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Romain AJ, Bernard P, Akrass Z, St-Amour S, Lachance JP, Hains-Monfette G, Atoui S, Kingsbury C, Dubois E, Karelis AD, Abdel-Baki A. Motivational theory-based interventions on health of people with several mental illness: A systematic review and meta-analysis. Schizophr Res 2020; 222:31-41. [PMID: 32522465 DOI: 10.1016/j.schres.2020.05.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 04/20/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
Motivational theory-based interventions are known to be effective for increasing physical activity (PA) in the general population but their effects in people with severe mental illness are poorly understood. Therefore, we conducted a meta-analysis on the effect of these interventions on PA and cardiometabolic risk factors. A systematic search of randomized controlled trials through 6 databases was carried out from inception to March 2019. Analyses were conducted using random-effect models. Weighted mean difference (WMD) were used as effect size when outcomes had the same units, otherwise Hedge's g was used. Fourteen articles including 2128 participants were identified. Motivational theory-based interventions were effective in increasing PA (g = 0.27, 95%CI[0.03; 0.51], p = .003), reducing weight (WMD = -1.87 kg, 95%CI[-2.98; -0.76], p = .001), body mass index (WMD = -0.82 kg/m2, 95%CI[-1.23; -0.41], p = .009), waist circumference (WMD = -1.91 cm, 95%CI[-3.63; -0.18], p = .03) and fasting glucose (g = -0.17, 95%CI[-0.34; -0.001], p = .04). Larger effect sizes were found in interventions based on only one theoretical model of motivation. In conclusion, interventions using motivational theories are effective to improve PA levels and the cardiometabolic health profile of people with severe mental illness. Systematic review registration: CRD42018104445.
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Affiliation(s)
| | - Paquito Bernard
- University of Quebec at Montreal, Montreal, QC H2X 1Y4, Canada; Mental health University Institute of Montreal, Montreal, QC H1N 3M5, Canada
| | - Zeina Akrass
- University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC H2X0A9, Canada
| | - Samuel St-Amour
- University of Quebec at Montreal, Montreal, QC H2X 1Y4, Canada; Mental health University Institute of Montreal, Montreal, QC H1N 3M5, Canada
| | - Jean-Philippe Lachance
- Mental health University Institute of Montreal, Montreal, QC H1N 3M5, Canada; Mental health University Institute of Montreal, Montreal, QC H1N 3M5, Canada
| | - Gabriel Hains-Monfette
- University of Quebec at Montreal, Montreal, QC H2X 1Y4, Canada; Mental health University Institute of Montreal, Montreal, QC H1N 3M5, Canada
| | - Sarah Atoui
- University of Quebec at Montreal, Montreal, QC H2X 1Y4, Canada; Mental health University Institute of Montreal, Montreal, QC H1N 3M5, Canada
| | - Celia Kingsbury
- University of Quebec at Montreal, Montreal, QC H2X 1Y4, Canada; Mental health University Institute of Montreal, Montreal, QC H1N 3M5, Canada
| | - Eve Dubois
- University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC H2X0A9, Canada
| | | | - Amal Abdel-Baki
- University of Montreal, Montreal, QC H3T 1J4, Canada; University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC H2X0A9, Canada; University Hospital of Montreal, Montreal, QC H2X 0C1, Canada
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102
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Schneider F, Erhart M, Hewer W, Loeffler LA, Jacobi F. Mortality and Medical Comorbidity in the Severely Mentally Ill. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:405-411. [PMID: 31366432 DOI: 10.3238/arztebl.2019.0405] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 09/04/2018] [Accepted: 03/27/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Mentally ill patients die on average 10 years earlier than the general population, largely due to general medical disorders. This study is the first to explore in a large German sample the prevalence, mortality, and medical comorbidity in pa- tients with severe mental illness (SMI). The patients were affected by borderline personality disorder (BPD), psychotic disorders, bipolar disorder, or severe unipolar depression. METHODS Our database consists of billing data from all adults with statutory health insurance in Germany. Twelve-month administrative SMI prevalence and medical comorbidity were estimated using cross-sectional data from 2016 (age ≥ 18; N = 59 561 310). Two-year mortality was established longitudinally in a randomly selected subset of the billing data (most recent mortality information available for 2012 to 2014; 2012: n = 15 590 107). RESULTS Severe unipolar depression had the highest prevalence (2.01%), followed by psychotic disorders (1.25%), BPD (0.34%), and bipolar disorder (0.29%). While the prevalence of malignant neoplasms showed moderate deviations from reference values [severe unipolar depression: OR = 1.30 (95% CI = 1.29; 1.31), BPD: OR = 1.11 (1.09; 1.14), psychotic dis- orders: OR = 0.90 (0.89; 0.90), bipolar disorder: OR = 1.07 (1.06; 1.09)], other disease groups (infectious, endocrine/nutritional/ metabolic, circulatory, respiratory) were substantially elevated in all categories of SMI. Mortality rates for psychotic disorders, BPD, bipolar disorder, and severe unipolar depression were increased (OR = 2.38 [95% CI=2.32; 2.44], 2.30 [2.08; 2.54], 1.52 [1.42; 1.62], and 1.40 [1.37; 1.44], respectively), with a loss of 2.6 to 12.3 years, depending on age, sex, and SMI. CONCLUSION Mortality is substantially elevated in all SMI patients. The results underline the need to remove barriers to adequate general medical care, both on the patient and the provider side, to reduce excess mortality.
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Affiliation(s)
- Frank Schneider
- University Hospital Düsseldorf; Central Institute for Ambulatory Care in Germany, Berlin, Germany; Alice Salomon University Berlin, Germany; Department of Geriatric Psychiatry, Christophsbad Hospital, Göppingen, Germany; Department of Psychiatry, Psychotherapy and Psychosomatics, School of Medicine, RWTH Aachen University, Aachen, Germany; Psychologische Hochschule Berlin, Berlin, Germany
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103
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Phalen PL, Muralidharan A, Travaglini L, Bennett M, Stahl N, Brown C, Hack S, Klingaman EA, Goldberg R. Predictors of attendance in health and wellness treatment groups for people with serious mental illness. Psychiatr Rehabil J 2020; 43:149-155. [PMID: 31259581 PMCID: PMC6938558 DOI: 10.1037/prj0000376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE People with serious mental illness have dramatically reduced life expectancy that is largely attributed to elevated rates of chronic medical conditions. Several group interventions have been developed and implemented in recent years to improve health and wellness among people with mental health conditions. Unfortunately, attendance in these interventions is often low, and there is limited understanding of factors that influence patient engagement in this treatment modality. METHOD Participants (N = 242) were enrolled in 1 of 2 group-based health and wellness treatment programs. Using descriptive statistics and regression, we assessed treatment attendance and a range of potential predictors of attendance. RESULTS We found lower attendance among people who were younger, people with more medical conditions, and people with more emergency room visits in the 6 months prior to the beginning of treatment. Younger age was a particularly strong predictor of low attendance and was the only variable significantly associated with attending zero treatment sessions. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE These results highlight the need for strategies to improve engagement of patients with poorer objective indicators of medical health and patients with younger age. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Peter L Phalen
- Mental Illness Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center
| | - Anjana Muralidharan
- Mental Illness Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center
| | - Letitia Travaglini
- Mental Illness Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center
| | - Melanie Bennett
- Mental Illness Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center
| | - Naomi Stahl
- Department of Psychology, American University
| | - Clayton Brown
- Mental Illness Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center
| | - Samantha Hack
- Mental Illness Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center
| | - Elizabeth A Klingaman
- Mental Illness Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center
| | - Richard Goldberg
- Mental Illness Research, Education, and Clinical Center, Baltimore Veterans Affairs Medical Center
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104
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Jahrami H, Saif Z, AlHaddad M, Faris MAI, Hammad L, Ali B. Assessing dietary and lifestyle risk behaviours and their associations with disease comorbidities among patients with depression: A case-control study from Bahrain. Heliyon 2020; 6:e04323. [PMID: 32637706 PMCID: PMC7327261 DOI: 10.1016/j.heliyon.2020.e04323] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES In Western populations, patients with depression die 10-25 years prematurely compared to controls, mainly due to lifestyle-related diseases. Tobacco smoking, excessive alcohol intake, poor diets and physical inactivity are among the major contributors to disease comorbidities. The objective of this research is to assess the dietary and lifestyle behaviours for Bahraini patients with depression and to determine their associations with different medical comorbidities. METHODS A case-control study was conducted from March to December 2019. A sample of 96 diagnosed patients with depression was recruited from the Psychiatric Hospital/Bahrain, and 96 age- and sex-matched controls were recruited from primary health centres. Assessment of anthropometrics, dietary and alcohol intakes, tobacco smoking and physical activity levels were undertaken for both cases and controls. National electronic medical records were reviewed retrospectively for medical comorbidities for the recruited cases. Logistic regression analysis was used to identify associations between lifestyle behaviours and medical comorbidities after controlling for confounding factors. RESULTS Patients with depression reported higher intakes of energy and energy-yielding macronutrients (e.g., carbohydrates, protein, and fat); three-fold higher rates of tobacco smoking; and significantly lower levels of physical activity. Cases appeared to be at a doubled risk for developing obesity, diabetes type 2, hypertension, and musculoskeletal disorders. The risk for cardiovascular problems was similar for cases and controls. CONCLUSIONS Poor dietary intakes, increased prevalence of smoking, and low levels of physical activity were evident in patients with depression in Bahrain; these factors were associated with some medical comorbidities.
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Affiliation(s)
- Haitham Jahrami
- Ministry of Health, Manama, Bahrain
- College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | | | | | - Mo'ez Al-Islam Faris
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
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105
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Daumit GL, Dalcin AT, Dickerson FB, Miller ER, Evins AE, Cather C, Jerome GJ, Young DR, Charleston JB, Gennusa JV, Goldsholl S, Cook C, Heller A, McGinty EE, Crum RM, Appel LJ, Wang NY. Effect of a Comprehensive Cardiovascular Risk Reduction Intervention in Persons With Serious Mental Illness: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e207247. [PMID: 32530472 PMCID: PMC7293000 DOI: 10.1001/jamanetworkopen.2020.7247] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE Persons with serious mental illness have a cardiovascular disease mortality rate more than twice that of the overall population. Meaningful cardiovascular risk reduction requires targeted efforts in this population, who often have psychiatric symptoms and cognitive impairment. OBJECTIVE To determine the effectiveness of an 18-month multifaceted intervention incorporating behavioral counseling, care coordination, and care management for overall cardiovascular risk reduction in adults with serious mental illness. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted from December 2013 to November 2018 at 4 community mental health outpatient programs in Maryland. The study recruited adults with at least 1 cardiovascular disease risk factor (hypertension, diabetes, dyslipidemia, current tobacco smoking, and/or overweight or obesity) attending the mental health programs. Of 398 participants screened, 269 were randomized to intervention (132 participants) or control (137 participants). Data collection staff were blinded to group assignment. Data were analyzed on the principle of intention to treat, and data analysis was performed from November 2018 to March 2019. INTERVENTIONS A health coach and nurse provided individually tailored cardiovascular disease risk reduction behavioral counseling, collaborated with physicians to implement appropriate risk factor management, and coordinated with mental health staff to encourage attainment of health goals. Programs offered physical activity classes and received consultation on serving healthier meals; intervention and control participants were exposed to these environmental changes. MAIN OUTCOMES AND MEASURES The primary outcome was the change in the risk of cardiovascular disease from the global Framingham Risk Score (FRS), which estimates the 10-year probability of a cardiovascular disease event, from baseline to 18 months, expressed as percentage change for intervention compared with control. RESULTS Of 269 participants randomized (mean [SD] age, 48.8 [11.9] years; 128 men [47.6%]), 159 (59.1%) had a diagnosis of schizophrenia or schizoaffective disorder, 67 (24.9%) had bipolar disorder, and 38 (14.1%) had major depressive disorder. At 18 months, the primary outcome, FRS, was obtained for 256 participants (95.2%). The mean (SD) baseline FRS was 11.5% (11.5%) (median, 8.6%; interquartile range, 3.9%-16.0%) in the intervention group and 12.7% (12.7%) (median, 9.1%; interquartile range, 4.0%-16.7%) in the control group. At 18 months, the mean (SD) FRS was 9.9% (10.2%) (median, 7.7%; interquartile range, 3.1%-12.0%) in the intervention group and 12.3% (12.0%) (median, 9.7%; interquartile range, 4.0%-15.9%) in the control group. Compared with the control group, the intervention group experienced a 12.7% (95% CI, 2.5%-22.9%; P = .02) relative reduction in FRS at 18 months. CONCLUSIONS AND RELEVANCE An 18-month behavioral counseling, care coordination, and care management intervention statistically significantly reduced overall cardiovascular disease risk in adults with serious mental illness. This intervention provides the means to substantially reduce health disparities in this high-risk population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02127671.
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Affiliation(s)
- Gail L. Daumit
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Arlene T. Dalcin
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | | | - Edgar R. Miller
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - A. Eden Evins
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Corinne Cather
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Gerald J. Jerome
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Kinesiology, Towson University, Towson, Maryland
| | - Deborah R. Young
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Jeanne B. Charleston
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Joseph V. Gennusa
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stacy Goldsholl
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Courtney Cook
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ann Heller
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emma E. McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rosa M. Crum
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lawrence J. Appel
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nae-Yuh Wang
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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106
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Frayne J, Hauck Y, Sivakumar P, Nguyen T, Liira H, Morgan VA. Nutritional status, food choices, barriers and facilitators to healthy nutrition in pregnant women with severe mental illness: a mixed methods approach. J Hum Nutr Diet 2020; 33:698-707. [PMID: 32391622 DOI: 10.1111/jhn.12752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Although widely acknowledged that adequate maternal nutrition is important for mother and baby, limited research has focussed on women with severe mental illnesses (SMI) in pregnancy. The present study reports on nutritional factors and food choices and investigates barriers and facilitators to healthy nutritional choices by pregnant women with SMI. METHODS A prospective mixed method study was undertaken of 38 pregnant women with SMI, including a cross-sectional survey, a food frequency questionnaire and 12 postnatal qualitative interviews, with integrated analysis of all data. RESULTS Elevated rates of obesity (35%) were found, with 82% of women having above the recommended gestational weight gain. Despite perceived knowledge, 32% of women did not meet any of the Five Food Group serving recommendations for pregnancy and consumed above-recommended levels for processed (19%) and sugar snacks (51%). Thematic analysis identified four main barriers: a discrepancy between knowledge and action, food cravings, mental health, and physical health. During pregnancy, food cravings were reported in 66% of women, psychological distress in 71% and physical distress in 37%. Screening identified 19% with potential eating disordered behaviours. Despite the challenges, several facilitators were identified and covered three themes: access to a dietitian, information delivery and support, and comprehensive care. DISCUSSION Women with SMI in pregnancy struggle with issues of obesity, gestational weight gain, food cravings and possible eating disorder behaviours. They have additional challenges when pregnant, with management of their mental health and physical health having a direct impact. Interventional strategies in this population should incorporate findings from this research.
