Participants were overweight/obese people with first-episode psychosis. Intervention was delivered by support, time, and recovery workers who attended a 3-day training program.Intervention:Healthy living intervention drew on the Leventhal’s Common Sense Model and contained both motivational and behavioural components. Sessions included patient-centered goals and implementation of and review of patient-led action plans. Optional group activities included football, walking, cycling, cooking groups. Booklets and a Web site were included to provide educational advice, action plans, goals and healthy-eating recipes. TAU received some level of support from their case manager to undertake physical health activities. Adherence:7-individual sessions over 6 months, and a booster session at 9-10 months. Primary outcome:BMIPower calculation:To achieve 90% power at p < 0.05 using a t-test, 39 participants required in each group (based on a systematic review giving effect size of 0.75).Secondary outcomes:WC, dietary intake, PAL, depression scale, health status (SF-36), QOL, medication adherence, health and social care costs Recruitment:105 participants randomised: 54 INTERACT and 51 TAURetention/adherence:93 participants were followed-up at 12-months.78% completed 6-8 sessions, 96% had at least 1 session.Primary outcome:No between group difference found. For participants taking clozapine/olanzapine at time of randomisation, mean weight change was -1.1kg in the intervention group (n=15), compared to 3.7kg in TAU (n=10), (p = 0.19, effect size 0.55).Secondary outcomes: No secondary variables assessed were associated to change in BMI. Overall costs of health and social care services were lower in the intervention group, but this was not statistically significant.Larger effect found in people taking clozapine/olanzapine at time of randomisation.More intensive intervention may be indicated.May be less effective in people who are already overweight at time of intervention.In SHAPE ADDIN EN.CITE <EndNote><Cite><Author>Bartels</Author><Year>2013</Year><RecNum>4141</RecNum><DisplayText><style face="superscript">103</style></DisplayText><record><rec-number>4141</rec-number><foreign-keys><key app="EN" db-id="vztrr2pxoswezaedfpsvdxvvx0wff0paassr" timestamp="1542290116">4141</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bartels, Stephen J</author><author>Pratt, Sarah I</author><author>Aschbrenner, Kelly A</author><author>Barre, Laura K</author><author>Jue, Kenneth</author><author>Wolfe, Rosemarie S</author><author>Xie, Haiyi</author><author>McHugo, Gregory</author><author>Santos, Meghan</author><author>Williams, Gail E</author></authors></contributors><titles><title>Clinically significant improved fitness and weight loss among overweight persons with serious mental illness</title><secondary-title>Psychiatric Services</secondary-title></titles><periodical><full-title>Psychiatric Services</full-title></periodical><pages>729-736</pages><volume>64</volume><number>8</number><dates><year>2013</year></dates><isbn>1075-2730</isbn><urls></urls></record></Cite></EndNote>103AimsStudy DesignResultsLessonsConduct a pragmatic clinical trial to determine whether an 12-month healthy coaching program can increase fitness and reduce weight in people with serious mental illness. Type: RCTSetting and participants:Participants were people with Major Depressive Disorder, Schizophrenia or Bipolar Affective Disorder and a BMI > 25kg/m2. In SHAPE delivered by health mentors in community mental health centres.Intervention:In SHAPEFitness club membership and a health mentor (fitness trainer who may also be a case manager) who had received instruction on healthy eating and nutrition and tailoring individual wellness plans to SMI. Coaches received 2x 60min supervision calls per week with a range of experts. Personalised were developed for participants at start of intervention and met with health mentor weekly at YMCA (for 45-60mins) for support. Nutrition component was included as individualized instruction during each meeting (focussed on healthy eating).Control conditionControl group received fitness membership with an introductory session of safe use of exercise equipment. Primary outcomes:CRF, WT and BMIPower calculation: Not reportedSecondary outcomes:PAL, dietary behaviourRecruitment: 210 participants: 67 In SHAPE and 66 fitness club membership and education.Retention/Adherence78% retention in both groups (n = 53 in each group). Mean gym visits was more than 2.5 times greater in intervention group (mean 28.5 ± 36.9) compared to control (10.7 ± 2.4).Primary outcomes:In SHAPE improved CRF more than fitness club membership and education alone (F = 5.6, p = 0.020, ES = 0.37)No between group difference for WT and BMI Secondary outcomes:In SHAPE had greater improvements in exercise minutes (F = 11.6, p = 0.001, ES = 0.28) and vigorous activity (F = 12.0, p = 0.001, ES = 0.48), compared to fitness club membership and education. In SHAPE resulted in greater self-reported improvements in dietary fat score (F = 13.0, p < 0.001, ES = 0.69) and portion size (F = 4.0, p = 0.047, ES = 0.15). In SHAPE participants had a trend to statistical significance for greater improvements in fruits and vegetable consumption (F = 3.7, p = 0.055, ES = 0.17).Incorporation of a health mentor (fitness trainer) with gym membership results in greater fitness club attendance, greater engagement in overall physical activity and specifically vigorous activity, and improvements in dietary behaviours compared to only providing greater access to physical exercise opportunities.The health mentor may assist in overcoming barriers to behaviour change such as motivational challenges.The absence of a difference in weight between groups may be explained in part by nutrition education focussing on healthy eating and improved nutrition whereas other weight management interventions incorporate caloric restriction and daily food diaries.The In SHAPE program has undergone a pragmatic replication trial, using the same conditions, delivering In SHAPE over a 12-month period with an added 18-month follow-up time point. The In SHAPE program was again superior in achieving greater weight loss and improving fitness