A Change in Perspective: From Dual Diagnosis to Multimorbidity

Bhalla, Ish P.; Rosenheck, Robert A.

doi:10.1176/appi.ps.201700194

Cited by 36 publications

(25 citation statements)

References 11 publications

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“…However, a recent study reported that nine out of 10 of the most common patient-reported reasons for primary care visits were nonpsychiatric [ 110 ], indicating that this outcome was likely to be mainly nonpsychiatric. It is very common for patients to have other psychiatric illnesses alongside SMI [ 111 ]. Unfortunately, because of the nature of the studies included, it was not within the scope of the current review to consider the impact of the overlap between SMI and other psychiatric conditions on nonpsychiatric health service utilisation.…”

Section: Discussionmentioning

confidence: 99%

Severe mental illness and health service utilisation for nonpsychiatric medical disorders: A systematic review and meta-analysis

et al. 2020

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Background Psychiatric comorbidity is known to impact upon use of nonpsychiatric health services. The aim of this systematic review and meta-analysis was to assess the specific impact of severe mental illness (SMI) on the use of inpatient, emergency, and primary care services for nonpsychiatric medical disorders. Methods and findings PubMed, Web of Science, PsychINFO, EMBASE, and The Cochrane Library were searched for relevant studies up to October 2018. An updated search was carried out up to the end of February 2020. Studies were included if they assessed the impact of SMI on nonpsychiatric inpatient, emergency, and primary care service use in adults. Study designs eligible for review included observational cohort and case-control studies and randomised controlled trials. Random-effects meta-analyses of the effect of SMI on inpatient admissions, length of hospital stay, 30-day hospital readmission rates, and emergency department use were performed. This review protocol is registered in PROSPERO (CRD42019119516). Seventy-four studies were eligible for review. All were observational cohort or case-control studies carried out in high-income countries. Sample sizes ranged from 27 to 10,777,210. Study quality was assessed using the Newcastle-Ottawa Scale for observational studies. The majority of studies ( n = 45) were deemed to be of good quality. Narrative analysis showed that SMI led to increases in use of inpatient, emergency, and primary care services. Meta-analyses revealed that patients with SMI were more likely to be admitted as nonpsychiatric inpatients (pooled odds ratio [OR] = 1.84, 95% confidence interval [CI] 1.21–2.80, p = 0.005, I 2 = 100%), had hospital stays that were increased by 0.59 days (pooled standardised mean difference = 0.59 days, 95% CI 0.36–0.83, p < 0.001, I 2 = 100%), were more likely to be readmitted to hospital within 30 days (pooled OR = 1.37, 95% CI 1.28–1.47, p < 0.001, I 2 = 83%), and were more likely to attend the emergency department (pooled OR = 1.97, 95% CI 1.41–2.76, p < 0.001, I 2 = 99%) compared to patients without SMI. Study limitations include considerable heterogeneity across studies, meaning that results of meta-analyses should be interpreted with caution, and the fact that it was not always possible to determine whether service use outcomes definitively excluded mental health treatment. Conclusions In this study, we found that SMI impacts significantly upon the use of nonpsychiatric health services. Illustrating and quantifying this helps to build a case for and guide the delivery of system-wide integration of mental and physical health services.

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Section: Discussionmentioning

confidence: 99%

Severe mental illness and health service utilisation for nonpsychiatric medical disorders: A systematic review and meta-analysis

et al. 2020

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“…Similar to the findings of a recent study conducted in the Veterans Health Administration (16), ECT patients (when compared with non-ECT patients) had substantially higher rates of personality disorders (RR=7.37) and alcohol dependence (RR=2.12); much higher rates of prescription fills for antipsychotics (RR=3.58), mood stabilizers and anticonvulsants (RR=2.01), and lithium (RR=6.03); and higher prescription fill rates of all psychotropics (Cohen’s d=.77). ECT thus appears to be used among patients with multimorbidity who have more complicated psychiatric disorders (23), perhaps as a treatment of last resort when clinicians judge other treatment possibilities to have failed.…”

Section: Discussionmentioning

confidence: 99%

Identifying Recipients of Electroconvulsive Therapy: Data From Privately Insured Americans

Wilkinson¹,

Agbese²,

Leslie³

et al. 2018

Self Cite

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Objective: Despite the effectiveness of electroconvulsive therapy (ECT), limited epidemiologic research has been conducted to identify rates of ECT use and characteristics of patients who receive ECT. Sociodemographic and clinical characteristics associated with ECT use were examined among patients with mood disorders in the MarketScan commercial insurance claims database. Methods: Among individuals with major depressive disorder or bipolar disorder, sociodemographic and clinical characteristics of those who received ECT and those who did not were compared by using bivariate effect size comparisons and multivariate logistic regression. Results: Among unique individuals in the 2014 MarketScan database (N=47,258,528), the ECT utilization rate was 5.56 ECT patients per 100,000 in the population. Of the 969,277 patients with a mood disorder, 2,471 (.25%) received ECT. Those who received ECT had substantially higher rates of additional comorbid psychiatric disorders (risk ratio [RR] =5.70 for any additional psychiatric disorder), numbers of prescription fills for any psychotropic medication (Cohen’s d=.77), rates of any substance use disorder (RR=1.97), and total outpatient psychotherapy visits (Cohen’s d=.49). The proportion of patients with a mood disorder who received ECT in the West (.19%) was substantially lower than in other U.S. regions (.28%). This difference was almost entirely accounted for by one western state comprising 59.1% of patients in that region. Conclusions: Use of ECT is exceptionally uncommon and limited to patients with extensive multimorbidity and high levels of service use. ECT utilization is most limited in areas of the country where regulatory restrictions are greatest.

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“…9À11 A variety of clinicians and researchers have questioned the validity of the categorical approach to these diseases, as psychotic symptoms can be present in both diseases, suggesting that they are less distinct than the DSM and ICD indicate. 9,12 In fact, several recent studies have shown that the majority of real-world patients have multiple psychiatric disorders, 13,14 and rates of mental health multimorbidity tend to be higher in patients with schizophrenia and BD compared with other psychiatric patients. 15,16 Psychiatric multimorbidity, and its associated clinical complexity, is increasingly recognized as ubiquitous by mental health professionals and according to research.…”

Section: Introductionmentioning

confidence: 99%

Health Care Resource Use, Costs, and Diagnosis Patterns in Patients With Schizophrenia and Bipolar Disorder: Real-world Evidence From US Claims Databases

Broder

Greene

Chang

et al. 2018

Clinical Therapeutics

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Our analyses indicate that a substantial number of patients received diagnoses of both SCZ and BD-I, based on claims, in a 2.5-year period. Patients with a diagnosis of both SCZ and BD-I had higher health care utilization and costs than patients with either diagnosis alone. We identified differential patient characteristics, utilization of medications and health care services, and health care costs among the cohorts.

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A Change in Perspective: From Dual Diagnosis to Multimorbidity

Abstract: Real-world psychiatric care is more accurately approached from the multimorbidity perspective than from the perspective of principal, dual, or comorbid diagnoses.

Cited by 36 publications

References 11 publications

Severe mental illness and health service utilisation for nonpsychiatric medical disorders: A systematic review and meta-analysis

Severe mental illness and health service utilisation for nonpsychiatric medical disorders: A systematic review and meta-analysis

Identifying Recipients of Electroconvulsive Therapy: Data From Privately Insured Americans

Health Care Resource Use, Costs, and Diagnosis Patterns in Patients With Schizophrenia and Bipolar Disorder: Real-world Evidence From US Claims Databases

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