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Affiliation(s)
- J Frayne
- Medical School, Division of General practice, The University of Western Australia, Crawley, WA, Australia.,Department of Obstetrics, Women and Newborn Health Service, Subiaco, WA, Australia
| | - Y Hauck
- Department of Nursing and Midwifery Education and Research, Women and Newborn Health Service, Subiaco, WA, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia
| | - P Sivakumar
- Department of Nutrition and Dietetics, Women and Newborn Health Service, Subiaco, WA, Australia
| | - T Nguyen
- Medical School, Division of Psychiatry, The University of Western Australia, Crawley, WA, Australia.,Peel and Rockingham, Kwinana Mental Health Services, Rockingham, WA, Australia
| | - H Liira
- Medical School, Division of General practice, The University of Western Australia, Crawley, WA, Australia
| | - V A Morgan
- Neuropsychiatric Epidemiology Research Unit, School of Population and Global Health, The University of Western Australia, Perth, WA, Australia.,Centre for Clinical Research in Neuropsychiatry, Medical School, Division of Psychiatry, The University of Western Australia, Crawley, WA, Australia
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107
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Bochicchio L, Stefancic A, Gurdak K, Swarbrick M, Cabassa LJ. "We're All in this Together": Peer-specialist Contributions to a Healthy Lifestyle Intervention for People with Serious Mental Illness. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:298-310. [PMID: 30565004 DOI: 10.1007/s10488-018-0914-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This qualitative study explored peer specialists' contributions to a healthy lifestyle intervention for obese/overweight individuals with serious mental illness (SMI) living in supportive housing. Intervention participants, peer specialists, and supervisors were interviewed and a grounded model emerged from the data identifying essential interpersonal attributes of the peer specialist-participant relationship. Peer specialists' disclosure of their own experiences making health behaviors changes was critical for building participants' motivation and ability to try lifestyle changes. Findings can inform peer specialist training and practice standards and facilitate the expansion of peer-delivered interventions to improve the physical health of people with SMI.
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Affiliation(s)
- Lauren Bochicchio
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, New York, NY, 10027, USA
| | - Ana Stefancic
- Department of Psychiatry, Columbia University, 1051 Riverside Dr., Rm 6203, New York, NY, 10031, USA
| | - Kristen Gurdak
- Department of Psychiatry, Columbia University, 1051 Riverside Dr., Rm 6203, New York, NY, 10031, USA
| | - Margaret Swarbrick
- Collaborative Support Programs of New Jersey, Rutgers Behavioral Health Care, 11 Spring Street, Freehold, NJ, 07728, USA
| | - Leopoldo J Cabassa
- George Warren Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA.
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Watkins A, Denney-Wilson E, Curtis J, Teasdale S, Rosenbaum S, Ward PB, Stein-Parbury J. Keeping the body in mind: A qualitative analysis of the experiences of people experiencing first-episode psychosis participating in a lifestyle intervention programme. Int J Ment Health Nurs 2020; 29:278-289. [PMID: 31840386 DOI: 10.1111/inm.12683] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/18/2019] [Indexed: 12/14/2022]
Abstract
The life expectancy gap experienced by people living with severe mental illness is primarily a result of cardiometabolic disease that is often exacerbated by side effects of antipsychotic medication. Commencement of atypical antipsychotic medication is commonly associated with weight gain. The Keeping the Body in Mind programme has demonstrated that early intervention with lifestyle activities can attenuate this weight gain and potentially improve long-term health outcomes. The aim of this study was to explore the experiences of young people who participated in the Keeping the Body in Mind programme, a targeted lifestyle intervention programme. A qualitative approach was used employing a semi-structured interview format. The interview schedule included questions related to four topics: aspects of the programmes that were useful, attributes of staff members that influenced the programme, changes in attitudes towards their own physical health, and suggestions for programme improvements. Interviews were recorded with duration ranging from 40 to 65 min. Thematic analysis was used to detect and assemble codes. These were then synthesized and classified into themes. Eleven participants were interviewed (seven males), aged between 18 and 25 years. Thematic analysis revealed four main themes: the role of physical health in mental health recovery; the importance of staff interactions; the value of peer interaction; and graduation to a sustainable healthy lifestyle. Study participants reported that they valued the programme for both their physical health and mental health recovery.
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Affiliation(s)
- Andrew Watkins
- Keeping the Body in Mind Program, The Bondi Centre, South Eastern Sydney Local Health District, Bondi Junction, New South Wales, Australia.,Faculty of Health, University of Technology, Sydney, Sydney, New South Wales, Australia
| | - Elizabeth Denney-Wilson
- Faculty of Medicine and Health, University of Sydney, Sydney, Sydney, New South Wales, Australia
| | - Jackie Curtis
- Keeping the Body in Mind Program, The Bondi Centre, South Eastern Sydney Local Health District, Bondi Junction, New South Wales, Australia.,School of Psychiatry, University of New South Wales, Sydney, Sydney, New South Wales, Australia
| | - Scott Teasdale
- Keeping the Body in Mind Program, The Bondi Centre, South Eastern Sydney Local Health District, Bondi Junction, New South Wales, Australia.,School of Psychiatry, University of New South Wales, Sydney, Sydney, New South Wales, Australia
| | - Simon Rosenbaum
- School of Psychiatry, University of New South Wales, Sydney, Sydney, New South Wales, Australia
| | - Philip B Ward
- School of Psychiatry, University of New South Wales, Sydney, Sydney, New South Wales, Australia.,Schizophrenia Research Unit, Ingham Institute for Applied Medical Research, Liverpool Hospital, South Western Sydney Local Health District, Bondi Junction, New South Wales, Australia
| | - Jane Stein-Parbury
- Faculty of Health, University of Technology, Sydney, Sydney, New South Wales, Australia
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Hoerster KD, Tanksley L, Simpson T, Saelens BE, Unützer J, Black M, Greene P, Sulayman N, Reiber G, Nelson K. Development of a Tailored Behavioral Weight Loss Program for Veterans With PTSD (MOVE!+UP): A Mixed-Methods Uncontrolled Iterative Pilot Study. Am J Health Promot 2020; 34:587-598. [PMID: 32162528 DOI: 10.1177/0890117120908505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Veterans with post-traumatic stress disorder (PTSD) lose less weight in the Veterans Affairs (VA) weight management program (MOVE!), so we developed MOVE!+UP. DESIGN Single-arm pre-post pilot to iteratively develop MOVE!+UP (2015-2018). SETTING Veterans Affairs Medical Center. PARTICIPANTS Overweight Veterans with PTSD (5 cohorts of n = 5-11 [N = 44]; n = 39 received ≥1 MOVE+UP session, with cohorts 1-4 [n = 31] = "Development" and cohort 5 [n = 8] = "Final" MOVE!+UP). INTERVENTION MOVE!+UP weight management for Veterans with PTSD modified after each cohort. Final MOVE!+UP was coled by a licensed clinical psychologist and Veteran peer counselor in 16 two-hour in-person group sessions and 2 individual dietician visits. Sessions included general weight loss support (eg, behavioral monitoring with facilitator feedback, weekly weighing), cognitive-behavioral skills to address PTSD-specific barriers, and a 30-minute walk to a nearby park. MEASURES To inform post-cohort modifications, we assessed weight, PTSD, and treatment targets (eg, physical activity, diet), and conducted qualitative interviews. ANALYSIS Baseline to 16-week paired t tests and template analysis. RESULTS Development cohorts suggested improvements (eg, additional sessions and weight loss information, professional involvement) and did not lose weight (mean [M] = 1.8 lbs (standard deviation [SD] = 8.2); P = .29. Conversely, the final cohort reported high satisfaction and showed meaningful weight (M = -14 pounds [SD = 3.7] and 71% lost ≥5% baseline weight) and PTSD (M = -17.9 [SD = 12.2]) improvements, P < .05. CONCLUSIONS The comprehensive, 16-week, in-person, cofacilitated Final MOVE!+UP was acceptable and may improve the health of people with PTSD. Iterative development likely produced a patient-centered intervention, needing further testing.
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Affiliation(s)
- Katherine D Hoerster
- Health Services Research and Development Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA.,Mental Health Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Lamont Tanksley
- Mental Health Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA
| | - Tracy Simpson
- Mental Health Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.,Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA
| | - Brian E Saelens
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.,Seattle Children's Research Institute, Seattle, WA, USA
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Marissa Black
- Geriatric Research Education and Clinical Center (GRECC), VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA
| | - Preston Greene
- Health Services Research and Development Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA
| | - Nadiyah Sulayman
- Health Services Research and Development Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA
| | - Gayle Reiber
- Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA.,Health Services Research Center of Innovation, Salt Lake City, UT, USA
| | - Karin Nelson
- Health Services Research and Development Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA.,General Internal Medicine Service, VA Puget Sound Health Care System, Seattle Division, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
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Suárez Benites CM, De La Cruz Vargas JA. Responsible prescription in Psychiatry: Metabolic Syndrome, an unresolved issue? ACTA ACUST UNITED AC 2020; 50:72-73. [PMID: 33735055 DOI: 10.1016/j.rcp.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/18/2019] [Indexed: 10/24/2022]
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111
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Young AS, Cohen AN, Niv N, Nowlin-Finch N, Oberman RS, Olmos-Ochoa TT, Goldberg RW, Whelan F. Mobile Phone and Smartphone Use by People With Serious Mental Illness. Psychiatr Serv 2020; 71:280-283. [PMID: 31744429 PMCID: PMC7054173 DOI: 10.1176/appi.ps.201900203] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Mobile technologies, such as smartphones, can improve health services by delivering assessments and interventions that reach people in their daily lives. There is, however, disagreement regarding whether people with serious mental illness make meaningful use of mobile technology and whether interventions that rely on mobile technology should be tailored for this population. METHODS At two clinics, 249 people with serious mental illness were interviewed regarding mobile phone use, and their cognitive functioning was assessed. RESULTS Mobile phones were used by 86% of participants, including 60% who used a smartphone. Phones were used for messaging by 81%, Internet by 52%, e-mail by 46%, and applications by 45%. Individuals who were older, had a persistent psychotic disorder rather than bipolar disorder, received disability income, or had worse neurocognitive functioning were less likely to own a smartphone (χ2=52.7, p<0.001). CONCLUSIONS Most patients with serious mental illness owned a mobile phone; a majority owned a smartphone. Developers should consider tailoring mobile interventions for psychosis and cognitive deficits.
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Affiliation(s)
- Alexander S Young
- Veterans Greater Los Angeles Healthcare System, Los Angeles (Young, Cohen, Oberman, Olmos-Ochoa); Department of Psychiatry, University of California, Los Angeles (Young, Cohen, Whelan); Veterans Long Beach Healthcare System, Long Beach, California (Niv); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch); Veterans Maryland Healthcare System, Baltimore (Goldberg)
| | - Amy N Cohen
- Veterans Greater Los Angeles Healthcare System, Los Angeles (Young, Cohen, Oberman, Olmos-Ochoa); Department of Psychiatry, University of California, Los Angeles (Young, Cohen, Whelan); Veterans Long Beach Healthcare System, Long Beach, California (Niv); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch); Veterans Maryland Healthcare System, Baltimore (Goldberg)
| | - Noosha Niv
- Veterans Greater Los Angeles Healthcare System, Los Angeles (Young, Cohen, Oberman, Olmos-Ochoa); Department of Psychiatry, University of California, Los Angeles (Young, Cohen, Whelan); Veterans Long Beach Healthcare System, Long Beach, California (Niv); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch); Veterans Maryland Healthcare System, Baltimore (Goldberg)
| | - Nancy Nowlin-Finch
- Veterans Greater Los Angeles Healthcare System, Los Angeles (Young, Cohen, Oberman, Olmos-Ochoa); Department of Psychiatry, University of California, Los Angeles (Young, Cohen, Whelan); Veterans Long Beach Healthcare System, Long Beach, California (Niv); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch); Veterans Maryland Healthcare System, Baltimore (Goldberg)
| | - Rebecca S Oberman
- Veterans Greater Los Angeles Healthcare System, Los Angeles (Young, Cohen, Oberman, Olmos-Ochoa); Department of Psychiatry, University of California, Los Angeles (Young, Cohen, Whelan); Veterans Long Beach Healthcare System, Long Beach, California (Niv); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch); Veterans Maryland Healthcare System, Baltimore (Goldberg)
| | - Tanya T Olmos-Ochoa
- Veterans Greater Los Angeles Healthcare System, Los Angeles (Young, Cohen, Oberman, Olmos-Ochoa); Department of Psychiatry, University of California, Los Angeles (Young, Cohen, Whelan); Veterans Long Beach Healthcare System, Long Beach, California (Niv); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch); Veterans Maryland Healthcare System, Baltimore (Goldberg)
| | - Richard W Goldberg
- Veterans Greater Los Angeles Healthcare System, Los Angeles (Young, Cohen, Oberman, Olmos-Ochoa); Department of Psychiatry, University of California, Los Angeles (Young, Cohen, Whelan); Veterans Long Beach Healthcare System, Long Beach, California (Niv); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch); Veterans Maryland Healthcare System, Baltimore (Goldberg)
| | - Fiona Whelan
- Veterans Greater Los Angeles Healthcare System, Los Angeles (Young, Cohen, Oberman, Olmos-Ochoa); Department of Psychiatry, University of California, Los Angeles (Young, Cohen, Whelan); Veterans Long Beach Healthcare System, Long Beach, California (Niv); Los Angeles County Department of Mental Health, Los Angeles (Nowlin-Finch); Veterans Maryland Healthcare System, Baltimore (Goldberg)
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112
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Ablett AD, Boyle BR, Avenell A. Fractures in Adults After Weight Loss from Bariatric Surgery and Weight Management Programs for Obesity: Systematic Review and Meta-analysis. Obes Surg 2020; 29:1327-1342. [PMID: 30725431 DOI: 10.1007/s11695-018-03685-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Weight loss interventions for obesity, such as bariatric surgery, are associated with reductions in bone mineral density and may increase the risk of fractures. We undertook a systematic review and meta-analysis of bariatric surgery and lifestyle weight management programs (WMPs) with fracture outcomes. METHODS We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials from 1966 to 2018, and our trial registry of WMP randomized controlled trials (RCTs). We included RCTs, non-randomized trials, and observational studies of bariatric surgery, and RCTs of WMPs. Studies had follow-up ≥ 12 months, mean group body mass index ≥ 30 kg/m2. The primary outcome measure was incidence of any type of fracture in participants, and the secondary outcome was weight change. We used random effects meta-analysis for trial data. RESULTS Fifteen studies were included. Three small trials provided short-term evidence of the association between bariatric surgery and participants with any fracture (365 participants; RR 0.82; 95% CI 0.29 to 2.35). Four out of six observational studies of bariatric surgery demonstrated significantly increased fracture risk. Six RCTs of WMPs with 6214 participants, the longest follow-up 11.3 years, showed no clear effect on any type of fracture (RR 1.04; 95% CI 0.91 to 1.18), although authors of the largest RCT reported an increased risk of frailty fracture by their definition (RR 1.40; 95% CI 1.04 to 1.90). CONCLUSION Bariatric surgery appears to increase the risk of any fracture; however, longer-term trial data are needed. The effect of lifestyle WMPs on the risk of any fracture is currently unclear.
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Affiliation(s)
- Andrew D Ablett
- Health Services Research Unit, Health Sciences Building, University of Aberdeen, 3rd Floor Health Sciences Building, Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK
| | - Bonnie R Boyle
- Health Services Research Unit, Health Sciences Building, University of Aberdeen, 3rd Floor Health Sciences Building, Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK
| | - Alison Avenell
- Health Services Research Unit, Health Sciences Building, University of Aberdeen, 3rd Floor Health Sciences Building, Foresterhill, Aberdeen, Scotland, AB25 2ZD, UK.
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Gaughran F, Stahl D, Patel A, Ismail K, Smith S, Greenwood K, Atakan Z, Gardner-Sood P, Stringer D, Hopkins D, Lally J, Forti MD, Stubbs B, Lowe P, Arbuthnott M, Heslin M, David AS, Murray RM. A health promotion intervention to improve lifestyle choices and
health outcomes in people with psychosis: a research programme including the
IMPaCT RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background
People with psychotic disorders have reduced life expectancy largely because
of physical health problems, especially cardiovascular disease, that are
complicated by the use of tobacco and cannabis.
Objectives
We set out to (1) chart lifestyle and substance use choices and the emergence
of cardiometabolic risk from the earliest presentation with psychosis, (2)
develop a pragmatic health promotion intervention integrated within the
clinical teams to improve the lifestyle choices and health outcomes of
people with psychosis and (3) evaluate the clinical effectiveness and
cost-effectiveness of that health promotion intervention.
