151
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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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152
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Nakanishi M, Tanaka S, Kurokawa G, Ando S, Yamasaki S, Fukuda M, Takahashi K, Kojima T, Nishida A. Inhibited autonomy for promoting physical health: qualitative analysis of narratives from persons living with severe mental illness. BJPsych Open 2019; 5:e10. [PMID: 30762505 PMCID: PMC6343122 DOI: 10.1192/bjo.2018.77] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Autonomy is a key factor in the reduction of inequitable physical healthcare among people with severe mental illness compared with the general population.AimsTo clarify the critical mechanism underlying autonomy in physical health promotion based on the perspectives of people with severe mental illness. METHOD We employed a conventional content analysis of narrative data from the Healthy Active Lives in Japan (HeAL Japan) workshop meetings. RESULTS 'Inhibited autonomy' was extracted as a central component and shaped by the users' experiences, both in a healthcare setting and in real life. This component emerged based on the lack of an empowerment mechanism in psychiatric services. CONCLUSIONS A barrier to the encouragement of autonomy in physical health promotion was found in current psychiatric services. An effective strategy should be explored to foster an empowerment mechanism in psychiatric and mental health services.Declaration of interestNone.
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Affiliation(s)
- Miharu Nakanishi
- Chief Researcher, Mental Health and Nursing Research Team,Mental Health Promotion Project,Tokyo Metropolitan Institute of Medical Science,Japan
| | - Shintaro Tanaka
- Research Assistant, Mental Health Promotion Project,Tokyo Metropolitan Institute of Medical Science,Japan
| | | | - Shuntaro Ando
- Lecturer, Department of Neuropsychiatry,Graduate School of Medicine,The University of Tokyo,Japan
| | - Syudo Yamasaki
- Chief Researcher, Mental Health Promotion Project,Tokyo Metropolitan Institute of Medical Science,Japan
| | - Masato Fukuda
- Professor, Department of Psychiatry and Neuroscience,Gunma University Graduate School of Medicine,Japan
| | | | | | - Atsushi Nishida
- Project Leader, Mental Health Promotion Project,Tokyo Metropolitan Institute of Medical Science,Japan
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153
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Soontornniyomkij V, Lee EE, Jin H, Martin AS, Daly RE, Liu J, Tu XM, Eyler LT, Jeste DV. Clinical Correlates of Insulin Resistance in Chronic Schizophrenia: Relationship to Negative Symptoms. Front Psychiatry 2019; 10:251. [PMID: 31065243 PMCID: PMC6488983 DOI: 10.3389/fpsyt.2019.00251] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 04/02/2019] [Indexed: 12/22/2022] Open
Abstract
Higher prevalence of physical comorbidity and premature mortality in persons with schizophrenia (PwS) results primarily from heightened cardiovascular and metabolic risks. The literature suggests that insulin resistance precedes the development of obesity, smoking, and use of antipsychotic medications, although these likely play a compounding role later in the course of the disorder. It is thus important to discover the clinical characteristics of PwS with high insulin resistance, as these individuals may represent an etiopathologically distinct subgroup with a distinct course and treatment needs. We conducted a cross-sectional study and compared insulin resistance between 145 PwS and 140 nonpsychiatric comparison (NC) participants, similar in age, sex, and race distribution. In addition, we examined correlates of insulin resistance in PwS. As expected, PwS had higher levels of insulin resistance [Homeostatic Model Assessment of Insulin Resistance (HOMA-IR)] and body mass index (BMI) compared to the NC participants. HOMA-IR in the PwS was most associated with negative symptoms, BMI, and non-White race/ethnicity. The mechanistic relationships between insulin resistance and negative symptoms in schizophrenia patients warrant further investigation, and future studies should examine outcomes of PwS with this cluster of physical and mental symptoms and determine how management of insulin resistance might improve health of these individuals.
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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
| | - Hua Jin
- Department of Psychiatry, 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
| | - 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
| | - 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
| | - Xin M Tu
- 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
| | - Lisa Todd Eyler
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States.,Desert-Pacific Mental Illness Research Education and Clinical Center, Veterans Affairs San Diego Healthcare System, San Diego, 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.,Center for Healthy Aging, University of California San Diego, La Jolla, CA, United States.,Department of Neurosciences, University of California San Diego, La Jolla, CA, United States
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154
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Woodward ML, Gicas KM, Warburton DE, White RF, Rauscher A, Leonova O, Su W, Smith GN, Thornton AE, Vertinsky AT, Phillips AA, Goghari VM, Honer WG, Lang DJ. Hippocampal volume and vasculature before and after exercise in treatment-resistant schizophrenia. Schizophr Res 2018; 202:158-165. [PMID: 30539767 DOI: 10.1016/j.schres.2018.06.054] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 06/11/2018] [Accepted: 06/20/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Schizophrenia is associated with poor cognitive function and elevated cardiometabolic disease risk. These health concerns may exacerbate neurocognitive dysfunction associated with hippocampal abnormalities, particularly hippocampal volume reductions. Regular exercise is thought to improve symptom severity, reduce depression, and improve cognition in schizophrenia, and may trigger exercise-mediated hippocampal growth. The potential for the benefits of exercise for treatment-resistant schizophrenia patients has not been clearly assessed. This study aims to assess the effect of exercise on hippocampal plasticity and clinical outcomes in chronic schizophrenia. METHODS Seventeen DSM-IV criteria schizophrenia or schizoaffective disorder patients completed a customized moderate intensity 12-week aerobic or weight-bearing exercise program. Adherence rates were 83% ± 9.4%) with 70% of participants completing the entire exercise program. Concomitant neuroimaging, clinical and cognitive assessments were obtained at baseline and 12-weeks. RESULTS At follow-up, symptom severity scores (t(16) = -16.8, p. ≤ 0.0001) and social functioning (t(16) = 4.4, p. = 0.0004) improved. A trend for improved depression scores (t(16) = -2.0, p. = 0.06) with no change in anxiety, or extrapyramidal symptoms were seen. Hippocampal volume increased (t(16) = -2.54, p. = 0.02), specifically in the left CA-1 field (F(16) = -2.33, p. = 0.03). Hippocampal vascular volume was unchanged. Change in hippocampal volume and vascular volume was not significantly correlated with change in symptom severity or affect scores. CONCLUSIONS Adjunct exercise may accelerate symptom improvement in treatment-resistant psychosis patients. While the underlying mechanism remains unclear, these results indicate that chronic schizophrenia patients experience hippocampal plasticity in response to exercise. STUDY REGISTRATION Clinical Trials.govNCT01392885.
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Affiliation(s)
- M L Woodward
- Department of Radiology, University of British Columbia, Canada
| | - K M Gicas
- Department of Psychology, Simon Fraser University, Canada
| | - D E Warburton
- School of Kinesiology, University of British Columbia, Canada; Experimental Medicine Program, University of British Columbia, Canada
| | - R F White
- Department of Psychiatry, University of British Columbia, Canada
| | - A Rauscher
- Department of Pediatrics, University of British Columbia, Canada
| | - O Leonova
- Department of Psychiatry, University of British Columbia, Canada
| | - W Su
- Department of Psychiatry, University of British Columbia, Canada
| | - G N Smith
- Department of Psychiatry, University of British Columbia, Canada
| | - A E Thornton
- Department of Pediatrics, University of British Columbia, Canada
| | - A T Vertinsky
- Department of Radiology, University of British Columbia, Canada
| | - A A Phillips
- School of Kinesiology, University of British Columbia, Canada
| | - V M Goghari
- Department of Psychology & Graduate Department of Psychological Clinical Science, University of Toronto, Canada
| | - W G Honer
- Department of Psychiatry, University of British Columbia, Canada
| | - D J Lang
- Department of Radiology, University of British Columbia, Canada.
