Comprehensive searches of major bibliographic databases were conducted in order to identify one or more systematic reviews that matched each of the outcomes for each of the PICO questions. The aim was to identify systematic reviews that were timely, of high quality and relevant to each of the PICO questions.
The Following Process was Employed for the Searches
Searched for systematic reviews (including meta-analyses) that were published in the last five years for each of the PICO questions. Guidelines from the last five years were also included, if these closely matched the population to whom the PICO question applies; any guidelines used needed to adhere to the WHO rules for guidelines. The searches were run in February 2018.
If no relevant high-quality systematic reviews were identified from the last five years for any of the PICO questions, the search was expanded to include systematic reviews from the last ten years for that PICO question. This was the case for the two PICO questions on HIV/AIDS and other infectious diseases; these searches were re-run in March 2018.
Where relevant, any guidelines that did not closely match the population to whom the PICO question applied (e.g. guidelines that apply to the general population) were used as indirect evidence.
For the PICO question on substance use disorder, based on the GDG’s feedback during the GDG meeting in May 2018, the searches were expanded to include further search terms and were re-run in June 2018 (searching for systematic reviews from the last five years).
The following bibliographic databases were searched:
- -
Cochrane Library (including DARE) (title, abstract, keywords + mesh terms)
- -
PubMed/Medline (all fields)
- -
EMBASE (Ovid)
- -
PSYCINFO (anywhere)
- -
Epistemonikos (title/abstract)
- -
Global Health Library (title/abstract/subject)
- -
For those PICO questions where the search was expanded (see step 2 above), the National Guideline Clearing House was also searched.
After the searches were run using the search strategies listed on the pages below, titles and abstracts of all results were screened in Endnote; subsequently the full texts of those papers were reviewed that could not be excluded based on the title/abstract review.
Grade Evidence Tables
All systematic reviews / meta-analyses that were identified as matching one of the PICO questions based on the search strategy described above were then assessed using the AMSTAR methodology2, which evaluates the quality of systematic reviews using eleven criteria.
For each outcome of each PICOquestion, one or more systematic reviews were then selected to be used within the GRADE evidence tables for the PICO questions’ evidence profiles. The following criteria were used when selecting which systematic review to use within the GRADE evidence tables:
Published in the last five years, ideally three years (timeliness)
High quality (i.e. at least six, but ideally more, of the eleven criteria of the AMSTAR scored positively)
Closely relevant to the PICO
Systematic reviews that dealt with SMD generally (rather than specific mental disorders) given preference
Comprehensive systematic reviews given preference, where possible
Cochrane reviews or other meta-analyses given preference, where possible/appropriate
The GRADE methodology involves rating the quality of the studies included in the systematic review according to study design, risk of bias, inconsistency, indirectness, imprecision, and publication bias. Together with the effect sizes of studies, an overall ‘certainty of evidence’ is provided of either very low, low, moderate or high.
GRADE evidence tables were completed using the GRADEpro online tool3; the same criteria were used as for the mhGAP Intervention Guide when completing the GRADE evidence tables in terms of the assessment of the quality of studies (for risk of bias, inconsistency, indirectness, imprecision, and publication bias)4.
Search Strategies
Separate searches were performed for each of the seven PICO questions. Where PICO questions included both pharmacological and non-pharmacological interventions, searches were run separately for these.
The three search sets outlined below for each of the PICO questions were separated by an ‘AND’ when running the searches.
Filters were used in the bibliographic databases where possible to restrict the searches to systematic reviews and meta-analyses, as well as to humans. No further restrictions were employed, for example in terms of language (apart from the publication date, as mentioned above).
The ‘Advanced Search’ option was selected in bibliographic databases, where possible.
PICO Question 2
For people with SMD who are use tobacco, are pharmacological (including nicotine replacement therapy, bupropion, varenicline) interventions effective to support tobacco cessation?