Design
We performed a longitudinal cohort study of people presenting with their
first episode of psychosis in three mental health trusts and followed up
participants for 1 year [work package 1, physical health and substance use
measures in first episode of psychosis (PUMP)]. We used an iterative Delphi
methodology to develop and refine a modular health promotion intervention,
improving physical health and reducing substance use in psychosis (IMPaCT)
therapy, which was to be delivered by the patient’s usual care
co-ordinator and used motivational interviewing techniques and
cognitive–behavioural therapy to improve health choices of people
with psychosis (work package 2). We then conducted a multicentre, two-arm,
parallel-cluster, randomised controlled trial to determine the clinical
effectiveness and cost-effectiveness of using the intervention with people
with established psychosis (work package 3: IMPaCT randomised controlled
trial) in five UK mental health trusts. The work took place between 2008 and
2014.
Participants
All people aged between 16 and 65 years within 6 months of their first
presentation with a non-organic psychosis and who were proficient in English
were eligible for inclusion in the PUMP study. Participants in the work
package 2 training development were staff selected from a range of settings,
working with psychosis. Participants in the phase 3 Delphi consensus and
manual development comprised three expert groups of (1)
therapists/researchers recruited from the local and national community, (2)
clinicians and (3) service users, each of whom took part in two iterative
review and feedback sessions. For work package 3, IMPaCT randomised
controlled trial, care co-ordinators in participating community mental
health teams who were permanently employed and had a minimum of four
eligible patients (i.e. aged between 18 and 65 years with a diagnosis of a
psychotic disorder) on their caseload were eligible to participate. In
studies 1 and 3, patient participants were ineligible if they were pregnant
or had a major illness that would have had an impact on their metabolic
status or if they had a significant learning disability. All participants
were included in the study only after giving written confirmed consent.
Main outcome measures
Cardiometabolic risk markers, including rates of obesity and central obesity,
and levels of glycated haemoglobin (HbA1c) and lipids, were the
main outcomes in work package 1 (PUMP), with descriptive data presented on
substance use. Our primary outcome measure for the IMPaCT randomised
controlled trial was the physical or mental health component Short Form
questionnaire-36 items quality-of-life scores at 12 months.
Results
Obesity rates rose from 18% at first presentation with psychosis to 24% by 1
year, but cardiometabolic risk was not associated with baseline lifestyle
and substance use choices. Patterns of increase in the levels of
HbA1c over the year following first presentation showed
variation by ethnic group. We recruited 104 care co-ordinators, of whom 52
(with 213 patients) were randomised to deliver IMPaCT therapy and 52 (with
193 patients) were randomised to deliver treatment as usual, in keeping with
our power calculations. Of these 406 participants with established
psychosis, 318 (78%) and 301 (74%) participants, respectively, attended the
12- and 15-month follow-ups. We found no significant effect of IMPaCT
therapy compared with treatment as usual on the physical or mental health
component Short Form questionnaire-36 items scores at either time point in
an intention-to-treat analysis [physical health score (‘d’)
–0.17 at 12 months and –0.09 at 15 months; mental health score
(‘d’) 0.03 at 12 months and –0.05 at 15 months] or on
costs. Nor did we find an effect on other cardiovascular risk indicators,
including diabetes, except in the case of high-density lipoprotein
cholesterol, which showed a trend for greater benefit with IMPaCT therapy
than with treatment as usual (treatment effect 0.085, 95% confidence
interval 0.007 to 0.16; p = 0.034).
Limitations
Follow-up in work package 1 was challenging, with 127 out of 293 participants
attending; however, there was no difference in cardiometabolic measures or
demographic factors at baseline between those who attended for follow-up and
those who did not. In work package 3, the IMPaCT randomised controlled
trial, care co-ordinators struggled to provide additional time to their
patients that was devoted to the health promotion intervention on top of
their usual clinical care contact with them.
Conclusions
Cardiometabolic risk is prominent even soon after first presentation with
psychosis and increases over time. Lifestyle choices and substance use
habits at first presentation do not predict those who will be most
cardiometabolically compromised 1 year later. Training and supervising care
co-ordinators to deliver a health promotion intervention to their own
patients on top of routine care is not effective in the NHS for improving
quality of life or reducing cardiometabolic risk.
Future work
Further work is needed to develop and evaluate effective, cost-effective and
affordable ways of preventing the emergence of and reversing existing
cardiometabolic risk indicators in people with psychosis.
Trial registration
Current Controlled Trials ISRCTN58667926.
Funding
This project was funded by the National Institute for Health Research (NIHR)
Programme Grants for Applied Research programme and will be published in
full in Programme Grants for Applied Research; Vol. 8, No.
1. See the NIHR Journals Library website for further project
information.
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Affiliation(s)
- Fiona Gaughran
- National Psychosis Service, South London and Maudsley NHS
Foundation Trust, London, UK
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
| | - Daniel Stahl
- Department of Biostatistics and Health Informatics, Institute
of Psychiatry, Psychology & Neuroscience, King’s College
London, London, UK
| | - Anita Patel
- Anita Patel Health Economics Consulting Ltd, London, UK
- Centre for Primary Care and Public Health, Blizard Institute,
Queen Mary University of London, London, UK
| | - Khalida Ismail
- Department of Psychological Medicine, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
| | - Shubulade Smith
- Department of Forensic and Neurodevelopmental Science,
Institute of Psychiatry, Psychology & Neuroscience, King’s
College London, London, UK
- Forensic Services, South London and Maudsley NHS Foundation
Trust, London, UK
| | - Kathryn Greenwood
- Sussex Partnership NHS Foundation Trust, Worthing, UK
- School of Psychology, University of Sussex, Brighton, UK
| | - Zerrin Atakan
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
| | - Poonam Gardner-Sood
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
| | - Dominic Stringer
- Department of Biostatistics and Health Informatics, Institute
of Psychiatry, Psychology & Neuroscience, King’s College
London, London, UK
| | - David Hopkins
- Institute of Diabetes, Endocrinology and Obesity, King’s
Health Partners, London, UK
| | - John Lally
- National Psychosis Service, South London and Maudsley NHS
Foundation Trust, London, UK
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
- Department of Psychiatry, Royal College of Surgeons in Ireland,
Beaumont Hospital, Dublin, Ireland
| | - Marta Di Forti
- Social, Genetic & Developmental Psychiatry Centre,
Institute of Psychiatry, Psychology & Neuroscience, King’s
College, London, UK
- Department of Psychiatry, Experimental Biomedicine and Clinical
Neuroscience (BIONEC), University of Palermo, Palermo, Italy
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
- Physiotherapy Department, South London and Maudsley NHS
Foundation Trust, London, UK
| | | | | | - Margaret Heslin
- King’s Health Economics, Health Service & Population
Research Department, Institute of Psychiatry, Psychology &
Neuroscience, King’s College London, London, UK
| | - Anthony S David
- Institute of Mental Health, Division of Psychiatry, University
College London, London, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry,
Psychology & Neuroscience, King’s College
London, London, UK
- Department of Psychiatry, Experimental Biomedicine and Clinical
Neuroscience (BIONEC), University of Palermo, Palermo, Italy
- South London and Maudsley NHS Foundation Trust, London, UK
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Mazoruk S, Meyrick J, Taousi Z, Huxley A. The effectiveness of health behavior change interventions in managing physical health in people with a psychotic illness: A systematic review. Perspect Psychiatr Care 2020; 56:121-140. [PMID: 31131451 DOI: 10.1111/ppc.12391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 04/02/2019] [Accepted: 04/14/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE People living with psychotic illness disproportionately experience more comorbidities and have a markedly shorter life expectancy compared to the general population. This review evaluates the effectiveness of health behavior change interventions in improving health outcomes in this group. DESIGN AND METHODS All studies included objective physical health measures or health behaviors as the main outcome measures and experimental design with baseline and follow-up quantitative data. Only studies of moderate and strong quality were included. Narrative synthesis was undertaken. FINDINGS Included studies utilized a range of methodological designs and outcome measures. The majority reported significant intervention effect on most outcome measures. PRACTICE IMPLICATIONS Health behavior change interventions can be effective in improving health outcomes in people with psychotic illness, with the potential benefit of improved psychiatric outcomes.
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Affiliation(s)
- Sabina Mazoruk
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Jane Meyrick
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Zohra Taousi
- Department of Community Psychiatry, Hertfordshire Partnership University NHS Foundation Trust, St Albans, Hertfordshire, UK
| | - Adam Huxley
- Change Grow Live, Department of Psychology, Hatfield, Hertfordshire, UK
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Fernández Guijarro S, Miguel García C, Pomarol-Clotet E, Egea López EN, Burjales Martí MD, Rigol Cuadra MA. Metabolic Syndrome Screening in People With Severe Mental Illness: Results From Two Spanish Community Mental Health Centers. J Am Psychiatr Nurses Assoc 2020; 26:162-171. [PMID: 30741068 DOI: 10.1177/1078390319826686] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The excess of mortality in people with severe mental illness is due to unnatural causes such as accidents or suicides and natural causes such as metabolic syndrome. The presence of modifiable risk factors like tobacco consumption increases cardiovascular and metabolic risk. AIMS: The purpose of this study was to identify the prevalence of metabolic syndrome and other cardiovascular risk factors in people with severe mental illness. This study also aimed to identify the prevalence of patients receiving treatment for any metabolic syndrome risk factor. METHOD: A cross-sectional descriptive study was performed. A total of 125 participants from two community mental health centers in Spain were recruited. RESULTS: More than half of the participants (58.4%) were active smokers. The prevalence of metabolic syndrome was 60%. A total of 16.8% received previous treatment for hypertension, 17.6% for hypertriglyceridemia, and 11.2% for diabetes. No differences were found between centers (22.7% vs. 18.7%, p = .9). CONCLUSIONS: The findings underscore the importance of monitoring the physical health of patients on antipsychotic therapy. The identification and management of cardiovascular and metabolic risks factors is an essential part of nursing care for people with severe mental illness. Mental health nurses are ideally positioned to carry out this task by performing physical health screening, health education, and lifestyle interventions.
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Affiliation(s)
| | | | - Edith Pomarol-Clotet
- Edith Pomarol-Clotet, MD, PhD, FIDMAG Hermanas Hospitalarias Research Foundation, Barcelona, Spain
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Korman N, Fox H, Skinner T, Dodd C, Suetani S, Chapman J, Parker S, Dark F, Collins C, Rosenbaum S, Siskind D. Feasibility and Acceptability of a Student-Led Lifestyle (Diet and Exercise) Intervention Within a Residential Rehabilitation Setting for People With Severe Mental Illness, GO HEART (Group Occupation, Health, Exercise And Rehabilitation Treatment). Front Psychiatry 2020; 11:319. [PMID: 32411024 PMCID: PMC7198865 DOI: 10.3389/fpsyt.2020.00319] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/31/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE People with severe mental illness (SMI) experience poor physical health and premature mortality, contributed significantly by modifiable lifestyle risk factors such as poor nutrition, low cardiorespiratory fitness, and physical inactivity. Lifestyle interventions can reduce cardiometabolic risk and confer a range of other positive mental and physical health benefits. We assessed the feasibility, acceptability, safety, and preliminary effectiveness of a lifestyle (combined dietary and exercise) intervention lead by senior exercise and dietetics students in a residential mental health rehabilitation setting. DESIGN Single arm, prospective study evaluating outcomes pre and post a 10-week dietary and exercise intervention. METHOD People with SMI from three residential rehabilitation units participated in a mixed aerobic and resistance training exercise intervention three times per week that was combined with a dietary intervention (six individual and group sessions). Primary outcome considerations were feasibility (recruitment, retention, and participation rates), acceptability, and adverse events. Secondary outcomes were preliminary effectiveness; (functional exercise capacity, volume of exercise, and metabolic markers), psychiatric symptoms, quality of life, and attitudes to exercise. RESULTS Forty-two participants were recruited (92% primary diagnosis of schizophrenia). Intervention feasibility was supported by high levels of recruitment (68%), retention (77%), and participation (70% exercise, 65% diet sessions); and the absence of serious adverse events. Significant improvements in functional exercise capacity, volume of exercise, general psychiatric symptoms, and negative psychotic symptoms occurred. Anthropometric and metabolic blood markers did not change. While the intervention was acceptable to participants, motivation for and perceived value of exercise reduced over 10 weeks. CONCLUSIONS A brief pragmatic student-led lifestyle intervention integrated into usual mental health care was feasible, acceptable, safe, and scalable across two additional mental health residential rehabilitation sites, and resulted in physical and mental health improvements. Increased frequency of dietary sessions and length of dietary intervention may improve metabolic outcomes in the future. People with SMI living in residential rehabilitation units should have access to lifestyle programs to address modifiable lifestyle risk factors. While this brief intervention was feasible and acceptable, this study highlights some of the challenges associated with maintaining motivation for healthy lifestyles for people with SMI. Longer term investigation of real-world lifestyle interventions is warranted, together with additional interventions that may support people with SMI to sustain motivation to address lifestyle factors. CLINICAL TRIAL REGISTRATION The trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), Unique Identifier: ACTRN 12618000478213, http://www.anzctr.org.au Universal trial number (UTN)-U1111-1211-4009.
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Affiliation(s)
- Nicole Korman
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Harley Fox
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Tina Skinner
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Cassandra Dodd
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia
| | - Shuichi Suetani
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia
| | - Justin Chapman
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia.,Queensland Institute of Medical Research, Mental Health and Complex Disorders, Brisbane, QLD, Australia
| | - Stephen Parker
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Frances Dark
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Cheryl Collins
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Simon Rosenbaum
- School of Psychiatry, Faculty of Medicine, UNSW, Sydney, NSW, Australia
| | - Dan Siskind
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
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Fernández Guijarro S, Pomarol-Clotet E, Rubio Muñoz MC, Miguel García C, Egea López E, Fernández Guijarro R, Castán Pérez L, Rigol Cuadra MA. Effectiveness of a community-based nurse-led lifestyle-modification intervention for people with serious mental illness and metabolic syndrome. Int J Ment Health Nurs 2019; 28:1328-1337. [PMID: 31411375 DOI: 10.1111/inm.12644] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2019] [Indexed: 11/29/2022]
Abstract
The development of metabolic syndrome negatively affects the quality of life of people with serious mental illness. Experts agree on the need to evaluate the physical health of patients and intervene in modifiable risk factors, with emphasis on the promotion of healthy lifestyles. Interventions should include nutritional counselling and physical activity. This 24-week randomized trial evaluated the effects of a community-based nurse-led lifestyle-modification intervention in people with serious mental illness meeting metabolic syndrome criteria, and its impact on health-related quality of life and physical activity. Sixty-one participants from two community mental health centres were randomly assigned to the intervention or control group. The intervention consisted of weekly group sessions, with 20 min of theoretical content and 60 min of nurse-led physical activity. Postintervention results between groups showed no differences in weight, waist circumference, fasting glucose, and systolic blood pressure. Differences in body mass index, triglyceride concentrations, and diastolic blood pressure were found to be significant (P = 0.010, P = 0.038, and P = 0.017). Participants who performed the intervention reported an increase in physical activity, which did not occur in the control group (P = 0.035), and also reported better health status (P < 0.001). Our intervention showed positive effects reducing participants' cardiovascular and metabolic risks and improving their physical activity and quality of life. To our knowledge, this is the first clinical trial led and carried out by mental health nurses in community mental health centres which takes into account the effects of a lifestyle intervention on every metabolic syndrome criterion, health-related quality of life, and physical activity.
