Widely used drugs may have the potential to help treat mental illness

Hayes, J.F. et al | 2019 | Association of Hydroxylmethyl Glutaryl Coenzyme A Reductase Inhibitors, L-Type Calcium Channel Antagonists, and Biguanides With Rates of Psychiatric Hospitalization and Self-Harm in Individuals With Serious Mental Illness | JAMA Psychiatry | Published online ahead of print| doi:10.1001/jamapsychiatry.2018.3907

A study that involved experts from University College London has been published in JAMA Psychiatry, following its finding that  hospital treatment for patients with serious mental illness was reduced  by up to a fifth when they were prescribed drugs in common use for physical health problems. 

The study investigated if drugs in common use for physical health problems are associated with reduced rates of psychiatric hospitalization and self-harm in individuals with serious mental illness.

The researchers analysed the patient information of 142 691 patients with bipolar disorder, schizophrenia, or nonaffective psychosis. It found that the drugs used to treat blood pressure, high cholesterol and type 2 diabetes were found to have the potential to treat severe mental illness as it was associated with reduced rates of psychiatric hospitalizaiton compared with unexposed periods. Self-harm was reduced in patients with bipolar disorder and schizophrenia during exposure to all study drugs and in patients with nonaffective psychosis taking L-type calcium channel antagonists.

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Abstract

Importance  Drug repurposing is potentially cost-effective, low risk, and necessary in psychiatric drug development. The availability of large, routine data sets provides the opportunity to evaluate the potential for currently used medication to benefit people with serious mental illness (SMI).

Objective  To determine whether hydroxylmethyl glutaryl coenzyme A reductase inhibitors (HMG-CoA RIs), L-type calcium channel (LTCC) antagonists, and biguanides are associated with reduced psychiatric hospitalization and self-harm in individuals with SMI.

Design, Setting, and Participants  These within-individual cohort studies of patients with SMI compared rates of psychiatric hospitalization and self-harm during periods of exposure and nonexposure to the study drugs, with adjusting for a number of time-varying covariates. Participants included 142 691 individuals from the entire population of Sweden with a diagnosis of bipolar disorder (BPD), schizophrenia, or nonaffective psychosis (NAP) who were 15 years or older and who were treated with psychiatric medication from October 1, 2005, through December 31, 2016. Data were analyzed from April 1 through August 31, 2018.

Interventions  Treatment with HMG-CoA RIs, LTCC antagonists, or biguanides.

Main Outcomes and Measures  Psychiatric hospitalizations and self-harm admissions.

Results  Among the 142 691 eligible participants, the HMG-CoA RI exposure periods were associated with reduced rates of psychiatric hospitalization in BPD, schizophrenia, and NAP and reduced self-harm rates in BPD and schizophrenia. Exposure to LTCC antagonists was associated with reduced rates of psychiatric hospitalization and self-harm in subgroups with BPD, schizophrenia and 0.30, respectively), and NAP  and 0.56, respectively). During biguanide exposure, psychiatric hospitalization rates were reduced in subgroups with BPD, schizophrenia, and NAP, and self-harm was reduced in BPD and schizophrenia.

Conclusions and Relevance  This study provides additional evidence that exposure to HMG-CoA RIs, LTCC antagonists, and biguanides might lead to improved outcomes for individuals with SMI. Given the well-known adverse event profiles of these agents, they should be further investigated as repurposed agents for psychiatric symptoms.

The article is available from JAMA Psychiatry

In the news:

BBC News Cheap common drugs may help mental illness

The Women’s Mental Health Taskforce: final report

Department of Health and Social Care | December 2018| The Women’s Mental Health Taskforce: final report

The Women’s Mental Health Taskforce was formed in response to a rise in mental ill health among women. The taskforce’s final report sets out how women’s experience of mental ill health can differ to men’s.

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It covers:

  • core themes in women’s mental health
  • the involvement of women with lived experience
  • principles for service design
  • future strategic priorities

This final report from the taskforce outlines how women’s experience of mental ill health can differ to men’s. It considers: core themes in women’s mental health; the involvement of women with lived experience; principles for service design; and future strategic priorities (Source: Department of Health and Social Care).

The Women’s Mental Health Taskforce: final report

 

Mental health funding squeeze has lengthened waiting times, say NHS finance leads

The King’s Fund | December 2018 | Mental health funding squeeze has lengthened waiting times, say NHS finance leads

Eight out of ten NHS trust finance directors say that funding pressures have led to longer waiting times for people who need mental health treatment, according to The King’s Fund’s latest quarterly monitoring report.

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New analysis for the report also shows that despite NHS England meeting its commitment to increase its investment in mental health, nearly a quarter of mental health trusts recorded a reduction in income between 2016/17 and 2017/18. An analysis of mental health trusts’ financial accounts carried out for the report found that, while mental health trusts as a whole reported an overall increase in funding, 21 per cent recorded a reduction in income last year, up from 13 per cent the previous year.

The report is published ahead of NHS England’s long-term plan, which was recently delayed amidst political turmoil over Brexit and is now expected early in the new year (Source: The King’s Fund).

Read the full press release from The King’s Fund

Reducing health inequalities in mental illness

Actions that local areas can take to reduce health inequalities experienced by people living with mental illness | Public Health England

Mental health problems can affect anyone and have a significant effect on the lives of individuals, their families, communities and wider society. One in six adults have had a common mental health disorder, such as anxiety, in the last week, according to survey data. Three quarters of mental health problems are established by the age of 24. Recent data indicates that there are close to 551,000 people in England with more severe mental illness (SMI) such as schizophrenia or bipolar disorder.