Search #1: SMD
(exp Mental Disorders/ OR exp Psychotic Disorders/ OR exp Bipolar and Related Disorders/ OR exp Depressive Disorder) OR
((Mental AND (disorder* OR disabilit* OR illness OR “health condition” OR “health problem” OR distress)) OR “psychological distress” OR “psychiatric disorder”) OR
((schizophrenia OR schizophrenic) OR Schizotyp* OR ((Delusional OR paranoid) AND disorder*) OR hallucination* OR Psychotic OR Schizoaffective OR psychosis) OR
(((manic OR bipolar OR mood) AND disorder*) OR (depressive AND (disorder* OR episode*)) OR “depressive symptom*” OR hypomania OR mania* OR ((major OR psychotic OR disorder*) AND depression))
Search #2: smoking
(exp Smoking/ OR exp Smokers/ OR exp Tobacco Smoking/ OR exp Tobacco Use/ OR exp Tobacco/ OR exp Nicotine/) OR
(smok* OR tobacco OR nicotin* OR cigarette*)
Search #2: smoking
(exp Smoking/ OR exp Smokers/ OR exp Tobacco Smoking/ OR exp Tobacco Use/ OR exp Tobacco/ OR exp Nicotine/) OR
(smok* OR tobacco OR nicotin* OR cigarette*)
Search #3: pharmacological tobacco cessation interventions
(exp Smoking Cessation/ OR exp Smoking Reduction/ OR exp Tobacco Use Cessation/ OR exp Tobacco Use Cessation Products/ OR exp Bupropion/ OR exp Varenicline/ OR exp Nicotine Chewing Gum) OR
(exp Drug Therapy/ OR exp Pharmacology/ OR exp Psychopharmacology/ OR exp Metabolic Side Effects of Drugs and Substances/ OR exp Pharmacologic Actions/ OR exp Drug Effects/ OR exp Psychotropic Drugs/) OR
((drug* OR pharmac* OR medic* OR psychotrop*) AND (intervent* OR therap* OR treat* OR care OR servic*)) OR (drug* OR medic*) OR
((smok* OR tobacco OR nicotin* OR cigarette*) AND (cessation OR reduc* OR abst*)) OR
(bupropion OR varenicline OR “nicotine replacement therapy” OR “nicotine gum” OR “nicotine patch”)
For people with SMD who are use tobacco, are nonpharmacological interventions effective to support tobacco cessation?
Search #1: SMD
(exp Mental Disorders/ OR exp Psychotic Disorders/ OR exp Bipolar and Related Disorders/ OR exp Depressive Disorder) OR
((Mental AND (disorder* OR disabilit* OR illness OR “health condition” OR “health problem” OR distress)) OR “psychological distress” OR “psychiatric disorder”) OR
((schizophrenia OR schizophrenic) OR Schizotyp* OR ((Delusional OR paranoid) AND disorder*) OR hallucination* OR Psychotic OR Schizoaffective OR psychosis) OR
(((manic OR bipolar OR mood) AND disorder*) OR (depressive AND (disorder* OR episode*)) OR “depressive symptom*” OR hypomania OR mania* OR ((major OR psychotic OR disorder*) AND depression))
Search #2: smoking
(exp Smoking/ OR exp Smokers/ OR exp Tobacco Smoking/ OR exp Tobacco Use/ OR exp Tobacco/ OR exp Nicotine) OR
(smok* OR tobacco OR nicotin* OR cigarette*)
Search #3: non-pharmacological tobacco cessation interventions
(exp Smoking Cessation/ OR exp Smoking Reduction/ OR exp Tobacco Use Cessation/OR exp Tobacco Use Cessation Products/) OR
(exp Exercise Therapy/ OR exp Therapy/ OR exp Therapeutics/ OR exp Family Therapy/ OR exp Psychotherapy/ OR exp Cognitive Therapy/ OR exp Behaviour Therapy/ OR exp Counseling/ OR exp Mental Health Services/ OR exp Problem Based Learning/ OR exp Problem Solving/) OR
((psychosocial OR psycho* OR lifestyle* OR cognit* OR behaviour* OR behaviour* OR non-pharmac*) AND (intervent* OR therap* OR treat* OR care OR servic*)) OR
(“problem solving” OR psychoeducation OR couns*) OR
((smok* OR tobacco OR nicotin* OR cigarette*) AND (cessation OR reduc* OR abst*))
PICO Questions 3.1 & 3.2
For people with SMD who are overweight or obese, are pharmacological interventions effective to support weight reduction?
Search #1: SMD
(exp Mental Disorders/ OR exp Psychotic Disorders/ OR exp Bipolar and Related Disorders/ OR exp Depressive Disorder) OR
((Mental AND (disorder* OR disabilit* OR illness OR “health condition” OR “health problem” OR distress)) OR “psychological distress” OR “psychiatric disorder”) OR
((schizophrenia OR schizophrenic) OR Schizotyp* OR ((Delusional OR paranoid) AND disorder*) OR hallucination* OR Psychotic OR Schizoaffective OR psychosis) OR
(((manic OR bipolar OR mood) AND disorder*) OR (depressive AND (disorder* OR episode*)) OR “depressive symptom*” OR hypomania OR mania* OR ((major OR psychotic OR disorder*) AND depression))
Search #2: overweight
(exp Overweight/ OR exp Obesity/) OR
(“overweight” OR obes* OR “weight-related side-effects” OR “weight gain”)
Search #3: pharmacological interventions for weight reduction
(exp Obesity Management/ OR exp Anti-Obesity Agents/ OR exp Body Weight Changes/ OR exp Body Weight Maintenance/ OR exp Weight Reduction Programs/) OR
(exp Drug Therapy/ OR exp Pharmacology/ OR exp Psychopharmacology/ OR exp Metabolic Side Effects of Drugs and Substances/ OR exp Pharmacologic Actions/ OR exp Drug Effects/ OR exp Psychotropic Drugs/) OR
((drug* OR pharmac* OR medic* OR psychotrop*) AND (intervent* OR therap* OR treat* OR care OR servic)) OR (drug* OR medic*) OR
((weight OR BMI OR “body mass*” OR fat* OR waist*) AND (loss OR reduc* OR maint*)) OR (“weight gain” AND (prevent* OR manag*)) OR
(orlistat OR “appetite suppressant*”)
For people with SMD who are overweight or obese, are pharmacological management strategies effective to support weight reduction?