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Kilicaslan EE, Karakilic M, Erol A. The Relationship between 10 Years Risk of Cardiovascular Disease and Schizophrenia Symptoms: Preliminary Results. Psychiatry Investig 2019; 16:933-939. [PMID: 31801314 PMCID: PMC6933131 DOI: 10.30773/pi.2019.0063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 09/25/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Previous research shows that patients with schizophrenia have increased cardiovascular disease risk than general population. Increased cardiovascular risk in schizophrenia patients have been associated with many reasons such as antipsychotic drugs, genetic predisposition, andlifestyle. In this study, we aimed to investigate the relationship between the risk of heart disease and schizophrenia symptomatology. METHODS The 10-year cardiovascular risk was assessed by the Framingham Risk Score (FRS) in 103 patients with schizophrenia and in 39 healthy controls. Sociodemographic characteristics, age at schizophrenia onset, duration of illness, number of hospitalizations, the course of the disease and antipsychotic medications were recorded. Patients' symptoms were evaluated via The Scale for the Assessment of Negative Symptoms (SANS), The Scale for the Assessment of Positive Symptoms (SAPS), and Calgary Depression Scale for Schizophrenia (CDSS). RESULTS Ten-year cardiovascular risk was 5.16% inpatients with schizophrenia, and 3.02% in control group (p=0.030). No significant correlation was found between FRS scores, SANS, SAPS, and CDSS scores. However, FRS scores were significantly correlated with age, number of hospitalizations and duration of disease (r=0.300, 0.261, 0.252, respectively). Moreover FRS scores were higher (p=0.008) and high-density lipoprotein (HDL) levels were lower (p=0.048) in patients using multiple antipsychotics. CONCLUSION Our findings suggest a relationship between the risk of cardiovascular disease and the duration and overall severity of schizophrenia and also highlights the role of antipsychotics in this relationship.
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Affiliation(s)
- Esin Evren Kilicaslan
- Department of Psychiatry, Atatürk Education and Training Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Merve Karakilic
- Department of Psychiatry, Atatürk Education and Training Hospital, Izmir Katip Celebi University, Izmir, Turkey
| | - Almila Erol
- Department of Psychiatry, Atatürk Education and Training Hospital, Izmir Katip Celebi University, Izmir, Turkey
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Looijmans A, Jörg F, Bruggeman R, Schoevers RA, Corpeleijn E. Multimodal lifestyle intervention using a web-based tool to improve cardiometabolic health in patients with serious mental illness: results of a cluster randomized controlled trial (LION). BMC Psychiatry 2019; 19:339. [PMID: 31690281 PMCID: PMC6833253 DOI: 10.1186/s12888-019-2310-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/09/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Unhealthy lifestyle behaviours contribute to alarming cardiometabolic risk in patients with serious mental illness (SMI). Evidence-based practical lifestyle tools supporting patients and staff in improving patient lifestyle are lacking. METHODS This multi-site randomized controlled pragmatic trial determined the effectiveness of a twelve-month multimodal lifestyle approach, including a web-based tool to improve patients' cardiometabolic health, versus care-as-usual. Using the web tool, nurses (trained in motivational interviewing) assisted patients in assessing their lifestyle behaviours, creating a risk profile and constructing lifestyle goals, which were discussed during fortnightly regular care visits. Twenty-seven community-care and sheltered-living teams were randomized into intervention (N = 17) or control (N = 10) groups, including 244 patients (140 intervention/104 control, 49.2% male, 46.1 ± 10.8 years) with increased waist circumference (WC), BMI or fasting glucose. The primary outcomes concerned differences in WC after six and twelve months intervention, while BMI and metabolic syndrome Z-score were secondary outcome measures. RESULTS General multilevel linear mixed models adjusted for antipsychotic medication showed that differences in WC change between intervention and control were - 0.15 cm (95%CI: - 2.49; 2.19) after six and - 1.03 cm (95%CI: - 3.42; 1.35) after twelve months intervention; however, the differences were not statistically significant. No intervention effects were found for secondary outcome measures. The intervention increased patients' readiness to change dietary behaviour. CONCLUSION A multimodal web-based intervention facilitating nurses to address lifestyle changes in SMI patients did not improve patient cardiometabolic health. Web-tool use was lower than expected and nurses need more lifestyle coaching knowledge and skills. The type of intervention and delivery mode need optimization to realize effective lifestyle care for SMI patients. TRIAL REGISTRATION Dutch Trial Registry, www.trialregister.nl , NTR3765, 21 December 2012.
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Affiliation(s)
- Anne Looijmans
- Department of Health Psychology, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700, RB, Groningen, The Netherlands.
| | - Frederike Jörg
- Rob Giel Research Centre, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands ,Research Department, Friesland Mental Health Services, Leeuwarden, The Netherlands
| | - Richard Bruggeman
- Rob Giel Research Centre, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands ,0000 0000 9558 4598grid.4494.dDepartment of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert A. Schoevers
- 0000 0000 9558 4598grid.4494.dDepartment of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eva Corpeleijn
- 0000 0000 9558 4598grid.4494.dDepartment of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Morell R, Curtis J, Watkins A, Poole J, Fibbins H, Rossimel E, Gerrard M, White A, Teasdale S, Ward PB, Lappin J. Cardio-metabolic risk in individuals prescribed long-acting injectable antipsychotic medication. Psychiatry Res 2019; 281:112606. [PMID: 31629301 DOI: 10.1016/j.psychres.2019.112606] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 12/24/2022]
Abstract
People living with severe mental illness (SMI) experience significant physical health co-morbidity. Few studies have focused on physical health outcomes for those prescribed long-acting injectable (LAI) antipsychotics. This observational cross-sectional study aimed to assess the prevalence of metabolic syndrome (MetS) and other cardio-metabolic risk factors in a large cohort prescribed LAI and managed by community mental health services. For participants with elevated cardio-metabolic risk factors, the proportion receiving appropriate management was assessed. Of the 301 eligible participants, many met the full criteria for MetS (44%) and its components. Cardio-metabolic risk factors were largely under- or un-treated. Smoking rates were very high (62%) along with reported high rates of physical inactivity and poor dietary intake. The vast majority (89%) reported seeing their general practitioner in the preceding twelve months. Individuals prescribed LAI have a very high prevalence of MetS and potentially modifiable risk factors for cardiovascular disease. Routine monitoring accompanied by evidence-based treatment of cardiometabolic abnormalities which contribute to significant morbidity, disability and premature death should be prioritised. Better collaboration between mental health services and primary care providers should be pursued to optimise the delivery of effective physical health care to individuals living with SMI.
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Affiliation(s)
- Rachel Morell
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia; School of Psychiatry, UNSW Sydney, Kensington, NSW, Australia.
| | - Jackie Curtis
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia; School of Psychiatry, UNSW Sydney, Kensington, NSW, Australia
| | - Andrew Watkins
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia
| | - Josephine Poole
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia
| | - Hamish Fibbins
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia; School of Psychiatry, UNSW Sydney, Kensington, NSW, Australia
| | - Elisa Rossimel
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia
| | - Mark Gerrard
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia
| | - Annette White
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia
| | - Scott Teasdale
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia; School of Psychiatry, UNSW Sydney, Kensington, NSW, Australia
| | - Philip B Ward
- School of Psychiatry, UNSW Sydney, Kensington, NSW, Australia; Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, NSW, Austraila
| | - Julia Lappin
- Keeping the Body In Mind, South Eastern Sydney Local Health District, Bondi Junction, NSW, Australia; School of Psychiatry, UNSW Sydney, Kensington, NSW, Australia
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Abstract
Individuals with bipolar disorder are at greater risk for cardiovascular disease and are less likely to adhere to lifestyle interventions than the general population. To decrease cardiovascular risk and improve adherence to lifestyle interventions, we developed the Nutrition Exercise and Wellness Treatment (NEW Tx). NEW Tx is an 18-session, 20-week cognitive behavioral therapy-based treatment comprising 3 modules: Nutrition, Exercise, and Wellness. To evaluate the feasibility and acceptability of this intervention as well as predictors of treatment satisfaction and expectations, 38 adult outpatients with bipolar disorder were randomized to either NEW Tx or a waitlist control condition. There was no statistically significant difference in dropout rates between the groups (26.3% in NEW Tx, 31.6% in the control condition). In the NEW Tx condition, participants attended a mean of 66.7% of sessions and reported moderate to high satisfaction. There were no study-related adverse events. We also found that expectations, but not perceived credibility (or believability), of NEW Tx (as measured by the Credibility/Expectancy Questionnaire) at baseline predicted treatment satisfaction (as measured by the Care Satisfaction Questionnaire) posttreatment. Manic symptoms at baseline predicted treatment satisfaction, and marital status predicted one's expectations of lifestyle interventions. Data suggest that NEW Tx is a feasible and acceptable intervention for individuals with bipolar disorder and that further research is warranted to explore potential moderators of treatment expectations and credibility in this clinical population.
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122
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Costa R, Teasdale S, Abreu S, Bastos T, Probst M, Rosenbaum S, Ward PB, Corredeira R. Dietary Intake, Adherence to Mediterranean Diet and Lifestyle-Related Factors in People with Schizophrenia. Issues Ment Health Nurs 2019; 40:851-860. [PMID: 31339786 DOI: 10.1080/01612840.2019.1642426] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The purpose of this study was to examine the dietary intake of both inpatients and outpatients with schizophrenia in the Portuguese population as a potential key contributing factor to the poor physical health profiles, and understand the relationship of diet quality to other lifestyle factors. Participants of this cross-sectional study completed a semi quantitative food frequency questionnaire. Diet quality was determined by adherence to the Mediterranean Diet. In addition participants completed the International Physical Activity Questionnaire-Short-Form and Pittsburgh Sleep Quality Index. Tobacco smoking was assessed through a series of general questions. A total of 100 patients (50% inpatients and 28% female) with schizophrenia were included in the final analysis. Patients reported a high consumption of caffeine, while deficits were evident for fibre and folate intakes, when compared to the European Food Safety Authority recommendations. Both inpatients and outpatients reported poor to moderate diet quality. Smokers reported poorer diet quality when compared to non-smokers (p < 0.001). Dietary intake, and its relationship to other lifestyle components, should be considered for intervention, in order to improve physical health of people living with schizophrenia.
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Affiliation(s)
- Raquel Costa
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto , Porto , Portugal
| | - Scott Teasdale
- Keeping the Body in Mind Program, South Eastern Sydney Local Health District , Bondi Junction , Australia.,School of Psychiatry, UNSW Sydney , Australia
| | - Sandra Abreu
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto , Porto , Portugal
| | - Tânia Bastos
- Centre of Research, Education, Innovation and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto , Porto , Portugal.,Research Center in Sports Sciences, Health Sciences and Human Development, CIDESD, University Institute of Maia, ISMAI , Maia , Portugal
| | - Michel Probst
- Faculty of Kinesiology and Rehabilitation Sciences, Research Group for Adapted Physical Activity and Psychomotor Rehabilitation , KU Leuven , Leuven , Belgium
| | - Simon Rosenbaum
- School of Psychiatry, UNSW Sydney , Australia.,Black Dog Institute, Prince of Wales Hospital, Sydney , Randwick , Australia
| | - Philip B Ward
- School of Psychiatry, UNSW Sydney , Australia.,Schizophrenia Research Unit, South Western Sydney Local Health District & Ingham Institute for Applied Medical Research , Liverpool , Australia
| | - Rui Corredeira
- Research Centre in Physical Activity, Health and Leisure (CIAFEL), Faculty of Sport, University of Porto , Porto , Portugal
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Mucheru D, Hanlon MC, McEvoy M, MacDonald-Wicks L. An appraisal of methodology reporting in lifestyle interventions among people with psychosis: A systematic review. Health Promot J Austr 2019; 31:540-552. [PMID: 31495017 DOI: 10.1002/hpja.293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 06/24/2019] [Accepted: 08/30/2019] [Indexed: 12/20/2022] Open
Abstract
ISSUE ADDRESSED Lifestyle interventions use nutrition and physical activity behaviour modification techniques to decrease obesity and cardio-metabolic risk in people with psychosis. Evidence on the specific behaviour modification strategies applied to decrease obesity is weakened by inadequate methodology reporting of lifestyle interventions. A systematic review that we conducted earlier highlighted a possible deficiency in reporting; hence we aim to critically appraise lifestyle intervention studies that target weight outcomes for people with psychosis against the methods component of the CONSORT statement for randomised trials of nonpharmacologic treatments. METHODS COMPONENT We considered randomised controlled studies which delivered lifestyle interventions to community-dwelling adults with psychotic disorders, and included those with the following outcomes of interest: weight, body mass index, waist circumference and waist-to-hip ratio. The Cochrane Library, MEDLINE/PREMEDLINE, EMBASE, CINAHL, Scopus and PsycINFO were searched for English publications between 1985 and 2018. Methodology and reporting of studies were evaluated using the CONSORT statement for randomised trials of nonpharmacologic treatments. RESULTS Thirty-two studies met the inclusion criteria. Critical appraisals revealed that reporting of lifestyle intervention studies was generally incomplete. Fewer than 50% provided the recommended information on trial design, participant characteristics, detail of interventions, outcomes, sample size, randomisation, blinding and statistical methods. CONCLUSIONS Application of guidelines, like the CONSORT statement, in future publications of lifestyle interventions for people with psychosis will improve accuracy of reporting. SO WHAT?: Enhanced reporting in lifestyle intervention studies for people with psychosis will promote guideline creation and translation of research, which is likely to positively impact physical health outcomes.
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Affiliation(s)
- Doreen Mucheru
- Faculty Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia
| | - Mary-Claire Hanlon
- Faculty Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Brain and Mental Health Program, Hunter Medical Research Institute, New Lambton, NSW, Australia.,Priority Research Centre for Brain and Mental Health, Mater Hospital, Waratah, NSW, Australia.,Hunter Cancer Research Alliance, The University of Newcastle, Callaghan, NSW, Australia
| | - Mark McEvoy
- Faculty Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Centre for Clinical Epidemiology & Biostatistics, Hunter Medical Research Institute, New Lambton, NSW, Australia
| | - Lesley MacDonald-Wicks
- Faculty Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.,Brain and Mental Health Program, Hunter Medical Research Institute, New Lambton, NSW, Australia.,Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Callaghan, NSW, Australia
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Williams J, Stubbs B, Richardson S, Flower C, Barr-Hamilton L, Grey B, Hubbard K, Spaducci G, Gaughran F, Craig T. 'Walk this way': results from a pilot randomised controlled trial of a health coaching intervention to reduce sedentary behaviour and increase physical activity in people with serious mental illness. BMC Psychiatry 2019; 19:287. [PMID: 31533686 PMCID: PMC6749630 DOI: 10.1186/s12888-019-2274-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 09/05/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of premature death among people with serious mental illness (SMI). Sedentary behaviour (SB) is an independent risk factor for CVD and mortality and people with SMI are highly sedentary. We developed a health coaching intervention called 'Walk this Way' to reduce SB and increase physical activity (PA) in people with SMI and conducted a pilot randomised controlled trial (RCT) to test its feasibility and acceptability. METHODS We randomised people with SMI from three community mental health teams into either the WTW intervention or treatment as usual. The WTW intervention lasted 17 weeks and included an initial education session, fortnightly coaching, provision of pedometers and access to a weekly walking group. Objective SB and PA were measured with accelerometers. Cardiometabolic risk factors and wellbeing measures were collected. RESULTS We recruited 40 people of whom 33 (82.5%) were followed up. 13/20 (65%) of participants allocated to the coaching intervention completed it. In the intervention group SB decreased by 56 min and total PA increased by 32 min per day on average which was sustained 6 months later. There was no change in PA or SB in the control group. When interviewed, participants in the intervention found the intervention helpful and acceptable. No adverse events were reported from the intervention. CONCLUSIONS The intervention was feasible and acceptable to participants. Preliminary results were encouraging with improvement seen in both SB and PA. A larger study is needed to assess the effectiveness of the intervention and address any implementation challenges. TRIAL REGISTRATION ISRCTN Registry identifier: ISRCTN37724980 , retrospectively registered 25 September 2015.
