With Increase in Bipolar Patients the VA Tackles Medication Side Effect Issues

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With Increase in Bipolar Patients the VA Tackles Medication Side Effect Issues

Categorized in: 2012 Compendium of Federal Medicine, Department of Veterans Affairs (VA), Depression, Psychiatry

The project’s goals include:

Improved monitoring for and management of physical-health problems among veterans taking atypical antipsychotic medications;
Improved adherence to guidelines around metabolic monitoring for antipsychotic medication; decreasing the number of veterans who are prescribed antipsychotic medications who are obese; and
Increasing the use of weight interventions among veterans who are prescribed antipsychotic medications and are obese.

Mental Illness Affects Physical Health
Even without side-effects from treatment, serious mental illnesses such as schizophrenia or bipolar disorder can strongly influence physical health for the worse, according to a new report from the Substance Abuse and Mental Health Services Administration (SAMHSA),
Adults who suffered a mental illness or major depressive disorder had increased rates of high blood pressure, asthma, diabetes, heart disease and stroke, according to the report Physical Health Conditions among Adults with Mental Illnesses. Research was based on data from SAMHSA’s 2008-2009 National Survey on Drug Use and Health (NSDUH), which is an annual nationally representative survey of the U.S. civilian, non-institutionalized population aged 12 or older.
The report noted that 21.9% of adults experiencing any mental illness in the past year had high blood pressure, compared to 18.3% of those who were mentally healthy. Asthma was a problem for 15.7% of adults who had a mental illness, compared to 10.6% of those who did not.
Patients with mental illness also were much higher users of healthcare resources, according to the report, which said that 47.6% of adults with serious mental illness in the past year used emergency departments, as opposed to only 30.5% of those without past-year serious mental illness. In addition, adults with serious mental illness in the past year were much more likely to have been hospitalized than those without -- 20.4% versus 11.6%.
“Behavioral health is essential to health. This is a key SAMHSA message and is underscored by this data,” said SAMHSA Administrator Pamela S. Hyde. “Promoting health and wellness for individuals, families and communities means treating behavioral-health needs with the same commitment and vigor as any other physical health condition. Communities, families, and individuals cannot achieve health without addressing behavioral health.”

In related work, the Department of Veterans Affairs Quality Enhancement Research Initiative (QUERI)’s Mental Health Strategic Plan was issued in December 2011.

“Although we have expectations for screening individuals for cardiovascular risk, we have not yet had official expectations or performance measures around screening seriously mentally ill patients -- but we should,” says Bauer. “There are also a series of weight loss and cardiovascular weight loss reduction programs like M.O.V.E., but still very few designed for this special population.”

M.O.V.E. is a national weight management program designed by the VHA National Center for Health Promotion and Disease Prevention, a part of the Office of Patient Care Services. It includes modules on physical activity, eating wisely, screenings and immunizations, smoking cessation and limiting alcohol consumption.

Mental illness can strongly impact how care is provided and whether interventions are affected.

“A lot of times these patients do not show up for the M.O.V.E. program, or they barely participate,” Bauer pointed out. “They are also socially disadvantaged, so it’s harder get there. They take medications that slow their thinking down, so compliance is lower. There are a variety of effects on these folks, which makes you feel like you need specially-designed programs.”

VA currently has effective cardiovascular-risk programs for patients who are not mentally ill and effective self-management programs for patients with bipolar disorder.

“What we need to do is combine them in a creative way to serve the veterans centers’ patient-specific needs of this population,” says Bauer. Those needs include management of mental-health symptoms and cardiovascular risk, such as exercise, smoking cessation, diet and sleep hygiene.

“But we have to deliver these kinds of treatments in such a way that this special population can participate,” he said. “They have a limited attention span, so we need flexible delivery models where they can do their part of the management at home sometime. In addition, some do not do well in groups but others do, so you have to approach this in a more customized way.”

Such a program, he added, would be the “holy grail” of care for these patients. “We have a pretty good idea of what these people need; it’s just a matter of putting it all together,” according to Bauer.

Back to 2012 Compendium