compared to control condition. ADDIN EN.CITE <EndNote><Cite><Author>Bartels</Author><Year>2015</Year><RecNum>242</RecNum><DisplayText><style face="superscript">107</style></DisplayText><record><rec-number>242</rec-number><foreign-keys><key app="EN" db-id="2rrp59zeu5xf0pe2t59xvfwidatvfvea2wdp" timestamp="1553755004">242</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bartels, Stephen J</author><author>Pratt, Sarah I</author><author>Aschbrenner, Kelly A</author><author>Barre, Laura K</author><author>Naslund, John A</author><author>Wolfe, Rosemarie</author><author>Xie, Haiyi</author><author>McHugo, Gregory J</author><author>Jimenez, Daniel E</author><author>Jue, Ken</author></authors></contributors><titles><title>Pragmatic replication trial of health promotion coaching for obesity in serious mental illness and maintenance of outcomes</title><secondary-title>American Journal of Psychiatry</secondary-title></titles><periodical><full-title>American Journal of Psychiatry</full-title></periodical><pages>344-352</pages><volume>172</volume><number>4</number><dates><year>2015</year></dates><isbn>0002-953X</isbn><urls></urls></record></Cite></EndNote>107 ACHIEVE PEVuZE5vdGU+PENpdGU+PEF1dGhvcj5EYXVtaXQ8L0F1dGhvcj48WWVhcj4yMDEzPC9ZZWFyPjxS
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ADDIN EN.CITE.DATA 104AimsStudy DesignResultsLessonsDetermine the effectiveness of an 18-month tailored behavioural weight-loss intervention in adults with serious mental illness. Type: RCTSettings and participants:Recruitment from 10 community psychiatric outpatient programs. Participants were living with schizophrenia, bipolar affective disorder or major depressive disorder. Intervention was delivered in outpatient rehabilitation programs.Intervention: ACHIEVERehabilitation programs routinely provided breakfast and lunch to all program attendees. To facilitate the availability of reduced-calorie food choices, healthier options were offered to program participants. Three intervention components were: i. group weight-management sessions, ii. individual weight-management sessions, and iii. group exercise sessions. Intervention aimed to reduced calorie intake by avoiding sugar-sweetened beverages and junk food, eating 5 servings of fruit and vegetables daily, choosing smaller portions and healthy snacks, and participating in moderate-intensity aerobic exercise.ControlControl group received standard nutrition and physical activity information at baseline, and health classes were offered quarterly (unrelated to weight). Primary outcome: WeightPower calculation: The original enrollment target was 320 participants. The initial study design assumed a 20% loss to follow-up, resulting in an effective sample size of 256. This study design provided 86% power to detect a between-group difference in weight change of 2.0 kg (4.5 lb) at 18 months.Secondary outcomes: WC, BP, blood biochemistryRecruitment:291 participants were randomised: 144 ACHIEVE intervention and 147 controls.Retention and adherence:18-month follow-up data were collected on 279 participants (96%). Median number of contacts in ACHIEVE were 2.5 per month. Participants attended 46 of 82 sessions offered (56%) in months 1-6 and 31 of 161 sessions offered (19%) in months 7-18.Primary outcome:Weight change was significantly higher in the intervention group at 6, 12 and 18 months. At 18 months, mean intervention group weight loss was 3.4kg versus 0.2kg in the control group (MD = 3.2kg, 95%CI -5.1 to -1.2, p = 0.002). At 18 months, 64% of intervention group were at, or lower than, their baseline weight, compared to 49% in the control group. 38% in the intervention group lost at least 5% of their baseline weight, compared to 23% in the control group. No significant changes in secondary outcomesStandardised procedures and materials promoted fidelity of the study, and ongoing training and quality assurance included regular observation of intervention staff.Weight loss achieved at 18 months in this trial compares favourably with lifestyle interventions in the general population. Patients continued to lose weight after 6 months, contrary to previous studies where weight-loss peaks at 6 months then weight regain occurs. CAPiCOR ADDIN EN.CITE <EndNote><Cite><Author>Masa-Font</Author><Year>2015</Year><RecNum>19</RecNum><DisplayText><style face="superscript">105</style></DisplayText><record><rec-number>19</rec-number><foreign-keys><key app="EN" db-id="p59d0ad2rr502se09wtptvxjs5s000edw9zx" timestamp="0">19</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Masa-Font, R</author><author>Fernández-San-Martín, MI</author><author>López, LM Martín</author><author>Mu?oz, AM Alba</author><author>Canet, S Oller</author><author>Royo, J Martín</author><author>Echevarría, L San Emeterio</author><author>Tabue?a, N Olona</author><author>Jato, M Ibarra</author><author>García, A Barroso</author></authors></contributors><titles><title>The effectiveness of a program of physical activity and diet to modify cardiovascular risk factors in patients with severe mental illness after 3-month follow-up: CAPiCOR randomized clinical trial</title><secondary-title>European Psychiatry</secondary-title></titles><periodical><full-title>European Psychiatry</full-title></periodical><pages>1028-1036</pages><volume>30</volume><number>8</number><dates><year>2015</year></dates><isbn>0924-9338</isbn><urls></urls></record></Cite></EndNote>105AimsStudy DesignResultsLessonsEvaluate the effectiveness of a 3-month educational intervention with a focus on diet and physical activity to improve PAL, BMI and waist circumference in people with severe mental illness. Type: RCTSetting and participants:10 recruitment centres. Participants were overweight/obese people with schizophrenia/schizoaffective disorder or major depressive disorder, and had been receiving antipsychotic medication treatment for at least 3 months.Intervention: CAPiCORIntervention group went through an educational program and followed a PA program and engaged in dietary intervention in groups of no more than 15 people. 24 session intervention in total (twice weekly). Participants given pedometers and routes to walk to reach 10,000 steps/day. Dietary intervention was 16 sessions for 20 minutes each, delivered by a nurse, based on basic healthy eating (Med Diet). 