To assess the safety and efficacy of exenatide in overweight or obese patients treated with olanzapine.

Adults with stable major mood or psychotic disorders were randomized to double-blind exenatide or placebo for 16 weeks. Weight and body mass index (BMI) were monitored throughout the study. A secondary objective was to evaluate the tolerability of exenatide and its effects on mood and psychotic symptoms.

A significant difference in weight change was detected between the treatment groups. Participants in the exenatide group experienced on average a minor weight loss, while participants in the placebo group on average experienced weight gain (-0.5 kg [-0.6 %] vs. +2.6 kg [+2.8 %], both p < .01). The most common side effects in the exenatide group were gastrointestinal symptoms and headaches. There were no clinically meaningful differences between the groups in changes to mood or psychotic symptoms.

Exenatide is effective and well-tolerated for attenuating olanzapine-associated weight gain.

Exenatide for the Treatment of Weight Gain Associated with Olanzapine in Obese Adults. NCT00845507.

Bipolar II disorder (BD-II) is currently identified by both the DSM-5 and ICD-11 as a distinct subtype of bipolar disorder, defined by at least one depressive episode and at least one hypomanic episode, with no history of mania. Despite its prevalence and impact, the literature on BD-II remains relatively sparse. This paper provides a comprehensive overview of the available research and current debate on the disorder, including its diagnostic criteria, clinical presentations, comorbidities, epidemiology, risk factors, and treatment strategies. Patients with BD-II often present with recurrent depressive episodes, which outnumber hypomanic episodes by a ratio of 39:1. The condition is therefore often misdiagnosed as major depressive disorder and treated with antidepressant monotherapy, which may worsen its prognosis. The recognition of BD-II is further complicated by the overlap of its symptoms with other disorders, in particular borderline personality disorder. Although BD-II is often perceived as a less severe form of bipolar disorder, evidence suggests significant functional and cognitive impairment, accompanied by an elevated risk of suicidal behavior, including a rate of completed suicide at least equivalent to that observed in bipolar I disorder (BD-I). Psychiatric comorbidities, in particular anxiety and substance use disorders, are common. The disorder is associated with a high prevalence of numerous physical comorbidities, with a particularly high risk of comorbid cardiovascular diseases. Various genetic and environmental risk factors have been identified. Inflammation, circadian rhythm dysregulation and mitochondrial dysfunction are being studied as potential pathophysiological mechanisms. Current treatment guidelines, often extrapolated from BD-I and depression research, may not fully address the unique aspects of BD-II. Nevertheless, substantial evidence supports the value of some pharmacological treatments - primarily mood stabilizers and atypical antipsychotics - augmented by psychoeducation, cognitive behavioral or interpersonal and social rhythm therapy, and lifestyle interventions. Further research on BD-II should be a priority, in order to refine diagnostic criteria, identify potentially modifiable risk factors, and develop targeted interventions.

Individuals with severe mental illnesses (SMI) like schizophrenia, bipolar disorder (BD), and major depressive disorder (MDD) have an increased risk for cardiovascular diseases (CVD), but the causal relationship remains unclear.

Mendelian randomization (MR) was used to investigate the potential causal relationship between SMI and CVD and its five subtypes of disease, coronary heart disease, myocardial infarction, stroke, heart failure, and atrial fibrillation. Subsequently, the MR results of SMI with CVD and its subtypes were meta-analyzed separately. To assess the robustness of the findings, Cochran's Q test, MR-Egger intercept test, MR-PRESSO, and leave-one-out analysis were used. Select single nucleotide polymorphisms (SNPs) related to SMI and CVD and their five subtypes (coronary heart disease, myocardial infarction, stroke, heart failure, and atrial fibrillation). Use univariable Mendelian randomization (UVMR) and multivariate Mendelian randomization (MVMR) to assess the causal relationship between these conditions. Conduct a meta-analysis of the MR results of SMI and CVD and their subtypes. Use MR mediation analysis to evaluate the mediating effect of BMI between BD and CVD. Use Cochran's Q test, MR-Egger intercept test, MR-PRESSO, and leave-one-out analysis to enhance the robustness of the study.

MR analyses have revealed correlations between schizophrenia and BD with CVD and their subtypes in certain datasets. No significant evidence of an association between MDD and CVD or its subtypes was observed in our MR analyses. After MVMR and MR meta-analysis, no basis for genetically predicted SMI increasing CVD and their subtypes was found. The MR mediation analysis showed that the reduced risk of certain CVDs in BD was partially related to BMI to some extent.

Our MR study did not provide conclusive evidence for a causal association between genetic predisposition to SMI and CVD. Based on the available evidence, it would be more appropriate to consider SMI as potential risk markers for CVD and its subtypes rather than definitive risk factors.

Social determinants of health (SDOH) contributed to preventable health inequities. However, association between SDOH and mortality in populations with cardiovascular-kidney-metabolic (CKM) syndrome remain still unclear. This study aims to investigate this association and the influence of SDOH on life expectancy in CKM syndrome populations.

A cohort study using data from the 2001-2018 National Health and Nutrition Examination Survey (NHANES). Participants with incomplete data were excluded.

CKM stages 1-4 were considered as CKM syndrome according to American Heart Association's suggestions. Ten measures of SDOH were assessed, and the combined score of SDOH were calculated as the sum of the weighted scores for each SDOH. Participants were then categorized into 3 groups according to SDOH tertiles. After adjustment for confounders, cox regression models were fitted to investigate the association between SDOH and all-cause mortality. Restricted cubic splines (RCS), subgroup analysis, and interaction analysis were also constructed.

During a median follow-up of 7.33 years (IQR 4.17-10.58), a total of 10,040 participants with CKM syndrome were enrolled. The linear positive association between SDOH and the risk of all-cause mortality was observed. Results were consistent in subgroup analysis and several sensitivity analyses, and interaction analysis showed that this association can be modified by drinking. We also found that unfavorable SDOH correlated with shorter life expectancy compared to favorable SDOH.

Unfavorable SDOH associated with higher risk of all-cause mortality and shorter life expectancy in populations with CKM syndrome, addressing the importance of integrating SDOH into the management of CKM syndrome.

Not applicable.

Growing evidence suggests that lipid metabolism may play a crucial role in mood disorder pathophysiology, and the correlation between blood lipids and mood disorder remains further clarified.

This prospective, population-based cohort study utilized data from the UK Biobank. The study included 268,098 and 292,121 participants who had never been diagnosed with depression or bipolar disorder and who had complete data at both the baseline and follow-up points. A principal component analysis (PCA) was conducted on seven blood lipids, and the first three principal components (PCs) were derived. Cox regression analysis was employed to examine the correlation between the risk of mood disorders and the PCs. Multiplicative interaction and sensitivity analyses were also conducted. The relationship between blood lipids and neurological biomarkers was explored using Spearman's analysis.