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155
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Singh VK, Karmani S, Malo PK, Virupaksha HG, Muralidhar D, Venkatasubramanian G, Muralidharan K. Impact of lifestyle modification on some components of metabolic syndrome in persons with severe mental disorders: A meta-analysis. Schizophr Res 2018; 202:17-25. [PMID: 30539768 DOI: 10.1016/j.schres.2018.06.066] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/28/2018] [Accepted: 06/30/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Metabolic syndrome (MS) is reportedly associated with high mortality from mostly cardiovascular causes in patients with severe mental disorders (SMD). Lifestyle interventions augment effective management of MS in patients with SMD. The present meta-analysis aims at updating the recent evidence on the effectiveness of lifestyle intervention for MS in patients with SMD. METHOD A literature search for English Language publications of randomized controlled trials (RCTs) from 2001 to 2016 comparing lifestyle modification (LM) with treatment as usual (TAU) in the management of MS were identified. Using PRISMA guidelines, 19 RCTs reporting data on 1688 SMD and MS patients and providing data on change in Body Weight, Body Mass Index (BMI) and waist circumference (WC) were included. Using random effects model, standardized mean difference between LM and TAU for the mean baseline-to-endpoint change in body weight, BMI and WC was calculated with a 95% confidence limit, on RevMan 5.3. The study was registered with PROSPERO (CRD42016046847). RESULTS LM had significantly superior efficacy in the reducing weight (-0.64, 95% CI -0.89, -0.39, Z = 5.03, overall effect p < 0.00001), BMI (-0.68, 95% CI -1.01, -0.35, Z = 4.05, overall effect p < 0.0001), and WC (-0.60, 95% CI -1.17, -0.03, Z = 2.06; overall effect p = 0.04), compared to TAU. LM was significantly more effective than TAU even in short duration (p = 0.0001) and irrespective of the treatment setting. CONCLUSION Interventions targeting LM in persons with SMD and MS are effective in reducing body weight, BMI and WC. It must be routinely recommended to all patients with SMD, ideally during commencement stage of second generation antipsychotic treatment.
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Affiliation(s)
- Vinit Kumar Singh
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences (INI), Bengaluru 560029, Karnataka, India
| | - Sneha Karmani
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bengaluru 560029, Karnataka, India
| | - Palash Kumar Malo
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences (INI), Bengaluru 560029, Karnataka, India
| | - H G Virupaksha
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences (INI), Bengaluru 560029, Karnataka, India
| | - Daliboina Muralidhar
- Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences (INI), Bengaluru 560029, Karnataka, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bengaluru 560029, Karnataka, India
| | - Kesavan Muralidharan
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (INI), Bengaluru 560029, Karnataka, India.
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156
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Quiñones MM, Lombard-Newell J, Sharp D, Way V, Cross W. Case study of an adaptation and implementation of a Diabetes Prevention Program for individuals with serious mental illness. Transl Behav Med 2018; 8:195-203. [PMID: 29346678 DOI: 10.1093/tbm/ibx064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The Diabetes Prevention Program (DPP) is an evidence-based lifestyle intervention developed to decrease the risk for type 2 diabetes and promote weight loss in individuals at risk for diabetes. Individuals with serious mental illness have a greater risk for developing diabetes compared with the general population. In this article, the authors provide a detailed description of the adaptation process of the DPP for individuals with serious mental illness (DPP-SMI). The adaptation process was based on a cultural adaptation framework for modifying evidence-based interventions. To assess the effectiveness of the DPP-SMI, 11 individuals from a community mental health residential agency completed a 22-session pilot study of the adapted program and provided physiological measures before and after the intervention. As primary outcomes, participants were expected to report decreased body weight and increased physical activity per week. Completers had an average weight loss of 19 lbs (8%) and their physical activity increased from 161 to 405 min per week. These preliminary results together with participants' feedback informed further refinement of the DPP-SMI. This case study supports that individuals with serious mental illness can benefit from the DPP-SMI, which is tailored to meet the unique needs of this population group.
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Affiliation(s)
- Maria M Quiñones
- School of Nursing, University of Rochester Medical Center, Rochester, NY
| | | | - Daryl Sharp
- School of Nursing, University of Rochester Medical Center, Rochester, NY
| | | | - Wendi Cross
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
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157
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Young AS, Cohen AN, Hamilton AB, Hellemann G, Reist C, Whelan F. Implementing Patient-Reported Outcomes to Improve the Quality of Care for Weight of Patients with Schizophrenia. J Behav Health Serv Res 2018; 46:129-139. [PMID: 30465314 DOI: 10.1007/s11414-018-9641-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
"Enhancing QUality of Care In Psychosis" (EQUIP) was an eight-site clustered controlled trial of the implementation and effectiveness of patient-reported outcomes to support evidence-based practice and improve care for schizophrenia. Implementation sites chose to improve care for weight. Implementation included monitoring patient-reported outcomes using kiosks, patient and staff education, quality improvement teams, and phone care management. Qualitative and quantitative methods compared implementation and effectiveness between sites for 13 months. Eighty percent of 801 randomly selected patients were overweight. Two hundred one clinicians varied in competency. Baseline use of behavioral weight services was low. At implementation sites, patients became 2.3 times more likely to use weight services compared with control sites (95% CI, 1.5-3.6; χ2 = 14.4; p < 0.01). There was no effect on the weight gain liability of medications prescribed. Controlling for baseline, patients' final weight at control sites was 5.9 ± 2.7 kg heavier than at implementation sites (F = 4.8, p = 0.03). Patient-reported outcomes can inform implementation of evidence-based practice and improvement in outcomes.
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Affiliation(s)
- Alexander S Young
- Greater Los Angeles Veterans Healthcare Center, Los Angeles, CA, USA. .,University of California, Los Angeles, CA, USA. .,UCLA Center for Health Services, 10920 Wilshire Blvd., Suite 300, Los Angeles, CA, 90024, USA. .,Veterans Health Administration, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA, 90073, USA.
| | - Amy N Cohen
- Greater Los Angeles Veterans Healthcare Center, Los Angeles, CA, USA.,University of California, Los Angeles, CA, USA.,Veterans Health Administration, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA, 90073, USA
| | - Alison B Hamilton
- Greater Los Angeles Veterans Healthcare Center, Los Angeles, CA, USA.,University of California, Los Angeles, CA, USA.,Veterans Health Administration, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA, 90073, USA
| | - Gerhard Hellemann
- University of California, Los Angeles, CA, USA.,Veterans Health Administration, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA, 90073, USA
| | - Christopher Reist
- Veterans Health Administration, MIRECC, 11301 Wilshire Blvd., 210A, Los Angeles, CA, 90073, USA.,Long Beach Veterans Healthcare System, Long Beach, CA, USA.,University of California, Irvine, CA, USA
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158
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Avenell A, Robertson C, Skea Z, Jacobsen E, Boyers D, Cooper D, Aceves-Martins M, Retat L, Fraser C, Aveyard P, Stewart F, MacLennan G, Webber L, Corbould E, Xu B, Jaccard A, Boyle B, Duncan E, Shimonovich M, Bruin MD. Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation. Health Technol Assess 2018; 22:1-246. [PMID: 30511918 PMCID: PMC6296173 DOI: 10.3310/hta22680] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Adults with severe obesity [body mass index (BMI) of ≥ 35 kg/m2] have an increased risk of comorbidities and psychological, social and economic consequences. OBJECTIVES Systematically review bariatric surgery, weight-management programmes (WMPs) and orlistat pharmacotherapy for adults with severe obesity, and evaluate the feasibility, acceptability, clinical effectiveness and cost-effectiveness of treatment. DATA SOURCES Electronic databases including MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials and the NHS Economic Evaluation Database were searched (last searched in May 2017). REVIEW METHODS Four systematic reviews evaluated clinical effectiveness, cost-effectiveness and qualitative evidence for adults with a BMI of ≥ 35 kg/m2. Data from meta-analyses populated a microsimulation model predicting costs, outcomes and cost-effectiveness of Roux-en-Y gastric bypass (RYGB) surgery and the most effective lifestyle WMPs over a 30-year time horizon from a NHS perspective, compared with current UK population obesity trends. Interventions were cost-effective if the additional cost of achieving a quality-adjusted life-year is < £20,000-30,000. RESULTS A total of 131 randomised controlled trials (RCTs), 26 UK studies, 33 qualitative studies and 46 cost-effectiveness studies were included. From RCTs, RYGB produced the greatest long-term weight change [-20.23 kg, 95% confidence interval (CI) -23.75 to -16.71 kg, at 60 months]. WMPs with very low-calorie diets (VLCDs) produced the greatest weight loss at 12 months compared with no WMPs. Adding a VLCD to a WMP gave an additional mean weight change of -4.41 kg (95% CI -5.93 to -2.88 kg) at 12 months. The intensive Look AHEAD WMP produced mean long-term weight loss of 6% in people with type 2 diabetes mellitus (at a median of 9.6 years). The microsimulation model found that WMPs were generally cost-effective compared with population obesity trends. Long-term WMP weight regain was very uncertain, apart from Look AHEAD. The addition of a VLCD to a WMP was not cost-effective compared with a WMP alone. RYGB was cost-effective compared with no surgery and WMPs, but the model did not replicate long-term cost savings found in previous studies. Qualitative data suggested that participants could be attracted to take part in WMPs through endorsement by their health-care provider or through perceiving innovative activities, with WMPs being delivered to groups. Features improving long-term weight loss included having group support, additional behavioural support, a physical activity programme to attend, a prescribed calorie diet or a calorie deficit. LIMITATIONS Reviewed studies often lacked generalisability to UK settings in terms of participants and resources for implementation, and usually lacked long-term follow-up (particularly for complications for surgery), leading to unrealistic weight regain assumptions. The views of potential and actual users of services were rarely reported to contribute to service design. This study may have failed to identify unpublished UK evaluations. Dual, blinded numerical data extraction was not undertaken. CONCLUSIONS Roux-en-Y gastric bypass was costly to deliver, but it was the most cost-effective intervention. Adding a VLCD to a WMP was not cost-effective compared with a WMP alone. Most WMPs were cost-effective compared with current population obesity trends. FUTURE WORK Improved reporting of WMPs is needed to allow replication, translation and further research. Qualitative research is needed with adults who are potential users of, or who fail to engage with or drop out from, WMPs. RCTs and economic evaluations in UK settings (e.g. Tier 3, commercial programmes or primary care) should evaluate VLCDs with long-term follow-up (≥ 5 years). Decision models should incorporate relevant costs, disease states and evidence-based weight regain assumptions. STUDY REGISTRATION This study is registered as PROSPERO CRD42016040190. FUNDING The National Institute for Health Research Health Technology Assessment programme. The Health Services Research Unit and Health Economics Research Unit are core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorate.
