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The scandal of premature mortality in people with serious mental illness is well established. Despite an increase in studies evaluating the efficacy of lifestyle interventions, translating this evidence into routine clinical care and policies is challenging, in part due to limited effectiveness or implementation research. We highlight the challenge of implementation that is increasingly recognized in clinical practice, advocate for adopting implementation science to study the implementation and systematic update of effective interventions in practice and policy, and provide directions for future research. [ABSTRACT FROM AUTHOR]

Objective: To investigate the long-term effects of antipsychotic (AP) treatment and AP-induced hyperprolactinemia on bone mineral density (BMD) and body composition in male adolescents with autism spectrum disorders (ASDs) and/or disruptive behavior disorder (DBD). Design: Physically healthy 10- to 20-year-old boys with ASD and/or DBD, chronically treated (nZ56; mean 52 months, range 16-126 months) or not treated (nZ47) with an AP, were recruited to this observational study. Prolactin levels and biochemical bone parameters were measured and BMD of the lumbar spine and total body, and body composition were assessed by dual-energy X-ray absorptiometry, and volumetric BMD of the lumbar spine calculated. Group differences were tested with Student's t-test, c2 test, Fisher exact test, and logistic regression analysis. Results: Forty-nine percent of the boys treated with an AP had hyperprolactinemia. The mean volumetric lumbar spine BMD z-score was lower (P=0.043), the total percentage of body fat z-score was higher (P=0.042), and biochemical bone marker carboxyterminal cross-linking telopeptide of bone collagen was lower in the AP-treated boys with hyperprolactinemia than in the AP-treated boys without hyperprolactinemia. Seven to 11% of the hyperprolactinemic boys had low BMD. The mean lumbar spine and total body BMD z-scores and body composition were similar in the boys who were or were not treated with an AP. The total study population had a lower mean lean tissue mass (mean z-score -0.37, P=0.004) and a higher percentage of total body fat (mean z-score 1.16, <0.001) than healthy controls (normative data); biochemical bone parameters were within normal limits. Conclusion: AP-induced hyperprolactinemia in boys with ASD or DBD may have a negative effect on lumbar spine BMD. Longitudinal studies are needed to confirm this finding and further disentangle the effects of the disorder, lifestyle, treatment, and hyperprolactinemia. [ABSTRACT FROM AUTHOR]

Tardive dyskinesia (TD) may occur in never-medicated patients with psychotic illness, indicating the existence of non-medication, possibly disease-related, causes. We tested the hypothesis that, independent of the antipsychotic-induced rise in prolactin, the incidence of TD would be associated with the incidence of prolactin-related sexual disturbances (PRSD), which would be suggestive of a common pathology involving multiple dopamine tracts. Simple, global measures of TD and PRSD (loss of libido, amenorrhea, gynaecomastia, impotence, and galactorrhea) were rated in a prospective, observational European Health Outcomes Study (SOHO). New onset of TD and new onset of PRSD at 3, 6, and 12 months was analyzed in a risk set of 4263 patients using a Cox proportional hazard model yielding adjusted hazard ratios (aHR). Incidence of TD was significantly and linearly comorbid with the incidence of PRSD in both men and women. Compared to those with no PRSD, the risk for TD was 2.0 (95% CI: 1.1, 3.7) with one PRSD, 2.4 (95% CI: 1.3, 4.5) with two PRSD, and 3.6 (95% CI: 1.1, 11.8) with three PRSD. Associations were stronger in those who only had received prolactin-sparing medications (aHR per unit PRSD increase=2.0, 95% CI: 1.2, 3.3) than in those who only had received prolactin-raising medications (aHR=1.3, 95% CI: 0.9, 1.9). In people with schizophrenia, TD and PRSD show comorbidities that are independent of antipsychotic-induced alterations in plasma prolactin. This may suggest a shared, pandopaminergic pathological mechanism associated with schizophrenia itself, rather than only a medication effect.Neuropsychopharmacology (2006) 31, 1832–1837. doi:10.1038/sj.npp.1301044; published online 15 February 2006 [ABSTRACT FROM AUTHOR]