1-day food diaries were reviewed to check knowledge acquired and adherence. ControlControl group had routine check-ups with their psychiatrist (every 2 months). Primary outcomes:PAL, BMI, WCPower calculation:Not reported, although states that 478 was the calculated sample size target.Secondary outcomes:BP, metabolic biochemistry, dietary habits, QOLRecruitment:322 participants were randomised: 169 CAPiCOR and 163 controls.Retention and adherence:87% remained engaged at 3 months (84% CAPiCOR and 89% controls). 49% of participants attended at least 60% of the sessions. 6.3% did not attend any sessions. Attendance at sessions within the centre (diet education and group exercise) was 58%, compared to external walking sessions 42.6% (p = 0.006).Primary outcomes: Intervention group increased in walking METs compared to control (MD = 266, 95% CI 16.86 to 515.25, p = 0.036). BMI decreased more in the control group (Mean = -0.23) compared to the intervention group (Mean = 0.04), (MD = 0.26, 95%CI 0.02 to 0.51, p = 0.038). No between group difference for WC.Secondary outcomes:Glucose also reduced more in the control group (mean = -2.43) compared to intervention (mean = 1.36), (MD = 3.79, 95% CI 0.27 to 7.30, p = 0.035). No between group difference for other metabolic biochemistry parameters or dietary habits. ‘Professional participants’ underwent training to deliver the intervention. Participants were given a pedometer and individual walking routes to reach goal based on participants residence. STRIDE ADDIN EN.CITE <EndNote><Cite><Author>Green</Author><Year>2015</Year><RecNum>1337</RecNum><DisplayText><style face="superscript">108</style></DisplayText><record><rec-number>1337</rec-number><foreign-keys><key app="EN" db-id="vztrr2pxoswezaedfpsvdxvvx0wff0paassr" timestamp="1411964647">1337</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Green, Carla A.</author><author>Yarborough, Bobbi Jo H.</author><author>Leo, Michael C.</author><author>Yarborough, Micah T.</author><author>Stumbo, Scott P.</author><author>Janoff, Shannon L.</author><author>Perrin, Nancy A.</author><author>Nichols, Greg A.</author><author>Stevens, Victor J.</author></authors></contributors><titles><title>The STRIDE Weight Loss and Lifestyle Intervention for Individuals Taking Antipsychotic Medications: A Randomized Trial</title><secondary-title>American Journal of Psychiatry</secondary-title></titles><periodical><full-title>American Journal of Psychiatry</full-title></periodical><pages>71-81</pages><volume>172</volume><number>1</number><dates><year>2015</year></dates><urls></urls></record></Cite></EndNote>108AimsStudy DesignResultsLessonsAssess whether a lifestyle intervention, tailored for individuals with serious mental illnesses, reduced weight and diabetes risk in comparison to usual careType: RCTSetting and participants:Community mental health centres. Participants were adults over 18 years of age, taking antipsychotic medication for at least 30 days with a body mass index of 27.Intervention: STRIDEBased on the PREMIER lifestyle intervention with the DASH diet. Focused on dietary change, moderate calorie restriction and increased energy expenditure through physical activity. Intervention was adapted for SMI through additional facilitators (mental health counsellor and nutritionist), repetition, sessions on psychiatric medications and planning for symptom exacerbation, sleep, budgeting and stress management. Intervention group attended weekly 2-hour group meetings with 20 minutes of physical activity over 6 months. Participants were taught to keep records of 1) food, beverages, and calories consumed; 2) servings of fruits, vegetables, and low-fat dairy products; 3) fibre and fat intake; 4) daily minutes exercised; and 5) nightly hours slept. ControlUsual carePrimary outcomes:BMIPower calculation:Based on a two-tailed alpha level of 0.05, and a target sample size of 252 participants, study had 96% power to detect a time-by-group effect on weight at 6 months and 87% power at 12 monthsSecondary outcomes:Metabolic biochemistry, waist circumference, blood pressureRecruitment:200 participants were randomised: 104 STRIDE and 96 controls.Retention and adherence:Follow-up data available for 91% of participants (N=181) at 6 months and for 85% (N=170) at 12 months, The average number of sessions attended was 14.5 (SD=7.2) out of 24 (60.2%) among intervention participants. Primary outcomes: The intervention group lost 4.4 kg more than the control group (95% CI= –6.96 kg to –1.78 kg) at 6 months and 2.6 kg more than the control group (95% CI5–5.14 kg to –0.07 kg) at 12 months.Among participants with complete data at baseline and the 6-month follow-up, the intervention group lost an average of 3.9% and the control group gained an average of 0.9% of baseline weight. No significant change in blood pressure, blood lipids, Secondary outcomes:Glucose also reduced more in the control group (mean = -2.43) compared to intervention (mean = 1.36), (MD = 3.79, 95% CI 0.27 to 7.30, p = 0.035). No between group difference for other metabolic biochemistry parameters or dietary habits. 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ADDIN EN.CITE.DATA 106 and long term (2 year) ADDIN EN.CITE <EndNote><Cite><Author>Curtis</Author><Year>2018</Year><RecNum>8926</RecNum><DisplayText><style face="superscript">109</style></DisplayText><record><rec-number>8926</rec-number><foreign-keys><key app="EN" db-id="p59d0ad2rr502se09wtptvxjs5s000edw9zx" timestamp="1547525402">8926</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Curtis, Jackie</author><author>Watkins, Andrew</author><author>Teasdale, Scott</author><author>Lederman, Oscar</author><author>Kalucy, Megan</author><author>Lappin, Julia</author><author>Samaras, Katherine</author><author>Rosenbaum, Simon</author><author>Ward, Philip B</author></authors></contributors><titles><title>2-year follow-up: Still keeping the body in mind</title><secondary-title>The Australian and New Zealand journal of psychiatry</secondary-title></titles><periodical><full-title>The Australian and New Zealand journal of