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Affiliation(s)
- Alison Avenell
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Zoë Skea
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Elisabet Jacobsen
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - Dwayne Boyers
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | - David Cooper
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Graeme MacLennan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | | | | | | | | | - Bonnie Boyle
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Eilidh Duncan
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
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159
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Maxwell AE, Castillo L, Arce AA, De Anda T, Martins D, McCarthy WJ. Eating Veggies Is Fun! An Implementation Pilot Study in Partnership With a YMCA in South Los Angeles. Prev Chronic Dis 2018; 15:E132. [PMID: 30388069 PMCID: PMC6219845 DOI: 10.5888/pcd15.180150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose and Objectives Children eat less than recommended amounts of vegetables. Repeated taste exposure can increase children’s acceptance of initially disliked vegetables. However, implementation of this strategy is lacking. We conducted a pilot study to assess the feasibility of implementing an evidence-based intervention to promote liking of initially disliked vegetables among children enrolled in a YMCA summer camp. Intervention Approach We adapted a research-tested intervention to promote child liking of vegetables for implementation in small groups. In summer 2015, 50 children aged 7 to 12 years were invited to taste 5 initially disliked vegetables daily for 10 days. Evaluation Methods Children rated how much they liked vegetables on a 5-point emoji-like faces Likert scale at baseline and 2- and 4-week follow-up. The mean ratings for liked and initially disliked vegetables were estimated over time using mixed effects modeling. Results We achieved excellent participation of parents and children; however, we experienced nonstudy-related attrition caused by disenrollment of some children from the weekly camp program. The average liking increased over time (linear trend, P = .003) for the 5 targeted vegetables but not for the other nontargeted vegetables, as predicted. Implications for Public Health This pilot study suggests that repeated vegetable tasting opportunities offered by community programs may be a practical strategy for introducing low-income, young children to new or initially disliked vegetables. The study demonstrates the feasibility of implementing a health promotion strategy that has the potential to improve population health in a community setting in an underresourced neighborhood.
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Affiliation(s)
- Annette E Maxwell
- Center for Cancer Prevention and Control Research, University of California, Los Angeles, Fielding School of Public Health, and Jonsson Comprehensive Cancer Center, Los Angeles, California.,UCLA Center for Cancer Prevention and Control Research, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, A2-125 CHS, Box 956900, Los Angeles, CA 90095-6900.
| | - Laura Castillo
- Center for Cancer Prevention and Control Research, University of California, Los Angeles, Fielding School of Public Health, and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Anthony A Arce
- Center for Cancer Prevention and Control Research, University of California, Los Angeles, Fielding School of Public Health, and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - Teresa De Anda
- Center for Cancer Prevention and Control Research, University of California, Los Angeles, Fielding School of Public Health, and Jonsson Comprehensive Cancer Center, Los Angeles, California
| | - David Martins
- Department of Medicine, College of Medicine, Charles R. Drew University, Los Angeles, California.,Department of General Internal Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - William J McCarthy
- Center for Cancer Prevention and Control Research, University of California, Los Angeles, Fielding School of Public Health, and Jonsson Comprehensive Cancer Center, Los Angeles, California
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Aschbrenner KA, Naslund JA, Gorin AA, Mueser KT, Scherer EA, Viron M, Kinney A, Bartels SJ. Peer support and mobile health technology targeting obesity-related cardiovascular risk in young adults with serious mental illness: Protocol for a randomized controlled trial. Contemp Clin Trials 2018; 74:97-106. [PMID: 30316998 PMCID: PMC6217796 DOI: 10.1016/j.cct.2018.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/29/2018] [Accepted: 10/10/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Individuals with serious mental illness (SMI) such as schizophrenia and bipolar disorder face a higher risk of early death due to cardiovascular disease and other preventable chronic illnesses. Young adulthood is a critical window of development for lifestyle interventions to improve the long-term health and quality of life in this population. Fit Forward is an NIH-funded randomized clinical trial examining the effectiveness of a group lifestyle intervention (PeerFIT) enhanced with mobile health technology compared to one-on-one mobile lifestyle coaching with Basic Education in fitness and nutrition supported by a wearable Activity Tracking device (BEAT) in achieving clinically significant weight loss and improved cardiorespiratory fitness in young adults with SMI. METHODS Fit Forward targets 144 young adults (18 to 35 years) with SMI and a body mass index (BMI) of ≥25 receiving public mental health services. In a two-arm randomized clinical trial, participants will be randomly assigned with equal probability to PeerFIT or BEAT, stratified by birth sex and psychiatric diagnosis. Participants will be assessed at baseline, 6, and 12 months. The primary outcome is cardiovascular risk reduction indicated by either clinically significant weight loss (5% or greater) or increased fitness (>50 m on the 6-Minute Walk Test). Secondary outcomes include change in BMI, lipids, and hemoglobin A1c. Perceived self-efficacy for exercise and peer support will be evaluated as mechanisms underlying intervention effects. CONCLUSION If effective, PeerFIT will provide a potentially scalable approach to addressing health risks among young adults with SMI in mental health settings. TRIALS REGISTRATION ClinicalTrials.gov, NCT02815813.
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Affiliation(s)
- Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, United States.
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, United States
| | - Amy A Gorin
- Department of Psychology, University of Connecticut, Storrs, CT, United States
| | - Kim T Mueser
- Department of Occupational Therapy, Boston University, Boston, MA, United States
| | - Emily A Scherer
- Biomedical Data Sciences, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Mark Viron
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Allison Kinney
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, United States
| | - Stephen J Bartels
- The Mongan Institute, Massachusetts General Hospital, Cambridge, MA, United States
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161
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Stumbo SP, Yarborough BJH, Yarborough MT, Green CA. Perspectives on Providing And Receiving Preventive Health Care From Primary Care Providers and Their Patients With Mental Illnesses. Am J Health Promot 2018; 32:1730-1739. [PMID: 29658287 PMCID: PMC7220499 DOI: 10.1177/0890117118763233] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Individuals with mental illnesses have higher morbidity rates and reduced life expectancy compared to the general population. Understanding how patients and providers perceive the need for prevention, as well as the barriers and beliefs that may contribute to insufficient care, are important for improving service delivery tailored to this population. DESIGN Cross-sectional; mixed methods. SETTING An integrated health system and a network of federally qualified health centers and safety net clinics. PARTICIPANTS Interviews (n = 30) and surveys (n = 249) with primary care providers. Interviews (n = 158) and surveys (n = 160) with patients diagnosed with schizophrenia, bipolar, anxiety, or major depressive disorders. MEASURES Semi-structured interviews and surveys. ANALYSIS Thematic analysis for qualitative data; frequencies for quantitative data. RESULTS More than half (n = 131, 53%) of clinicians believed patients with mental illnesses care less about preventive care than the general population, yet 88% (n = 139) of patients reported interest in improving health. Most providers (n = 216, 88%) lacked confidence that patients with mental illnesses would follow preventive recommendations; 82% (n = 129) of patients reported they would try to change lifestyles if their doctor recommended. Clinicians explained that their perception of patients' chaotic lives and lack of interest in preventive care contributed to their fatalistic attitudes on care delivery to this population. Clinicians and patients agreed on substantial need for additional support for behavior changes. Clinicians reported providing informational support by keeping messages simple; patients reported a desire for more detailed information on reasons to complete preventive care. Patients also detailed the need for assistive and tangible support to manage behavioral health changes. CONCLUSIONS Our results suggest a few clinical changes could help patients complete preventive care recommendations and improve health behaviors: improving clinician-patient collaboration on realistic goal setting, increasing visit time or utilizing behavioral health consultants that bridge primary and specialty mental health care, and increasing educational and tangible patient support services.