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Affiliation(s)
- Julie Williams
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Brendon Stubbs
- 0000 0001 2322 6764grid.13097.3cHealth Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,0000 0000 9439 0839grid.37640.36Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK ,0000 0001 2322 6764grid.13097.3cPsychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sol Richardson
- 0000 0001 2322 6764grid.13097.3cAddiction Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,grid.501140.1UK Centre for Tobacco and Alcohol Studies, Nottingham, UK
| | - Cathy Flower
- 0000 0000 9439 0839grid.37640.36Psychosis Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
| | - Lucy Barr-Hamilton
- 0000 0000 9439 0839grid.37640.36Psychosis Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
| | - Barbara Grey
- 0000 0000 9439 0839grid.37640.36Psychosis Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
| | - Kathryn Hubbard
- 0000 0001 2322 6764grid.13097.3cHealth Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Gilda Spaducci
- 0000 0001 2322 6764grid.13097.3cHealth Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Fiona Gaughran
- 0000 0001 2322 6764grid.13097.3cHealth Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,0000 0001 2322 6764grid.13097.3cPsychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,0000 0000 9439 0839grid.37640.36National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Tom Craig
- 0000 0001 2322 6764grid.13097.3cHealth Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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125
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Abstract
PURPOSE OF REVIEW The prevalence of diabetes is 2-3-fold higher in people with severe mental illness than the general population. There are concerns that antipsychotics increase the risk of diabetes. This review will examine the latest epidemiological studies linking antipsychotics and diabetes, as well as the mechanisms underlying the association and the clinical implications to minimise the impact of antipsychotics on metabolic health. RECENT FINDINGS Although there is an increased risk of diabetes in people with first-episode psychosis, the prevalence increases rapidly after antipsychotics are started. Antipsychotics likely increase the risk of diabetes through weight gain and directly by adversely affecting insulin sensitivity and secretion. It is important to implement measures to prevent diabetes, to screen for diabetes to ensure prompt diagnosis and to provide effective diabetes care. Further research is needed to understand how antipsychotics cause diabetes and to improve the clinical management of diabetes in people with severe mental illness.
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Affiliation(s)
- Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
- University Hospital Southampton NHS Trust, The IDS Building (MP887), Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
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126
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Mucheru D, Hanlon MC, McEvoy M, Thakkinstian A, MacDonald-Wicks L. Comparative efficacy of lifestyle intervention strategies targeting weight outcomes in people with psychosis. ACTA ACUST UNITED AC 2019; 17:1770-1825. [DOI: 10.11124/jbisrir-2017-003943] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Ning Y, Jia H, Chen P, Zhu H, Yin D. Efficacy and safety of electroacupuncture on metabolic syndrome due to olanzapine and risperidone: Study protocol for a randomized controlled pilot trial. Medicine (Baltimore) 2019; 98:e17237. [PMID: 31567988 PMCID: PMC6756590 DOI: 10.1097/md.0000000000017237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION With the second-generation antipsychotics (SGAs) widely applied to treat patients with schizophrenia, adverse effects, especially the metabolic syndrome (MetS), were paid more attention following by the efficacy of SGAs. Several studies have suggested that acupuncture could be an effective and safe intervention for MetS. Here, we present a study protocol to investigate the effect of electroacupuncture on MetS due to olanzapine and risperidone. METHODS This study is a prospective, randomized, single-centered, patient-assessor-blinded, parallel-controlled clinical pilot trial. In all, 36 patients will be randomized to an experimental group or control group by a 1:1 ratio. All patients will receive lifestyle interventions. The experimental group will receive electroacupuncture treatment. The control group will receive sham electroacupuncture treatment. The primary outcomes are body mass index (BMI) and waist circumference (WC). The secondary outcome measures include blood pressure (BP), fasting blood glucose (FBG), triglycerides (TG), total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), leptin, and adiponectin. We will assess at baseline, 8 weeks after intervention and at the end of 3 months' follow-up. DISCUSSION The results of this trial are expected to provide data on the efficacy and safety of electroacupuncture on MetS due to olanzapine and risperidone, and potential biochemical mechanism.
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Affiliation(s)
- Yanzhe Ning
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital
- Advanced Innovation Center for Human Brain Protection, Capital Medical University
| | - Hongxiao Jia
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital
- Advanced Innovation Center for Human Brain Protection, Capital Medical University
- Beijing University of Chinese Medicine, Beijing, China
| | - Pei Chen
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital
- Advanced Innovation Center for Human Brain Protection, Capital Medical University
| | - Hong Zhu
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital
- Advanced Innovation Center for Human Brain Protection, Capital Medical University
| | - Dongqing Yin
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital
- Advanced Innovation Center for Human Brain Protection, Capital Medical University
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128
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Olmos-Ochoa TT, Niv N, Hellemann G, Cohen AN, Oberman R, Goldberg R, Young AS. Barriers to participation in web-based and in-person weight management interventions for serious mental illness. Psychiatr Rehabil J 2019; 42:220-228. [PMID: 31081651 PMCID: PMC6715516 DOI: 10.1037/prj0000363] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study examines barriers to participation and retention in 2 modalities (web-based and in-person) of a weight-management intervention tailored for individuals with serious mental illness (SMI). METHOD Using a mixed-methods approach, we explored the barriers veterans with SMI face when participating in a web-based (WebMOVE) or in-person (MOVE-SMI) version of the same SMI-adapted MOVE weight-management program. Participants in the randomized controlled trial (n = 277) were recruited from specialty mental health clinics at a Veterans Affairs medical center. Barriers were analyzed across treatment condition and program attendance (engagement) at baseline and follow-up using a generalized lineal model. Post hoc analyses assessed whether changes in the trajectory of barriers over time were associated with engagement. A subsample of participants (n = 48) from the WebMOVE and MOVE-SMI treatment conditions completed a qualitative interview, and 2 coders used open coding to analyze the data. RESULTS Although barriers specific to treatment modality existed, most barriers cut across intervention modality, including financial hardship, lack of reliable housing and transportation, comorbid physical and mental health issues, and competing demands on personal time. Results of post hoc analyses found the association between engagement and emotional and motivational factors to be statistically significant. CONCLUSIONS This study is the 1st to identify barriers in a web-based intervention for SMI. Similar barriers persisted across treatment modalities. Known barriers, particularly socioeconomic barriers, should be addressed to improve engagement and retention of individuals in weight-management interventions adapted for SMI, irrespective of modality. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Tanya T Olmos-Ochoa
- Veterans Affairs Desert Pacific Mental Illness Research, Education, and Clinical Center
| | - Noosha Niv
- Veterans Affairs Desert Pacific Mental Illness Research, Education, and Clinical Center, and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Gerhard Hellemann
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Amy N Cohen
- Veterans Affairs Desert Pacific Mental Illness Research, Education, and Clinical Center, and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Rebecca Oberman
- VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Richard Goldberg
- VA Capitol Healthcare Network Mental Illness, Research, Education, and Clinical Center
| | - Alexander S Young
- VA Greater Los Angeles Healthcare System, and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
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Singh N, Stewart RAH, Benatar JR. Intensity and duration of lifestyle interventions for long-term weight loss and association with mortality: a meta-analysis of randomised trials. BMJ Open 2019; 9:e029966. [PMID: 31427335 PMCID: PMC6701694 DOI: 10.1136/bmjopen-2019-029966] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To evaluate the importance of the frequency and duration of lifestyle interventions for achieving weight loss over ≥1 year and associations with all-cause mortality. DESIGN Meta-analysis of randomised trials using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and RevMan software version 5·2 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen). DATA SOURCES MEDLINE, CENTRAL, Google and Science Direct databases alongside reference lists of appropriate articles and meta-analyses. ELIGIBILITY CRITERIA Randomised studies published in English-language journals from 1980 to June 2018 that assessed lifestyle compared with control interventions on weight loss and that included ≥100 subjects and reported weight change and mortality for ≥1 year. DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed risk of bias. Data were pooled using the generic inverse-variance method and expressed as mean differences (MDs) with 95% CI and OR with 95% CI as appropriate. Heterogeneity was assessed (Cochran Q statistic) and quantified (I2 statistic). The Grading of Recommendations Assessment, Development, and Evaluation score was used to assess the certainty of the evidence. RESULTS 31 randomised trials with a total of 20 816 overweight or obese participants were included. 70% of participants had cardiometabolic risk factors. Body weight was lower for lifestyle intervention compared with the control at 1 year (3.63 kg, 95% CI 2.58 to 4.67) and at 3 years (2.45 kg, 95% CI 1.17 to 3.73). Weight loss at 1 year was greater in studies with >28 compared with ≤28 interventions per year (4.50 kg, 95% CI 3.03, 5.97 vs 2.38, 95% CI 0.78 to 3.98 kg, p=0.001). In all studies, there were 593 deaths (~0.3%/year). The ORs for mortality for weight loss interventions compared with the controls was 0.86 (95% CI 0.73 to 1.02), p=0.09. CONCLUSION In predominantly healthy populations with risk factors, there is a dose response with number of lifestyle interventions and weight loss. Frequent and sustained interventions are needed to achieve a clinically significant 5% weight loss. There was insufficient evidence to reliably evaluate the benefits in persons with known cardiovascular disease or cancer. TRIAL REGISTRATION NUMBER CRD42018095067.
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Affiliation(s)
- Navneet Singh
- School of Medicine, The University of Auckland, Auckland, New Zealand
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Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C, Allan S, Caneo C, Carney R, Carvalho AF, Chatterton ML, Correll CU, Curtis J, Gaughran F, Heald A, Hoare E, Jackson SE, Kisely S, Lovell K, Maj M, McGorry PD, Mihalopoulos C, Myles H, O'Donoghue B, Pillinger T, Sarris J, Schuch FB, Shiers D, Smith L, Solmi M, Suetani S, Taylor J, Teasdale SB, Thornicroft G, Torous J, Usherwood T, Vancampfort D, Veronese N, Ward PB, Yung AR, Killackey E, Stubbs B. The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry 2019; 6:675-712. [PMID: 31324560 DOI: 10.1016/s2215-0366(19)30132-4] [Citation(s) in RCA: 708] [Impact Index Per Article: 141.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Joseph Firth
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Najma Siddiqi
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK; Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain; Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Simon Rosenbaum
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Cherrie Galletly
- Ramsay Health Care Mental Health, Adelaide, SA, Australia; Northern Adelaide Local Health Network, Adelaide, SA, Australia; Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Constanza Caneo
- Departamento de Psiquiatría, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rebekah Carney
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Andre F Carvalho
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Mary Lou Chatterton
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Christoph U Correll
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Jackie Curtis
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Fiona Gaughran
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adrian Heald
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
| | - Erin Hoare
- Food and Mood Centre, Deakin University, Melbourne, VIC, Australia
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Steve Kisely
- School of Medicine, University of Queensland, Brisbane, QLD, Australia; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Patrick D McGorry
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Hannah Myles
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Brian O'Donoghue
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Toby Pillinger
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Medical Research Council London Institute of Medical Sciences, London, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia; The Melbourne Clinic, Melbourne, VIC, Australia
| | - Felipe B Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - David Shiers
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Marco Solmi
- Neurosciences Department and Padua Neuroscience Centre, University of Padua, Padua, Italy
| | - Shuichi Suetani
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Johanna Taylor
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK
| | - Scott B Teasdale
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of General Practice, Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium; University Psychiatric Centre, Katholieke Universiteit Leuven, Kortenberg, Belgium
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Philip B Ward
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Alison R Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Nicol GE, Kolko R, Lenze EJ, Yingling MD, Miller JP, Ricchio AR, Schweiger JA, Findling RL, Wilfley D, Newcomer JW. Adiposity, Hepatic Triglyceride, and Carotid Intima Media Thickness During Behavioral Weight Loss Treatment in Antipsychotic-Treated Youth: A Randomized Pilot Study. J Child Adolesc Psychopharmacol 2019; 29:439-447. [PMID: 30994376 PMCID: PMC6661918 DOI: 10.1089/cap.2018.0120] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objectives: The purpose of this pilot study was to evaluate changes in adiposity, carotid intima media thickness (CIMT), and hepatic fat content measured via magnetic resonance imaging-estimated hepatic proton density fat fraction (PDFF) in antipsychotic (AP)-treated youth versus nonpsychiatric (NP) participants during participation in a 16-week behavioral weight loss (BWL) intervention. Subjects/Methods: Overweight/obese AP-treated youth (n = 26) were randomized 2:1 to weekly treatment versus recommended care (RC) over 16 weeks. NP controls (n = 21) were assigned to weekly treatment. Dual-energy X-ray absorptiometry (DEXA)-measured adiposity, CIMT, and PDFF were measured at baseline and 16 weeks. Analyses assessed group differences in the effect of BWL on adiposity, CIMT, and PDFF. Results: BWL was well tolerated in both AP-treated and NP groups. DEXA-measured fat decreased significantly in the NP group (F[1,16] = 11.81, p = 0.003), with modest improvements in adiposity and hepatic fat in the AP-treated group, while an increase in adiposity was observed in the RC group. Significant differences in endpoint DEXA total fat (F[2,34] = 4.81, p = 0.01) and PDFF (F[2,30] = 3.60, p = 0.04) occurred across treatment groups, explained by larger improvements in NP versus RC youth in DEXA total fat (p = 0.03) and PDFF (p = 0.04). Conclusions: Intensive, family-based BWL treatment can improve whole-body adiposity and liver fat in obese youth, with decreases or attenuation of additional fat gain observed in AP-treated youth.
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Affiliation(s)
- Ginger E. Nicol
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Rachel Kolko
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, Pennsylvania
| | - Eric J. Lenze
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Michael D. Yingling
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - J. Philip Miller
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
| | - Amanda R. Ricchio
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Julia A. Schweiger
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Robert L. Findling
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Denise Wilfley
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - John W. Newcomer
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
- Thriving Mind South Florida Behavioral Health Network, Miami, Florida
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Foresman J, Mitchell A, Ren D, Lee H. Implementing a brief healthy-lifestyle group program on a psychiatric inpatient unit. Perspect Psychiatr Care 2019; 55:424-429. [PMID: 30430594 DOI: 10.1111/ppc.12328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 08/29/2018] [Accepted: 09/07/2018] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This paper describes a project to assess the feasibility of a brief healthy lifestyle health education group (HE) program and its effects on patient outcomes. DESIGN AND METHODS Forty adult inpatients were enrolled in the HE program, which featured a one-group, pretest or posttest design deployed in an adult psychiatric unit. Outcomes comprised (1) feasibility and acceptability of the program and (2) changes in patient knowledge and weight. FINDINGS The HE program demonstrates not only feasibility, but also improvement in patient outcomes related to maintaining a healthy lifestyle. PRACTICE IMPLICATIONS Requisite changes in practice are necessary for the success of the HE program deployed in a typical, inpatient psychiatric unit.
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Affiliation(s)
- Jennifer Foresman
- Cedar Hills Hospital and Western Psychological and Counseling Services, Portland, Oregon
| | - Ann Mitchell
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dianxu Ren
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Heeyoung Lee
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
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Pratt SI, Brunette MF, Wolfe R, Scherer EA, Xie H, Bartels S, Ferron JC, Capuchino K. Incentivizing healthy lifestyle behaviors to reduce cardiovascular risk in people with serious mental illness: An equipoise randomized controlled trial of the wellness incentives program. Contemp Clin Trials 2019; 81:1-10. [PMID: 30991110 DOI: 10.1016/j.cct.2019.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 03/01/2019] [Accepted: 04/11/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Medicaid recipients with serious mental illness die 25-30 years earlier than people in the general population due to health conditions that are modifiable through lifestyle changes. Cardiovascular diseases from excess weight, smoking, and sedentary lifestyle contribute substantially to this life expectancy disparity. The current study evaluated the impact of incentives on participation in weight management programming (for overweight and obese adults) and smoking cessation treatment (for regular smokers). METHODS Participants were Medicaid recipients with disabling mental illness receiving services at any one of 10 community mental health centers across New Hampshire. Using an equipoise stratified randomized design, n = 1348 were enrolled and assigned to one of four weight management programs (Healthy Choices Healthy Changes: HCHC) and n = 661 were enrolled and assigned to one of three smoking cessation interventions (Breathe Well Live Well: BWLW). Following assignment to an intervention, participants were randomized to receive financial incentives (to attend weight management programs, or to achieve abstinence from smoking) or not. Data were collected at baseline and every 3 months for 12 months. DISCUSSION New Hampshire's HCHC and BWLW programs were designed to address serious and preventable health disparities by providing incentivized health promotion programs to overweight/obese and/or tobacco-smoking Medicaid beneficiaries with mental illness. This study was an unprecedented opportunity to evaluate an innovative statewide implementation of incentivized health promotion targeting the most at-risk and costly beneficiaries. If proven effective, this program has the potential to serve as a national model for widespread implementation.
