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首页> 外文学位 >Prevention in the severely mentally ill: Primary care quality and adverse events among persons with schizophrenia, and the benefit of physical activity on sleep in a community sample of persons with severe mental illness.
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Prevention in the severely mentally ill: Primary care quality and adverse events among persons with schizophrenia, and the benefit of physical activity on sleep in a community sample of persons with severe mental illness.

机译：严重精神疾病的预防：精神分裂症患者的初级保健质量和不良事件，以及在社区严重精神疾病患者样本中睡眠对身体活动的益处。

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摘要

The public health impact of schizophrenia extends beyond the psychiatric effects of the illness itself, to the associated adverse health risk profile, medical comorbidity, mortality, and the complexity of management of medical disease in this population. This dissertation traces the path of persons with schizophrenia through the healthcare system by examining the quality of primary care, evaluating the risk of adverse events during hospitalization, and examining the impact of exercise as a remedy for poor sleep quality, a common complaint of people with severe mental illness (SMI).;Paper 1 systematically reviews the evidence evaluating the quality of primary care for physical conditions among persons with schizophrenia. Only 17 studies with persons with either schizophrenia or a psychotic disorder were identified. Most studies indicated that the quality of care for persons with schizophrenia is both below clinical standards and reduced when compared to that given to the general population. Further research for the quality of primary care regarding other illnesses and settings is needed.;Paper 2 estimates the national cumulative incidence of adverse events in non-psychiatric hospitalizations for persons with schizophrenia compared with those for persons without schizophrenia and examines the relationship between adverse events and in-hospital death, length of stay, and total charges for persons with schizophrenia using the Nationwide Inpatient Sample. Hospitalizations for patients with schizophrenia had greater risk of the following adverse event compared with those for patients without schizophrenia: decubitus ulcer, postoperative respiratory failure, postoperative deep venous thrombosis, and postoperative sepsis and reduced risk for accidental puncture or laceration and failure to rescue. Adverse events were associated with greater risk of in-hospital death, longer length of stay, and greater total charges.;Paper 3 examines the potential of physical activity as a possible remedy for sleep problems frequently experienced by persons with SMI. We assessed self-reported sleepiness and sleep quality in a group of 24 overweight and obese participants with SMI before and after undergoing a 6-month physical activity and nutritional counseling program as part of the Trial of Achieving Healthy Lifestyles in Psych Rehabilitation Study. Significant pre- to post-treatment improvements were found for sleep quality and reductions in daytime sleepiness.;People with schizophrenia and other severe mental illnesses encounter the same physical health problems and have adverse risk profiles as people without mental illness. More effort should be made for detection, management, and prevention of medical comorbidity in patients with schizophrenia. In addition, care should be taken to prevent certain adverse events that tend to be elevated in persons with schizophrenia. Finally, further study of sleep quality following a 6-month exercise and nutritional guidance program in persons with SMI is warranted, with a control group, a larger number of participants, and objective measures of sleep in addition to self-report. The high levels of morbidity and mortality in this population warrant a comprehensive strategy for the understanding and prevention of medical comorbidity in persons with SMI.
机译：精神分裂症对公众健康的影响不仅限于疾病本身的精神病学影响，还涉及该人群中相关的不良健康风险状况，医疗合并症，死亡率以及医疗疾病管理的复杂性。本论文通过检查初级保健的质量，评估住院期间不良事件的风险以及检查运动对睡眠质量差的补救措施（这是精神分裂症患者的常见抱怨）来追踪精神分裂症患者通过医疗保健系统的路径。严重精神疾病（SMI）。；论文1系统评估了评估精神分裂症患者身体状况的初级保健质量的证据。仅有17项针对精神分裂症或精神病患者的研究。大多数研究表明，与普通人群相比，精神分裂症患者的护理质量既低于临床标准，又降低。需要对其他疾病和环境的初级保健质量进行进一步研究。；论文2估计了精神分裂症患者与非精神分裂症患者在非精神病院住院治疗中全国性不良事件的累积发生率，并研究了不良事件之间的关系使用全国住院样本收集的精神分裂症患者的院内死亡，住院时间和总费用。与没有精神分裂症的患者相比，精神分裂症患者的住院发生以下不良事件的风险更高：褥疮，术后呼吸衰竭，术后深静脉血栓形成和术后败血症，降低了意外穿刺或撕裂伤和抢救失败的风险。不良事件与院内死亡的风险更大，住院时间更长和总费用更高有关。论文3检验了体育锻炼作为SMI患者经常出现的睡眠问题的可能疗法的潜力。我们在进行为期6个月的体育锻炼和营养咨询计划之前和之后，对24名SMI超重和肥胖参与者的自我报告的嗜睡和睡眠质量进行了评估，这是“实现心理康复研究中健康生活方式的一部分”。发现治疗前和治疗后的睡眠质量有了显着改善，白天的嗜睡减少了。精神分裂症和其他严重精神疾病的人与没有精神疾病的人一样，会遇到同样的身体健康问题，并且有不良的风险状况。在精神分裂症患者中，应该更加努力地检测，管理和预防合并症。此外，应注意预防某些精神分裂症患者中可能加剧的不良事件。最后，有必要对SMI患者进行为期6个月的运动和营养指导计划后进一步研究睡眠质量，其中包括对照组，大量参与者以及除自我报告外的客观睡眠指标。该人群的高发病率和高死亡率，为理解和预防SMI患者的合并症提供了全面的策略。

著录项

  • 作者

    Khaykin, Elizabeth.;

  • 作者单位

    The Johns Hopkins University.;

  • 授予单位 The Johns Hopkins University.;
  • 学科 Epidemiology.;Mental health.
  • 学位 Ph.D.
  • 年度 2009
  • 页码 167 p.
  • 总页数 167
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

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