psychiatry</full-title></periodical><pages>602</pages><volume>52</volume><number>6</number><dates><year>2018</year></dates><isbn>1440-1614</isbn><urls></urls></record></Cite></EndNote>109 weight-gain (and associated cardiometabolic decline) was prevented by the early lifestyle intervention and mindful APM prescribing.Expansion of KBIM intervention to all early psychosis services in the local health district, delivered as routine care, with ongoing evaluation for program refinement.Pilot specialist-delivered smoking cessation intervention to young people with first-episode psychosis.Delivery of specialist-driven intervention (diet, exercise & smoking cessation) to those receiving clozapine or a long-acting injectable antipsychotic (high metabolic risk groups). Early Intervention Service (Psychosis)PHAstER study (Melbourne, Australia).To evaluate whether the addition of a physical health nurse into the treating team can prevent the onset of weight gain or other metabolic factors in young people with a first episode of psychosisA number of interventions for physical health have been introduced – including exercise physiologists, dieticians, gym group, yoga group and boxing group. The role of the physical health nurse will co-ordinate the young person in engaging with these interventions and conduct metabolic monitoring. Intervention and selected components were selected on basis of service user consultations and feedback on other initatives to maximize acceptability Recruitment commencing August 2018 and will continue until December 2019. Study will evaluate whether a service model of case-manager, doctor and physical health nurse will be effective to prevent weight gain and metabolic factors. If demonstrated then a multi-site RCT will be conducted. A number of secondary outcomes are being examined – including symptoms severity, sleep, satisfaction with services. Outpatients from Private Psychiatric Hospital(severe mental illness): Healthy Body,Healthy Mind (HBHM) study ADDIN EN.CITE <EndNote><Cite><Author>Murphy</Author><Year>2019</Year><RecNum>8968</RecNum><DisplayText><style face="superscript">110</style></DisplayText><record><rec-number>8968</rec-number><foreign-keys><key app="EN" db-id="p59d0ad2rr502se09wtptvxjs5s000edw9zx" timestamp="1548029728">8968</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Murphy, JA</author><author>Oliver, G</author><author>Ng, C</author><author>Wain, C</author><author>Magennis, J</author><author>Opie, R</author><author>Bannatyne, A</author><author>Sarris, J</author></authors></contributors><titles><title>Pilot-Testing of “Healthy Body Healthy Mind”: An Integrative Lifestyle Program for Patients with a Mental Illness and Co-morbid Metabolic Syndrome</title><secondary-title>Frontiers in Psychiatry</secondary-title></titles><periodical><full-title>Frontiers in Psychiatry</full-title></periodical><pages>in press</pages><dates><year>2019</year></dates><urls></urls></record></Cite></EndNote>110(Melbourne, Australia)Reducing weight, abdominal obesity and improving metabolic parameters & enhancing mental wellbeing in people with SMI and comorbid metabolic syndrome, using a weekly group program delivered through outpatient psychiatric hospital. A group lifestyle intervention:a) Exercise instruction (weekly via a qualified exercise physiologist)b) Dietary instruction (practical) and education (via a qualified dietician)c) Psychoeducation (on a range of healthy lifestyle practices)d) Mindfulness training (meditation, mindful eating etc.)e) Motivation and goal setting training. Mixed-methods evaluation of participant’s and clinician’s experiences of the program and reported changesThe most beneficial/useful components of the program reported by the majority of participants were the cooking and exercise ‘practical’ elementsAfter 12-weeks, significant reductions of bodyweight, waist circumference and BMI had occurred. ADDIN EN.CITE <EndNote><Cite><Author>Murphy</Author><Year>2019</Year><RecNum>8968</RecNum><DisplayText><style face="superscript">110</style></DisplayText><record><rec-number>8968</rec-number><foreign-keys><key app="EN" db-id="p59d0ad2rr502se09wtptvxjs5s000edw9zx" timestamp="1548029728">8968</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Murphy, JA</author><author>Oliver, G</author><author>Ng, C</author><author>Wain, C</author><author>Magennis, J</author><author>Opie, R</author><author>Bannatyne, A</author><author>Sarris, J</author></authors></contributors><titles><title>Pilot-Testing of “Healthy Body Healthy Mind”: An Integrative Lifestyle Program for Patients with a Mental Illness and Co-morbid Metabolic Syndrome</title><secondary-title>Frontiers in Psychiatry</secondary-title></titles><periodical><full-title>Frontiers in Psychiatry</full-title></periodical><pages>in press</pages><dates><year>2019</year></dates><urls></urls></record></Cite></EndNote>110 There were no significant changes in mental health or on any other biometrics including blood levels.Study replication is now required using a controlled design in a larger sample. HBHM can still be further fine-tuned to provide the best method of delivery: format, intensity, and duration of the program for people with SMI. Especially in integrating in online components to reduce cost and potentially improve patient compliance. Community Leisure Services (transdiagnostic referrals, from primary care, addiction and mental health services): The Take Charge! Project(Sydney, Australia)Using community leisure services and fitness centres to improve physical and mental health outcomes in people with mental illness‘Referral Scheme’ from CMHTs and primary care to local authority-linked leisure providers (Belgravia Leisure): a) Leisure centre access and free personalised health & fitness programs to people with diagnosed mental illness (transdiagnostic). b) Delivered by personal trainers and exercise physiologists who have received specialist training in ‘Understanding Mental Health’ and ‘Mental Health First Aid’. 