Saudi Cultural Missions Theses & Dissertations
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Item Restricted Breast Cancer Treatment Disparities in Patients with Severe Mental Illness: A Systematic Review and Meta-Analysis(Queensland University of Technology, 2024) Alotiby, Meshary; Protani, Melinda; Kisely, Steve; Siskind, DanBackground Disparities in breast cancer treatment for people with pre-existing severe mental illness (SMI) have not been well studied compared to disparities in cancer screening and stage at diagnosis. Aims To conduct a systematic review of the available evidence and investigate whether female breast cancer patients with pre-existing SMI had equitable access to guideline recommended breast cancer treatment compare to those without SMI. Methods We conducted systematic review and meta-analysis of observational studies that were retrieved from PubMed, EMBASE, CINAHL and PsycINFO databases from 22 February 2021 to 26 March 2021. Female breast cancer patients with SMI were included in the analyses. SMI was defined as Schizophrenia, Bipolar disorder, and major depression. Guideline recommended treatment was defined as surgery, chemotherapy, radiotherapy and adjuvant endocrine therapy. Pooled odds ratios, and other estimates, such as hazard ratios and risk ratios were presented. Risk of bias was assessed using Newcasle-Ottawa scale. DerSimonian-Laird random effects models were used. Results 3,325 citations were identified; 10 studies were included, and 4 studies were meta-analysed. Pooled analyses suggested that people with SMI were less likely to receive guideline recommended breast cancer treatment than those without SMI (OR: 0.83; 95% CI: 0.77 to 0.90). Breast cancer patients with schizophrenia had a reduced likelihood for receiving adjuvant radiotherapy (Crude RR: 0.81, 95% CI: 0.77 to 0.85), while those with major depression and bipolar I disorder had lower likelihood of receiving adjuvant chemotherapy (Crude RR: 0.71, 95% CI: 0.60 to 0.84). Conclusions This review identified disparities in breast cancer care for individuals with pre-existing SMI, which contributed to poorer prognosis and excess mortality. Improving collaboration between psycho-oncology teams is advised to address patients’ needs for treatment. Future research is necessary for identifying disparities in primary and systemic treatments and investigating the reasons for treatment inequity.8 0Item Restricted Diet and exercise interventions for mitigating the effects of antipsychotic medications on body weight in individuals with severe mental illness (Narrative review)(Saudi Digital Library, 2023) Alswaidani, Salma; Ranawana, VirenBackground: Individuals with severe mental illness (SMI), including bipolar disorder and schizophrenia, who are treated with antipsychotic medication are at higher risk for early death, obesity, and chronic diseases such as diabetes, hypertension, and cardiovascular disease. Antipsychotic medications are strongly associated with rapid weight gain, and a variety of interventions are available to help patients using these medications to lose weight. Aim: This review aimed to identify dietary patterns and physical activity that can be adopted by patients with SMI to aid in weight loss while receiving treatment with antipsychotic medication. Method: A narrative review of the literature with the use of three electronic multidisciplinary databases: Psych info via Ovid, CINHAL via EBSCO, and Medline via Ovid. Cross-referencing and a manual search of journals were also employed. A systematic search was implemented for studies on lifestyle intervention that combined diet and physical activity in adult participants. All studies were published in the English language. Results: A total of 1176 relevant research papers were identified from all sources, and 12 studies met the inclusion criteria. There were different dietary patterns that were used to reduce body weight in SMI patients using antipsychotics. These dietary patterns were a diabetic diet, Dietary approaches to stop hypertension (DASH diet), a low-fat diet, a Mediterranean diet, a low-calorie diet, and recommendations based on German and Canadian dietary guidelines. In addition, most of the studies focused on the effects of aerobic exercise, such as walking or cycling, and a few studies examined the use of resistance exercise. Conclusion: Lifestyle interventions that combine aerobic exercise and a personalised reduced-calorie diet may result in promising effects for reducing weight in adult patients with SMI who are treated with second-generation antipsychotic (SGAs) medications. In addition, lifestyle interventions also may help reduce central obesity, waist circumference, fasting blood glucose, and cholesterol levels.61 0