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Affiliation(s)
- Scott P. Stumbo
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | | | | | - Carla A. Green
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
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Can We Improve Physical Health Monitoring for Patients Taking Antipsychotics on a Mental Health Inpatient Unit? J Clin Psychopharmacol 2018; 38:447-453. [PMID: 30113352 DOI: 10.1097/jcp.0000000000000931] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with severe mental illness are at risk of medical complications, including cardiovascular disease, metabolic syndrome, and diabetes. Given this vulnerability, combined with metabolic risks of antipsychotics, physical health monitoring is critical. Inpatient admission is an opportunity to screen for medical comorbidities. Our objective was to improve the rates of physical health monitoring on an inpatient psychiatry unit through implementation of an electronic standardized order set. METHODS Using a clinical audit tool, we completed a baseline retrospective audit (96 eligible charts) of patients aged 18 to 100 years, discharged between January and March 2012, prescribed an antipsychotic for 3 or more days. We then developed and implemented a standard electronic admission order set and provided training to inpatient clinical staff. We completed a second chart audit of patients discharged between January and March 2016 (190 eligible charts) to measure improvement in physical health monitoring and intervention rates for abnormal results. RESULTS In the 2012 audit, thyroid-stimulating hormone (TSH), blood pressure, blood glucose, fasting lipids, electrocardiogram (ECG), and height/weight were measured in 71%, 92%, 31%, 36%, 51%, and 75% of patients, respectively. In the 2016 audit, TSH, blood pressure, blood glucose, fasting lipids, ECG, and height/weight were measured in 86%, 96%, 96%, 64%, 87%, and 71% of patients, respectively. There were statistically significant improvements (P < 0.05) in monitoring rates for blood glucose, lipids, ECG, and TSH. Intervention rates for abnormal blood glucose and/or lipids (feedback to family doctor and/or patient, consultation to hospitalist, endocrinology, and/or dietician) did not change between 2012 and 2016. CONCLUSIONS Electronic standardized order set can be used as a tool to improve screening for physical health comorbidity in patients with severe mental illness receiving antipsychotic medications.
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Muralidharan A, Niv N, Brown CH, Olmos-Ochoa TT, Fang LJ, Cohen AN, Kreyenbuhl J, Oberman RS, Goldberg RW, Young AS. Impact of Online Weight Management With Peer Coaching on Physical Activity Levels of Adults With Serious Mental Illness. Psychiatr Serv 2018; 69:1062-1068. [PMID: 30041588 PMCID: PMC6611674 DOI: 10.1176/appi.ps.201700391] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Many adults with serious mental illness are sedentary and experience significant medical illness burden. This study examined the effectiveness of online weight management with peer coaching (WebMOVE) for increasing general physical activity among adults with serious mental illness. METHODS Using quantitative and qualitative data from a randomized controlled trial (N=276), this study compared WebMOVE, in-person weight management for adults with serious mental illness (MOVE SMI), and usual care. Participants completed assessments of general physical activity (baseline, three months, and six months) and a qualitative assessment (six months). Mixed-effects models examined group × time interactions on general physical activity. RESULTS There were significant differences between MOVE SMI and usual care for total physical activity at three (t=3.06, p=.002) and six (t=3.12, p=.002) months, walking at six months (t=1.99, p=.048), and moderate (t=2.12, p=.035) and vigorous (t=2.34, p=.020) physical activity at six months. There was a significant difference between WebMOVE and usual care for total physical activity at six months (t=2.02, p=.044) and a trend for a group difference in walking at six months (t=1.78, p=.076). These findings reflected a decline in physical activity among participants in usual care and an increase in physical activity among participants in MOVE SMI or WebMOVE. CONCLUSIONS In-person weight management counseling increased total physical activity and led to initiation of moderate and vigorous physical activity among adults with serious mental illness. Computerized weight management counseling with peer support led to more gradual increases in total physical activity.
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Affiliation(s)
- Anjana Muralidharan
- Dr. Muralidharan, Dr. Brown, Dr. Kreyenbuhl, and Dr. Goldberg are with the Mental Illness Research, Education and Clinical Center (MIRECC),U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (VISN 5), Baltimore. They are also with the University of Maryland School of Medicine, Baltimore, where Ms. Fang is affiliated. Dr. Muralidharan, Ms. Fang, Dr. Kreyenbuhl, and Dr. Goldberg are with the Division of Psychiatric Services Research, Department of Psychiatry, and Dr. Brown is with the Department of Epidemiology and Public Health. Dr. Niv and Dr. Olmos-Ochoa are with the MIRECC, VA Desert Pacific Healthcare Network, Long Beach, California. Dr. Niv is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, where Dr. Cohen and Dr. Young are affiliated. Dr. Cohen and Dr. Young are also with the MIRECC, VISN 22, Los Angeles. Ms. Oberman is with the VA Greater Los Angeles Healthcare System, Los Angeles
| | - Noosha Niv
- Dr. Muralidharan, Dr. Brown, Dr. Kreyenbuhl, and Dr. Goldberg are with the Mental Illness Research, Education and Clinical Center (MIRECC),U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (VISN 5), Baltimore. They are also with the University of Maryland School of Medicine, Baltimore, where Ms. Fang is affiliated. Dr. Muralidharan, Ms. Fang, Dr. Kreyenbuhl, and Dr. Goldberg are with the Division of Psychiatric Services Research, Department of Psychiatry, and Dr. Brown is with the Department of Epidemiology and Public Health. Dr. Niv and Dr. Olmos-Ochoa are with the MIRECC, VA Desert Pacific Healthcare Network, Long Beach, California. Dr. Niv is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, where Dr. Cohen and Dr. Young are affiliated. Dr. Cohen and Dr. Young are also with the MIRECC, VISN 22, Los Angeles. Ms. Oberman is with the VA Greater Los Angeles Healthcare System, Los Angeles
| | - Clayton H Brown
- Dr. Muralidharan, Dr. Brown, Dr. Kreyenbuhl, and Dr. Goldberg are with the Mental Illness Research, Education and Clinical Center (MIRECC),U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (VISN 5), Baltimore. They are also with the University of Maryland School of Medicine, Baltimore, where Ms. Fang is affiliated. Dr. Muralidharan, Ms. Fang, Dr. Kreyenbuhl, and Dr. Goldberg are with the Division of Psychiatric Services Research, Department of Psychiatry, and Dr. Brown is with the Department of Epidemiology and Public Health. Dr. Niv and Dr. Olmos-Ochoa are with the MIRECC, VA Desert Pacific Healthcare Network, Long Beach, California. Dr. Niv is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, where Dr. Cohen and Dr. Young are affiliated. Dr. Cohen and Dr. Young are also with the MIRECC, VISN 22, Los Angeles. Ms. Oberman is with the VA Greater Los Angeles Healthcare System, Los Angeles
| | - Tanya T Olmos-Ochoa
- Dr. Muralidharan, Dr. Brown, Dr. Kreyenbuhl, and Dr. Goldberg are with the Mental Illness Research, Education and Clinical Center (MIRECC),U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (VISN 5), Baltimore. They are also with the University of Maryland School of Medicine, Baltimore, where Ms. Fang is affiliated. Dr. Muralidharan, Ms. Fang, Dr. Kreyenbuhl, and Dr. Goldberg are with the Division of Psychiatric Services Research, Department of Psychiatry, and Dr. Brown is with the Department of Epidemiology and Public Health. Dr. Niv and Dr. Olmos-Ochoa are with the MIRECC, VA Desert Pacific Healthcare Network, Long Beach, California. Dr. Niv is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, where Dr. Cohen and Dr. Young are affiliated. Dr. Cohen and Dr. Young are also with the MIRECC, VISN 22, Los Angeles. Ms. Oberman is with the VA Greater Los Angeles Healthcare System, Los Angeles
| | - Li Juan Fang