Search #1: SMD
(exp Mental Disorders/ OR exp Psychotic Disorders/ OR exp Bipolar and Related Disorders/ OR exp Depressive Disorder) OR
((Mental AND (disorder* OR disabilit* OR illness OR “health condition” OR “health problem” OR distress)) OR “psychological distress” OR “psychiatric disorder”) OR
((schizophrenia OR schizophrenic) OR Schizotyp* OR ((Delusional OR paranoid) AND disorder*) OR hallucination* OR Psychotic OR Schizoaffective OR psychosis) OR
(((manic OR bipolar OR mood) AND disorder*) OR (depressive AND (disorder* OR episode*)) OR “depressive symptom*” OR hypomania OR mania* OR ((major OR psychotic OR disorder*) AND depression))
Search #2: overweight
(exp Overweight/ OR exp Obesity/) OR
(“overweight” OR obes* OR “weight-related side-effects” OR “weight gain”)
Search #3: pharmacological interventions for weight reduction
(exp Obesity Management/ OR exp Anti-Obesity Agents/ OR exp Body Weight Changes/ OR exp Body Weight Maintenance/ OR exp Weight Reduction Programs/) OR
(exp Drug Therapy/ OR exp Pharmacology/ OR exp Psychopharmacology/ OR exp Metabolic Side Effects of Drugs and Substances/ OR exp Pharmacologic Actions/ OR exp Drug Effects/ OR exp Psychotropic Drugs/) OR
((drug* OR pharmac* OR medic* OR psychotrop*) AND (intervent* OR therap* OR treat* OR care OR servic)) OR (drug* OR medic*) OR
((weight OR BMI OR “body mass*” OR fat* OR waist*) AND (loss OR reduc* OR maint*)) OR (“weight gain” AND (prevent* OR manag*)) OR
(switch* AND (medic* OR drug*))
For people with SMD who are overweight or obese, are non-pharmacological interventions effective to support weight reduction?
For people with SMD who are at risk of becoming overweight or obese, are non-pharmacological interventions effective to support prevention of weight gain?
Search #1: SMD
(exp Mental Disorders/ OR exp Psychotic Disorders/ OR exp Bipolar and Related Disorders/ OR exp Depressive Disorder) OR
((Mental AND (disorder* OR disabilit* OR illness OR “health condition” OR “health problem” OR distress)) OR “psychological distress” OR “psychiatric disorder”) OR
((schizophrenia OR schizophrenic) OR Schizotyp* OR ((Delusional OR paranoid) AND disorder*) OR hallucination* OR Psychotic OR Schizoaffective OR psychosis) OR
(((manic OR bipolar OR mood) AND disorder*) OR (depressive AND (disorder* OR episode*)) OR “depressive symptom*” OR hypomania OR mania* OR ((major OR psychotic OR disorder*) AND depression))
Search #2: overweight
(exp Overweight/ OR exp Obesity/) OR
(“overweight” OR obes* OR “weight-related side-effects” OR “weight gain”)
Search #3: non-pharmacological intervention for weight reduction and prevention
(exp Obesity Management/ OR exp Nutrition Therapy/ OR exp Body Weight Changes/ OR exp Body Weight Maintenance/ OR exp Weight Reduction Programs/ OR exp Health Promotion/ OR exp Diet/ OR exp Risk Reduction Behaviour/ OR Risk Management/ OR exp Health Risk Behaviours/ OR exp Risk Factors/ OR exp Risk-Taking/) OR
(exp Exercise Therapy/OR exp Therapy/ OR exp Therapeutics/ OR exp Family Therapy/ OR exp Psychotherapy/ OR exp Cognitive Therapy/ OR exp Behaviour Therapy/ OR exp Counseling/ OR exp Mental Health Services/ OR exp Problem Based Learning/ OR exp Problem Solving/) OR
(exp Preventive Health Services/) OR
((psychosocial OR psycho* OR lifestyle* OR cognit* OR behaviour* OR behaviour* OR non-pharmac*) AND (intervent* OR therap* OR treat* OR care OR servic*)) OR
(problem solving OR psychoeducation OR couns*) OR
((weight OR BMI OR body mass* OR fat* OR waist*) AND (loss OR reduc* OR maint*)) OR (weight gain AND (prevent* OR manag*)) OR
(diet* OR nutrition* OR exercis* OR sport* OR physical activit* OR health promot* OR self-monit* OR calor* OR healthy eating OR food intake)
PICO Questions 4
For people with SMD and substance (drug and/or alcohol) use disorder, are pharmacological interventions for substance use disorder effective to support reduction in substance use-related outcomes?