PC1, primarily reflecting levels of Apolipoprotein B (ApoB), cholesterol, and low-density lipoprotein cholesterol (LDL-C), showed a protective effect against depression, with HRs of 0.98 (95 % CI: 0.96,1.00) in the fully adjusted Cox regression model. In contrast, PC2, characterized by opposite loadings for triglycerides and high-density lipoprotein cholesterol (HDLC), was positively associated with the risk of depression and bipolar disorder.(HR = 1.03,95 % CI: 1.01,1.06; HR = 1.11, 95 % CI: 1.01,1.23). Increased PC2 level was related to a significant increase in bipolar disorder risk among participants with high genetic risk (genetic risk score > 90 %, HR = 1.22, 95 % CI: 1.02,1.46). Complicated correlations between blood lipids and serum neuroproteins were detected.

These findings suggest complex associations between blood lipid profiles and the risk of depression and bipolar disorder.

Patients with bipolar disorder face higher mortality risks from natural causes and suicide. Lipid-modifying medications, among the most widely prescribed medications, also show potential in alleviating mood symptoms. Limited research explores if these medications reduce all-cause, natural, and suicide mortality risks.

This national cohort study, using Taiwan's National Health Insurance Research Database (2001-2022), included 32,479 bipolar disorder patients. Among them, 6800 died (4963 natural causes, 1154 suicide). Standardized Mortality Ratios (SMRs) were calculated, and Hazard Ratios (HRs) for lipid-modifying medications were estimated using multivariable Cox proportional hazards regression with a time-dependent model.

SMRs for all-cause, natural, and suicide mortality in the bipolar cohort were 6.36, 5.28, and 29.07, respectively. Lipid-modifying medications were associated with significantly reduced risks of all-cause (aHR = 0.38, P < .001), natural (aHR = 0.41, P < .001), and suicide mortality (aHR = 0.41, P < .001) within the 5-year follow-up post-index admission. Among the differing classes of lipid-modifying medications, statins and fibrates were linked to lower risks of all-cause (statins: aHR = 0.42, P < .001; fibrates: aHR = 0.49, P < .001), natural mortality (statins: aHR = 0.42, P < .001; fibrates: aHR = 0.59, P = .003), and suicide mortality (statins: aHR = 0.51, P = .002; fibrates: aHR = 0.33, P = .006).

Besides protecting against natural mortality, lipid-modifying medications exhibit salutary associations with suicide and all-cause mortality in bipolar disorder patients. To meaningfully reduce the high mortality rate, future studies should explore the pleiotropic benefits of these medications.

Lipid-modifying medications are widely recommended to treat cardiometabolic diseases and can have therapeutic potentials to improve mood symptoms associated with bipolar disorder. However, few studies have evaluated whether lipid-modifying medications are associated with a decreased risk of mortality from either natural causes or suicide among patients with bipolar disorder. This study found that in addition to having protective effects against natural mortality, lipid-modifying medications exert protective effects against suicide and all-cause mortality among patients with bipolar disorder.

Recent evidence suggests a link between albuminuria and mental illness. However, whether this association is stable, and its specific mechanisms remain unclear.

The cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) 2005-2018. Weighted multivariable-adjusted logistic regression, subgroup analysis, interaction tests, and restricted cubic spline (RCS) were conducted to assess the correlation between albuminuria and the risk of mental illness (depression). Subsequently, two-sample Mendelian randomization analyses were performed to investigate the relationship between albuminuria and various mental illnesses (anxiety disorder, persistent delusional disorder, schizophrenia, schizotypal personality disorder, panic disorder, post-traumatic stress disorder [PTSD], obsessive-compulsive disorder, bipolar I disorder, bipolar II disorder, depression, autism, social anxiety disorder).

Albuminuria was consistently found to have a significant association with the risk of depression, regardless of its classification as a continuous or outcome variable. A positive correlation was found between albuminuria and depression in different age groups, gender, race, education attainment, and those with hypertension, coronary heart disease, and diabetes. Further, there is a positive correlation between albuminuria and the occurrence of schizophrenia and persistent delusional disorder.

There is a close association between albuminuria and mental illness, with albuminuria being a risk factor for schizophrenia and persistent delusional disorder. Further research is needed to establish the specific connections.

Schizophrenia (SCZ) represents a considerable health concern, not only due to its impact on cognitive and psychiatric domains, but also because of its association with metabolic abnormalities. Individuals with SCZ face an increased risk of developing metabolic syndrome (MS), which contributes to the increased cardiovascular burden and reduced life expectancy observed in this population. Metabolic alterations are associated with both the SCZ condition itself and extrinsic factors, particularly the use of antipsychotic medications. Additionally, the link between SCZ and MS seems to be guided by distinct genetic parameters. The present narrative review summarizes the relationship between SCZ and MS and emphasizes the various therapeutic approaches for managing its components in patients with these conditions. Recommended therapeutic approaches include lifestyle modifications as the primary strategy, with a focus on behavioral lifestyle programs, addressing dietary patterns and physical activity. Pharmacological interventions include administering common antidiabetic medications and the selection of less metabolically harmful antipsychotics. Alternative interventions with limited clinical application are also discussed. Ultimately, a personalized therapeutic approach encompassing both the psychological and metabolic aspects is essential for the effective management of MS in patients with SCZ.

Smoking significantly increases the risk of cardiovascular diseases (CVD), yet quitting smoking after diagnosis of CVD can mitigate further negative impacts. However, encouraging smoking cessation remains a challenge for General Practitioners (GPs) with concerns regarding mental health. Since 2004, the UK's Quality and Outcomes Framework (QOF) incentivises GP smoking cessation support. Despite this, a significant proportion of individuals diagnosed with CVD continue to smoke after diagnosis. This study aims to investigate the frequencies and types of smoking cessation interventions offered to people with CVD (defined as coronary heart disease (CHD) and stroke), with and without mental illness, and assess their association with successful cessation.

This retrospective cohort study examined adults diagnosed with CHD or stroke using the QResearch general practice records database (1996-2019). We evaluated the frequency and types of smoking cessation interventions documented in patients' records, including education, brief interventions, pharmacological support, referrals, and counselling. Logistic regression assessed the relationship between recorded interventions and smoking abstinence rates within the one-year post-index event, considering QOF incentives and mental illness presence.

While smoking cessation education was common in general practice settings, prescriptions for nicotine replacement therapy or other evidence-based interventions were comparatively low. CHD and stroke populations showed a significant association between any intervention and smoking cessation within one year (CHD: OR 1.41, 95% CI 1.36-1.45; stroke: OR 1.49, 95% CI 1.43-1.55). Education consistently correlated with higher cessation likelihoods, while other interventions were linked to lower rates. Individuals with common and serious mental illness were less likely to quit, irrespective of intervention. QOF implementation led to increased documentation of advice but not intensive support or treatment, with pre-QOF interventions associated with significantly increased abstinence likelihoods (CHD: OR 5.09, 95% CI 4.84-5.35; stroke: OR 4.44, 95% CI 4.07-4.86).