- Dr. Muralidharan, Dr. Brown, Dr. Kreyenbuhl, and Dr. Goldberg are with the Mental Illness Research, Education and Clinical Center (MIRECC),U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (VISN 5), Baltimore. They are also with the University of Maryland School of Medicine, Baltimore, where Ms. Fang is affiliated. Dr. Muralidharan, Ms. Fang, Dr. Kreyenbuhl, and Dr. Goldberg are with the Division of Psychiatric Services Research, Department of Psychiatry, and Dr. Brown is with the Department of Epidemiology and Public Health. Dr. Niv and Dr. Olmos-Ochoa are with the MIRECC, VA Desert Pacific Healthcare Network, Long Beach, California. Dr. Niv is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, where Dr. Cohen and Dr. Young are affiliated. Dr. Cohen and Dr. Young are also with the MIRECC, VISN 22, Los Angeles. Ms. Oberman is with the VA Greater Los Angeles Healthcare System, Los Angeles
| | - Amy N Cohen
- Dr. Muralidharan, Dr. Brown, Dr. Kreyenbuhl, and Dr. Goldberg are with the Mental Illness Research, Education and Clinical Center (MIRECC),U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (VISN 5), Baltimore. They are also with the University of Maryland School of Medicine, Baltimore, where Ms. Fang is affiliated. Dr. Muralidharan, Ms. Fang, Dr. Kreyenbuhl, and Dr. Goldberg are with the Division of Psychiatric Services Research, Department of Psychiatry, and Dr. Brown is with the Department of Epidemiology and Public Health. Dr. Niv and Dr. Olmos-Ochoa are with the MIRECC, VA Desert Pacific Healthcare Network, Long Beach, California. Dr. Niv is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, where Dr. Cohen and Dr. Young are affiliated. Dr. Cohen and Dr. Young are also with the MIRECC, VISN 22, Los Angeles. Ms. Oberman is with the VA Greater Los Angeles Healthcare System, Los Angeles
| | - Julie Kreyenbuhl
- Dr. Muralidharan, Dr. Brown, Dr. Kreyenbuhl, and Dr. Goldberg are with the Mental Illness Research, Education and Clinical Center (MIRECC),U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (VISN 5), Baltimore. They are also with the University of Maryland School of Medicine, Baltimore, where Ms. Fang is affiliated. Dr. Muralidharan, Ms. Fang, Dr. Kreyenbuhl, and Dr. Goldberg are with the Division of Psychiatric Services Research, Department of Psychiatry, and Dr. Brown is with the Department of Epidemiology and Public Health. Dr. Niv and Dr. Olmos-Ochoa are with the MIRECC, VA Desert Pacific Healthcare Network, Long Beach, California. Dr. Niv is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, where Dr. Cohen and Dr. Young are affiliated. Dr. Cohen and Dr. Young are also with the MIRECC, VISN 22, Los Angeles. Ms. Oberman is with the VA Greater Los Angeles Healthcare System, Los Angeles
| | - Rebecca S Oberman
- Dr. Muralidharan, Dr. Brown, Dr. Kreyenbuhl, and Dr. Goldberg are with the Mental Illness Research, Education and Clinical Center (MIRECC),U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (VISN 5), Baltimore. They are also with the University of Maryland School of Medicine, Baltimore, where Ms. Fang is affiliated. Dr. Muralidharan, Ms. Fang, Dr. Kreyenbuhl, and Dr. Goldberg are with the Division of Psychiatric Services Research, Department of Psychiatry, and Dr. Brown is with the Department of Epidemiology and Public Health. Dr. Niv and Dr. Olmos-Ochoa are with the MIRECC, VA Desert Pacific Healthcare Network, Long Beach, California. Dr. Niv is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, where Dr. Cohen and Dr. Young are affiliated. Dr. Cohen and Dr. Young are also with the MIRECC, VISN 22, Los Angeles. Ms. Oberman is with the VA Greater Los Angeles Healthcare System, Los Angeles
| | - Richard W Goldberg
- Dr. Muralidharan, Dr. Brown, Dr. Kreyenbuhl, and Dr. Goldberg are with the Mental Illness Research, Education and Clinical Center (MIRECC),U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (VISN 5), Baltimore. They are also with the University of Maryland School of Medicine, Baltimore, where Ms. Fang is affiliated. Dr. Muralidharan, Ms. Fang, Dr. Kreyenbuhl, and Dr. Goldberg are with the Division of Psychiatric Services Research, Department of Psychiatry, and Dr. Brown is with the Department of Epidemiology and Public Health. Dr. Niv and Dr. Olmos-Ochoa are with the MIRECC, VA Desert Pacific Healthcare Network, Long Beach, California. Dr. Niv is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, where Dr. Cohen and Dr. Young are affiliated. Dr. Cohen and Dr. Young are also with the MIRECC, VISN 22, Los Angeles. Ms. Oberman is with the VA Greater Los Angeles Healthcare System, Los Angeles
| | - Alexander S Young
- Dr. Muralidharan, Dr. Brown, Dr. Kreyenbuhl, and Dr. Goldberg are with the Mental Illness Research, Education and Clinical Center (MIRECC),U.S. Department of Veterans Affairs (VA) Capitol Health Care Network (VISN 5), Baltimore. They are also with the University of Maryland School of Medicine, Baltimore, where Ms. Fang is affiliated. Dr. Muralidharan, Ms. Fang, Dr. Kreyenbuhl, and Dr. Goldberg are with the Division of Psychiatric Services Research, Department of Psychiatry, and Dr. Brown is with the Department of Epidemiology and Public Health. Dr. Niv and Dr. Olmos-Ochoa are with the MIRECC, VA Desert Pacific Healthcare Network, Long Beach, California. Dr. Niv is also with the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, where Dr. Cohen and Dr. Young are affiliated. Dr. Cohen and Dr. Young are also with the MIRECC, VISN 22, Los Angeles. Ms. Oberman is with the VA Greater Los Angeles Healthcare System, Los Angeles
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164
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Stroup TS, Gray N. Management of common adverse effects of antipsychotic medications. World Psychiatry 2018; 17:341-356. [PMID: 30192094 PMCID: PMC6127750 DOI: 10.1002/wps.20567] [Citation(s) in RCA: 257] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 06/13/2018] [Accepted: 06/13/2018] [Indexed: 12/16/2022] Open
Abstract
The benefits of antipsychotic medications are sometimes obscured by their adverse effects. These effects range from relatively minor tolerability issues (e.g., mild sedation or dry mouth) to very unpleasant (e.g., constipation, akathisia, sexual dysfunction) to painful (e.g., acute dystonias) to disfiguring (e.g., weight gain, tardive dyskinesia) to life-threatening (e.g., myocarditis, agranulocytosis). Importantly, adverse effect profiles are specific to each antipsychotic medication and do not neatly fit into first- and second-generation classifications. This paper reviews management strategies for the most frequent side effects and identifies common principles intended to optimize net antipsychotic benefits. Only use antipsychotics if the indication is clear; only continue antipsychotics if a benefit is discernible. If an antipsychotic is providing substantial benefit, and the adverse effect is not life-threatening, then the first management choice is to lower the dose or adjust the dosing schedule. The next option is to change the antipsychotic; this is often reasonable unless the risk of relapse is high. In some instances, behavioral interventions can be tried. Finally, concomitant medications, though generally not desirable, are necessary in many instances and can provide considerable relief. Among concomitant medication strategies, anticholinergic medications for dystonias and parkinsonism are often effective; beta-blockers and anticholinergic medications are useful for akathisia; and metformin may lead to slight to moderate weight loss. Anticholinergic drops applied sublingually reduce sialorrhea. Usual medications are effective for constipation or dyslipidemias. The clinical utility of recently approved treatments for tardive dyskinesia, valbenazine and deutetrabenazine, is unclear.
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Affiliation(s)
- T Scott Stroup
- New York State Psychiatric Institute, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Neil Gray
- Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
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165
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Waugh A, Crumlish N, Kelleher E, Forde C, Broderick J. A feasibility study of a physiotherapy-led motivational programme to increase physical activity and improve cardiometabolic risk in people with major mental illness. Gen Hosp Psychiatry 2018; 54:37-44. [PMID: 29678276 DOI: 10.1016/j.genhosppsych.2018.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/02/2018] [Accepted: 03/05/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Alice Waugh
- Department of Physiotherapy, St. James's Hospital, Dublin 8, Ireland.