Search #1: SMD
(exp Mental Disorders/ OR exp Psychotic Disorders/ OR exp Bipolar and Related Disorders/ OR exp Depressive Disorder) OR
((Mental AND (disorder* OR disabilit* OR illness OR “health condition” OR “health problem” OR distress)) OR “psychological distress” OR “psychiatric disorder”) OR
((schizophrenia OR schizophrenic) OR Schizotyp* OR ((Delusional OR paranoid) AND disorder*) OR hallucination* OR Psychotic OR Schizoaffective OR psychosis) OR
(((manic OR bipolar OR mood) AND disorder*) OR (depressive AND (disorder* OR episode*)) OR “depressive symptom*” OR hypomania OR mania* OR ((major OR psychotic OR disorder*) AND depression))
Search #2: Substance use disorder
(exp Narcotics/ OR exp Substance-Related Disorders/ OR exp Alcoholism/ OR exp Alcoholics/ OR exp Alcohol Related-Disorders/ OR exp Drug Users/ OR exp Drug Misuse/ OR exp Street Drugs/ OR exp Nonprescription Drugs/ OR exp Drug-Seeking Behaviour/ OR exp substance abuse, intravenous/) OR
(“drug abuse” OR “drug addict*” OR “drug depend*” OR “drug withdrawal” OR “drug misuse”) OR
(“addictive disease*” OR “addictive disorder*” OR addiction OR addictive OR “substance abuse” OR “substance misuse” OR “withdrawal syndrome” OR psychoactive*) OR
(“alcoholic patient*” OR “alcoholic subject*” OR alcoholism OR “alcohol depend*” OR “fetal alcohol*” OR “prenatal alcohol*” OR “chronic ethanol*” OR “chronic* alcohol*” OR “alcohol withdrawal” OR “ethanol withdrawal” OR “excessive alcohol consumption” OR “alcohol use disorder” OR “alcohol misuse” OR “alcohol abuse”) OR
((cocaine OR heroin OR cannabis OR marijuana OR mdma OR methylenedioxymethamphetamin* OR ecstasy OR morphine* OR amphetamin* OR methamphetamin* OR opioid* OR opiat* OR “prescription drug*” OR “illegal drug*” OR “illicit drug*” OR “street drug” OR benzodiazepin* OR tranquiliz* OR narcot* OR methadone OR fentanyl) AND (abuse OR misuse OR depend* OR addict* OR withdrawal OR overdose OR intoxication OR “harmful use”)) OR
(“injecting drug use” OR IDU$1 OR IVDU$1 OR PWID$1 OR “injecting drug” OR “intravenous drug” OR “injecting substance” OR “intravenous substance”)
Search #3: pharmacological interventions for substance use disorders
(exp Substance Abuse Treatment Centers/ OR exp Alcohol Abstinence/) OR
(exp Drug Therapy/ OR exp Pharmacology/ OR exp Psychopharmacology/ OR exp Metabolic Side Effects of Drugs and Substances/ OR exp Pharmacologic Actions/ OR exp Drug Effects/ OR exp Psychotropic Drugs/) OR
(exp buprenorphine/ OR exp methadone/ OR exp opiate substitution treatment/ OR exp buprenorphine, naloxone drug combination/) OR
((drug* OR pharmac* OR medic* OR psychotrop*) AND (intervent* OR therap* OR treat* OR care OR servic*)) OR (drug* OR medic*) OR
(methadone OR buprenorphine OR naloxone OR naltrexone OR disulfiram OR nalmefene OR thiamine OR clonidine OR lofexidine OR acamprosate OR baclofen) OR
(“opioid agonist maintenance treatment” OR OST OR MMT OR BMT OR “opioid substitution treatment” OR “methadone” OR “methadone maintenance” OR “buprenorphine” OR “buprenorphine maintenance” OR “opioid replacement”)
For people with SMD and substance (drug and/or alcohol) use disorder, are non-pharmacological interventions for substance use disorder effective to support reduction in substance use-related outcomes?