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Image source: http://www.gov.uk

This edition of Health matters brings together in one place the most informative data and the best evidence of what works in removing health inequalities experienced by people living with mental illness. It focuses on some of the actions that local areas can take to reduce these health inequalities, so that people with mental illness can achieve the same health outcomes and life expectancy as the rest of the population.

It is aimed at health and care professionals, local commissioners and system partners, including the community and voluntary sector. The focus is on adults and those with more severe and enduring mental illness, but many of the actions will be of benefit to all people experiencing mental illness.

Full guidance: Health matters: reducing health inequalities in mental illness

The Women’s Mental Health Taskforce report

This report sets out how women’s experience of mental ill health can differ to men’s and the strategic priorities for the future | Department of Health and Social Care

The Women’s Mental Health Taskforce was formed in response to a rise in mental ill health among women. Women are more likely to experience common mental health conditions than men, and while rates remain relatively stable in men, prevalence is increasing in women. Young women are a particularly high-risk group, with over a
quarter (26%) experiencing a common mental disorder, such as anxiety or depression – almost three times more than young men (9.1%).

The taskforce’s final report sets out how women’s experience of mental ill health can differ to men’s. It covers:

  • core themes in women’s mental health
  • the involvement of women with lived experience
  • principles for service design
  • future strategic priorities

The report urges commissioners and providers across the health and care system to take note of the report’s findings and to embed these in their work.

Full document: The Women’s Mental Health Taskforce report

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Image source: http://www.gov.uk

Victimised adolescents more likely to self-harm and have suicidal thoughts

Baldwin, J. R. et al. | 2018| Adolescent Victimization and Self-Injurious Thoughts and Behaviors: A Genetically Sensitive Cohort Study| Journal of the American Academy of Child & Adolescent Psychiatry | Vol.0 |Issue 0| DOI: https://doi.org/10.1016/j.jaac.2018.07.903

Children and young people that are victimised have double the likelihood of self-harm and their risk of suicide  is trebled compared to non-victimised peers according to researchers at King’s College London. The study looked at over 2000 twins born in England and Wales between 1994-95. They studied different forms of adolescent victimisation- including maltreatment, neglect, bullying, crime, sexual victimisation, and family violence- which were identified in interviews with the participants when they turned 18. Among their findings was that over a third of the sample had experienced one severe form of victimisation during their adolescence and 7 per cent had experienced at least three or more severe types of victimisation. Almost 20 per cent (18.9%) had had some form of self-injurious thoughts and behaviours. Victimized adolescents had an increased risk of suicidal ideation and over a quarter had atempted suicide.  

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Abstract

Objective

Victimized adolescents have elevated risk of self-injurious thoughts and behaviors. However, poor understanding of causal and non-causal mechanisms underlying this observed risk limits the development of interventions to prevent premature death among adolescents. We tested whether pre-existing family-wide and individual vulnerabilities account for victimized adolescents’ elevated risk of self-injurious thoughts and behaviors.


Method

Participants were 2,232 British children followed from birth to age 18 as part of the Environmental Risk (E-Risk) Longitudinal Twin Study. Adolescent victimization (maltreatment, neglect, sexual victimization, family violence, peer/sibling victimization, cyber-victimization, and crime victimization) was assessed through interviews with participants and co-informant questionnaires at the age 18 assessment. Suicidal ideation, self-harm, and suicide attempt in adolescence were assessed through interviews with participants at age 18.

Results

Victimized adolescents had an increased risk of suicidal ideation, self-harm, and suicide attempt. Co-twin control and propensity-score matching analyses showed that these associations were largely accounted for pre-existing familial and individual vulnerabilities, respectively. Over and above their prior vulnerabilities, victimized adolescents still showed a modest elevation in risk for suicidal ideation.

Conclusion

Risk for self-injurious thoughts and behaviors in victimized adolescents is only partly explained by the experience of victimization. Pre-existing vulnerabilities account for a large proportion of the risk. Therefore, effective interventions to prevent premature death in victimized adolescents should not only target the experience of victimization but also address pre-existing vulnerabilities.

The article is in press but may be requested through interlibrary loan by Rotherham NHS staff 

In the news:

BBC News Teenage victims ‘more likely to self-harm’

The Mental Health Foundation report: ‘Londoners said’

The Mental Health Foundation | December 2018 | Londoners said

The Mental Health Foundation, in partnership with Thrive LDN,  asked Londoners how we could better support people to be mentally healthy.  This was achieved through community conversations held in half of all London’s boroughs where they asked over 1,000 Londoners including those who commission, provide and use services, about asked how they could deliver Thrive LDN’s six aspirations.

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The six aspirations are:

  • A city where communities and individuals take the lead.
  • A city free from mental health stigma and discrimination.
  • A city that maximises the potential of children and young people.
  • A city with a happy, healthy and productive workforce.
  • A city with services that are there, when and where needed.

The publication that was written as a result of these conversations provides insights and feedback from each of the community conversations held. Common themes were identified from the conversations  namely, to spread knowledge, skills and support so that people can better look after themselves and their neighbours.

The publication also includes  10 recommendations; the Mental Health Foundation, in partnership with Thrive LDNWe invite feedback and responses to their recommendations.

See the Mental Health Foundation for full details