| | - Niall Crumlish
- Department of Psychiatry, St. James's Hospital, Dublin 8, Ireland
| | - Eric Kelleher
- Department of Psychiatry, St. James's Hospital, Dublin 8, Ireland; Trinity College, The University of Dublin, Ireland
| | - Cuisle Forde
- Discipline of Physiotherapy, Trinity College, The University of Dublin, Ireland
| | - Julie Broderick
- Discipline of Physiotherapy, Trinity College, The University of Dublin, Ireland
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166
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Cardio-metabolic risk and its management in a cohort of clozapine-treated outpatients. Schizophr Res 2018; 199:367-373. [PMID: 29486959 DOI: 10.1016/j.schres.2018.02.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/13/2017] [Accepted: 02/19/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To comprehensively assess cardio-metabolic risk factors and their management in a large sample of outpatients treated with clozapine. METHODS Observational cross-sectional study of all clozapine users attending specialized clozapine monitoring outpatient clinics in three public hospitals in Sydney, Australia were approached to participate over the one-year period 01/10/2015-30/09/2016. Cardio-metabolic risk factors including metabolic syndrome, risk for future development of diabetes, smoking, physical activity, nutrition, and prescribed medications were assessed at face-to-face interview and through medical record review. Among patients who had cardio-metabolic risk factors, the proportion receiving appropriate management was assessed. RESULTS Of 451 registered clozapine clinic attenders, 92.2% completed questionnaires and anthropometric measurements. 58.3% met criteria for metabolic syndrome. 79.6% were overweight or obese. 55.9% had blood pressure meeting metabolic syndrome criteria. 46.6% had elevated fasting blood glucose and 55.2% had elevated blood triglycerides. 43.6% were current smokers. Only 10% achieved recommended weekly physical activity levels. Unhealthy food categories were highly consumed. 32.1% were on additional antipsychotics. In the majority of individuals, cardio-metabolic risk factors were untreated or under-treated. CONCLUSIONS Clozapine use was associated with very high rates of cardiovascular and metabolic risk factors, which were frequently under-treated. Management of both physical and mental health should be prioritized. Polypharmacy should be rationalized. Future research should investigate the effectiveness of smoking cessation and lifestyle interventions in this high-risk population.
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167
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Brown C, Geiszler LC, Lewis KJ, Arbesman M. Effectiveness of Interventions for Weight Loss for People With Serious Mental Illness: A Systematic Review and Meta-Analysis. Am J Occup Ther 2018; 72:7205190030p1-7205190030p9. [PMID: 30157007 DOI: 10.5014/ajot.2018.033415] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE We examined the effectiveness of weight loss interventions in community-based settings for people with serious mental illness (SMI). METHOD Four databases were searched for randomized controlled trials published in 2008 or later that met the criteria for the research question and used weight loss as an outcome measure. Data were extracted, and weight loss was analyzed using a meta-analysis. Similarities and differences in interventions were analyzed qualitatively. RESULTS Seventeen studies and a total of 1,874 participants with various diagnoses of SMI were included in the meta-analysis. The various lifestyle-focused interventions had a significant effect on weight loss with an overall effect size of -0.308 (p < .001). CONCLUSION Community-based interventions for people with SMI are effective for weight loss. Occupational therapists can be involved in the provision of weight loss interventions and in the development and study of intervention components that are most effective.
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Affiliation(s)
- Catana Brown
- Catana Brown, PhD, OTR/L, FAOTA, is Professor, Midwestern University-Glendale, Glendale, AZ;
| | - Lydia C Geiszler
- Lydia C. Geiszler, MOT, OTR/L, is Occupational Therapist, Mayo Clinic Hospital, Saint Mary's Campus, Rochester, MN
| | - Kelsie J Lewis
- Kelsie J. Lewis, MOT, OTR/L, is Occupational Therapist, Carondelet St. Mary's, Tucson, AZ
| | - Marian Arbesman
- Marian Arbesman, PhD, OTR/L, FAOTA, is Adjunct Associate Professor, Department of Clinical Research and Leadership, George Washington University School of Medicine and Health Sciences, Washington, DC, and President, ArbesIdeas, Inc., Williamsville, NY
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Abstract
PURPOSE OF REVIEW Mental and addictive disorders commonly co-occur with medical comorbidities, resulting in poor health and functioning, and premature mortality. This review provides an overview of the intertwined causal pathways and shared risk factors that lead to comorbidity. Additionally, this review examines the strategies to prevent the onset of and to effectively manage chronic medical conditions among people with mental and addictive disorders. RECENT FINDINGS Recent research provides further evidence for the shared genetic and biological, behavioral, and environmental risk factors for comorbidity. Additionally, there is evidence of effective approaches for screening, self-management, and treatment of medical conditions among people with mental disorders. There are promising health system models of integrated care, but additional research is needed to fully establish their effectiveness. A combination of public health and clinical approaches are needed to better understand and address comorbidity between mental and addictive disorders and chronic medical conditions.
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Affiliation(s)
- Elizabeth Reisinger Walker
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Ave, Atlanta, GA, 30322, USA.
| | - Benjamin G Druss
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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169
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Jormfeldt H, Carlsson IM. Equine-Assisted Therapeutic Interventions Among Individuals Diagnosed With Schizophrenia. A Systematic Review. Issues Ment Health Nurs 2018; 39:647-656. [PMID: 29509053 DOI: 10.1080/01612840.2018.1440450] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Persons diagnosed with schizophrenia are not sufficiently offered health promotion interventions, notwithstanding their increased risk of bodily ill health. Physical activity is found to improve health and decrease psychiatric symptoms although, there is a challenge to motivate and increase physical activity in people with schizophrenia and innovative evidence-based treatment interventions are needed. The aim was to systematically review studies concerning equine assisted interventions among individuals diagnosed with schizophrenia. The findings of the six included articles indicate that therapeutic equine assisted interventions could be beneficial for individuals with severe mental illness such as schizophrenia or schizophrenia like disorders.
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Affiliation(s)
- Henrika Jormfeldt
- a School of Health and welfare , Halmstad University , Halmstad , Sweden
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Srivastava G, Johnson ED, Earle RL, Kadambi N, Pazin DE, Kaplan LM. Underdocumentation of Obesity by Medical Residents Highlights Challenges to Effective Obesity Care. Obesity (Silver Spring) 2018; 26:1277-1284. [PMID: 29956489 DOI: 10.1002/oby.22219] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 05/08/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The goal of this study was to determine attitudes and practices of physicians in training with respect to the evaluation and treatment of obesity. METHODS Resident-generated admission and discharge notes of all 1,765 general medicine hospital admissions during 4 nonconsecutive months were analyzed, and any references to weight, obesity, BMI, adiposity, and body fat were identified. The full general resident cohort was then surveyed for perceptions and behaviors related to obesity. RESULTS Obesity was considered a highly important medical issue by 98.5% of residents; 90% correctly identified a class II obesity Stunkard phenotype, and 80% accurately calculated a BMI given height and weight in metric units. Residents overestimated inpatient obesity prevalence (estimate = 75%; actual = 35%) and the rate of obesity recording in the hospital admission note (estimate = 94%; actual = 49.5%). A BMI or current weight in the admission note or discharge summary was reported in none of the 1,765 patient records, and only 6% of the patients with obesity had obesity noted in either the inpatient admission or discharge assessment or plan. CONCLUSIONS Though residents recognize obesity and its clinical implications, it is underreported in the assessment of inpatients. This low level of documenting obesity and its impact on clinical care planning underscores a missed opportunity to establish appropriate referrals and initiate treatment at a clinically opportune time.
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Affiliation(s)
- Gitanjali Srivastava
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Erica D Johnson
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rebecca L Earle
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nitya Kadambi
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dorothy E Pazin
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lee M Kaplan
- Obesity, Metabolism and Nutrition Institute, Gastrointestinal Unit and MGH Weight Center, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
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171
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Mocking RJT, Assies J, Ruhé HG, Schene AH. Focus on fatty acids in the neurometabolic pathophysiology of psychiatric disorders. J Inherit Metab Dis 2018. [PMID: 29524021 DOI: 10.1007/s10545-018-0158-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Continuous research into the pathophysiology of psychiatric disorders, such as major depressive disorder (MDD), posttraumatic stress disorder (PTSD), and schizophrenia, suggests an important role for metabolism. This narrative review will provide an up-to-date summary of how metabolism is thought to be involved in the pathophysiology of these psychiatric disorders. We will focus on (I) the important role of fatty acids in these metabolic alterations, (II) whether fatty acid alterations represent epiphenomena or risk factors, and (III) similarities and dissociations in fatty acid alterations between different psychiatric disorders. (Historical) epidemiological evidence links fatty acid intake to psychiatric disorder prevalence, corroborated by altered fatty acid concentrations measured in psychiatric patients. These fatty acid alterations are connected with other concomitant pathophysiological mechanisms, including biological stress (hypothalamic-pituitary-adrenal (HPA)-axis and oxidative stress), inflammation, and brain network structure and function. Metabolomics and lipidomics studies are underway to more deeply investigate this complex network of associated neurometabolic alterations. Supplementation of fatty acids as disease-modifying nutraceuticals has clinical potential, particularly add-on eicosapentaenoic acid (EPA) in depressed patients with markers of increased inflammation. However, by interpreting the observed fatty acid alterations as partly (mal)adaptive phenomena, we attempt to nuance translational expectations and provide new clinical applications for these novel neurometabolic insights, e.g., to predict treatment response or depression recurrence. In conclusion, placing fatty acids in context can contribute to further understanding and optimized treatment of psychiatric disorders, in order to diminish their overwhelming burden of disease.