Search #1: SMD
(exp Mental Disorders/ OR exp Psychotic Disorders/ OR exp Bipolar and Related Disorders/ OR exp Depressive Disorder) OR
((Mental AND (disorder* OR disabilit* OR illness OR “health condition” OR “health problem” OR distress)) OR “psychological distress” OR “psychiatric disorder”) OR
((schizophrenia OR schizophrenic) OR Schizotyp* OR ((Delusional OR paranoid) AND disorder*) OR hallucination* OR Psychotic OR Schizoaffective OR psychosis) OR
(((manic OR bipolar OR mood) AND disorder*) OR (depressive AND (disorder* OR episode*)) OR “depressive symptom*” OR hypomania OR mania* OR ((major OR psychotic OR disorder*) AND depression))
Search #2: Substance use disorder
(exp Narcotics/ OR exp Substance-Related Disorders/ OR exp Alcoholism/ OR exp Alcoholics/ OR exp Alcohol Related-Disorders/ OR exp Drug Users/ OR exp Drug Misuse/ OR exp Street Drugs/ OR exp Nonprescription Drugs/ OR exp Drug-Seeking Behaviour/ OR exp substance abuse, intravenous/) OR
(“drug abuse” OR “drug addict*” OR “drug depend*” OR “drug withdrawal” OR “drug misuse”) OR
(“addictive disease*” OR “addictive disorder*” OR addiction OR addictive OR “substance abuse” OR “substance misuse” OR “withdrawal syndrome” OR psychoactive*) OR
(“alcoholic patient*” OR “alcoholic subject*” OR alcoholism OR “alcohol depend*” OR “fetal alcohol*” OR “prenatal alcohol*” OR “chronic ethanol*” OR “chronic* alcohol*” OR “alcohol withdrawal” OR “ethanol withdrawal” OR “excessive alcohol consumption” OR “alcohol use disorder” OR “alcohol misuse” OR “alcohol abuse”) OR
((cocaine OR heroin OR cannabis OR marijuana OR mdma OR methylenedioxymethamphetamin* OR ecstasy OR morphine* OR amphetamin* OR methamphetamin* OR opioid* OR opiat* OR “prescription drug*” OR “illegal drug*” OR “illicit drug*” OR “street drug” OR benzodiazepin* OR tranquiliz* OR narcot* OR methadone OR fentanyl) AND (abuse OR misuse OR depend* OR addict* OR withdrawal OR overdose OR intoxication OR “harmful use”)) OR
(“injecting drug use” OR IDU$1 OR IVDU$1 OR PWID$1 OR “injecting drug” OR “intravenous drug” OR “injecting substance” OR “intravenous substance”)
Search #3: non-pharmacological interventions for substance use disorders
(exp Substance Abuse Treatment Centers/ OR exp Alcohol Abstinence/ OR exp Needle-Exchange Programs/) OR
(exp Exercise Therapy/ OR exp Occupational Therapy/ OR exp Therapy/ OR exp Therapeutics/ OR exp Family Therapy/ OR exp Psychotherapy/ OR exp Cognitive Therapy/ OR exp Behaviour Therapy/ OR exp Counseling/ OR exp Mental Health Services/ OR exp Problem Based Learning/ OR exp Problem Solving/ OR exp harm reduction/) OR
((psychosocial OR psycho* OR lifestyle* OR cognit* OR behaviour* OR behaviour* OR non-pharmac*) AND (intervent* OR therap* OR treat* OR care OR servic*)) OR
(“problem solving” OR psychoeducation OR couns*) OR
(“motivational interviewing” OR “motivational enhancement therapy” OR MET OR CBT OR “cognitive behavioural therapy” OR “cognitive behavioural therapy” OR “brief assessment interview” OR “contingency management” OR “social skills training” OR “relapse prevention” OR “case management” OR “assertive community treatment” OR “family interventions”) OR
(SBIRT OR “screening and brief interventions” OR outreach OR “residential programmes” OR “recovery management” OR “mutual self-help group” OR “Alcoholic Anonymous” OR “Narcotic Anonymous”) OR
(“harm reduction” OR NSP$1 OR NSEP$1 OR “needle syringe program$” OR “needle syringe exchange program$” OR “needle exchange$1” OR “syringe exchange $1”)
PICO Questions 5.1 and 5.2
For people with SMD and pre-existing cardiovascular disease, what pharmacological interventions are effective to support reduction of cardiovascular disease outcomes?
For people with SMD and cardiovascular risk factors (a. high blood pressure; b. high lipid levels), what pharmacological interventions are effective to support reduction of cardiovascular risk factors?
Search #1: SMD
(exp Mental Disorders/ OR exp Psychotic Disorders/ OR exp Bipolar and Related Disorders/ OR exp Depressive Disorder) OR
((Mental AND (disorder* OR disabilit* OR illness OR “health condition” OR “health problem” OR distress)) OR “psychological distress” OR “psychiatric disorder”) OR
((schizophrenia OR schizophrenic) OR Schizotyp* OR ((Delusional OR paranoid) AND disorder*) OR hallucination* OR Psychotic OR Schizoaffective OR psychosis) OR
(((manic OR bipolar OR mood) AND disorder*) OR (depressive AND (disorder* OR episode*)) OR “depressive symptom*” OR hypomania OR mania* OR ((major OR psychotic OR disorder*) AND depression))
Search #2: cardiovascular disease / risk factors
(exp Cardiovascular Diseases/) OR
(“heart disease” OR “heart attack*” OR stroke* OR “myocardial infarction” OR “transient ischemic attack” OR “cerebrovascular disease” OR “congestive heart failure” OR “vascular disease”) OR
(“cardiovascular risk*” OR ((high OR abnormal OR elevat*) AND (“blood pressure” OR cholesterol OR “blood glucose”)))
Search #3: pharmacological interventions for cardiovascular disease/risk
(exp Cardiac Rehabilitation/ OR exp Risk Reduction Behaviour/ OR exp Risk Management/ OR exp Health Risk Behaviours/ OR exp Risk Factors/ OR exp Risk-Taking/) OR
(exp Drug Therapy/ OR exp Pharmacology/ OR exp Psychopharmacology/ OR exp Metabolic Side Effects of Drugs and Substances/ OR exp Pharmacologic Actions/ OR exp Drug Effects/ OR exp Psychotropic Drugs/) OR
((drug* OR pharmac* OR medic* OR psychotrop*) AND (intervent* OR therap* OR treat* OR care OR servic)) OR (drug* OR medic*) OR
(exp Preventive Health Services/) OR
(switch* AND (medic* OR drug*))
For people with SMD and pre-existing cardiovascular disease, what non-pharmacological interventions are effective to support reduction of cardiovascular disease outcomes?