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ADDIN EN.CITE.DATA 111-113As of Dec 2018, ~350 people have completed the 8-weeks Take Charge! programThe Take Charge! scheme is undergoing translation into more youth-friendly formats (for young people with mental illness), while also aiming to be rolled out across up to 60 leisure centres throughout Australia by 2020. Alongside this, 6000 leisure centre staff with undergo the aforementioned mental health training. Outpatients from Private Psychiatric Hospital(severe mental illness): Healthy Body,Healthy Mind (HBHM) study ADDIN EN.CITE <EndNote><Cite><Author>Murphy</Author><Year>2019</Year><RecNum>8968</RecNum><DisplayText><style face="superscript">110</style></DisplayText><record><rec-number>8968</rec-number><foreign-keys><key app="EN" db-id="p59d0ad2rr502se09wtptvxjs5s000edw9zx" timestamp="1548029728">8968</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Murphy, JA</author><author>Oliver, G</author><author>Ng, C</author><author>Wain, C</author><author>Magennis, J</author><author>Opie, R</author><author>Bannatyne, A</author><author>Sarris, J</author></authors></contributors><titles><title>Pilot-Testing of “Healthy Body Healthy Mind”: An Integrative Lifestyle Program for Patients with a Mental Illness and Co-morbid Metabolic Syndrome</title><secondary-title>Frontiers in Psychiatry</secondary-title></titles><periodical><full-title>Frontiers in Psychiatry</full-title></periodical><pages>in press</pages><dates><year>2019</year></dates><urls></urls></record></Cite></EndNote>110(Melbourne, Australia)Reducing weight, abdominal obesity and improving metabolic parameters & enhancing mental wellbeing in people with SMI and comorbid metabolic syndrome, using a weekly group program A group lifestyle intervention:a) Exercise instruction (weekly via a qualified exercise physiologist)b) Dietary instruction (practical) and education (via a qualified dietician)c) Psychoeducation d) Mindfulness training e) Motivation and goal setting training. Mixed-methods evaluation of participant’s and clinician’s experiences of the program and reported changesThe most useful components reported by participants were cooking and exercise ‘practical’ elements.After 12-weeks, reductions of bodyweight, waist circumference and BMI had occurred. ADDIN EN.CITE <EndNote><Cite><Author>Murphy</Author><Year>2019</Year><RecNum>8968</RecNum><DisplayText><style face="superscript">110</style></DisplayText><record><rec-number>8968</rec-number><foreign-keys><key app="EN" db-id="p59d0ad2rr502se09wtptvxjs5s000edw9zx" timestamp="1548029728">8968</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Murphy, JA</author><author>Oliver, G</author><author>Ng, C</author><author>Wain, C</author><author>Magennis, J</author><author>Opie, R</author><author>Bannatyne, A</author><author>Sarris, J</author></authors></contributors><titles><title>Pilot-Testing of “Healthy Body Healthy Mind”: An Integrative Lifestyle Program for Patients with a Mental Illness and Co-morbid Metabolic Syndrome</title><secondary-title>Frontiers in Psychiatry</secondary-title></titles><periodical><full-title>Frontiers in Psychiatry</full-title></periodical><pages>in press</pages><dates><year>2019</year></dates><urls></urls></record></Cite></EndNote>110 No significant changes in mental health or any other biometrics Study replication is now required using a controlled design in a larger sample. HBHM can still be further fine-tuned to provide the best method of delivery: format, intensity, and duration of the program for people with SMI. Especially in integrating in online components to reduce cost and potentially improve patient compliance. Residential Rehabilitation Units (Severe Mental Illness)GO HEART ADDIN EN.CITE <EndNote><Cite><Author>Korman</Author><Year>2018</Year><RecNum>12785</RecNum><DisplayText><style face="superscript">114</style></DisplayText><record><rec-number>12785</rec-number><foreign-keys><key app="EN" db-id="0tpsw9zfo5z2wuex0fkvwsr6pewsdxxrsrx5" timestamp="1548739428">12785</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Korman, Nicole H</author><author>Shah, Shelukumar</author><author>Suetani, Shuichi</author><author>Kendall, Karen</author><author>Rosenbaum, Simon</author><author>Dark, Frances</author><author>Nadareishvili, Ketevan</author><author>Siskind, Dan</author></authors></contributors><titles><title>Evaluating the Feasibility of a Pilot Exercise Intervention Implemented Within a Residential Rehabilitation Unit for People With Severe Mental Illness: GO HEART:(Group Occupational Health Exercise and Rehabilitation Treatment)</title><secondary-title>Frontiers in Psychiatry</secondary-title></titles><periodical><full-title>Frontiers in Psychiatry</full-title></periodical><volume>9</volume><dates><year>2018</year></dates><urls></urls></record></Cite></EndNote>114 study(Brisbane, Australia)The GO HEART project aims to offer a lifestyle (diet plus exercise) intervention for people with severe and persistent mental illness in a residential rehabilitation facility in Brisbane Australiaa) a 10-week exercise physiology student led circuit mixed aerobic and resistance exercise intervention provided 3 times per week on site for residentsb) an interactive dietary training program led by a dietitian. Single arm, prospective pilot study evaluating outcomes pre- and post- a 10 week interventionThe program was well accepted with recruitment, retention and participation rates around 80%. There were promising improvements in functional exercise capacity, amount of time spent exercising and reduction of negative symptoms.This program has been extended to other residential rehabilitation facilities in Brisbane, with ongoing munity Mental Health Services (Severe Mental Illness)Walk this Way ADDIN EN.CITE <EndNote><Cite><Author>Williams</Author><Year>2016</Year><RecNum>3356</RecNum><DisplayText><style face="superscript">115</style></DisplayText><record><rec-number>3356</rec-number><foreign-keys><key app="EN" db-id="vztrr2pxoswezaedfpsvdxvvx0wff0paassr" timestamp="1503532725">3356</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Williams, Julie</author><author>Stubbs, Brendon</author><author>Gaughran, Fiona</author><author>Craig, Tom</author></authors></contributors><titles><title>‘Walk This Way’–a pilot of a health coaching intervention to reduce sedentary behaviour and increase low intensity exercise in people with serious mental illness: study protocol for a randomised controlled