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Affiliation(s)
- Sarah I Pratt
- Department of Psychiatry, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America.
| | - Mary F Brunette
- Department of Psychiatry, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Rosemarie Wolfe
- Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Emily A Scherer
- Department of Biomedical Data Sciences, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Haiyi Xie
- Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America; Department of Biomedical Data Sciences, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Stephen Bartels
- Department of Psychiatry, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America; Department of Community and Family Medicine, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Joelle C Ferron
- Department of Psychiatry, The Geisel School of Medicine at Dartmouth, Hanover, NH, United States of America
| | - Kelley Capuchino
- Division of Behavioral Health, New Hampshire Department of Health and Human Services, Concord, NH, United States of America
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Walburg FS, van Meijel B, van Tulder MW, Adriaanse MC. Cost-effectiveness of a lifestyle intervention for people with a serious mental illness (SMILE): design of a pragmatic cluster-randomised controlled trial. BMC Psychiatry 2019; 19:151. [PMID: 31096941 PMCID: PMC6524284 DOI: 10.1186/s12888-019-2132-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiovascular disease is the leading cause of the estimated 11-25 years reduced life expectancy for persons with serious mental illness (SMI). This excess cardiovascular mortality is primarily attributable to obesity, diabetes, hypertension, and dyslipidaemia. Obesity is associated with a sedentary lifestyle, limited physical activity and an unhealthy diet. Lifestyle interventions for persons with SMI seem promising in reducing weight and cardiovascular risk. The aim of this study is to evaluate the effectiveness and cost-effectiveness of a lifestyle intervention among persons with SMI in an outpatient treatment setting. METHODS The Serious Mental Illness Lifestyle Evaluation (SMILE) study is a cluster-randomized controlled trial including an economic evaluation in approximately 18 Flexible Assertive Community Treatment (FACT) teams in the Netherlands. The intervention aims at a healthy diet and increased physical activity. Randomisation takes place at the level of participating FACT-teams. We aim to include 260 outpatients with SMI and a body mass index of 27 or higher who will either receive the lifestyle intervention or usual care. The intervention will last 12 months and consists of weekly 2-h group meetings delivered over the first 6 months. The next 6 months will include monthly group meetings, supplemented with regular individual contacts. Primary outcome is weight loss. Secondary outcomes are metabolic parameters (waist circumference, lipids, blood pressure, glucose), quality of life and health related self-efficacy. Costs will be measured from a societal perspective and include costs of the lifestyle program, health care utilization, medication and lost productivity. Measurements will be performed at baseline and 3, 6 and 12 months. DISCUSSION The SMILE intervention for persons with SMI will provide important information on the effectiveness, cost-effectiveness, feasibility and delivery of a group-based lifestyle intervention in a Dutch outpatient treatment setting. TRIAL REGISTRATION Dutch Trial Registration NL6660 , registration date: 16 November 2017.
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Affiliation(s)
- Florine S. Walburg
- Department of Health Sciences and Amsterdam Public Health Research Institute, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands
| | - Berno van Meijel
- Department of Psychiatry, UMC Amsterdam and Amsterdam Public Health research institute, Amsterdam, The Netherlands
- Department of Health, Sports & Welfare, Cluster Nursing, Inholland University of Applied Sciences, Amsterdam, The Netherlands
- Parnassia Psychiatric Institute, The Hague, The Netherlands
- GGZ-VS Academy for Masters in Advanced Nursing Practice, Utrecht, The Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, The Netherlands
| | - Maurits W. van Tulder
- Department of Health Sciences and Amsterdam Public Health Research Institute, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands
| | - Marcel C. Adriaanse
- Department of Health Sciences and Amsterdam Public Health Research Institute, Faculty of Science, Vrije Universiteit, Amsterdam, The Netherlands
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Xiang SY, Zhao J, Lu Y, Chen RM, Wang Y, Chen Y, Long B, Zhu LP, Yao PF, Xu YF, Chen JH. Network pharmacology-based identification for therapeutic mechanism of Ling-Gui-Zhu-Gan decoction in the metabolic syndrome induced by antipsychotic drugs. Comput Biol Med 2019; 110:1-7. [PMID: 31085379 DOI: 10.1016/j.compbiomed.2019.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 04/29/2019] [Accepted: 05/06/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND The metabolic syndrome (MetS) is a common side effect of second-generation antipsychotic drugs (SGAs), leading to poor prognosis in patients with mental illness. The traditional Chinese herbal formula Ling-Gui-Zhu-Gan decoction (LGZGD) is a clinically validated remedy for SGAs-induced MetS, but its underlying mechanism remains unclear. METHODS A network pharmacology-based analysis was performed to explore predicted plasma-absorbed components, putative therapeutic targets, and main pathways involved in LGZGD bioactivity. We constructed a target interaction network between the predicted targets of LGZGD and the known targets of MetS, after which we extracted major hubs using topological analysis. Thereafter, the maximum value of "edge betweenness" of all interactions was defined as a bottleneck, which suggested its importance in connecting all targets in the network. Finally, a pathway enrichment analysis of major hubs was used to reveal the biological functions of LGZGD. RESULTS This approach identified 120 compounds and 361 candidate targets of LGZGD. According to the data generated in this study, the interaction between JUN and APOA1 plays a vital role in the treatment of SGAs-induced MetS using LGZGD. Interestingly, JUN was a putative target of LGZGD and APOA1 is one of the known targets of both MetS and SGAs (olanzapine and clozapine). LGZGD was significantly associated with several pathways including PI3K-Akt signaling, insulin resistance, and MAPK signaling pathway. CONCLUSIONS LGZGD might inhibit JUN and thereby increases the expression of APOA1 to maintain metabolic homeostasis via some vital pathways.
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Affiliation(s)
- Si-Ying Xiang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - Jing Zhao
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - Ying Lu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - Ru-Meng Chen
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - Yan Wang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - Yi Chen
- Department of Nephrology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, PR China
| | - Bin Long
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - Li-Ping Zhu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - Pei-Fen Yao
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China
| | - Yi-Feng Xu
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China.
| | - Jian-Hua Chen
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, PR China.
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Holt RI, Hind D, Gossage-Worrall R, Bradburn MJ, Saxon D, McCrone P, Morris TA, Etherington A, Shiers D, Barnard K, Swaby L, Edwardson C, Carey ME, Davies MJ, Dickens CM, Doherty Y, French P, Greenwood KE, Kalidindi S, Khunti K, Laugharne R, Pendlebury J, Rathod S, Siddiqi N, Wright S, Waller G, Gaughran F, Barnett J, Northern A. Structured lifestyle education to support weight loss for people with schizophrenia, schizoaffective disorder and first episode psychosis: the STEPWISE RCT. Health Technol Assess 2019; 22:1-160. [PMID: 30499443 DOI: 10.3310/hta22650] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Obesity is twice as common in people with schizophrenia as in the general population. The National Institute for Health and Care Excellence guidance recommends that people with psychosis or schizophrenia, especially those taking antipsychotics, be offered a healthy eating and physical activity programme by their mental health care provider. There is insufficient evidence to inform how these lifestyle services should be commissioned. OBJECTIVES To develop a lifestyle intervention for people with first episode psychosis or schizophrenia and to evaluate its clinical effectiveness, cost-effectiveness, delivery and acceptability. DESIGN A two-arm, analyst-blind, parallel-group, randomised controlled trial, with a 1 : 1 allocation ratio, using web-based randomisation; a mixed-methods process evaluation, including qualitative case study methods and logic modelling; and a cost-utility analysis. SETTING Ten community mental health trusts in England. PARTICIPANTS People with first episode psychosis, schizophrenia or schizoaffective disorder. INTERVENTIONS Intervention group: (1) four 2.5-hour group-based structured lifestyle self-management education sessions, 1 week apart; (2) multimodal fortnightly support contacts; (3) three 2.5-hour group booster sessions at 3-monthly intervals, post core sessions. Control group: usual care assessed through a longitudinal survey. All participants received standard written lifestyle information. MAIN OUTCOME MEASURES The primary outcome was change in weight (kg) at 12 months post randomisation. The key secondary outcomes measured at 3 and 12 months included self-reported nutrition (measured with the Dietary Instrument for Nutrition Education questionnaire), objectively measured physical activity measured by accelerometry [GENEActiv (Activinsights, Kimbolton, UK)], biomedical measures, adverse events, patient-reported outcome measures and a health economic assessment. RESULTS The trial recruited 414 participants (intervention arm: 208 participants; usual care: 206 participants) between 10 March 2015 and 31 March 2016. A total of 341 participants (81.6%) completed the trial. A total of 412 participants were analysed. After 12 months, weight change did not differ between the groups (mean difference 0.0 kg, 95% confidence interval -1.59 to 1.67 kg; p = 0.964); physical activity, dietary intake and biochemical measures were unchanged. Glycated haemoglobin, fasting glucose and lipid profile were unchanged by the intervention. Quality of life, psychiatric symptoms and illness perception did not change during the trial. There were three deaths, but none was related to the intervention. Most adverse events were expected and related to the psychiatric illness. The process evaluation showed that the intervention was acceptable, with participants valuing the opportunity to interact with others facing similar challenges. Session feedback indicated that 87.2% of participants agreed that the sessions had met their needs. Some indicated the desire for more ongoing support. Professionals felt that the intervention was under-resourced and questioned the long-term sustainability within current NHS settings. Professionals would have preferred greater access to participants' behaviour data to tailor the intervention better. The incremental cost-effectiveness ratio from the health-care perspective is £246,921 per quality-adjusted life-year (QALY) gained and the incremental cost-effectiveness ratio from the societal perspective is £367,543 per QALY gained. CONCLUSIONS Despite the challenges of undertaking clinical research in this population, the trial successfully recruited and retained participants, indicating a high level of interest in weight management interventions; however, the STEPWISE intervention was neither clinically effective nor cost-effective. Further research will be required to define how overweight and obesity in people with schizophrenia should be managed. The trial results suggest that lifestyle programmes for people with schizophrenia may need greater resourcing than for other populations, and interventions that have been shown to be effective in other populations, such as people with diabetes mellitus, are not necessarily effective in people with schizophrenia. TRIAL REGISTRATION Current Controlled Trials ISRCTN19447796. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 65. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Richard Ig Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK.,University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Daniel Hind
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | | | | | - David Saxon
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Paul McCrone
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tiyi A Morris
- King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.,School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Katharine Barnard
- Faculty of Health & Social Sciences, Bournemouth University, Poole, UK
| | - Lizzie Swaby
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | | | - Marian E Carey
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | | | - Yvonne Doherty
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK.,Psychological Medicine, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Paul French
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kathryn E Greenwood
- Sussex Partnership NHS Foundation Trust, Worthing, UK.,School of Psychology, University of Sussex, Brighton, UK
| | - Sridevi Kalidindi
- Rehabilitation and Recovery, South London and Maudsley NHS Foundation Trust, London, UK
| | - Kamlesh Khunti
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Richard Laugharne
- Research and Innovation, Cornwall Partnership NHS Foundation Trust, Redruth, UK
| | | | - Shanaya Rathod
- Research and Development, Southern Health NHS Foundation Trust, Southampton, UK
| | - Najma Siddiqi
- Department of Health Sciences, Hull York Medical School, University of York, York, UK.,Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Stephen Wright
- Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Glenn Waller
- Sheffield Health & Social Care NHS Foundation Trust, Sheffield, UK.,Department of Psychology, University of Sheffield, Sheffield, UK
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,National Psychosis Unit and Research and Development Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - Janette Barnett
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
| | - Alison Northern
- Leicester Diabetes Centre, University Hospitals of Leicester, Leicester, UK
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Feasibility of a Bike-Share Program in Adults With Serious Mental Illness Enrolled in an Outpatient Psychiatric Rehabilitation Program. J Phys Act Health 2019; 16:380-383. [PMID: 30925847 DOI: 10.1123/jpah.2018-0233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Individuals with serious mental illness (SMI) die 10-25 years earlier than the general population, partially due to cardiovascular disease. Those with SMI have poor cardiovascular disease behavioral risk profiles, including low physical activity engagement. This study examined the feasibility of providing city bike-share access to individuals with SMI. Methods: Participants were outpatients with SMI in a psychiatric rehabilitation program and were provided with a complimentary bike-share program membership (Nice Ride). Demographic and clinical variables were extracted from medical records. Lab values, body mass index, 10-year cardiovascular disease risk score, and tobacco use were collected at intake. Nice Ride provided ride frequency and duration data. Results: Of 22 SMI patients enrolled, 72.7% completed ≥1 ride. Among users, median ride length was 9 minutes (interquartile range = 49.5) and 56.3% averaged ≥10 minutes of riding per week. Individuals living <0.5 miles from a station were more likely to be users. Riding ≥10 minutes per week was associated with lower body mass index and male gender. Conclusion: Further work is warranted to determine if bike-share programs offer a feasible, scalable, and cost-effective method for increasing physical activity in those with SMI. These findings are currently being used for program adaptation to increase uptake.
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138
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Losing to Gain: The Effects of a Healthy Lifestyle Intervention on the Physical and Psychosocial Well-being of Clients in a Community-based Mental Health Setting. Community Ment Health J 2019; 55:608-614. [PMID: 30701375 DOI: 10.1007/s10597-019-00371-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 01/23/2019] [Indexed: 10/27/2022]
Abstract
Individuals with severe and persistent mental illness (SPMI) encounter both poorer physical health and psychosocial well-being in comparison to the general population. Obesity, hypertension, heart disease, and diabetes can result from the symptoms of mental illness, the side effects from psychotropic medications, as well as disparities associated with being mentally ill. Mental health nurses are in a prime position to implement healthy lifestyle interventions (HLIs). This study tested a HLI (physical exercise and nutrition) and examined the effects on physical and psychosocial outcomes in clients obtaining mental health services at a community-based facility. Key findings included a decrease in anxiety and depressive symptoms at 3 months and consistent improvement in self-efficacy for exercise in the intervention group. Bridges and barriers to achieving optimal results in physical and psychosocial well-being were identified. Findings from this study offer insight into designing and executing more effective HLIs with individuals who have SPMI.
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139
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Lee EE, Martin AS, Kaufmann CN, Liu J, Kangas J, Daly RE, Tu XM, Depp CA, Jeste DV. Comparison of schizophrenia outpatients in residential care facilities with those living with someone: Study of mental and physical health, cognitive functioning, and biomarkers of aging. Psychiatry Res 2019; 275:162-168. [PMID: 30925304 PMCID: PMC6504557 DOI: 10.1016/j.psychres.2019.02.067] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 11/16/2022]
Abstract
This paper aims to compare mental and physical health, cognitive functioning, and selected biomarkers of aging reflecting metabolic pathology and inflammation, in outpatients with schizophrenia from two residential settings: residential care facilities (RCFs) and living with someone in a house/apartment. This cross-sectional study examined community-dwelling adults with schizophrenia either in RCFs (N = 100) or in a house/apartment with someone (N = 76), recruited for two NIH-funded studies in San Diego. Assessments included measures of mental/physical health, cognitive function, and metabolic (glycosylated hemoglobin, cholesterol) and inflammatory (C-Reactive Protein, Tumor Necrosis Factor-alpha, Interleukin-6) biomarkers of aging. General logistic models were used to analyze factors associated with residential status. RCF residents had several indicators of worse prognosis (never being married, higher daily antipsychotic dosages, increased comorbidities and higher Framingham risk for coronary heart disease) than individuals living with someone. However, RCF residents had better mental well-being and lower BMI, as well as comparable biomarkers of aging as those living with someone. While the cross-sectional nature of the study does not allow us to infer causality, it is possible that the supportive environment of RCFs may have a positive impact on mental and physical health of persons with schizophrenia. Longitudinal follow-up studies are needed to test this hypothesis.