For people with SMD and cardiovascular risk factors (a. high blood pressure; b. high lipid levels), what non-pharmacological interventions are effective to support reduction of cardiovascular risk factors?
Search #1: SMD
(exp Mental Disorders/ OR exp Psychotic Disorders/ OR exp Bipolar and Related Disorders/ OR exp Depressive Disorder) OR
((Mental AND (disorder* OR disabilit* OR illness OR “health condition” OR “health problem” OR distress)) OR “psychological distress” OR “psychiatric disorder”) OR
((schizophrenia OR schizophrenic) OR Schizotyp* OR ((Delusional OR paranoid) AND disorder*) OR hallucination* OR Psychotic OR Schizoaffective OR psychosis) OR
(((manic OR bipolar OR mood) AND disorder*) OR (depressive AND (disorder* OR episode*)) OR “depressive symptom*” OR hypomania OR mania* OR ((major OR psychotic OR disorder*) AND depression))
Search #2: cardiovascular disease / risk factors
(exp Cardiovascular Diseases/) OR
(“heart disease” OR “heart attack* OR stroke* OR “myocardial infarction” OR “transient ischemic attack” OR “cerebrovascular disease” OR “congestive heart failure” OR “vascular disease”) OR
(“cardiovascular risk*” OR ((“high OR abnormal OR elevat*) AND (“blood pressure” OR cholesterol OR “blood glucose”)))
Search #3: non-pharmacological interventions for cardiovascular disease/risk
(exp Cardiac Rehabilitation/ OR exp Risk Reduction Behaviour/ OR exp Risk Management/ OR exp Health Risk Behaviours/ OR exp Risk Factors/ OR exp Risk-Taking/OR exp Health Promotion/) OR
(exp Exercise Therapy/OR exp Therapy/ OR exp Therapeutics/ OR exp Family Therapy/ OR exp Psychotherapy/ OR exp Cognitive Therapy/ OR exp Behaviour Therapy/ OR exp Counseling/ OR exp Mental Health Services/ OR exp Problem Based Learning/ OR exp Problem Solving/) OR
((psychosocial OR psycho* OR lifestyle* OR cognit* OR behaviour* OR behaviour* OR non-pharmac*) AND (intervent* OR therap* OR treat* OR care OR servic*)) OR
(“problem solving” OR psychoeducation OR couns*) OR
(exp Preventive Health Services/)
PICO Question 6
For people with SMD and diabetes mellitus, what pharmacological interventions are effective to improve glycaemic control?
Search #1: SMD
(exp Mental Disorders/ OR exp Psychotic Disorders/ OR exp Bipolar and Related Disorders/ OR exp Depressive Disorder) OR
((Mental AND (disorder* OR disabilit* OR illness OR “health condition” OR “health problem” OR distress)) OR “psychological distress” OR “psychiatric disorder”) OR ((schizophrenia OR schizophrenic) OR Schizotyp* OR ((Delusional OR paranoid) AND disorder*) OR hallucination* OR Psychotic OR Schizoaffective OR psychosis) OR
(((manic OR bipolar OR mood) AND disorder*) OR (depressive AND (disorder* OR episode*)) OR “depressive symptom*” OR hypomania OR mania* OR ((major OR psychotic OR disorder*) AND depression))
Search #2: Diabetes mellitus
(exp Diabetes Mellitus/) OR
(diabet* OR NIDDM OR IDDM OR T2D* OR T1D*) OR
(“non-insulin* depend*” OR “noninsulin* depend*” OR “insulin* depend*”)
Search #3: pharmacological interventions for diabetes
(exp Drug Therapy/ OR exp Pharmacology/ OR exp Psychopharmacology/ OR exp Metabolic Side Effects of Drugs and Substances/ OR exp Pharmacologic Actions/ OR exp Drug Effects/ OR exp Psychotropic Drugs/) OR
((drug* OR pharmac* OR medic* OR psychotrop*) AND (intervent* OR therap* OR treat* OR care OR service)) OR (drug* OR medic*) OR
((glucose* OR glycaem*) AND (treat* OR control* OR care OR servic* OR therap* OR interven* OR manag* OR monit*)) OR
(metformin OR sulphonylureas OR insulin OR thiazolidinediones) OR
((switch* AND (medic* OR drug*)) OR “appetite suppressant*” OR antiparkinsonian OR anticonvulsant* OR antidepressant* OR “health check*“) OR
(weight AND (loss OR reduc* OR maint*)) OR (“weight gain” AND (prevent* OR manag*)) OR
((smok* OR tobacco OR nicotin* OR cigarette*) AND (cessation OR reduc* OR abst*))
For people with SMD and diabetes mellitus, what non-pharmacological interventions are effective to improve glycaemic control?
