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Management of Physical Health Conditions in Adults with Severe Mental Disorders. Geneva: World Health Organization; 2018.

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Management of Physical Health Conditions in Adults with Severe Mental Disorders.

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Annex 3Scoping questions

Background Questions

1. Association of physical health conditions with SMD

What is the comorbidity between physical health conditions (NCDs and infectious diseases) and SMD?

What is the impact of physical health conditions on the morbidity and mortality of people with SMD?

PICO (POPULATION, INTERVENTION, COMPARISON, OUTCOME) Questions

2. Tobacco cessation

For people with SMD who use tobacco, are pharmacological (including nicotine replacement therapy, bupropion, varenicline) and/or non-pharmacological interventions effective to support tobacco cessation?

P.

people with SMD who use tobacco

I.

pharmacological interventions and/or non-pharmacological interventions:

  • pharmacological interventions: including nicotine replacement therapy, bupropion, varenicline
  • non-pharmacological interventions

C.

care as usual and/or placebo

O.

  • Critical
    –

    Tobacco cessation/abstinence rates

    –

    Tobacco consumption rates

    –

    Respiratory disease outcomes (COPD, asthma)

  • Important
    –

    Frequency of adverse events/side-effects (including drug interactions)

3. Weight management

3.1. For people with SMD who are overweight or obese, are non-pharmacological and/or pharmacological interventions and/or pharmacological management strategies effective to support weight reduction?

P.

people with SMD who are overweight or obese

I.

non-pharmacological and/or pharmacological interventions and/or pharmacological management strategies:

  • Non-pharmacological interventions: e.g. cognitive-behavioural intervention strategies, lifestyle interventions (e.g. diet, exercise, physical activity / decreased sedentary behaviour, health education), family involvement in interventions
  • Pharmacological interventions: weight-loss medication (e.g. orlistat)
  • Pharmacological management strategies: e.g. switching antipsychotic medication

C.

care as usual and/or placebo

O.

  • Critical
    –

    Change in weight

    –

    Mean BMI (kg/m2) or change in BMI

  • Important
    –

    Reduced sedentary behaviour

    –

    Maintenance of weight change/Attenuation/prevention of weight gain

    –

    Frequency of adverse events/side-effects

3.2. For people with SMD who are at risk of becoming overweight or obese, are non-pharmacological interventions effective to support prevention of weight gain?

P.

people with SMD who are at risk of becoming overweight or obese, e.g. people who have just started anti-psychotic medication

I.

non-pharmacological interventions, e.g. cognitive-behavioural intervention strategies, lifestyle interventions (e.g. diet, exercise, physical activity / decreased sedentary behaviour, health education), family involvement in interventions

C.

care as usual

O.

  • Critical
    –

    Change in weight

    –

    Mean BMI (kg/m2) or change in BMI

    –

    Maintenance of weight change

    –

    Attenuation/prevention of weight gain

  • Important
    –

    Reduced sedentary behaviour

    –

    Frequency of adverse events/side-effects

4. Substance use disorders; drugs and/or alcohol

For people with SMD and substance (drug and/or alcohol) use disorder, are pharmacological and/or non-pharmacological interventions for substance use disorder effective to support reduction in substance use-related outcomes?

P.

people with SMD and substance (drug and/or alcohol) use disorder

I.

pharmacological and/or non-pharmacological interventions for substance use disorders:

  • Pharmacological interventions
  • Non-pharmacological interventions: e.g. motivational interviewing and/or CBT, psychoeducation, brief assessment interview, dual-focus interventions

C.

care as usual / placebo or one treatment vs another

O.

  • Critical
    –

    Level of consumption

    –

    Frequency of use

    –

    Abstinence

    –

    Relapse rates

  • Important
    –

    Frequency of adverse events / side-effects

5. Cardiovascular disease / risk factors

5.1. For people with SMD and pre-existing cardiovascular disease, what pharmacological and/or non-pharmacological interventions are effective to support reduction of cardiovascular disease outcomes

P.

people with SMD and pre-existing cardiovascular disease: e.g. coronary heart disease, prior heart failure or stroke, cardiomyopathy, congenital heart disease, peripheral vascular disease

I.

pharmacological and/or non-pharmacological interventions:

  • pharmacological interventions
  • non-pharmacological interventions

C.

one treatment versus another or care as usual/placebo

O.

  • Critical
    –

    Major adverse cardiovascular event (MACE) - includes cardiovascular death, myocardial infarction, stroke, heart failure, hospitalization, amputation

  • Important
    –

    Frequency of adverse events/side-effects

5.2. For people with SMD and cardiovascular risk factors (a. high blood pressure; b. high lipid levels), what pharmacological and/or non-pharmacological interventions are effective to support reduction of cardiovascular risk factors?

P.

people with SMD and cardiovascular risk factors: a) high blood pressure (BP>140/90 mmHg; b) high lipid levels (e.g. cholesterol>200mg/dl or 5.2 mmol/l)

I.

pharmacological and/or non-pharmacological interventions:

  • pharmacological interventions: a) medication to control high blood pressure; b) medications for high lipid levels
  • non-pharmacological interventions

C.

one treatment versus another or care as usual/placebo

O.

  • Critical
    –

    Adequacy of control of CVD risk factors (a. blood pressure <130/80mmHg; b. cholesterol <200mg/dl)

    –

    Cardiovascular disease incidence - MI, stroke, chronic cardiovascular disease

  • Important
    –

    Frequency of adverse events/side-effects

6. Diabetes mellitus

For people with SMD and diabetes mellitus, what pharmacological and/or non-pharmacological interventions are effective to improve glycaemic control?

P.

people with SMD and diabetes mellitus

I.

pharmacological interventions and/or non-pharmacological interventions:

  • pharmacological interventions: e.g. medication to treat diabetes
  • non-pharmacological interventions: e.g. e.g. behavioural lifestyle interventions, cognitive behaviour therapy

C.

one treatment versus another or care as usual

O.

  • Critical
    –

    Fasting blood glucose <120mg/dl; post-prandial blood glucose<160mg/dl,

    –

    Glycosylated haemoglobin A1c (HbA1c<7 for people below 60 years and 7–8 for people above 60 years with other risk factors)

    –

    Diabetes complications – MACE, chronic kidney disease, diabetic retinopathy, diabetic neuropathy, hospitalization for infection

  • Important
    –

    Frequency of adverse events / side-effects

7. HIV/AIDS

For people with SMD and HIV/AIDS, what pharmacological (i.e. ARV drugs, psychopharmacology) and nonpharmacological interventions are effective to support reduction in HIV-related outcomes?

P.

people with SMD and HIV/AIDS

I.

  • pharmacological interventions (ARV drugs, psychopharmacology)
  • Nonpharmacological interventions

C.

one treatment versus another or care as usual

O.

  • Critical
    –

    HIV-related outcomes

  • Important
    –

    Frequency of adverse events / side-effects

8. Other infectious diseases (Tuberculosis, Hepatitis B/C)

For people with SMD and infectious diseases (Tuberculosis, Hepatitis B/C), what pharmacological and nonpharmacological (social, psychological) interventions are effective for treatment of infectious diseases (i.e. tuberculosis, hepatitis B, hepatitis C)?

P.

people with SMD and infectious diseases (Tuberculosis, Hepatitis B/C)

I.

  • pharmacological interventions for infectious diseases
  • Nonpharmacological (social, psychological) interventions for infectious diseases

C.

one treatment versus another or care as usual

O.

  • Critical
    –

    Infectious disease-related outcomes

  • Important
    –

    Frequency of adverse events / side-effects

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