Objetivos: Este estudio examinó si los síntomas extrapiramidales pronosticaban la incidencia de discinesia tardía al cabo de 1 año. Método: Se utilizaron medidas globales sencillas para evaluar los síntomas extrapiramidales y la discinesia tardía en un estudio prospectivo observacional de los desenlaces clínicos. Se analizaron los datos de la evaluación inicial y a los 3, 6 y 12 meses en 9.298 pacientes utilizando el modelo de riesgo proporcional de Cox. Se examinó el inicio de discinesia tardía en dos grupos: 1) ausencia de discinesia tardía en la evaluación inicial (grupo de riesgo alto) y 2) ausencia de discinesia tardía en la evaluación inicial y a los 3 meses (grupo de riesgo bajo). Resultados: Los síntomas extrapiramidales basales pronosticaron el desarrollo posterior de discinesia tardía (grupo de riesgo alto: índice de riesgo = 2,0; grupo de riesgo bajo: índice de riesgo = 1,6). En los análisis ajustados a la edad, el sexo y la exposición a fármacos, no disminuyó el tamaño de efecto. Aproximadamente la mitad de los pacientes que desarrollaron discinesia tardía había experimentado, con anterioridad, síntomas extrapiramidales. Conclusiones: Aunque existe una relación estrecha entre la discinesia tardía y los síntomas extrapiramidales, éstos no identifican de forma concluyente a los individuos con un riesgo elevado de desarrollar discinesia tardía. No obstante, los regímenes farmacoterapéuticos y los procesos patológicos que acentúan los síntomas extrapiramidales aumentan, probablemente, el riesgo de discinesia tardía. [ABSTRACT FROM AUTHOR]

Objective. Constipation is a prevalent problem in patients with psychiatric disorders; it reduces quality of life and may lead to severe complications. The prevalence distribution of constipation across all psychiatric diagnoses in patients with severe mental illness (SMI) has hardly been studied. The aim of this study is to estimate the association between psychiatric disorders and constipation in SMI inpatients. Methods. The strength of the association between constipation (based on use of laxatives) and DSM-IV psychiatric diagnosis was studied in a cross-sectional study with "adjustment disorders" as the reference group. The association was analyzed using logistic regression. Results. Of the 4728 patients, 20.3% had constipation. In the stratum of patients older than 60 years, all psychiatric categories except for substance related disorders were significantly associated with a higher prevalence of constipation (odds ratios ranging from 3.38 to 6.52), whereas no significant associations were found in the stratum of patients between 18 and 60 years (odds ratios ranging from 1.00 to 2.03). Conclusion. In the elderly, all measured psychiatric diagnoses are strongly associated with an increased prevalence of constipation. Physicians should be extra alert for constipation in SMI patients, independent of specific psychiatric diagnoses.

Tardive dyskinesia (TD) is a common and potentially irreversible side effect of dopamine blocking agents, most often antipsychotics. It is often socially and sometimes also physically disabling. The clinical picture can be divided into orofacial, limb-truncal, and respiratory dyskinesia. The clinical options to prevent or mitigate TD include psychoeducation, systematic screening, and evaluation of the need for antipsychotics and/or dosages, managementof known risk factors, and switching to an antipsychotic with a lower risk of TD. There is no evidence-based approach for treating existing TD but several clinical interventions can be effective including discontinuing the antipsychotics or reducing the dosage, switching to clozapine, adding an antidyskinetic agent, or applying deep brain stimulation., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Dyskinesia can develop in patients with schizophrenia in the course of the disease with or without the use of antipsychotics.In patients with psychiatric disorders other than schizophrenia Tardive Dyskinesia (TD) can develop in patients treated with antipsychotics or other drugs with dopamine D2 blocking properties. Spontaneous Dyskinesia in antipsychotic naive patients with schizophrenia ranges from 4 to 40%, depending on the age and duration of the illness. Moreover, siblings of patients with schizophrenia have higher prevalence rates of dyskinesia than matched controls. Incidence rates of TD due to dopamine blocking properties vary due to the sample population and the affinity for the dopamine blocker to the D2 dopamine receptor. Once developed, TD seems very persistent, the course of TD might be mediated by the affinity for the dopamine D2 receptor. Risk factors for TD in the literature are numerous, in this chapter only replicated and risk factors from longitudinal studies will be reported limiting the amount of risk factors. Furthermore only meta-analyses on genetic factors related to TD will be discussed due to inconsistency of genetic effects because of sample heterogeneity, small effects of multiple genes, (epi)genetic interactions,pleiotropy and small sample size. Finally the concept "Tardive Dyskinesia" will be discussed and the influence hereof on the above mentioned factors., (Copyright © 2011 Elsevier Inc. All rights reserved.)