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Affiliation(s)
- R J T Mocking
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, Amsterdam, 1105 AZ, The Netherlands.
| | - J Assies
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, Amsterdam, 1105 AZ, The Netherlands
| | - H G Ruhé
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, Amsterdam, 1105 AZ, The Netherlands
- Warneford Hospital, Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A H Schene
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 5, Amsterdam, 1105 AZ, The Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, the Netherlands
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172
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Janney CA, Greenberg JM, Moin T, Kim HM, Holleman RG, Hughes M, Damschroder LJ, Richardson CR, Young AS, Steinle N. Does mental health influence weight loss in adults with prediabetes? Findings from the VA Diabetes Prevention Program. Gen Hosp Psychiatry 2018; 53:32-37. [PMID: 29729586 DOI: 10.1016/j.genhosppsych.2018.04.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Mental illness may impact outcomes from structured behavioral weight loss interventions. This secondary analysis investigated the influence of mental health on weight loss among Veterans with prediabetes enrolled in either an in-person diabetes prevention program (DPP) or the usual care weight management program (MOVE!) designed to help patients achieve weight loss through changes in physical activity and diet. METHODS Prediabetes was defined by Hemoglobin A1c between 5.7 and 6.4% or Fasting Plasma Glucose 100-125 mg/dL and no use of antiglycemic medications during the past six months. Veterans Health Administrative data were used to assign Veterans into one of three mental health diagnoses: severe mental illness (SMI), affective disorder (AD) without SMI, or No SMI/No AD. The influence of mental health on weight changes at 6 and 12 months was modeled using linear mixed-effects regression. RESULTS On average, Veterans with prediabetes (n = 386) were 59 years old (SD = 10.0 years), with a BMI of 34.8 kg/m2 (SD = 5.3 kg/m2) and A1c of 6.0% (SD = 0.2%). The sample consisted of 12% (n = 47), 39% (n = 150), and 49% (n = 189) diagnosed with SMI, AD and No SMI/No AD, respectively. Across interventions, Veterans with SMI lost less weight than those with AD or No SMI/No AD. From baseline to 6 months, weight loss was significantly less for Veterans with SMI (1.53 kg) compared to Veterans with AD (3.85 kg) or No SMI/No AD (3.73 kg). This weight loss trend by mental health diagnosis continued from baseline to 12 months but was no longer statistically significant at 12 months. CONCLUSION Weight loss was not clinically or statistically different among Veterans with prediabetes diagnosed with AD or No SMI/No AD. However, Veterans diagnosed with SMI exhibited less weight loss over 6 months than Veterans with AD or No SMI/No AD and though not statistically significant, the trend continued to 12 months, suggesting that SMI may influence weight loss outcomes.
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Affiliation(s)
- Carol A Janney
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States; Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine - Midland Regional Campus 4611 Campus Ridge Drive, Midland, MI 48670, United States.
| | - Jared M Greenberg
- VA Greater Los Angeles Health Care System and David Geffen School of Medicine at UCLA, United States
| | - Tannaz Moin
- VA Greater Los Angeles Health Care System and David Geffen School of Medicine at UCLA, United States
| | - Hyungjin Myra Kim
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States; Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, United States
| | - Robert G Holleman
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Maria Hughes
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Laura J Damschroder
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Caroline R Richardson
- Department of Family Medicine, University of Michigan School of Medicine, Ann Arbor, MI, United States
| | - Alexander S Young
- VA Greater Los Angeles Health Care System and David Geffen School of Medicine at UCLA, United States
| | - Nanette Steinle
- University of Maryland Baltimore, School of Medicine and the Maryland VA Health Care System, United States
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173
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Gastala NM, Wingrove PM, Gaglioti AH, Liaw W, Bazemore A. The Growing Trend of Health Coaches in Team-Based Primary Care Training A Multicenter Pilot Study. Fam Med 2018; 50:526-530. [PMID: 30005115 PMCID: PMC6378695 DOI: 10.22454/fammed.2018.459897] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Team-based care with health coaches has improved the quality and cost effectiveness of chronic disease management and prevention. Clinical health coaches partner with patients to identify health goals, create action plans, overcome barriers to change, reinforce physician recommendations, and coordinate care. It is important to train resident physicians to practice in team-based settings. To date, there have been no studies of resident family physician exposure to health coaches. METHODS We surveyed 465 residency directors through a larger omnibus survey sent out by CERA; the response rate was 53.7%. Directors were asked about resident exposure to health coaches, the types of patients seen by health coaches, and the training background of the health coaches. We used chi-square tests to examine the relationship among these variables and program characteristics including status as a patient-centered medical home. RESULTS Almost two-thirds of the programs reported at least some residents had exposure to health coaches. Residents who trained in continuity sites with a PCMH certification of level 3 were more likely to have any exposure to health coaches (P<.05). There were multiple significant relationships between populations of patients seen and the training background of health coaches. CONCLUSIONS To improve quality, reduce costs, and become more patient centered, primary care is rapidly transforming into a team sport with a broadening roster of new players, including health coaches. This study documents positive rates of resident exposure to health coaches but also great variability in types and amount of exposure that merit further investigation and exploration of ways to grow family medicine residency contact with a diversifying practice team.
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Affiliation(s)
- Nicole M Gastala
- University of Illinois Health Mile Square Community Health Center, Chicago, IL
| | | | - Anne H Gaglioti
- National Center for Primary Care-Morehouse school of Medicine, Atlanta, GA
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174
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Abstract
BACKGROUND Cardiorespiratory fitness (CRF) among people with severe mental illness (SMI) (i.e., schizophrenia, bipolar disorder, and major depressive disorder) is a critical clinical risk factor given its relationship to cardiovascular disease and premature mortality. OBJECTIVES This study aimed to: (1) investigate the mean CRF in people with SMI versus healthy controls; (2) explore moderators of CRF; and (3) investigate whether CRF improved with exercise interventions and establish if fitness improves more than body mass index following exercise interventions. METHODS Major electronic databases were searched systematically. A meta-analysis calculating Hedges' g statistic was undertaken. RESULTS Across 23 eligible studies, pooled mean CRF was 28.7 mL/kg/min [95 % confidence interval (CI) 27.3 to 30.0 mL/kg/min, p < 0.001, n = 980]. People with SMI had significantly lower CRF compared with controls (n = 310) (Hedges' g = -1.01, 95 % CI -1.18 to -0.85, p < 0.001). There were no differences between diagnostic subgroups. In a multivariate regression, first-episode (β = 6.6, 95 % CI 0.6-12.6) and inpatient (β = 5.3, 95 % CI 1.6-9.0) status were significant predictors of higher CRF. Exercise improved CRF (Hedges' g = 0.33, 95 % CI = 0.21-0.45, p = 0.001), but did not reduce body mass index. Higher CRF improvements were observed following interventions at high intensity, with higher frequency (at least three times per week) and supervised by qualified personnel (i.e., physiotherapists and exercise physiologists). CONCLUSION The multidisciplinary treatment of people with SMI should include a focus on improving fitness to reduce all-cause mortality. Qualified healthcare professionals supporting people with SMI in maintaining an active lifestyle should be included as part of multidisciplinary teams in mental health treatment.
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175
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Hyun HS, Kim Y. Associations between working environment and weight control efforts among workers with obesity in Korea. J Int Med Res 2018; 46:2307-2316. [PMID: 29623760 PMCID: PMC6023066 DOI: 10.1177/0300060518764212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 02/16/2018] [Indexed: 11/22/2022] Open
Abstract
Objective The aim of this study was to investigate the relationship between working environment and weight control efforts among obese workers in Korea. Methods This study was based on the 2011 3rd Korean Working Conditions Survey, which was conducted on workers aged 15 years or older. A sample of 484 obese workers was included in the study. Multivariable logistic regression analysis was used to investigate the relationship between working environment and weight control efforts after controlling for individual variables. Adjusted odds ratios (ORs) and 95% confidence intervals were calculated. Results Of the participants, 63.4% reported that they made efforts to control their weight. After controlling for personal factors, the OR of weight control efforts for individuals working 40-49 hours per week was 2.4 times that for individuals working 60 hours or more per week. The OR of regular employment workers was 2.2 times that of non-regular workers. Conclusion We established that working hours and employment type were significantly related to weight control efforts. Therefore, we recommend that working conditions should be considered in designing effective workplace health promotion programs.