trial</title><secondary-title>Trials</secondary-title></titles><periodical><full-title>Trials</full-title></periodical><pages>594</pages><volume>17</volume><number>1</number><dates><year>2016</year></dates><isbn>1745-6215</isbn><urls></urls></record></Cite></EndNote>115 study (London, England)Using health coaching in community dwelling people with SMI to increase physical and reduce sedentary behaviour. Intervention from self-efficacy theory consists of:1) Educational session on benefits of active lifestyle, addressing common barriers2) Provision of digital objective devices to self-monitor PA3) Fortnightly health coaching intervention for 16 weeks.4) Weekly walking group.Feasibility RCT to consider acceptability of the intervention and outcomes. Target recruitment (N=40) were reached. The intervention was reported to be feasible and acceptable to participants and staff delivering the coaching. There was an indication of an increase in objective (accelerometer) PA and reduced SB. We are currently refining the intervention and applying for funding for a larger RCT. Homeless Population in central London, UK (Alcohol addiction, drug addiction and a range of mental health complications).‘Promoting physical activity in vulnerable adults “at risk” of homelessness: A Randomised Controlled Trial’The aim of this study is to evaluate the impact of a group exercise intervention on activity levels, mental health, and physical health in people who are homeless or at risk of homelessness in central London, UK. A group exercise intervention:a) Participants recruited through a London-based homeless charityb) Allocated to intervention (exercise classes) or control (usual care), then followed up at 3, 6, 9, and 12 month. c) All exercise sessions (one per week for 12 months) will be run by qualified fitness instructors or sport coaches. d) All sessions will be designed to cater for the participants needs after conversations between participants and programme lead at the start and throughout the intervention. e) Conversations will be unstructured and participant-led. Exercise sessions were run across four cites over a period of nine months and all data to be collected in the main were collected. The intervention and data collection method were deemed acceptable in this high risk population and no adverse events were encountered. No substantial changes will be made to the intervention or the protocol and data collected may be used in the main analyses. The intervention and evaluation procedures will be delivered to a further 900 patrons of the homeless charity. The study is expected to be completed in 2022. Appendix Table 5.1. Key Recommended Resources for Integrating Physical Healthcare at Individual, Health Service, and Population Levels for People with Mental IllnessDocument NameConditions FocusTarget Audience/ SettingsPrimary OutcomesAccessible at:World Health Organisation2018Management of physical health conditions in adultswith severe mental disorders: WHO GuidelinesSevere Mental IllnessMental health practitioners Reducing morbidity and premature mortality. Context“In addition to causing a large proportion of morbidity, mental disorders – especially severe mental disorders (SMD) – are linked with poorer health outcomes and increased mortality... The objective of these guidelines is to improve the management of physical health conditions in adults with SMD and support the reduction of individual health behaviours constituting risk factors for these illnesses, with the aim of decreasing morbidity and premature mortality amongst people with SMD.”“Furthermore, people with SMD are more likely to engage in lifestyle behaviours that constitute risk factors for non-communicable diseases (NCDs) such as tobacco consumption, physical inactivity and consuming unhealthy diets.”Content GuidePart 1: IntroductionPart 2: Guideline development processPart 3: Evidence and recommendationsPart 4: Implementation considerationsPart 5: Publication, dissemination, and evaluationKey Message/FindingsPage 42 – Implementation considerations“The recommendations in these guidelines must be implemented using a person-centred and integrated approach to address factors associated with excess mortality in persons with SMD. This integration is needed at four levels – screening and early detection of physical health conditions, counselling for behavioural risk factors, assessment and management of cardiovascular disease risk and management of established physical and mental health conditions.”“We propose a multilevel intervention framework that will be useful for designing, implementing and evaluating interventions and programmes to reduce excess mortality in persons with SMD (Liu et al., 2017). The first level is individual focused interventions. The second and third levels of the framework consist of strategies focussed on the health systems and socio-environmental context, respectively, which provide the enabling environment for implementation of the recommendations”Document NameConditions FocusTarget Audience/ SettingsPrimary OutcomesAccessible at:Public Health England2018Health matters: reducing health inequalities in mental illnessSMIPublic Health authorities and Health ServicesReducing morbidity and premature mortality. Context“People with severe and enduring mental illness are at greater risk of poor physical health and reduced life expectancy compared to the general population….This edition of Health matters sets out the scale of the problem and presents actions that local areas can take to reduce health inequalities, improve physical health and life chances of people living with mental illness… Although the focus is on adults with more severe and enduring mental illness, many of the actions will be of benefit to all people experiencing mental illness.”Content GuidePart 1: SummaryPart 2: Scale of the problemPart 3: Inequalities experienced by people with mental illnessPart 4: Local actions to reduce inequalities in mental illnessPart 5: ResourcesKey Message/Findings2667035560A range of preventative actions that local areas can take to reduce inequalities and improve health outcomes and the lives of people with mental illness:Understand local population needAddress the