Financial incentives for GP smoking cessation support outlined in QOF may not suffice to enhance methods that are more efficacious or improve cessation rates, especially among people with mental illness. Practical strategies that provide tangible support and treatment are needed for CVD patients, including those with mental illness, to facilitate successful cessation.

Ziprasidone is primarily metabolized by CYP3A4, an enzyme with genetic variability and susceptibility to inhibition or induction. This study explored the functional variability of CYP3A4 in ziprasidone metabolism, focusing on drug interactions and genetic polymorphisms.

The metabolic inhibition and kinetic properties of ziprasidone were evaluated through in vitro experiments utilizing rat liver microsomes (RLM), human liver microsomes (HLM), and CYP3A4 baculosomes. In vivo validation studies were conducted in Sprague-Dawley rats.

Quercetin significantly inhibited ziprasidone metabolism in vitro, with in vivo coadministration led to marked increasing in ziprasidone's AUC, CLz/F, and Cmax. Inhibition followed mixed mechanisms in RLM, HLM, and CYP3A4.1 systems. Analysis of CYP3A4 variants revealed distinct metabolic efficiencies: CYP3A4.3, 15, and 33 exhibited elevated clearance, while CYP3A4.24, 31, and 34 showed reduced activity. Quercetin's inhibitory potency varied across alleles, with IC50 values of 17.59 ± 1.01 μM in CYP3A4.1 and 54.51 ± 1.35 μM in CYP3A4.33. Molecular docking identified ARG106, PHE108, PHE215, THR224, and GLU374 as key residues mediating inhibition.

The findings of this study underscore the critical role of quercetin-mediated CYP3A4 inhibition and CYP3A4 genetic polymorphisms in modulating ziprasidone metabolism.

Prior observations of low physical activity in psychiatric inpatient care suggest a risk of physical deconditioning, but to date no studies have explicitly investigated this possibility by measuring change in cardiovascular fitness over the course of hospitalization. The present study used mattress actigraphy to obtain a passive measure of sleep heart rate (sHR) among a sample of 111 male Veterans receiving treatment for PTSD at the VA Palo Alto Health Care System Trauma Recovery Program (TRP). A linear mixed-effect regression model indicated that sHR significantly increased over nights hospitalized, though this effect was attenuated among those who participated at least once in a voluntary cycling program. Conversely, higher BMI at intake was associated with greater increases in sHR over nights. These findings provide evidence of physical deconditioning in the context of residential psychiatric treatment, while suggesting that at least some patients are protected from its impacts. Whole health interventions that promote exercise in tandem with mental health treatment may help to counteract physical deconditioning in psychiatric inpatient settings and should be designed to support patients of diverse fitness levels.

With nearly three-quarters of global deaths attributed to lifestyle-associated diseases, effective lifestyle modifications are more urgent than ever. The American Heart Association's framework for cardiovascular health has evolved significantly, transitioning from 'Life's Simple 7' to 'Life's Essential 8' with the incorporation of sleep, and further to 'Life's Essential 9' by adding mental health as a key component. Despite these advancements, recent evidence reveals a persistently low prevalence of ideal cardiovascular and cerebrovascular health behaviors across populations. These findings highlight the critical gap in addressing modifiable lifestyle and psychosocial factors. To reduce the global disease burden, public health strategies must prioritize comprehensive interventions that encompass physical, neurological, and mental well-being.

Metabolic syndrome (MetS) is the leading cause of mortality and morbidity in patients with severe mental illness (SMI). The present study was designed to determine the prevalence and associated factors of MetS among people with SMI attending the Amanuel Mental Specialized Hospital in Addis Ababa, Ethiopia.

A hospital-based cross-sectional study was conducted among people with SMI attending the outpatient psychiatric department. Socio-demographic and other clinical data were collected using a structured questionnaire. A standardized chemistry analyzer measured lipid profiles and blood glucose levels at the Ethiopian Public Health Institute. Univariable and multivariable logistic regression analysis was conducted to examine the association of the outcome with clinical and socio-demographic variables.

A total of 305 participants with SMI were recruited, 79% (n = 241) were male. The overall prevalence of MetS was 28.5% (n = 87), 31.5% (n = 63) among all the participants diagnosed with schizophrenia, and 25% (n = 13) among participants diagnosed with bipolar disorders. The most frequent metabolic abnormality was low high-density lipoprotein (HDL) 88.5% (n = 77). About 54% (n = 47) had abnormal waist circumference; 27.5% (n = 84) of the participants had a blood pressure of ≥ 130/85 mmHg; 4.6% (n = 14) had fasting blood glucose above 100 mg/dl; and 36.4% (n = 111) had triglyceride levels above 150 mg/dl. On multivariable analysis, increasing age (Adjusted odds ratio (aOR) = 1.12, 95% CI 1.08, 1.16) and having secondary education and above (aOR = 2.64, 95% CI 1.24, 5.50) compared to primary education, increasing duration of treatment (aOR = 1.11, 95% CI 1.03, 1.18) and alcohol use (aOR = 1.89, 95% CI 1.03, 3.47) were associated with MetS. 27.2% (n = 83) of the participants with SMI were overweight, and 4.6% (n = 14) had obesity. Increasing age (aOR = 1.11, 95% CI 1.05, 1.14), being female (aOR = 2.42, 95% CI 1.17, 5.01), smoking (aOR = 2.83, 95% CI 1.30, 6.15) and use of second-generation antipsychotics (aOR = 2.64, 95% CI 1.41, 4.94) were significantly associated with being overweight/obesity.

Individuals with SMI receiving care at a tertiary healthcare facility in Ethiopia exhibited a high prevalence of overweight/obesity and MetS. Therefore, health education and early screening for the components of MetS in this vulnerable population are recommended.

Although psychotic disorders are associated with significant morbidity and mortality, the diagnostic trajectories and mortality risks across the spectrum of these disorders remain poorly understood. This study aimed to characterize diagnostic pathways and compare mortality outcomes across psychotic disorders in Catalonia.

We conducted a retrospective cohort study using electronic health records of 357,007 adults accessing mental health services in Catalonia from 2015 through 2019. Diagnostic categories included schizophrenia, bipolar disorder, schizoaffective disorder, delusional disorder, other non-organic psychoses, unipolar psychotic depression, and other mental health diagnoses. Cox proportional hazards models assessed mortality risk, adjusting for sociodemographic factors and comorbidities.

