Over the past few years, our group has carried out its research activity as an associated group of IMIBIC. Prior to that, individual research initiatives were performed by our leading professionals, covering a range of fields and initiatives, as part of the Clinical Management Unit of the Mental Health Department.
The initial idea, and the one we wish to pursue, consists of deriving maximum benefit from the most outstanding features of Mental Health care in Andalusia. This network of community care provides us with first-rate accessibility and coordination with primary care and the addictions network, mental health teams made up of multi-disciplinary groups and the acute unit, which is an area of the general hospital. We believe that this organization gives us an excellent opportunity to deal directly with the real problems of the population we serve and to find practical answers which can be used immediately in this context.
Our action plan is known as -20+20, and we work to launch initiatives which address the severe problem of early mortality suffered by patients with a Serious Mental Illness (SMI). This population has 20 years’ lower life expectancy than the norm and the commonest causes of mortality are cardiovascular, respiratory and oncological problems.
Currently, our activity is mainly focused on initiatives linked to the main preventable factor, smoking. With the aim of recovering this population, which is somewhat isolated from the continued reduction of consumption observed in patients in the Western world, we strive for: greater awareness of the problem among the patient’s medical caregivers; the use of motivational tools to prepare the patient to try to change; and the study of the respiratory damage resulting from the severe comorbidity of SMI and smoking, as well as the chances of early prevention.
With this aim, our Clinical Unit has been carrying out research, training and diffusion activities in close collaboration with other units in Andalusia, as well as with other national groups which also research into the needs of SMI patients and which are also members of the CIBERSAM Group.
Funding from the Instituto de Salud Carlos III, together with alternative private resources, must be able to guarantee our activity and scientific production over the coming years.
Research Lines
The existence of safe, effective treatments for smoking cessation in this population and the few cases of attempts obliges us to work on designing new approaches based on the value of motivation. Here, using a clinical, multi-center, randomized, open and one-year follow-up trial design, we are evaluating the stage when the patient is informed of their respiratory damage and the opportunities they have for prevention.
One basic feature of the study is that it is being conducted in the real-life clinical surroundings of mental health community care, and it combines information on respiratory damage with support from mobile technology via motivational messages which are sent to the patients. We are evaluating the use of this level of technology in populations with SMI.
Within the major problem of early mortality that looms over our patients with this type of mental illness, the second commonest cause is mortality due to respiratory disease.
These patients tend to start their tobacco consumption at an early age and develop higher levels of dependence, and their more frequent smoking habit leads to higher levels of nicotine and its metabolites in the blood.
These are patients who, due to their special characteristics, tend to avoid their primary care medical environment and are less prone to consult their doctor, despite suffering frequently from respiratory processes or the presence of symptoms such as dyspnea, expectoration, or cough.
There is a lack of data on this subject in the international literature, and the possibilities of early diagnosis of respiratory damage have not been reported to date.
To complement this longitudinal trial, we have also designed a case-control study to compare the damage found in the sample studied with non-smoking patients with the same mental illness as well as with smokers and non-smokers in the general population.
The aim is to describe the respiratory damage, its age of onset, its dimension compared with the general population with the same problem and the possible influence of other factors common to non-smoking SMI patients, such as a sedentary lifestyle, obesity and poor health conditions in general.
We are carrying out an exploratory study, supported by our junior researchers, to verify the completion of prevention programs for this oncological disease in women over the age of 50 with schizophrenia.
The aim is to ensure compliance, and we will therefore look at the socio-demographic, clinical and global functioning variables that may influence the degree of completion of the program. Where appropriate, we will attempt to create a tool to aid coordination between the Mental Health Care and the Breast Program units.
Psychopathology, which we understand as the description and detailed classification of the experiences reported by our patients, has provided the basis for a number of this group’s research projects, involving a range of approaches, such as psychometric or purely descriptive projects.
Currently, a project is being launched in collaboration with the London Institute of Psychiatry to validate a psychometric scale for studying the sensation of presence in greater depth.
Networks
CIBERSAM - CIBER on Mental Health (Group 05)
PAIDI CTS-550 (The Andalusian Plan for Research, Development and Innovation)
GETBA (Grupo para el Estudio del Trastorno bipolar en Andalucía)
Keywords
- severe mental disorder
- schizophrenia
- bipolar disorder
- tobacco cessation
- mortality
- readiness to change
- chronic obstructive pulmonary disease
- screening