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Affiliation(s)
- Ellen E Lee
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
| | - Averria Sirkin Martin
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
| | - Christopher N Kaufmann
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States; Division of Geriatrics and Gerontology, Department of Medicine, University of California San Diego, La Jolla, CA, United States
| | - Jinyuan Liu
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States; Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States
| | - Julie Kangas
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Rebecca E Daly
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
| | - Xin M Tu
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States; Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, United States
| | - Colin A Depp
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States
| | - Dilip V Jeste
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States; Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, United States; Department of Neurosciences, University of California San Diego, United States.
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140
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Tseng E, Dalcin AT, Jerome GJ, Gennusa JV, Goldsholl S, Cook C, Appel LJ, Maruthur NM, Daumit GL, Wang NY. Effect of a Behavioral Weight Loss Intervention in People With Serious Mental Illness and Diabetes. Diabetes Care 2019; 42:804-809. [PMID: 30765433 PMCID: PMC6489111 DOI: 10.2337/dc18-2201] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/21/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Given the high prevalence of obesity and diabetes in patients with serious mental illness (SMI) and the lack of evidence on the effects of weight loss programs in SMI patients with diabetes, we evaluated the effectiveness of a behavioral weight loss intervention among SMI participants with and without diabetes. RESEARCH DESIGN AND METHODS Using data from ACHIEVE, a randomized controlled trial to evaluate the effects of a behavioral weight loss intervention among overweight/obese people with SMI, we assessed and compared weight change from baseline to 18 months in participants with and without diabetes using a longitudinal mixed-effects model. RESULTS Of the 291 trial participants, 82 (28.2%) participants had diabetes (34 and 48 in intervention and control groups, respectively) at baseline. Participants with diabetes were more likely to be taking antipsychotics (31.7% vs. 18.7%, P = 0.02). At 18 months, participants in the control group with diabetes lost 1.2 lb (0.6%) of body weight compared with 0.8 lb (0.7%) among those without diabetes. In the intervention group, participants with diabetes lost 13.7 lb (6.6%) of their initial body weight compared with 5.4 lb (2.9%) for those without diabetes. Corresponding net effects (intervention minus control) were 4.6 lb (2.2%) and 12.5 lb (6.0%) net weight reduction over 18 months in the no diabetes and the diabetes subgroups, respectively. However, the between-group difference in intervention effects was statistically nonsignificant (absolute weight change: P-interaction = 0.08; % weight change: P-interaction = 0.10). CONCLUSIONS A behavioral weight loss intervention is effective among overweight and obese individuals with SMI regardless of their diabetes status.
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Affiliation(s)
- Eva Tseng
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD .,Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD
| | - Arlene T Dalcin
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD
| | | | - Joseph V Gennusa
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stacy Goldsholl
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Courtney Cook
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Lawrence J Appel
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD.,Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Nisa M Maruthur
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD.,Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Gail L Daumit
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD.,Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD.,Department of Mental Health, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Nae-Yuh Wang
- Division of General Internal Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD.,Welch Center for Prevention, Epidemiology, and Clinical Research, The Johns Hopkins University, Baltimore, MD.,Department of Epidemiology, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.,Department of Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
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141
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Opinions of Primary Care Clinicians and Psychiatrists on Monitoring the Metabolic Effects of Antipsychotics. J Am Board Fam Med 2019; 32:418-423. [PMID: 31068407 PMCID: PMC7213492 DOI: 10.3122/jabfm.2019.03.180176] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 01/04/2019] [Accepted: 01/05/2019] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Although people with severe mental illness (SMI) have high rates of diabetes and other metabolic disorders, adherence to recommended screening guidelines is low. This study aimed to compare primary care clinicians' and psychiatrists' attitudes toward metabolic monitoring and treatment of patients with SMI. METHODS Primary care clinicians and psychiatrists within 1 large urban integrated public health system were recruited to participate in this online survey study. Multivariate logistic regression analyses were used to examine if clinician characteristics were associated with attitudes or perceived barriers toward metabolic monitoring and treatment. RESULTS Response rates were 77% (164/214) of primary care providers and 69% (56/81) of psychiatrists completing the survey. There were no significant differences in age or race/ethnicity between provider groups, although primary care clinicians were more likely to be women when compared with the psychiatrists (69% vs 39%, P < .001). Psychiatrists were more likely than primary care clinicians to believe that psychiatrists should conduct metabolic monitoring even if patients had a primary care provider (80% vs 60%, P = .011) However, fewer psychiatrists than primary care clinicians believed that psychiatrists should treat identified cardiometabolic abnormalities (15% vs 42%, P < .001). CONCLUSION Systemic problems with care coordination and these varying expectations likely contribute to poor cardiometabolic outcomes in this vulnerable population.
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142
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Cabassa LJ, Stefancic A. Context before implementation: a qualitative study of decision makers' views of a peer-led healthy lifestyle intervention for people with serious mental illness in supportive housing. Transl Behav Med 2019; 9:217-226. [PMID: 29660091 DOI: 10.1093/tbm/iby034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
People with serious mental illness die at an earlier age than people in the general population largely due to cardiovascular disease. Healthy lifestyle interventions can help reduce this health inequity. In this qualitative study, we examined the perceptions that decision makers in supportive housing agencies had toward a peer-led healthy lifestyle intervention and their views of contextual factors that could shape implementation at these agencies. A purposive sample of 12 decision makers from three supportive housing agencies was recruited. We presented participants a vignette describing our peer-led intervention and used semistructured qualitative interviews to examine their views. Interviews were recorded, professionally transcribed, and analyzed using directed content analysis. Participants reported positive views toward the intervention with the most valued intervention attributes being relative advantage over existing services, compatibility to clients' needs, ability to pilot the intervention, and cost. A model emerged from our data depicting multilevel contextual factors believed to shape the implementation of our intervention at these agencies, including system- (funding, marketability, and external regulations), organization- (leadership support, fit with organization, staff buy-in and burden), and client-level (adaptability to clients' needs, and clients' buy-in) factors. Study findings illustrate the importance of understanding the context of practice before implementation. This examination can help identify critical views from decision makers that could undermine or advance the integration of peer-led interventions in supportive housing agencies and help identify structures, policies, and organizational practices that can inform the implementation process.
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Affiliation(s)
- Leopoldo J Cabassa
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO, USA
| | - Ana Stefancic
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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143
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Osborn D, Burton A, Walters K, Atkins L, Barnes T, Blackburn R, Craig T, Gilbert H, Gray B, Hardoon S, Heinkel S, Holt R, Hunter R, Johnston C, King M, Leibowitz J, Marston L, Michie S, Morris R, Morris S, Nazareth I, Omar R, Petersen I, Peveler R, Pinfold V, Stevenson F, Zomer E. Primary care management of cardiovascular risk for people with severe mental illnesses: the Primrose research programme including cluster RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2019. [DOI: 10.3310/pgfar07020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Effective interventions are needed to prevent cardiovascular disease (CVD) in people with severe mental illnesses (SMI) because their risk of CVD is higher than that of the general population.
Objectives
(1) Develop and validate risk models for predicting CVD events in people with SMI and evaluate their cost-effectiveness, (2) develop an intervention to reduce levels of cholesterol and CVD risk in SMI and (3) test the clinical effectiveness and cost-effectiveness of this new intervention in primary care.
Design
Mixed methods with patient and public involvement throughout. The mixed methods were (1) a prospective cohort and risk score validation study and cost-effectiveness modelling, (2) development work (focus groups, updated systematic review of interventions, primary care database studies investigating statin prescribing and effectiveness) and (3) cluster randomised controlled trial (RCT) assessing the clinical effectiveness and cost-effectiveness of a new practitioner-led intervention, and fidelity assessment of audio-recorded appointments.
Setting
General practices across England.
Participants
All studies included adults with SMI (schizophrenia, bipolar disorder or other non-organic psychosis). The RCT included adults with SMI and two or more CVD risk factors.
Interventions
The intervention consisted of 8–12 appointments with a practice nurse/health-care assistant over 6 months, involving collaborative behavioural approaches to CVD risk factors. The intervention was compared with routine practice with a general practitioner (GP).
Main outcome measures
The primary outcome for the risk score work was CVD events, in the cost-effectiveness modelling it was quality-adjusted life-years (QALYs) and in the RCT it was level of total cholesterol.
Data sources
Databases studies used The Health Improvement Network (THIN). Intervention development work included focus groups and systematic reviews. The RCT collected patient self-reported and routine NHS GP data. Intervention appointments were audio-recorded.
Results
Two CVD risk score models were developed and validated in 38,824 people with SMI in THIN: the Primrose lipid model requiring cholesterol levels, and the Primrose body mass index (BMI) model with no blood test. These models performed better than published Cox Framingham models. In health economic modelling, the Primrose BMI model was most cost-effective when used as an algorithm to drive statin prescriptions. Focus groups identified barriers to, and facilitators of, reducing CVD risk in SMI including patient engagement and motivation, staff confidence, involving supportive others, goal-setting and continuity of care. Findings were synthesised with evidence from updated systematic reviews to create the Primrose intervention and training programme. THIN cohort studies in 16,854 people with SMI demonstrated that statins effectively reduced levels of cholesterol, with similar effect sizes to those in general population studies over 12–24 months (mean decrease 1.2 mmol/l). Cluster RCT: 76 GP practices were randomised to the Primrose intervention (n = 38) or treatment as usual (TAU) (n = 38). The primary outcome (level of cholesterol) was analysed for 137 out of 155 participants in Primrose and 152 out of 172 in TAU. There was no difference in levels of cholesterol at 12 months [5.4 mmol/l Primrose vs. 5.5 mmol/l TAU; coefficient 0.03; 95% confidence interval (CI) –0.22 to 0.29], nor in secondary outcomes related to cardiometabolic parameters, well-being or medication adherence. Mean cholesterol levels decreased over 12 months in both arms (–0.22 mmol/l Primrose vs. –0.39 mmol/l TAU). There was a significant reduction in the cost of inpatient mental health attendances (–£799, 95% CI –£1480 to –£117) and total health-care costs (–£895, 95% CI –£1631 to –£160; p = 0.012) in the intervention group, but no significant difference in QALYs (–0.011, 95% CI –0.034 to 0.011). A total of 69% of patients attended two or more Primrose appointments. Audiotapes revealed moderate fidelity to intervention delivery (67.7%). Statin prescribing and adherence was rarely addressed.
Limitations
RCT participants and practices may not represent all UK practices. CVD care in the TAU arm may have been enhanced by trial procedures involving CVD risk screening and feedback.
Conclusions
SMI-specific CVD risk scores better predict new CVD if used to guide statin prescribing in SMI. Statins are effective in reducing levels of cholesterol in people with SMI in UK clinical practice. This primary care RCT evaluated an evidence-based practitioner-led intervention that was well attended by patients and intervention components were delivered. No superiority was shown for the new intervention over TAU for level of cholesterol, but cholesterol levels decreased over 12 months in both arms and the intervention showed fewer inpatient admissions. There was no difference in cholesterol levels between the intervention and TAU arms, which might reflect better than standard general practice care in TAU, heterogeneity in intervention delivery or suboptimal emphasis on statins.
Future work
The new risk score should be updated, deployed and tested in different settings and compared with the latest versions of CVD risk scores in different countries. Future research on CVD risk interventions should emphasise statin prescriptions more. The mechanism behind lower costs with the Primrose intervention needs exploring, including SMI-related training and offering frequent support to people with SMI in primary care.
Trial registration
Current Controlled Trials ISRCTN13762819.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 7, No. 2. See the NIHR Journals Library website for further project information. Professor David Osborn is supported by the University College London Hospital NIHR Biomedical Research Centre and he was also in part supported by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Barts Health NHS Trust.
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Affiliation(s)
- David Osborn
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Alexandra Burton
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Kate Walters
- Department of Primary Care and Population Health, University College London, London, UK
| | - Lou Atkins
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, UK
| | - Thomas Barnes
- Faculty of Medicine, Department of Medicine, Imperial College London, London, UK
| | - Ruth Blackburn
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Thomas Craig
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Hazel Gilbert
- Department of Primary Care and Population Health, University College London, London, UK
| | - Ben Gray
- The McPin Foundation, London, UK
| | - Sarah Hardoon
- Department of Primary Care and Population Health, University College London, London, UK
| | - Samira Heinkel
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
| | - Richard Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Rachael Hunter
- Department of Primary Care and Population Health, University College London, London, UK
| | - Claire Johnston
- School of Health and Education, Faculty of Professional and Social Sciences, Middlesex University, London, UK
| | - Michael King
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Judy Leibowitz
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
| | - Louise Marston
- Department of Primary Care and Population Health, University College London, London, UK
| | - Susan Michie
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, UK
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, UK
| | - Richard Morris
- Department of Primary Care and Population Health, University College London, London, UK
| | - Steve Morris
- Department of Allied Health Research, University College London, London, UK
| | - Irwin Nazareth
- Department of Primary Care and Population Health, University College London, London, UK
| | - Rumana Omar
- Department of Statistical Science, University College London, London, UK
| | - Irene Petersen
- Department of Primary Care and Population Health, University College London, London, UK
| | - Robert Peveler
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Fiona Stevenson
- Department of Primary Care and Population Health, University College London, London, UK
| | - Ella Zomer
- Department of Primary Care and Population Health, University College London, London, UK
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Chan SYY, Ho GWK, Bressington D. Experiences of self-stigmatization and parenting in Chinese mothers with severe mental illness. Int J Ment Health Nurs 2019; 28:527-537. [PMID: 30575250 DOI: 10.1111/inm.12558] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2018] [Indexed: 12/16/2022]
Abstract
Mental health stigma has serious ramifications on people with a severe mental illness (SMI). Stigma damages self-esteem, recovery outcomes, family relationships, socialization abilities, access to housing, and career prospects. The cultural tendencies of Chinese people have been shown to be associated with particularly high levels of stigmatization. These cultural tenets can result in high levels of self-stigma due to experiencing shame and a perceived need to keep mental illness a secret. Although there is a lack of existing evidence, it is possible that such experiences present unique challenges to Chinese mothers diagnosed with SMI when they parent their children. Therefore, this qualitative study explored the experiences of parenting and self-stigmatization of Chinese mothers with SMI. Individual semi-structured interviews were conducted with 15 mothers who were direct carers of their children aged under 18 and who were receiving community-based care in Hong Kong. Manual inductive thematic analysis was used to analyse the interview data. Three main themes related to self-stigmatization emerged from the interviews: (i) distancing and being distanced; (ii) doubting myself; and (iii) struggling for control. The experiences of self-stigmatization appeared to damage these mothers' self-efficacy, which may negatively affect their parenting self-esteem, tendency to seek professional help, and ability to manage their own mental health. Strategies to improve self-efficacy, including psychoeducation, and additional childcare support/resources are required for mothers with SMI so they can better manage and balance the demands of motherhood and their mental healthcare needs.
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Affiliation(s)
| | - Grace W K Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China SAR
| | - Daniel Bressington
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China SAR
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145
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Alexander E, McGinty EE, Wang NY, Dalcin A, Jerome GJ, Miller ER, Dickerson F, Charleston J, Young DR, Gennusa JV, Goldsholl S, Cook C, Appel LJ, Daumit GL. Effects of a behavioural weight loss intervention in people with serious mental illness: Subgroup analyses from the ACHIEVE trial. Obes Res Clin Pract 2019; 13:205-210. [PMID: 30852244 PMCID: PMC7255457 DOI: 10.1016/j.orcp.2019.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/01/2019] [Accepted: 02/08/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Persons with serious mental illnesses (SMI) such as schizophrenia and bipolar disorder have an increased risk of obesity and related chronic diseases and die 10-20years earlier than the overall population, primarily due to cardiovascular disease. In the ACHIEVE trial, a behavioural weight loss intervention led to clinically significant weight loss in persons with SMI. As the field turns its attention to intervention scale-up, it is important to understand whether the effectiveness of behavioural weight loss interventions for people with SMI, like ACHIEVE, differ for specific subgroups. METHODS This study examined whether the effectiveness of the ACHIEVE intervention differed by participant characteristics (e.g. age, sex, race, psychiatric diagnosis, body mass index) and/or their weight-related attitudes and behaviours (e.g. eating, food preparation, and shopping habits). We used likelihood-based mixed effects models to examine whether the baseline to 18 month effects of the ACHIEVE intervention differed across subgroups. RESULTS No statistically significant differences were found in the effectiveness of the ACHIEVE intervention across any of the subgroups examined. CONCLUSIONS These findings suggest that the ACHIEVE behavioural weight loss intervention is broadly applicable to the diverse population of individuals with SMI.