About one-third of the sample received their first psychotic disorder diagnosis in specialized care. All psychotic disorders showed elevated mortality risk vs other mental health conditions. Schizophrenia had the highest risk (HR, 2.63; 95%CI, 2.46-2.81, p<0.001 followed by schizoaffective (HR, 1.99; 95%CI, 1.77-2.24, p<0.001) and delusional disorders (HR, 1.92; 95%CI, 1.66-2.21, p<0.001). Low socioeconomic status (HR, 3.69; 95%CI, 3.48-3.92, p<0.001) and comorbidities (HR, 1.82 per comorbidity; 95%CI, 1.81-1.83, p<0.001) were significant predictors of mortality across diagnoses. Gradient boosting machine modeling identified comorbidities (56.07%) and diagnostic category (24.51%) as top predictors of mortality risk.

This study demonstrates significantly elevated mortality risk across the spectrum of psychotic disorders in a Southern European context, with socioeconomic factors and medical comorbidities emerging as critical determinants. These findings underscore the need for integrated care approaches addressing both mental and physical health needs in psychotic disorders.

While psychiatric treatment mostly focuses on mental health, comorbid somatic conditions are frequent and often undertreated. This study aimed to bridge the gap by assessing the feasibility of medical consultations for psychiatric inpatients and to identify somatic and lifestyle-related conditions, as well as abnormal paraclinical findings. Secondly, we aimed to identify psychiatric treatments and diagnoses associated with metabolic outcomes.

Patients admitted to Department of Psychiatry Vejle, Denmark, between October 2022 and December 2023 were invited to participate in a medical consultation. The consultations gathered data on comorbidities and lifestyle, including smoking habits, alcohol and drug use, and body metrics. Additionally, information on medical treatment and biochemical markers was collected.

A total of 238 patients were enrolled [mean age 48.2 ± 18.6 years; 50.8% were men]. Health assessment revealed that 111 (46.6%) were active smokers and 129 (54.2%) had a body mass index (BMI) of ≥ 25 kg/m2. Biochemical analysis showed that 78 (32.8%) had vitamin D levels below 50 nmol/L and 89 (38%) had a low-density lipoprotein level >3 mmol/L. Patients treated with two or more antipsychotic drugs had a significantly higher BMI (4.6 kg/m2, 95% CI: 0.8-8.3) compared with individuals not taking antipsychotic medication.

The study demonstrates that medical consultations for hospitalized psychiatric patients are feasible and important, revealing abnormal biochemical markers and significant somatic comorbidities and lifestyle-related conditions. These findings suggest that routine medical assessments could enhance patient treatment and care and guide targeted interventions for metabolic and somatic health issues in psychiatric settings.

This study aimed to investigate whether antipsychotic medications can cause metabolic abnormalities independent of weight gain. Six hundred twenty-four patients treated with olanzapine and risperidone were enrolled. Body weight, body mass index (BMI), biochemical indicators of blood glucose and lipids, the proportion of patients who gained > 7% of their baseline weight, dyslipidemia, and dysglycemia were evaluated. The association between the prevalence of metabolic disturbances and groups was analyzed using logistic regression, adjusting confounding variables including age, sex, weight, duration and Chlorpromazine (CLO)-equivalent dosage. Assessments were conducted at baseline and 4, 8, and 24-weeks post-treatment. The rate of weight gain > 7% at 8-weeks was significantly higher than at 4-weeks in the total population (F = 49.02, p < 0.001) and in patients with abnormal metabolism (F = 29.97, p < 0.001). No significant differences were observed between follow-up time points in the 24-weeks. The proportion of abnormal blood lipids and glucose did not differ significantly between the 4-week and 8-week follow-ups. Logistic regression analyses revealed significant differences between olanzapine and risperidone groups regarding the prevalence of hypertriglyceridemia at week 4 ([adjusted odds ratio; aOR] = 1.710; 95% [ confidence interval; CI] = 1.213-2.410) and week 8 ([aOR] = 1.594; 95% [CI] = 0.859-2.957) and low LDL at week 4 ([aOR] = 1.772; 95%[CI] = 1.014-3.097) and week 8 ([aOR] = 3.851; 95%[CI] = 1.732-5.588). In conclusion, antipsychotics-induced metabolic abnormalities and weight gain are not fully synchronized, and metabolic abnormalities vary significantly across different atypical antipsychotic medication (AAP) groups, even after adjusting BMI. AAPs may have a direct effect on metabolic parameters.

Comorbid diabetes mellitus in patients with bipolar disorder may contribute to increased morbidity and mortality. To determine the prevalence of diabetes mellitus in bipolar disorder patients and its clinico-demographic and homocysteine correlates, we conducted a cross-sectional survey of 195 bipolar disorder inpatients. They received questionnaires, clinical measurements and laboratory tests to assess demographic characteristics, anthropometric variables, clinical variables and plasma homocysteine levels. The prevalence of diabetes mellitus (including type 1, type 2 and special types) in Chinese bipolar disorder patients was 14.9%. Analysis of variance or chi-square test showed that compared with non-diabetic bipolar disorder patients, diabetic bipolar disorder patients were older, more often married, had a longer duration of disease, took less olanzapine and had a higher frequency of hypertension. However, there were no significant differences in body mass index (BMI) and homocysteine levels between diabetic and non-diabetic bipolar disorder patients. Logistic regression analysis showed that marital status and duration of disease were independently associated with diabetes mellitus in patients with bipolar disorder after controlling for age, use of olanzapine, presence of hypertension, BMI and homocysteine levels. These findings shed light on the clinico-demographic correlates of the increased prevalence of diabetes mellitus in bipolar disorder patients, rather than the correlation with some metabolic risk factors.

Individuals with schizophrenia are at high risk of developing type 2 diabetes. This study aimed to develop a tailored solution to address their complex diabetes care needs, based on insights from patients and healthcare professionals, to enhance self-care.

Using a Participatory Design approach, we conducted three workshops and an evaluation, which included focus groups, interviews, and written feedback. Patients, healthcare professionals, and stakeholders actively participated in all stages of the process between May 2022 and December 2023. Iterative processes ensured comprehensive input in idea generation and concept development. Data analysis followed the steps of planning, acting, observing, and reflecting. The study is reported using SRQR framework.

Participants highlighted challenges such as navigating a fragmented healthcare system, undertreatment, and stigma. In response, a tailored educational manual for voluntary mentors was developed. This two-day training program equips mentors to support individuals with type 2 diabetes and schizophrenia, fostering collaboration and bridging the gap between psychiatric and somatic care.

A co-designed approach may enhance diabetes self-care and improve coordination between healthcare sectors.

