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Thesis Hsf 2020 Kwobah Edith Wanjiku

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Thesis Hsf 2020 Kwobah Edith Wanjiku TITLE PAGE CARDIOVASCULAR RISK PROFILE OF ADULTS WITH PSYCHOTIC DISORDERS IN ELDORET, KENYA EDITH WANJIKU KAMARU KWOBAH KWBEDI001 Thesis Presented for the Degree of Town DOCTOR OF PHILOSOPHY In the Department of PsychiatryCape and Mental health UNIVERSITYof OF CAPE TOWN October 2020 SUPERVISORS: Professor Dan J. Stein: University of Cape Town 2. University Professor Lukoye Atwoli: Moi University School of Medicine, Kenya. 3. Dr Nastassja Koen: University of Cape Town 1 The copyright of this thesis vests in the author. No quotation from it or information derived fromTown it is to be published without full acknowledgement of the source. The thesis is to be used for private study or non- commercial research purposes only. Cape Published by the University of Cape Town (UCT) in terms of the non-exclusive licenseof granted to UCT by the author. University Table of Contents TITLE PAGE .................................................................................................................................................................................. 1 LIST OF ABBREVIATIONS .................................................................................................................................................... 5 WORKING DEFINITION OF TERMS ................................................................................................................................... 7 LIST OF TABLES ..................................................................................................................................................................... 8 TABLE OF FIGURES .............................................................................................................................................................. 9 DECLARATION ...................................................................................................................................................................... 10 ACKNOWLEDGEMENT ........................................................................................................................................................ 11 ABSTRACT ............................................................................................................................................................................. 14 CHAPTER 1: CARDIOVASCULAR RISK FACTORS IN THE GENERAL POPULATION ....................................................................... 18 1.0 Introduction ................................................................................................................................................................... 18 1.1: Cardiovascular Risk Factors .................................................................................................................................... 18 1.1.1: Modifiable Cardiovascular risk factors ............................................................................................................. 18 1.1.2: Non Modifiable cardiovascular risk factors...................................................................................................... 26 1.2: Non -conventional CVD risk factors; Trauma, Psychological distress and chronic medical conditions. ...... 29 1.2.1: Marital status ...................................................................................................................................................... 29 1.2.2 Exposure to Potentially traumatic Events ......................................................................................................... 31 1.2.3 Psychological distress and cardiovascular risk ............................................................................................... 32 1.2.4: Comorbid medical conditions and cardiovascular risk. ................................................................................. 33 1.3: Estimating the 10 year risk of cardiovascular disorders ....................................................................................... 35 1.4: CVD Risk Factors in the Context of Low and Middle Income countries ........................................................... 36 CHAPTER 2: BURDEN AND ETIOLOGICAL MECHANISMS OF CARDIOVASCULAR RISK FACTORS AMONG PATIENTS WITH PSYCHOSIS. .......................................................................................................................... 40 2.0: Introduction .................................................................................................................................................................. 40 2.1: Multimorbidity and Excess Mortality Among Patients with Mental Illness. ................................................................. 40 2.2: Conventional Cardiovascular Risk Factors Among Patients with Psychosis ................................................... 42 2.3: Psychopharmacological treatment and cardiovascular risk .......................................................................................... 51 2.4: Exposure to Potentially Traumatic Events Among Patients with Psychosis ..................................................... 54 2.5: Estimating the Overall Cardiovascular Risk in Patients with Psychosis ............................................................ 55 2.6: Treatment Gap for Cardiovascular Risk Factors among Patients with Psychosis ........................................... 55 2.7 : Study justification ......................................................................................................................................................... 58 2.8: Study aim and objectives ............................................................................................................................................... 59 2.9: Conceptual Frame work ............................................................................................................................................ 60 CHAPTER 3: MATERIALS AND METHODS ..................................................................................................................... 62 3.0: Introduction .................................................................................................................................................................. 62 2 3.1: Study Design ............................................................................................................................................................... 62 3.2: Study Setting ............................................................................................................................................................... 63 3.3 Study Population.......................................................................................................................................................... 65 3.4: Inclusion and Exclusion Criteria ............................................................................................................................... 65 3.5: Participant recruitment ............................................................................................................................................... 66 3.6: Sample size and sampling procedure ..................................................................................................................... 67 3.7: Data Collection tools .................................................................................................................................................. 67 3.8: Study procedures ..................................................................................................................................................... 70 3.9: Data management and analysis ..................................................................................................................................... 72 3.10: Ethical Considerations ................................................................................................................................................. 75 CHAPTER 4: RESULTS ................................................................................................................................................................ 76 4.0: Introduction .................................................................................................................................................................. 76 4.1: Conventional non modifiable CVD risk factors and other demographic characteristics. ............................... 76 4.2. Lifestyle factors ........................................................................................................................................................... 77 4.3: Metabolic disorders .................................................................................................................................................... 79 4.4. Trauma and cardiovascular risk ............................................................................................................................. 84 4.4.1.: Lifetime Exposure to potentially traumatic events ....................................................................................... 84 4.4.2: Childhood trauma ................................................................................................................................................ 89 4.5: Psychological distress among controls ................................................................................................................... 94 4.6: Comorbid chronic medical conditions ....................................................................................................................
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