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Affiliation(s)
- Eleanore Alexander
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, United States.
| | - Emma E McGinty
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, United States
| | - Nae-Yuh Wang
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, United States; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
| | - Arlene Dalcin
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
| | - Gerald J Jerome
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Department of Kinesiology, Towson University, Baltimore, MD, 21252, United States
| | - Edgar R Miller
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
| | - Faith Dickerson
- Stanley Research Program, Sheppard Pratt Health System, Baltimore, MD 21204, United States
| | - Jeanne Charleston
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
| | - Deborah R Young
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91024, United States
| | - Joseph V Gennusa
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States
| | - Stacy Goldsholl
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States
| | - Courtney Cook
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, United States; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medicine, Baltimore, MD, 21205, United States
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146
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Lee DW, Lee SA, Choi DW, Jang SI, Park EC. Weight control success and depression by gender with respect to weight control behaviors. Obes Res Clin Pract 2019; 13:168-175. [DOI: 10.1016/j.orcp.2018.11.245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 11/09/2018] [Accepted: 11/27/2018] [Indexed: 12/13/2022]
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147
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Yarborough BJH, Stumbo SP, Cavese JA, Yarborough MT, Green CA. Patient perspectives on how living with a mental illness affects making and maintaining healthy lifestyle changes. PATIENT EDUCATION AND COUNSELING 2019; 102:346-351. [PMID: 30205919 PMCID: PMC6377329 DOI: 10.1016/j.pec.2018.08.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/27/2018] [Accepted: 08/31/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To understand the ways that mental health symptoms interfere with achieving health goals. METHODS Individuals with mental illness diagnoses and varying levels of preventive service use were recruited from federally qualified health centers and an integrated health care delivery system and interviewed. Thematic analysis was used to characterize descriptions of how mental illness experiences influenced lifestyle change efforts. RESULTS Three themes described patients' (n = 163) perspectives on barriers to making healthy lifestyle changes: 1) Thinking about making lifestyle changes is overwhelming for individuals already managing the burdens of mental illnesses; 2) Depression makes it difficult to care about a healthy future; and 3) When mental illness symptoms are not adequately treated unhealthy behaviors that provide relief are unlikely to be discontinued. Participants also made suggestions for improving health care delivery to facilitate positive behavior change. CONCLUSION Patients with mental illnesses need their clinicians to be empathic, help them envision a healthier future, address unmet mental health needs, and provide resources. PRACTICE IMPLICATIONS Primary care clinicians should encourage their patients with mental illnesses to make healthy lifestyle changes within the context of a supportive relationship. Lifestyle change can be overwhelming; clinicians should acknowledge progress and provide ongoing tangible support.
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Affiliation(s)
- Bobbi Jo H Yarborough
- Kaiser Permanente Northwest Center for Health Research, 3800 North Interstate Avenue, Portland, 97227, OR, USA.
| | - Scott P Stumbo
- Kaiser Permanente Northwest Center for Health Research, 3800 North Interstate Avenue, Portland, 97227, OR, USA
| | - Julie A Cavese
- Kaiser Permanente Northwest Center for Health Research, 3800 North Interstate Avenue, Portland, 97227, OR, USA
| | - Micah T Yarborough
- Kaiser Permanente Northwest Center for Health Research, 3800 North Interstate Avenue, Portland, 97227, OR, USA
| | - Carla A Green
- Kaiser Permanente Northwest Center for Health Research, 3800 North Interstate Avenue, Portland, 97227, OR, USA
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148
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Holt RIG, Gossage-Worrall R, Hind D, Bradburn MJ, McCrone P, Morris T, Edwardson C, Barnard K, Carey ME, Davies MJ, Dickens CM, Doherty Y, Etherington A, French P, Gaughran F, Greenwood KE, Kalidindi S, Khunti K, Laugharne R, Pendlebury J, Rathod S, Saxon D, Shiers D, Siddiqi N, Swaby EA, Waller G, Wright S. Structured lifestyle education for people with schizophrenia, schizoaffective disorder and first-episode psychosis (STEPWISE): randomised controlled trial. Br J Psychiatry 2019; 214:63-73. [PMID: 30251622 PMCID: PMC6330076 DOI: 10.1192/bjp.2018.167] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Obesity is a major challenge for people with schizophrenia.AimsWe assessed whether STEPWISE, a theory-based, group structured lifestyle education programme could support weight reduction in people with schizophrenia. METHOD In this randomised controlled trial (study registration: ISRCTN19447796), we recruited adults with schizophrenia, schizoaffective disorder or first-episode psychosis from ten mental health organisations in England. Participants were randomly allocated to the STEPWISE intervention or treatment as usual. The 12-month intervention comprised four 2.5 h weekly group sessions, followed by 2-weekly maintenance contact and group sessions at 4, 7 and 10 months. The primary outcome was weight change after 12 months. Key secondary outcomes included diet, physical activity, biomedical measures and patient-related outcome measures. Cost-effectiveness was assessed and a mixed-methods process evaluation was included. RESULTS Between 10 March 2015 and 31 March 2016, we recruited 414 people (intervention 208, usual care 206) with 341 (84.4%) participants completing the trial. At 12 months, weight reduction did not differ between groups (mean difference 0.0 kg, 95% CI -1.6 to 1.7, P = 0.963); physical activity, dietary intake and biochemical measures were unchanged. STEPWISE was well-received by participants and facilitators. The healthcare perspective incremental cost-effectiveness ratio was £246 921 per quality-adjusted life-year gained. CONCLUSIONS Participants were successfully recruited and retained, indicating a strong interest in weight interventions; however, the STEPWISE intervention was neither clinically nor cost-effective. Further research is needed to determine how to manage overweight and obesity in people with schizophrenia.Declaration of interestR.I.G.H. received fees for lecturing, consultancy work and attendance at conferences from the following: Boehringer Ingelheim, Eli Lilly, Janssen, Lundbeck, Novo Nordisk, Novartis, Otsuka, Sanofi, Sunovion, Takeda, MSD. M.J.D. reports personal fees from Novo Nordisk, Sanofi-Aventis, Lilly, Merck Sharp & Dohme, Boehringer Ingelheim, AstraZeneca, Janssen, Servier, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceuticals International Inc.; and, grants from Novo Nordisk, Sanofi-Aventis, Lilly, Boehringer Ingelheim, Janssen. K.K. has received fees for consultancy and speaker for Novartis, Novo Nordisk, Sanofi-Aventis, Lilly, Servier and Merck Sharp & Dohme. He has received grants in support of investigator and investigator-initiated trials from Novartis, Novo Nordisk, Sanofi-Aventis, Lilly, Pfizer, Boehringer Ingelheim and Merck Sharp & Dohme. K.K. has received funds for research, honoraria for speaking at meetings and has served on advisory boards for Lilly, Sanofi-Aventis, Merck Sharp & Dohme and Novo Nordisk. D.Sh. is expert advisor to the NICE Centre for guidelines; board member of the National Collaborating Centre for Mental Health (NCCMH); clinical advisor (paid consultancy basis) to National Clinical Audit of Psychosis (NCAP); views are personal and not those of NICE, NCCMH or NCAP. J.P. received personal fees for involvement in the study from a National Institute for Health Research (NIHR) grant. M.E.C. and Y.D. report grants from NIHR Health Technology Assessment, during the conduct of the study; and The Leicester Diabetes Centre, an organisation (employer) jointly hosted by an NHS Hospital Trust and the University of Leicester and who is holder (through the University of Leicester) of the copyright of the STEPWISE programme and of the DESMOND suite of programmes, training and intervention fidelity framework that were used in this study. S.R. has received honorarium from Lundbeck for lecturing. F.G. reports personal fees from Otsuka and Lundbeck, personal fees and non-financial support from Sunovion, outside the submitted work; and has a family member with professional links to Lilly and GSK, including shares. F.G. is in part funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research & Care Funding scheme, by the Maudsley Charity and by the Stanley Medical Research Institute and is supported by the by the Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London.
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Affiliation(s)
- Richard I. G. Holt
- Professor in Diabetes and Endocrinology, Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton andHonorary Consultant Physician, Division B, University Hospital Southampton NHS Foundation Trust, UK,Correspondence: Richard I. G. Holt, The IDS Building (MP887), Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.
| | - Rebecca Gossage-Worrall
- Trial Manager (Research Associate), Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, UK
| | - Daniel Hind
- Reader in Complex Interventions and Assistant Director, Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, UK
| | - Michael J. Bradburn
- Senior Medical Statistician, Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, UK
| | - Paul McCrone
- Professor of Health Economics and Director of King's Health Economics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Tiyi Morris
- Research Assistant, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Charlotte Edwardson
- Associate Professor in Physical Activity, Sedentary Behaviour and Health, Diabetes Research Centre, University of Leicester, UK
| | - Katharine Barnard
- Health Psychologist and Visiting Professor, Faculty of Health and Social Science, University of Bournemouth, UK
| | - Marian E. Carey
- Director: Structured Education Research Portfolio, Leicester Diabetes Centre, University Hospitals of Leicesterand Honorary Associate Professor, Diabetes Research Centre, University of Leicester, UK
| | - Melanie J. Davies
- Professor of Diabetes Medicine, Diabetes Research Centre, University of Leicester, UK
| | - Chris M. Dickens
- Professor of Psychological Medicine, Institute of Health Research, University of Exeter Medical School, UK
| | - Yvonne Doherty
- Consultant Clinical Psychologist and Senior Research Associate, Leicester Diabetes Centre, University Hospitals of Leicester, UK
| | | | - Paul French
- Associate Director, Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Fiona Gaughran
- Reader, Institute of Psychiatry, Psychology & Neuroscience, King's College London and Consultant Psychiatrist and Director of Research, National Psychosis Service, South London and Maudsley NHS Foundation Trust, UK
| | - Kathryn E. Greenwood
- Consultant Clinical Psychologist, Sussex Partnership NHS Foundation Trust and Professor in Clinical Psychology, Sussex Psychosis Research Interest Group, School of Psychology, University of Sussex, UK
| | - Sridevi Kalidindi
- Consultant Psychiatrist, Rehabilitation and Recovery, South London and Maudsley NHS Foundation Trust and Senior Clinical Lecturer, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Kamlesh Khunti
- Professor of Primary Care Diabetes and Vascular Medicine, Diabetes Research Centre, University of Leicester, UK
| | - Richard Laugharne
- Consultant Psychiatrist and Honorary Senior Lecturer, Cornwall Partnership NHS Foundation Trust, UK
| | | | - Shanaya Rathod
- Consultant Psychiatrist and Director of Research, Southern Health NHS Foundation Trust and Visiting Professor, Faculty of Science, University of Portsmouth, UK
| | - David Saxon
- Research Fellow, Mental Health Unit, School of Health and Related Research, University of Sheffield, UK
| | - David Shiers
- Honorary Research Consultant, Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust andHonorary Reader in Early Psychosis, School of Health Sciences, Division of Psychology and Mental Health, University of Manchester, UK
| | - Najma Siddiqi
- Clinical Senior Lecturer in Psychiatry, Health Sciences, University of York, Hull York Medical School and Consultant Psychiatrist, Bradford District Care NHS Foundation Trust, UK
| | - Elizabeth A. Swaby
- Study Manager, Clinical Trials Research Unit, School of Health and Related Research, University of Sheffield, UK
| | - Glenn Waller
- Professor of Psychology, Department of Psychology, University of Sheffield, UK
| | - Stephen Wright
- Lead Consultant, Early Intervention Psychiatry, Tees Esk & Wear Valleys NHS Foundation Trust, UK
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149
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Health, Health Behaviors, and Health Care Utilization Among Adults with Serious Psychological Distress Who Receive Federal Housing Assistance. J Behav Health Serv Res 2019; 46:586-606. [PMID: 30684168 DOI: 10.1007/s11414-018-09647-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Using newly available U.S. Department of Housing and Urban Development (HUD) administrative data linked with National Health Interview Survey (NHIS) data, this study estimates the prevalence of serious psychological distress (SPD) among non-elderly HUD-assisted adults and examines differences in health, health behaviors, and health care utilization for this population. The linked data estimate that 13% of HUD-assisted adults experience SPD. Controlling for individual characteristics and HUD program type, assisted housing residents who had SPD experienced higher rates of self-reported fair or poor health, chronic disease, and cigarette smoking than HUD-assisted adults without SPD. Adults with SPD had more frequent use of emergency rooms and were more likely than residents without SPD to have more frequent contact with specialists, general doctors, and mental health providers, although they also reported increased levels of unmet health care needs due to affordability. Policy implications are discussed.
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150
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Svensson CK, Larsen JR, Vedtofte L, Jakobsen MSL, Jespersen HR, Jakobsen MI, Koyuncu K, Schjerning O, Nielsen J, Ekstrøm CT, Correll CU, Vilsbøll T, Fink-Jensen A. One-year follow-up on liraglutide treatment for prediabetes and overweight/obesity in clozapine- or olanzapine-treated patients. Acta Psychiatr Scand 2019; 139:26-36. [PMID: 30374965 DOI: 10.1111/acps.12982] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Treatment with most antipsychotics is associated with an increased risk of weight gain and metabolic disturbances. In a randomized trial, we previously demonstrated that 16 weeks of glucagon-like peptide-1 receptor agonist liraglutide treatment vs. placebo significantly reduced glucometabolic disturbances and body weight in prediabetic, overweight/obese schizophrenia-spectrum disorder patients treated with clozapine or olanzapine. The aim of this study was to investigate whether the beneficial effects of the 16-week intervention were sustained beyond the intervention period. METHOD One year after completion of the intervention, we investigated changes in body weight, fasting glucose, glycated hemoglobin, C-peptide, and lipids comparing 1-year follow-up levels to end of treatment (week 16) and baseline (week 0) levels. RESULTS From end of treatment to the 1-year follow-up, body weight had increased in the liraglutide-treated group. However, compared to baseline levels, the placebo-subtracted body weight loss remained significantly reduced (-3.8 kg, 95% CI: -7.3 to -0.2, P = 0.04). Fasting glucose, glycated hemoglobin, C-peptide, and lipids had each returned to baseline levels 1 year after stopping liraglutide. CONCLUSION The body weight reduction during 16 weeks of liraglutide treatment was partially sustained 1 year after the intervention was completed. However, the improvements in other metabolic parameters returned to baseline levels.
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Affiliation(s)
- C K Svensson
- Psychiatric Centre Copenhagen, Rigshospitalet, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - J R Larsen
- Psychiatric Centre Copenhagen, Rigshospitalet, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark.,Novo Nordisk A/S, Bagsvaerd, Denmark
| | - L Vedtofte
- Clinical Metabolic Physiology, Steno Diabetes Center Copenhagen, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - M S L Jakobsen
- Psychiatric Centre Copenhagen, Rigshospitalet, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - H R Jespersen
- Psychiatric Centre Copenhagen, Rigshospitalet, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - M I Jakobsen
- Psychiatric Centre Copenhagen, Rigshospitalet, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - K Koyuncu
- Psychiatric Centre Copenhagen, Rigshospitalet, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - O Schjerning
- Department of Psychiatry, Aalborg University, Aalborg, Denmark
| | - J Nielsen
- Psychiatric Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - C T Ekstrøm
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - C U Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, NY, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - T Vilsbøll
- Clinical Metabolic Physiology, Steno Diabetes Center Copenhagen, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - A Fink-Jensen
- Psychiatric Centre Copenhagen, Rigshospitalet, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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