Mental illnesses can have a significant impact on individuals experiencing acute coronary syndromes (ACS). Mental illnesses are associated with an increased cardiovascular risk profile and early onset of cardiovascular disease. A critical aspect of this interplay is the effect of psychiatric conditions on left ventricular ejection fraction (LVEF), a key parameter in evaluating cardiac function and predicting long-term outcomes in ACS patients. The present single-center, retrospective study investigated the associations between psychiatric conditions and cardiac function, with a focus on LVEF in ACS patients. The inclusion criteria were Italian nationality and 30 years or older. One hundred and sixty-four patients without (Mage = 68.8 ± 10.6, 62 females) and 161 patients with a psychiatric diagnosis (Mage = 68.4 ± 13.7, 63 females) were enrolled. The data collected included sociodemographic variables, psychiatric diagnoses, LVEF, ACS type (STEMI/NSTEMI), smoking status, previous interventions, and pharmacological treatments. Statistical analyses included chi-square, t-tests, ANOVAs, and ANCOVA to assess differences across groups. Findings revealed lower LVEF in patients with a psychiatric diagnosis compared to patients without a psychiatric diagnosis (p = 0.004, d = 0.36). Patients without a psychiatric diagnosis were associated with NSTEMI (p = 0.047, φ = 0.11), hypertension (p = 0.003, φ = -0.16), and dyslipidemia (p = 0.022, φ = -0.13). In contrast, patients with a psychiatric diagnosis were associated with STEMI (p = 0.047, φ = 0.11), neurological dysfunction (p = 0.014, φ = 0.14), and chronic obstructive pulmonary disease (p = 0.010, φ = 0.14). Among psychiatric diagnoses, anxiety disorders were associated with lower LVEF compared to substance abuse disorders (p = 0.012, d = -0.81). The findings underscore the complex relationship between mental illness and cardiac function, emphasising the need to integrate psychiatric evaluations into cardiology care to optimise the management of both mental and cardiovascular health. This study has several limitations, including its design, which prevents causal conclusions, and the use of convenience sampling, which limits the generalizability of the findings.

Schizophrenia (SCZ) and bipolar disorder (BD) and are severe psychiatric conditions that contribute to disability and increased healthcare costs globally. Although first-, second-, and third-generation antipsychotics are available for treating BD and SCZ, most have various side effects unrelated to their unique functions. Many antipsychotics affect K+ channels (Kv, KCa, Kir, K2P, and other channels), which change the functions of various organs. This review summarizes the biological actions of antipsychotics, including off-target side effects involving K+ channels.

Multimorbidity is characterized by the accrual of two or more long-term conditions (LTCs) in an individual. This state of health is increasingly prevalent and poses public health challenges. Adapting approaches to effectively analyse electronic health records is needed to better understand multimorbidity. We propose a novel unsupervised clustering approach to multiple time-to-event health records denoted as multiple state clustering analysis (MSCA). In MSCA, patients' pairwise dissimilarities are computed using patients' state matrices which are composed of multiple censored time-to-event indicators reflecting patients' health history. The use of state matrices enables the analysis of an arbitrary number of LTCs without reducing patients' health trajectories to a particular sequence of events. MSCA was applied to analyse multimorbidity associated with myocardial infarction using electronic health records of 26 LTCs, including conventional cardiovascular risk factors (CVRFs) such as diabetes and hypertension, collected from south London general practices between 2005 and 2021 in 5087 patients using the MSCA R library. We identified a typology of 11 clusters, characterised by age at onset of myocardial infarction, sequences of conventional CVRFs and non-conventional risk factors including physical and mental health conditions. Interestingly, multivariate analysis revealed that clusters were also associated with various combinations of socio-demographic characteristics including gender and ethnicity. By identifying meaningful sequences of LTCs associated with myocardial infarction and distinct socio-demographic characteristics, MSCA proves to be an effective approach to the analysis of electronic health records, with the potential to enhance our understanding of multimorbidity for improved prevention and management.

Autonomic nervous system dysfunction and reduced heart rate variability (HRV) often co-exist with mood disorders, a phenomenon likely influenced by sleep disturbances. This study investigated heart rate (HR) and HRV across wake, rapid eye movement (REM) sleep, and non-REM (NREM) sleep in individuals with sleep complaints and bipolar or unipolar depressive disorder.

Polysomnographic data was retrospectively collated for 120 adult patients with sleep complaints and depressive symptoms [60 diagnosed with bipolar disorder, 60 diagnosed with a unipolar depressive disorder], and 60 healthy controls. HR and time-based HRV variables were computed on 30-s segments and averaged across the night for wake, NREM and REM sleep.

Significant group by consciousness state interactions showed that the unipolar and bipolar groups had lower standard deviation of normal-to-normal intervals root mean square of successive R-R interval differences compared to controls during NREM and REM sleep, but not during wake (SDNN: F(4, 330) = 3.0, p = .021, np2 = 0.035; RMSSD: F(4, 332) = 5.8, p < .001, np2 = 0.065). The magnitude of these group differences did not vary significantly between NREM 1, NREM 2 and NREM 3 sleep. These interactions persisted after excluding individuals taking 3rd generation antipsychotic, lithium, anticonvulsant, and cardiovascular medications.

Although further work is required to account for the impact of psychotropic and cardiac medications, as well as manic and euthymic states, these findings suggest that the sleep-based autonomic signature of depressive states differs across different types of mood disorders and could potentially inform the development of biomarkers and therapeutic targets.

The etiology of schizophrenia is elusive, in part due to its polygenic nature. Genome-wide association studies (GWAS) have successfully identified hundreds of schizophrenia risk loci, that are pinpointed to over one hundred genes through fine mapping. Besides common variants with relatively small effect size from GWAS, rare variants or ultra rare variants also play a significant role in conferring the schizophrenia risk from SCHEMA (Schizophrenia Exome Sequencing Meta-Analysis) results. However, burden results from SCHEMA study indicate that more new risk genes remain hidden and to be discovered. To boost the power of identifying new risk genes, we integrated genetics from SCHEMA and transcriptome data from BrainSpan using a multi-omics integration tool, DAWN, through which we have identified 47 schizophrenia putative risk genes that include 19 new risk genes, in addition to nearly all SCHEMA risk genes with FDR < 5 %. GO functional enrichment reveals that 47 SCZ putative risk genes are significantly enriched in cell to cell signaling, cell communications, transporter, in line with the hypothesis of two hit schizophrenia model. SynGO analysis suggests 47 schizophrenia putative risk genes are enriched in pre-synapse, synapse and post-synapse, supporting the well established link between synapses and schizophrenia.

Evidence on subclinical cardiac organ damage and, particularly on myocardial deformation, detected by speckle tracking echocardiography (STE), in patients with schizophrenia and bipolar disorder free from known cardiac disease is scanty. The aim of the present systematic review was investigate whether global longitudinal strain (GLS) could be a more sensitive index of systolic dysfunction than left ventricular ejection fraction (LVEF) in this setting, after having preliminary focused on LV structural and functional changes by standard echocardiography or magnetic resonance imaging (MRI).