social determinants of poor healthBuild stronger communities and social connectionsEarly detection and intervention for physical health risksNo wrong door: support available through every contact pointBuild a confident, competent and committed public mental health workforce 00A range of preventative actions that local areas can take to reduce inequalities and improve health outcomes and the lives of people with mental illness:Understand local population needAddress the social determinants of poor healthBuild stronger communities and social connectionsEarly detection and intervention for physical health risksNo wrong door: support available through every contact pointBuild a confident, competent and committed public mental health workforce Document NameConditions FocusTarget Audience/SettingsPrimary Outcomes Accessible at:The Kings Fund (London, U.K.) 2016Bringing together physical and mental health A new frontier for integrated care- All mental illness- Prevention- MH caused by Chronic Cond- Public Health- Primary Care- Hospital Care- Community Care- Psychiatric CareCardiometabolic Health ContextThe importance of the third of these components has been further emphasised in the report of the independent Mental Health Taskforce to the NHS in England, which called for the development of integrated care spanning people’s physical, mental and social needs (Mental Health Taskforce 2016). The purpose of our report is to explore in greater detail what this should involve.Content Guide? Part 1: Introduction to the report and importance of tackling physical mental health co-morbidities? Part 2: Analysis of what integrated care for mental and physical health would look like from a patient or service user perspective? Part 3: Overview of 10 areas where integrated care is most needed, highlighting existing evidence for each ? Part 4: Examples of innovative service models currently being developed and deployed in England ? Part 5: Analysis of the barriers to change and suggestions as to how these can be overcome Key FindingsDocument NameConditions FocusTarget Audience/ SettingsPrimary OutcomesAccessible at:NHS England2018Improving physical healthcare for people living with severe mental illness (SMI) in primary care: Guidance for CCGsSevere Mental IllnessCommissioners of Mental Health and Primary Care servicesReducing Premature mortality gap ContextThis guidance highlights the responsibilities of CCGs in England to commission services that deliver comprehensive physical health assessments and follow up care to people on the severe mental illness (SMI) register in primary care, addressing the premature mortality experienced by people with SMI compared to the general population.Content GuidePart 1: IntroductionPart 2: Purpose of the guidance Part 3: Priority actions for improving physical healthcare for people with SMIPart 4: Commissioning comprehensive physical healthcare for people with SMIPart 5: Preparing for implementationKey Message/Findings393890588265This guidance does not recommend one specific model for how physical healthcare for people with SMI should be commissioned and delivered in primary care but sets out what good quality physical healthcare provision in primary care must include in terms of:Completion of recommended physical health assessmentsFollow-up: delivery of or referral to appropriate NICE-recommended interventionsFollow-up: personalised care planning, engagement and psychosocial supportBest practice evidence indicates that where primary care teams deliver care collaboratively with secondary care services outcomes are improved. The lead responsibility for assessing and supporting physical health will transfer depending on where an individual is in their pathway of care.00This guidance does not recommend one specific model for how physical healthcare for people with SMI should be commissioned and delivered in primary care but sets out what good quality physical healthcare provision in primary care must include in terms of:Completion of recommended physical health assessmentsFollow-up: delivery of or referral to appropriate NICE-recommended interventionsFollow-up: personalised care planning, engagement and psychosocial supportBest practice evidence indicates that where primary care teams deliver care collaboratively with secondary care services outcomes are improved. The lead responsibility for assessing and supporting physical health will transfer depending on where an individual is in their pathway of care.Figure 1. The recommended physical health assessments for people on theSMI registerDocument NameConditions FocusTarget Audience/ SettingsPrimary OutcomesAccessible at:Te PouNew Zealand Equally Well collaborative2017Equally Well : The physical health of people with mental health conditions and/or addictionSevere mental health conditions and/or addictionMental health, addiction and disability sectorsReducing mortality and morbidity Context“This report is a summary of the 2017 evidence update, which follows on from an earlier literature review The physical health of people with a serious mental illness and/or addiction: An evidence review (Te Pou o te Whakaaro Nui, 2014).”“In summary, it found that: people living with serious mental health problems are at a greater risk of many chronic health conditions and have a much shorter life expectancy than their general population counterparts; the disparities are due to greater exposure to known risk factors including low socioeconomic status, high rates of smoking, alcohol and other drug use, reduced physical activity and poor nutrition, the side effects of psychotropic medication, and reduced access to physical healthcare; a comprehensive approach involving collaboration across the health and social sectors, and including interventions at policy, healthcare service and individual behaviour change levels, is needed to address these inequities (Te Pou o te Whakaaro Nui, 2014).”Content GuidePage 4: Findings: How does recent evidence advance our understanding of the higher rates of premature mortality and its causes?Page 5: Findings: What does a more in-depth investigation of the literature on psychotropic medications tell us about their impact on physical health?Page 6: