Please select the eligibility criteria that correspond to the clinical trial below.
Title: Comprehensive Cardiovascular Diseases (CVD) Risk Reduction Trial in Persons With Serious Mental Illness
Brief Summary: This study will determine whether a program where a health coach works with participants on heart healthy behaviors and treatment of risk factors is coordinated with primary care can reduce overall heart disease risk in people with serious mental illness.


Options:
A: Inclusion Criteria:

* Adult (age 18-up)admitted to inpatient cardiac unit at Massachusetts General Hospital
* Primary diagnosis of acute coronary syndrome, congestive heart failure, or arrhythmia
* Positive anxiety or depression screen during initial nursing intake interview that is performed as part of usual clinical care
* Meets criteria for clinical depression, generalized anxiety disorder, or panic disorder

Exclusion Criteria:

* Bipolar disorder
* Substance use disorder
* Psychosis
* Cognitive disorder
* Active suicidal ideation
* Medical condition with likely survival less than 6 months
* Non-English speaking
B: Inclusion Criteria:

* ▪ Age 18 and older

  ▪ Body mass index at least 25 kg/m2 OR one of the following CVD risk factors:
* Hypertension (SBP\>= 140mmHg or DBP\>= 90mmHg or on antihypertensive medications;
* Diabetes mellitus (fasting blood sugar\> 125mg/dl or hemoglobin A1c\>6.5 or on a hypoglycemic medication);
* Dyslipidemia (LDL \>130 mg/dl , HDL\<40 or total cholesterol \>=200 or on a lipid lowering agent);
* Current tobacco smoker

  * Able and willing to give informed consent
  * Completion of baseline data collection
  * Willing to accept randomization
  * Willing to participate in the intervention

Exclusion Criteria:

* ▪ Cardiovascular event (unstable angina, myocardial infarction) within the past 6 months

  * Serious medical condition which either limits life expectancy or requires active management (e.g., certain cancers)
  * Condition which interferes with outcome measurement (e.g., dialysis)
  * Pregnant or planning a pregnancy during study period. Nursing mothers would need approval from physician.
  * Alcohol or substance use disorder if not sober/abstinent for 30 days
  * Planning to leave rehabilitation center or clinic within 6 months or move out of geographic area within 18 months
  * Investigator judgment (e.g., for concerns about participant or staff safety)
C: General Inclusion Criteria:

* current age 15 or older (Best Practice Pathway) or 18 years or older (Randomized Care Pathways);
* able to give informed consent for data to be harvested;
* meet DSM-IV criteria for Bipolar I Disorder, Bipolar II Disorder, Bipolar Disorder NOS, or Cyclothymic Disorder;
* undergo a complete standard evaluation including clinical interview, self ratings, and laboratory studies;
* meet with Clinical Specialist as scheduled;
* able to complete all Study Registry Forms within 3 months of registration.

General Exclusion Criteria:

* unwilling or unable to adhere to basic study requirements (i.e., complete rating forms, or attend scheduled evaluations);
* not competent to give informed consent in the opinion of the investigator (e.g., psychotic).

Participants will be asked to remain in the study for up to five years so that the investigators can document and evaluate long-term treatment outcome. Participants will meet with their STEP-BD psychiatrist for periodic evaluations and/or treatment adjustments during the course of the study, fill out various self-rating forms, and when applicable, participate in psychotherapy. One of the psychotherapy options, Family-Focused Therapy, will require participants and their families to attend counseling sessions together. Overall, the estimated amount of time required from participants in the study is 2 to 4 hours per month.
D: Inclusion Criteria:

* Diagnosis of diabetes and/or heart disease
* Poor disease control (defined as an HbA1c level of at least 8.5%, blood pressure greater than 140/90 mm Hg, LDL cholesterol greater than 130 mg/dL)
* Diagnosis of major depressive disorder

Exclusion Criteria:

* History of psychosis
* At high risk for suicide
* Cognitive impairment
* Current alcohol or substance abuse disorder
* Does not own a telephone
* Currently seeking psychiatric care
* Pregnant or breastfeeding
* Currently enrolled in a Group Health Cooperative disease management program
* Terminal illness
* Plans to leave Group Health Cooperative in less than a year
* Does not speak English

Answer: B