To identify eligible studies targeting GLS in patients with schizophrenia and bipolar disorder systematic searches were conducted across bibliographic databases (Pub-Med, OVID, EMBASE and Cochrane library) following the PRISMA guidelines, from inception up to August 31, 2024.

Six studies focusing on GLS including a total of 535 patients with schizophrenia (n = 185) or bipolar disorder (n = 350), and 153 healthy controls were considered for the review. Four studies compared GLS values of patients with schizophrenia and bipolar disorder with healthy controls and the other two studies evaluated the impact of antipsychotic therapy on this index of myocardial deformation. Overall, GLS emerged as a more sensitive index in assessing early systolic dysfunction than LVEF as well as the effects of antipsychotic drugs on systolic function.

The evaluation of LV mechanics in patients with schizophrenia and bipolar disorder is underused despite the fact that could unmask subclinical systolic dysfunction better than LVEF. Thus, the role of STE in detecting early LV systolic dysfunction in this clinical setting needs to be further investigated in future studies.

Inaccurate diagnosis of physical health problems in people with mental health conditions may contribute to poorer health outcomes. We review the evidence on whether individuals with mental health conditions are at risk of diagnostic inequalities related to their physical health.

We searched MEDLINE, PsycINFO, Embase, and CINAHL, 1 September 2002-18 Septemebr 2024 (PROSPERO 2022: CRD42022375892). Seventy-nine studies were eligible for inclusion. Risk of Bias (RoB) was assessed using the Newcastle-Ottawa or RoB2 tools and results were presented as a narrative synthesis.

Findings from the included studies suggests that people with mental health conditions face diagnostic inequalities for their physical health. A minority of studies adopted a design that specifically measured professional- and service-related factors associated with diagnostic inequalities. Most studies, however, measured diagnostic endpoints only, meaning that no inference could be made regarding the relative impact of patients' and clinicians' behaviour in producing inequalities.

Further investigations should consider the stage of the diagnostic process at which inequalities occur, to improve knowledge of the mechanisms underpinning diagnostic inequalities, and support the development of targeted improvement interventions.

This study is funded by The Health Foundation's grant to the University of Cambridge for The Healthcare Improvement Studies (THIS) Institute. Grant number not applicable.

Schizophrenia is a severe mental illness associated with significantly elevated mortality rates. However, factors related to the mortality risk among people with schizophrenia in low and middle-income countries remain to be examined. This study aims to explore the clinical factors for all-cause mortality in people with schizophrenia.

We conducted a 9-year retrospective cohort study on people with schizophrenia in Guangzhou, China. Cox proportional hazards regression analysis and competing risk analysis was used to identify clinical factors associated with all-cause mortality and specific-cause mortality. A propensity score matching method was performed to minimize the impact of confounding factors.

The overall age-standardized mortality rate in people with schizophrenia between 2013 and 2021 was 1606.04 per 100,000 person-years. We found that medical expenses not covered by medical insurance (adjusted hazard ratio [aHR]: 2.49 [95 % CI: 2.21-2.82]), relatively-stable (aHR: 1.18 [95 % CI: 1.01-1.38]) and unstable illness (aHR: 2.65 [95 % CI: 1.90-3.68]), history of non-continuous treatment (aHR: 1.35 [95 % CI: 1.25-1.46]), and no treatment history (aHR: 1.41 [95 % CI: 1.29-1.55]) were associated with a higher risk of all-cause mortality. Frequent hospital stays (once: aHR: 0.46 [95 % CI: 0.42-0.50], more than once: aHR: 0.23 [95 % CI: 0.21-0.26]) and a family history of mental disorders (aHR: 0.50 [95 % CI: 0.40-0.64]) were associated with a lower risk of mortality.

We identified clinical factors associated with all-cause mortality. Targeted interventions should be developed to reduce the mortality risk in people with schizophrenia.

Individuals with bipolar disorder are at greater risk of developing cardiovascular disease. However, the mechanisms underlying this association remain poorly understood. This study aimed to (1) determine the risk of major adverse cardiovascular events (MACE) after adjusting for important confounders and (2) evaluate the neural, autonomic, and immune mechanisms underlying the link between bipolar disorder and cardiovascular disease.

Leveraging the Mass General Brigham Biobank, bipolar disorder and incident MACE were identified using the International Classification of Disease (ICD) codes. Incident MACE events were assessed from enrollment to the date of data lock (December 2020); or to the 10-year period. Health behavior data were derived from optional surveys. Cox regression hazard models were applied.

Of 118,827 Biobank participants, 6009 were diagnosed with bipolar disorder. Those with bipolar disorder (vs. without) demonstrated a higher risk of MACE after adjusting for cardiovascular risk factors (hazard ratio [95% confidence interval] = 1.29 [1.10-1.51], p = 0.002). The relationship remained significant over 10 years after adjustment for unhealthy lifestyle behaviors (1.29 [1.03, 1.61], p = 0.025). Furthermore, SNA, autonomic nervous system, and inflammatory markers each significantly associated with both bipolar disorder and MACE risk. Each of these measures mediated the association between bipolar disorder and MACE (accounting for 3.8%-17.8% of the relationship).

This study demonstrates that bipolar disorder associates with heightened cardiovascular risk, even after accounting for cardiovascular risk. Moreover, the findings suggest that neurobiological pathways and perturbations in autonomic and inflammatory pathways may confer cardiovascular risk in bipolar disorder.

The Clubhouse model of psychosocial rehabilitation has supported the recovery of people with serious mental illness for over 75 years, but many of the roughly 350 Clubhouses are not well-integrated into the larger health care system, limiting their reach. This article examines Clubhouses' and psychiatric providers' interactions and experiences to understand the nature of and barriers to partnerships. The directors of Clubhouses affiliated with Clubhouse International were surveyed, examining their attitudes and practices around collaboration with psychiatric providers. To provide context, psychiatric providers were also surveyed regarding their understanding of and experiences with Clubhouses. Findings reveal broad support among both Clubhouse directors and psychiatrists for enhancing partnerships, despite current barriers, limited interactions, and the need for greater mutual understanding. Key considerations that emerged include the importance of maintaining the Clubhouse model's distinct non-clinical, community-based, and member-directed identity in any integration efforts.

Severe mental illness (SMI) encompasses depression, bipolar disorder, and schizophrenia which affect the daily quality of life. While it has a significant impact on their social life, it is also supposedly linked with various comorbidities, of which, cardiovascular disease (CVD) is the most frequently reported. Various biological, behavioral, and genetic mechanisms are thought to play a role: hypothalamic-pituitary-adrenal axis, autonomic nervous system dysregulation, inflammation, and psychotropic medications. Lack of exercise, low-fiber diet, smoking, substance abuse, and failure of medicine compliance also strongly contribute to the increased risk for CVD-related death. The understanding of the complex relationship between CVD and SMI would thus play a significant role in decreasing the incidence of CVD-related morbidity and mortality. This article aims to review and explain the hypothesized increased risk of CVD events in patients with SMI.