Search #1: SMD
(exp Mental Disorders/ OR exp Psychotic Disorders/ OR exp Bipolar and Related Disorders/ OR exp Depressive Disorder) OR
((Mental AND (disorder* OR disabilit* OR illness OR “health condition” OR “health problem” OR distress)) OR “psychological distress” OR “psychiatric disorder”) OR
((schizophrenia OR schizophrenic) OR Schizotyp* OR ((Delusional OR paranoid) AND disorder*) OR hallucination* OR Psychotic OR Schizoaffective OR psychosis) OR
(((manic OR bipolar OR mood) AND disorder*) OR (depressive AND (disorder* OR episode*)) OR “depressive symptom*” OR hypomania OR mania* OR ((major OR psychotic OR disorder*) AND depression))
Search #2: Diabetes mellitus
(exp Diabetes Mellitus/) OR
(diabet* OR NIDDM OR IDDM OR T2D* OR T1D*) OR
(“non-insulin* depend*” OR “noninsulin* depend*” OR “insulin* depend*”)
Search #3: non-pharmacological interventions for diabetes
(exp Diet, Diabetic/) OR
(exp Exercise Therapy/ OR exp Occupational Therapy/ OR exp Therapy/ OR exp Therapeutics/ OR exp Family Therapy/ OR exp Psychotherapy/ OR exp Cognitive Therapy/ OR exp Behaviour Therapy/ OR exp Counseling/ OR exp Mental Health Services/ OR exp Problem Based Learning/ OR exp Problem Solving/) OR
((psychosocial OR psycho* OR lifestyle* OR cognit* OR behaviour* OR behaviour* OR non-pharmac* OR organisat* OR organizat*) AND (intervent* OR therap* OR treat* OR care OR servic*)) OR
(“problem solving” OR psychoeducation OR couns* OR education) OR
((glucose* OR glycaem*) AND (treat* OR control* OR care OR servic* OR therap* OR interven* OR manag* OR monit*)) OR
(diet* OR nutrition* OR exercis* OR “physical activity” OR “health promot*” OR self-monit* OR self-manag* OR self-care OR calor* OR “healthy eating” OR “healthy body weight” OR “food intake” OR “health check*”) OR
(weight AND (loss OR reduc* OR maint*)) OR (“weight gain” AND (prevent* OR manag*)) OR
((smok* OR tobacco OR nicotin* OR cigarette*) AND (cessation OR reduc* OR abst*))
PICO Question 7
For people with SMD and HIV/AIDS, what pharmacological interventions (i.e. ART drugs) and non-pharmacological interventions are effective to support reduction in HIV-related outcomes?
Search #1: SMD
(exp Mental Disorders/ OR exp Psychotic Disorders/ OR exp Bipolar and Related Disorders/ OR exp Depressive Disorder) OR
((Mental AND (disorder* OR disabilit* OR illness OR “health condition” OR “health problem” OR distress)) OR “psychological distress” OR “psychiatric disorder”) OR
((schizophrenia OR schizophrenic) OR Schizotyp* OR ((Delusional OR paranoid) AND disorder*) OR hallucination* OR Psychotic OR Schizoaffective OR psychosis) OR
(((manic OR bipolar OR mood) AND disorder*) OR (depressive AND (disorder* OR episode*)) OR “depressive symptom*” OR hypomania OR mania* OR ((major OR psychotic OR disorder*) AND depression))
Search #2: HIV/AIDS
(exp HIV/ OR exp Sexually Transmitted Diseases/ OR exp Lymphoma, AIDS-Related/ OR exp HIV Long-Term Survivors/ OR exp HIV Infections OR exp Acquired Immunodeficiency Syndrome/) OR
(HIV OR “human immunodeficiency syndrome” OR “human immunodeficiency virus” OR AIDS OR “acquired immunodeficiency syndrome”)
Search #3: interventions for HIV/AIDS
(exp HIV Antigens/ OR exp Anti-HIV Agents/ OR exp Anti-Retroviral Agents/ OR exp Antiretroviral Therapy, Highly Active/ OR exp AIDS Vaccines/) OR
(exp Drug Therapy/ OR exp Pharmacology/ OR exp Psychopharmacology/ OR exp Metabolic Side Effects of Drugs and Substances/ OR exp Pharmacologic Actions/ OR exp Drug Effects/ OR exp Psychotropic Drugs/) OR
((drug* OR pharmac* OR medic* OR psychotrop*) AND (intervent* OR therap* OR treat* OR care OR servic)) OR (drug* OR medic*) OR
((“anti-retroviral” OR ART) AND (drug* OR medic* OR intervent* OR therap* OR treat* OR care)) OR
(tenofovir OR TDF OR lamivudine OR 3TC OR emtricitabine OR FTC OR efavirenz OR EFV OR Abacavir
OR Zidovudine OR Nevirapine OR Atazanavir OR ritonavir OR Darunavir OR Lopinavir OR Dolutegravir OR Raltegravir)
PICO Question 8
For people with SMD and infectious diseases (Tuberculosis, Hepatitis B/C), what pharmacological and non-pharmacological interventions are effective for treatment of infectious diseases (e.g. tuberculosis, hepatitis B, hepatitis C)?