Findings: What does recent evidence tell us about priorities for interventions at systems, health services, and individual levels?Page 12: Recommended priorities for actionPage 13: Proposed research agendaPage 15: ConclusionsKey Message/FindingsConclusions – page 15“Research summarised in this review indicates that the widening inequities may also be due to structural socioeconomic factors. This includes increasing income inequalities in many countries which are associated with a range of social and economic challenges – loss of employment, poor quality accommodation and homelessness – all of which have been exacerbated in many countries following austerity measures after the 2008 global financial crisis. Other contributing factors are the relatively high rates of tobacco smoking, an international trend of increased prescribing of psychotropic medications, and difficulties in co-ordinating between primary care and secondary mental health service”“Recent review studies summarised in this report identify possible interventions across health, social and economic policy, healthcare service delivery, and at individual behaviour change levels. The evidence base is growing in strength, and certainly provides a good steer on where limited resources may be targeted to impact most effectively on the health disparities.”Document NameConditions FocusTarget Audience/ SettingsPrimary OutcomesAccessible at:World Psychiatric Association (in collaboration with WHO)2017Excess mortality in persons with severe mental disordersSMI (MDD, BPD, SZ)Researchers, Clinicians and Policy-MakersPremature Mortality Gap ContextDespite known risk factors for premature mortality, evidence for effective interventions in persons with SMD is limited. In this paper we proposed and described models to better understand the complex relationships among risk factors and correlates of mortality, and to conceptualize interventions at the individual, health system and socio-environmental levels. These models guided us to outline key action points for clinical practice, policy and research agendas to move towards health equity for those with SMDContent Guidepage 1. Introductionpage 2. Multilevel model of risk for excess mortalitypage 3. Multilevel intervention framework to reduce excess mortalitypage 7. Priorities for clinical practice, policy and research agendasKey Message/FindingsDocument NameConditions FocusTarget Audience/SettingsPrimary OutcomesAccessible at:World Health Organization(Geneva, Switzerland)2017Helping peoplewith severe mentaldisorders live longer and healthier livesSMI (MDD, BPD, SZ), particularly in LMIC SettingsPolicy-makers, health programmers/services, NGOs, service users, carers – particularly in LMICs. Premature Mortality Gap, particularly in LMICs ContextPeople with SMI experience a large gap in life-expectancy, which is worst in LMIC settings. “There are concrete actions that different stakeholder groups can take to ensure that people with severe mental disorders live healthier and longer lives. Government, health-care managers, care providers and nongovernmental organizations need to work in a coordinated way with people with severe mental disorders and their families in order for progress to be made. This policy document provides different stakeholder groups including policy-makers, health-programme managers, health-service providers, NGOs and service users and carers with concrete steps they can take to ensure that people with severe mental disorders live healthier and longer lives.”Content GuidePage 4: Actions for Policy Makers Page 5: Actions for health-programmes managersPage 6: Actions for Health Care ServicesPage 7: Actions for NGOsPage 8: Actions for service users, carersKey Message/FindingsDocument NameConditions FocusTarget Audience/ SettingsPrimary OutcomesAccessible at:Academy of Medical Royal Colleges 2017Improving the physical health of adults with severe mental illness: essential actionsSevere Mental IllnessOrganisations, services and professionals involved in health servicesReducing Premature Mortality Gap, and co-morbidity gap Context“The physical health of people with severe mental illness (SMI) is significantly worse than the health of the general population. People with SMI: have a life expectancy that is shortened by 10–20 years (Davies, 2013); have higher rates of physical ill-health than the general population; have higher rates of health-risk behaviours, including obesity and tobacco smoking (approximately twice as high than the general population) (Davies, 2013) ; are likely to have a long-term physical condition (Naylor et al, 2012). This report recommends practical ways to improve physical healthcare services for people with SMI.”Content GuideOverview and IntroductionPart 1. Recommendations for actionPart 2: Key areas for service improvementsKey Message/FindingsPage 6“There are major differences in the life expectancy of people with severe mental illness”“…This report highlights these differences and sets out clear recommendations for action. It recommends establishing an expert group to set priorities and national standards, improve training standards and promote research in this important area. There are many other important recommendations, not least that there should be the same level of physical healthcare available to people with severe mental illness as is available to members of the general population. This will be helped by activity driven by the Five Year Forward View for Mental Health recommendation for improvement in this area, and should be ensured through inspection by the Care Quality Commission”Appendices References ADDIN EN.REFLIST 1.Blanner Kristiansen C, H?strup Vestergaard C. Secular trends in the interest of physical health in patients with mental illness. Acta Psychiatrica Scandinavica 2015; 132(5): 408-10.2.Prochaska JJ, Das S, Young-Wolff KC. Smoking, Mental Illness, and Public Health. Annual review of public health 2017; 38: 165-85.3.Jiang M, Qin P, Yang X. Comorbidity between depression and asthma via immune-inflammatory pathways: A meta-analysis. Journal of affective disorders 2014; 166: 22-9.4.Gao YH, Zhao HS, Zhang FR, et al. 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