Patients with schizophrenia have a high risk of cardiovascular death. Increased cardiac left ventricular (LV) mass has been reported to be associated with heart failure and cardiac mortality. However, few studies have used echocardiographic imaging to evaluate the associations between cardiac LV mass and the clinical characteristics of schizophrenia. We recruited 121 adults to undergo standard and two-dimensional speckle-tracking echocardiography. Cardiac LV mass was determined using the Devereux formula and indexed with reference to the body surface area to obtain the cardiac LV mass index (LVMI). Clinical and demographic data were obtained through interviews and chart review. The results showed that relative to the mentally healthy controls (n = 55), individuals with schizophrenia (n = 66) had significantly higher mean values of cardiac LVMI as well as lower mitral valve E/A ratio, LV ejection fraction, and LV global longitudinal strain. Among the individuals with schizophrenia, cardiac LVMI was positively correlated with the number of acute episodes, and this association remained significant after adjustment for age, age at onset, and body mass index. On the contrary, there were no significant associations between cardiac LVMI and traditional cardiovascular risk factors. Taken together, this study suggests that the burden of psychotic symptoms may contribute to the increased risk of cardiac hypertrophy in individuals with schizophrenia independent of traditional cardiovascular risk factors. Because cardiac hypertrophy is among the major risk factors of heart failure and cardiac mortality, future research must investigate the mechanisms underlying the association between psychosis and increased cardiac LV mass.

To evaluate the feasibility, acceptability and efficacy of an Acceptance and Commitment Therapy-based Lifestyle Counselling Program (ACT-LCP) on health outcomes of individuals with early psychosis.

In this assessor-blinded, parallel-group pilot randomized controlled trial, 72 early psychosis patients (mean age [SD] = 30.51 [8.02], 58.3 % female) were randomized to either the ACT-LCP group or a control group. The ACT-LCP group underwent a five-week group program focusing on ACT-based motivation for healthy lifestyles, a booster session, and two follow-up calls. The control group received standard care, one lifestyle education session, and three follow-up calls. Outcomes including physical activity, autonomous motivation, psychological flexibility, mental status, and quality of life were measured at baseline, 1-week, and 12-week post-intervention. Recruitment, retention, and adherence rates were evaluated. Focus group interviews explored participants' experiences.

Generalized estimating equation models demonstrated that when compared to the Control group, the ACT-LCP group showed a sixfold likelihood of engaging in at least 150 min of moderate to vigorous physical activity per week (adjusted prevalence ratio = 6.28, 95 % CI [2.09-18.93], P ≤ 0.001) at 12-week post-intervention. Improvements at 12-week also included autonomous motivation (adjusted mean difference, aMD = 4.74; P < .001), psychological inflexibility (aMD = -7.69; P < .001), mental status (aMD = -6.83; P < .001), and quality of life (aMD = 0.46; P = .006). Recruitment was successful at 55.8 %, retention at 89 %, and adherence at 80.6 %. Engagement challenges were noted in focus groups.

The ACT-LCP is feasible and acceptable, demonstrating initial efficacy in individuals with early psychosis. Further research should refine the intervention and explore long-term impacts.

gov Identifier: NCT04916496.

Schizophrenia is associated with an increased risk of mortality and physical comorbidities, indicating a potentially accelerated frailty process in affected individuals. This study aimed to test association between schizophrenia and frailty using the frailty index based on laboratory markers (FI-Lab).

A total of 600 patients with schizophrenia and 518 healthy controls, aged between 20 and 69 years were included in the present study. Frailty was assessed using the FI-Lab, incorporating routine laboratory markers, body mass index, and blood pressure measurements. FI-Lab for patients with schizophrenia and healthy controls was compared, with stratification by age group and sex. In addition, robust was defined as FI-Lab ≤ 0.12, pre-frail as 0.12-0.25, and frail as >0.25. Multiple linear regression analysis was used to test the association between schizophrenia and FI-Lab. Multinomial logistic regression was used to test the association between schizophrenia and frailty status. Spearman correlation analysis was performed to assess the relationship between the Positive and Negative Syndrome Scale (PANSS) scores and FI-Lab in schizophrenia patients.

Schizophrenia patients exhibited significantly higher FI-Lab than healthy controls across all age groups, indicating accelerated pace of frailty in schizophrenia patients. Schizophrenia was significantly associated with FI-Lab (β = 0.044, p = 0.004) in the adjusted model. Schizophrenia was significantly associated with both pre-frail status (OR = 2.26, 95% CI = 1.40-3.68, p = 0.001) and frail status (OR = 10.33, 95% CI = 5.65-19.93, p = 0.007) compared to robust status in the adjusted model. Additionally, a positive correlation between FI-Lab and PANSS scores suggests that more severe schizophrenia symptoms correlate with higher degree of frailty.

These findings suggest that schizophrenia contributes to an increased risk of frailty. The FI-Lab provides a quantitative measure of frailty. This underscores the importance of integrating frailty considerations into the treatment and management of schizophrenia.

MK-8189 is a novel phosphodiesterase 10A (PDE10A) inhibitor being evaluated in clinical studies for the treatment of schizophrenia. PDE10A is a cyclic nucleotide phosphodiesterase enzyme highly expressed in medium spiny neurons of the striatum. MK-8189 exhibits subnanomolar potency on the PDE10A enzyme and has excellent pharmaceutical properties. Oral administration of MK-8189 significantly increased cyclic guanosine monophosphate and phospho glutamate receptor 1 in rat striatal tissues. Activation of the dopamine D1 direct and D2 indirect pathways was demonstrated by detecting significant elevation of mRNA encoding substance P and enkephalin after MK-8189 administration. The PDE10A tracer [3H]MK-8193 was used to determine the PDE10A enzyme occupancy (EO) required for efficacy in behavioral models. In the rat-conditioned avoidance responding assay, MK-8189 significantly decreased avoidance behavior at PDE10A EO greater than ∼48%. MK-8189 significantly reversed an MK-801-induced deficit in prepulse inhibition at PDE10A EO of ∼47% and higher. Target engagement of MK-8189 in rhesus monkeys was examined with [11C]MK-8193 in positron emission tomography studies, and plasma concentrations of 127 nM MK-8189 yielded ∼50% EO in the striatum. The impact of MK-8189 on cognitive symptoms was evaluated using the objective retrieval task in rhesus monkeys. MK-8189 significantly attenuated a ketamine-induced deficit in object retrieval performance at exposure that yielded ∼29% PDE10A EO. These findings demonstrate the robust impact of MK-8189 on striatal signaling and efficacy in preclinical models of symptoms associated with schizophrenia. Data from these studies were used to establish the relationship between preclinical efficacy, plasma exposures, and PDE10A EO to guide dose selection of MK-8189 in clinical studies. SIGNIFICANCE STATEMENT: We describe the primary pharmacology of MK-8189, a phosphodiesterase 10A (PDE10A) inhibitor under evaluation for the treatment of schizophrenia. We report efficacy in preclinical models that have been used to characterize other PDE10A inhibitors and atypical antipsychotics. The PDE10A occupancy achieved by MK-8189 in behavioral studies was used to support dose selection in clinical trials. This work provides evidence to support exploration of higher levels of PDE10A occupancy in clinical trials to determine if this translates to improved efficacy in patients.