Search #1: SMD
(exp Mental Disorders/ OR exp Psychotic Disorders/ OR exp Bipolar and Related Disorders/ OR exp Depressive Disorder) OR
((Mental AND (disorder* OR disabilit* OR illness OR “health condition” OR “health problem” OR distress)) OR “psychological distress” OR “psychiatric disorder”) OR
((schizophrenia OR schizophrenic) OR Schizotyp* OR ((Delusional OR paranoid) AND disorder*) OR hallucination* OR Psychotic OR Schizoaffective OR psychosis) OR
(((manic OR bipolar OR mood) AND disorder*) OR (depressive AND (disorder* OR episode*)) OR “depressive symptom*” OR hypomania OR mania* OR ((major OR psychotic OR disorder*) AND depression))
Search #2: infectious diseases (tuberculosis, hepatitis B/C)
(exp Hepatitis/ OR exp Hepatitis, Viral, Human/ OR exp Tuberculosis/ OR exp Hepatitis B/ OR exp Hepatitis B Virus/ OR exp Hepatitis C/) OR
(“hepatitis B” OR “hepatitis C” OR tuberculosis)
Search #3: interventions for infectious diseases
(exp Hepatitis B Vaccines/ OR exp Hepatitis B Antigens/ OR exp Hepatitis C Antigens/ OR exp Tuberculosis Vaccines/) OR
(exp Drug Therapy/ OR exp Pharmacology/ OR exp Psychopharmacology/ OR exp Metabolic Side Effects of Drugs and Substances/ OR exp Pharmacologic Actions/ OR exp Drug Effects/ OR exp Psychotropic Drugs/) OR
((drug* OR pharmac* OR medic* OR psychotrop*) AND (intervent* OR therap* OR treat* OR care OR servic)) OR (drug* OR medic*) OR
(vaccin* OR BCG OR treatment adherence OR treatment completion) OR
(Ethambutol OR Rifampicin OR Insoniazid OR Pyrazinamide OR Rifabutin OR Rifampicin OR Rifapentine OR Entecavir OR Tenofovir OR Sofosbuvir OR Simeprevir OR Daclatasvir OR Dasabuvir OR Ribavarin OR Pegylated interferon)
Drug-drug interactions search strategy
Drug-drug interaction searches were conducted between medicines relevant for each PICO question and medicines used for SMD. The following process was employed for the searches:
Medicines of interest were identified for each PICO question by referring to relevant sections of the 2017 WHO Model List of Essential Medicines (EML), as well as prior WHO Guidelines and WHO Mental Health Gap Action Programme Intervention Guide (mhGAP-IG) where applicable. Physical health medicines were limited in scope to those used on a routine basis, rather than emergently. Technical consultation was also sought with relevant departments of WHO. Pharmacological interventions recommended in the forthcoming guidelines were also included.
Medicines used for SMD were limited to those included in the WHO mhGAP-IG and/or the 2017 WHO EML. These will be expanded to include a wider range of medicines which may be used in different settings based on availability and costs. Since its inception in 1977, the WHO Model List of Essential Medicines has played an important role in identifying priority medications for major health conditions in countries of all income groups. Updated every two years, this list in many cases has been used as a gold standard for national health systems and nongovernmental organization. Priority medications are selected based on efficacy, safety, and cost-effectiveness.
Searches between both lists (medicines relevant for each PICO question and medicines used for SMD) were run using the drug-drug interaction software Lexi-Interact. Lexi-Interact was chosen as it is commonly used in clinical practice and scored well on accuracy and comprehensiveness in a recent review comparing 5 drug-drug interaction engines5. Severity of drug-drug interactions (minor, moderate, major)) were reported in the Lexi-Interact database and have reported here.
Search results for each PICO question were summarized into a narrative synthesis within each Evidence Profile, as well as a table coded by drug-drug interaction severity with accompanying information in the annex.
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Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Medical Research Methodology. 2007; 7:10
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Sh Kheshti R, Aalipour M, Namazi S. “A comparison of five common drug-drug interaction software programs regarding accuracy and comprehensiveness.” Journal of Research in Pharmacy Practice. 2016; 5: 257–263.