Metabolic syndrome (MetS), a condition that includes several risk factors specific for cardiovascular disease, is commonly detected among patients with schizophrenia (SCZ). This study elucidated the factors contributing to the development and severity of MetS in first-treatment drug-naïve (FTDN) patients with SCZ.

The study enrolled 668 individuals with FTDN SCZ, aged 18-49 years, who had no exposure to antipsychotic medications and been hospitalized between February 2017 and June 2022 at the largest psychiatric specialty institution in central China. Patient sociodemographic and general clinical data were collected, and their psychopathology scores and illness severity were assessed using the Positive and Negative Symptom Scale (PANSS) and Clinical Global Impression Scale-Severity of Illness (CGI-SI), respectively. MetS score was calculated to determine the disease severity.

The prevalence of MetS among this study population was 10.93%. Binary logistic regression analysis revealed onset age, female sex, total cholesterol, and red blood and white blood cell counts as risk factors for MetS, and deemed free tetraiodothyronine (FT4) and CGI-SI score as protective factors. Multiple linear regression analysis result confirmed older SCZ onset age as a risk factor for elevated MetS score.

This study determined the prevalence of MetS in patients with FTDN SCZ and revealed the factors that influence the occurrence and severity of the disease. These findings will allow development of specific prevention and treatment strategies in clinical practice.

This study investigated all-cause and suicide mortality rates in adolescents and young adults following an initial psychiatric admission to elucidate the long-term outcomes for this vulnerable group by focusing on the risks associated with various psychiatric diagnostic categories.

This study involved 9762 adolescents and young adults discharged from their first psychiatric admission and matched 1:1 with 9762 individuals discharged following a diagnosis of appendicitis on the basis of birth year and sex by using Taiwan's National Health Insurance Research Database. Both stratified (model 1) and standard (model 2) Cox regression analyses were conducted to assess variations in all-cause and suicide mortality between the groups.

Over the 15-year follow-up period, the adolescents and young adults discharged from their first psychiatric admission exhibited an approximately 3-fold increased risk of death from any cause (hazard ratio [HR]: 2.97 in model 1, 2.83 in model 2) and an approximately ten times higher risk of suicide (11.13 in model 1, 9.23 in model 2) compared with those discharged with a diagnosis of appendicitis. Those discharged with alcohol use disorder or major depressive disorder exhibited higher hazard ratios for both all-cause and suicide compared with the reference group.

The findings reveal a considerable risk of all-cause and suicide mortality in adolescents and young adults following discharge from their first psychiatric admission. These results highlight an urgent need for tailored interventions and continued support for this demographic.

to understand nurses' experiences in caring for people with mental health problems hospitalized due to clinical comorbidities in non-psychiatric Inpatient Units.

qualitative study, guided by Alfred Schutz's social phenomenology. Sixteen phenomenological interviews were conducted. The content was analyzed and discussed based on the literature, through the composition of three categories of analysis.

three categories emerged in the study: Challenges in care faced by nurses; Fragmented care action; and Ideal care. The disarticulation of the clinic was revealed, as described by nurses, showing care as an action far removed from the comprehensiveness of a person. Nurses' performance is guided predominantly by biomedical reference, disregarding appreciation of subjectivity.

it was observed that nurses attribute the responsibility for patient care to factors external to their life-world, when, in fact, these aspects should be components that help them in comprehensive care construction.

Indoor fine particulate matter (PM2.5) poses a considerable hazard to the aging process, particularly in vulnerable populations such as schizophrenia patients who frequently spend extended periods in indoor environments. Currently, the evidence on which PM2.5 components contribute to accelerated aging remains unclear. To address these issues, we conducted a prospective, repeated-measurement study on 104 schizophrenia patients. Our findings indicated that exposure to PM2.5 components was significantly associated with accelerated biological aging in schizophrenia patients. Notably, the most prominent effects were observed for thallium (1.303, 95 % CI: 0.481-2.125), chromium (1.029, 95 % CI: 0.303-1.756), lead (1.021, 95 % CI: 0.296-1.746), antimony (0.915, 95 % CI: 0.233-1.597), selenium (0.854, 95 % CI: 0.209-1.499), and manganese (0.833, 95 % CI: 0.186-1.480). Multivariate analysis revealed that PM2.5 components predominantly induced alterations in serum glycerophospholipid metabolites, accelerating the aging process. This intricate connection was closely linked to the gut microbiota, particularly to species such as Dorea and Blautia. Mediation analysis showed that the Blautia-PC (16:0/0:0) pathway mediated the largest proportion (30.69 %) of the effect of manganese exposure on accelerating immune biological aging in schizophrenia patients, as measured using the Klemera-Doubal method. These results underscore the need to address pollution sources that harm health, and provide new evidence for improving regional air quality.

Cardiovascular disease (CVD) is a leading cause of premature mortality among patients with severe mental illness (SMI). Effective care delivery models are needed to address this mortality gap. This study examines the impact of an enhanced primary care (PC) program that specializes in the treatment of patients with SMI, called Medicine in Psychiatry Service-Primary Care (MIPS-PC). Using multipayer claims data in Western New York from January 1, 2016 to December 31, 2021, patients with SMI and CVD were identified using International Classification of Diseases, Tenth Revision codes. National Provider Identification numbers of MIPS-PC providers were then used to identify those patients who were treated by MIPS-PC during the period. These MIPS-PC-treated patients were compared against a cohort of one-to-one propensity score matched contemporaneous comparison group (ie, patients receiving PC from providers unaffiliated with MIPS-PC). A difference-in-difference approach was used to identify the treatment effects of MIPS-PC on all-cause emergency department (ED) visits and hospitalization rates. The MIPS-PC group was associated with a downtrend in the acute care utilization rates over a 3-year period following the index date (ie, date of first MIPS-PC or other PC provider encounter), specifically a lower hospitalization rate in the first year since the index date (25%; P < 0.001). ED visit rate reduction was significant in the third-year period (18%; P = 0.021). In summary, MIPS-PC treatment is associated with a decreasing trend in acute care utilization. Prospective studies are needed to validate this effect of enhanced PC in patients with SMI and CVD.