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Affiliation(s)
- Hye Sun Hyun
- Department of Nursing, Sangmyung University, Cheonan, Republic of Korea
| | - Yunyoung Kim
- Department of Nursing, Andong National University, Andong, Republic of Korea
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176
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Whicher CA, Price HC, Holt RIG. Mechanisms in endocrinology: Antipsychotic medication and type 2 diabetes and impaired glucose regulation. Eur J Endocrinol 2018; 178:R245-R258. [PMID: 29559497 DOI: 10.1530/eje-18-0022] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/15/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE There have been concerns about the effects of antipsychotics on weight gain and the development of type 2 diabetes (T2DM). This article aims to provide an up-to-date review on the evidence addressing this issue and the practical implications for the management of people taking antipsychotics in the context of T2DM. METHODS We carried out searches on MEDLINE/PUBMED and the ClinicalTrials.gov website in August 2017 using the terms 'antipsychotic' and 'diabetes' or 'glucose' citing articles published after 2006 preferentially. RESULTS Antipsychotics are associated with T2DM and are likely to exert a causal effect of uncertain magnitude. Children and adolescents appear especially vulnerable to these metabolic effects; as T2DM is not common in healthy younger people, the relative risk is more apparent. Antipsychotics act on glucose and insulin homeostasis in a variety of direct and indirect mechanisms. To reduce the increasing health inequalities among individuals with mental illness screening, monitoring and prevention of T2DM is important, as is improved diabetes care in this population. CONCLUSION It remains unclear whether these antipsychotic medications exacerbate an underlying predisposition to the development of T2DM or have a direct effect. Potential risks need to be weighed up and balanced between improved and lasting mental health benefits and any detrimental physical health side effects. Achieving parity of esteem between mental and physical health is a worldwide priority if we wish to improve life expectancy and quality of life in people with severe mental illness.
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Affiliation(s)
- Clare A Whicher
- Research and Development Department, Tom Rudd Unit, Moorgreen Hospital, Southampton, UK
| | - Hermione C Price
- Research and Development Department, Tom Rudd Unit, Moorgreen Hospital, Southampton, UK
| | - Richard I G Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
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177
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Rosenbaum S, Hobson-Powell A, Davison K, Stanton R, Craft LL, Duncan M, Elliot C, Ward PB. The Role of Sport, Exercise, and Physical Activity in Closing the Life Expectancy Gap for People with Mental Illness: An International Consensus Statement by Exercise and Sports Science Australia, American College of Sports Medicine, British Association of Sport and Exercise Science, and Sport and Exercise Science New Zealand. TRANSLATIONAL JOURNAL OF THE AMERICAN COLLEGE OF SPORTS MEDICINE 2018. [DOI: 10.1249/tjx.0000000000000061] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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178
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Lin CH, Lin SC, Huang YH, Wang FC, Huang CJ. Early prediction of olanzapine-induced weight gain for schizophrenia patients. Psychiatry Res 2018; 263:207-211. [PMID: 29574355 DOI: 10.1016/j.psychres.2018.02.058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 12/24/2017] [Accepted: 02/28/2018] [Indexed: 01/19/2023]
Abstract
The aim of this study was to determine whether weight changes at week 2 or other factors predicted weight gain at week 6 for schizophrenia patients receiving olanzapine. This study was the secondary analysis of a six-week trial for 94 patients receiving olanzapine (5 mg/d) plus trifluoperazine (5 mg/d), or olanzapine (10 mg/d) alone. Patients were included in analysis only if they had completed the 6-week trial (per protocol analysis). Weight gain was defined as a 7% or greater increase of the patient's baseline weight. The receiver operating characteristic curve was employed to determine the optimal cutoff points of statistically significant predictors. Eleven of the 67 patients completing the 6-week trial were classified as weight gainers. Weight change at week 2 was the statistically significant predictor for ultimate weight gain at week 6. A weight change of 1.0 kg at week 2 appeared to be the optimal cutoff point, with a sensitivity of 0.92, a specificity of 0.75, and an AUC of 0.85. Using weight change at week 2 to predict weight gain at week 6 is favorable in terms of both specificity and sensitivity. Weight change of 1.0 kg or more at 2 weeks is a reliable predictor.
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Affiliation(s)
- Ching-Hua Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Chi Lin
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Yu-Hui Huang
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Fu-Chiang Wang
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Chun-Jen Huang
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Psychiatry, Kaohsiung Medical University Hospital, Taiwan.
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179
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Romain AJ. An ounce of prevention outweighs kilograms of weight loss. Psychiatry Res 2018; 262:341-342. [PMID: 28602474 DOI: 10.1016/j.psychres.2017.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 03/09/2017] [Accepted: 06/04/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Ahmed Jérôem Romain
- University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada H2X 0A9.
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180
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O'Hara K, Stefancic A, Cabassa LJ. Developing a peer-based healthy lifestyle program for people with serious mental illness in supportive housing. Transl Behav Med 2018; 7:793-803. [PMID: 28155109 DOI: 10.1007/s13142-016-0457-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Overweight and obesity disproportionally impact people with serious mental illness (SMI). Healthy lifestyle interventions can improve the health of people with SMI but may need to be adapted for this population. The aims of this study were: to (1) examine the feasibility and acceptability of delivering the Peer-based Group Lifestyle Balance (PGLB) intervention and (2) describe intervention adaptations for people with SMI in supportive housing. Peer specialists and social workers co-facilitated 12 weekly PGLB sessions for 14 supportive housing clients. We conducted structured interviews and collected qualitative data through field notes and two focus groups. Frequencies and measures of central tendencies were used to describe participant characteristics and PGLB feasibility and acceptability measures. Qualitative data was analyzed using directed content analysis. Participants on average attended 8 of 12 sessions, and reported that services were satisfactory and helpful. Intervention adaptations, ongoing throughout the study, focused on adding peer-specialists as co-facilitators, increasing individualized support and developing strategies to address socioeconomic barriers impacting participants' ability to engage in healthy lifestyle changes. Study findings suggest that participants with SMI in supportive housing perceived PGLB as feasible and acceptable. Expanding the relevance and reach of peer-based healthy lifestyle interventions in community settings serving people with SMI requires careful adaptations to the socioeconomic realities of this population and the complexities of living with co-morbid health and mental health conditions.
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Affiliation(s)
- Kathleen O'Hara
- Columbia University School of Social Work, 1255 Amsterdam Ave, New York, NY, 10027, USA
| | - Ana Stefancic
- Columbia University School of Social Work, 1255 Amsterdam Ave, New York, NY, 10027, USA
| | - Leopoldo J Cabassa
- Columbia University School of Social Work, 1255 Amsterdam Ave, New York, NY, 10027, USA.
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Naslund JA, Aschbrenner KA, Marsch LA, McHugo GJ, Bartels SJ. Facebook for Supporting a Lifestyle Intervention for People with Major Depressive Disorder, Bipolar Disorder, and Schizophrenia: an Exploratory Study. Psychiatr Q 2018; 89:81-94. [PMID: 28470468 PMCID: PMC5758428 DOI: 10.1007/s11126-017-9512-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
To examine whether Facebook could support a community-based group lifestyle intervention for adults with serious mental illness. Participants with serious mental illness and obesity enrolled in a 6-month group lifestyle program were invited to join a secret Facebook group to support their weight loss and physical activity goals. Two peer co-facilitators moderated the Facebook group. The proportion of participants who achieved ≥5% weight loss or improved fitness was measured at follow-up. The relationship between this outcome and participants' interactions in the Facebook group was examined. Interactions were defined as active contributions including posts, comments, or likes. Content of participants' Facebook posts was also explored. Participants (n = 25) had major depression (44%), bipolar disorder (36%), and schizophrenia (20%). Nineteen (76%) participants joined the Facebook group, and contributed 208 interactions (70 posts; 81 comments; 57 likes). Participants who achieved ≥5% weight loss or improved fitness contributed more interactions in the Facebook group (mean = 19.1; SD = 20.5) compared to participants who did not (mean = 3.9; SD = 6.7), though this relationship approached statistical significance (t = -2.1; Welch's df = 13.1; p = 0.06). Participants' posts containing personal sharing of successes or challenges to adopting healthy behaviors generated more interaction compared to posts containing program reminders (p < 0.01), motivational messages (p < 0.01), and healthy eating content (p < 0.01). Facebook appears promising for supporting health behavior change among people with serious mental illness. These findings can inform social media initiatives to scale up health promotion efforts targeting this at-risk group.
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Affiliation(s)
- John A Naslund
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA.
- Health Promotion Research Center at Dartmouth, Lebanon, NH, USA.
- The Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, USA.
| | - Kelly A Aschbrenner
- Health Promotion Research Center at Dartmouth, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Lisa A Marsch
- The Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Gregory J McHugo
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Stephen J Bartels
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
- Health Promotion Research Center at Dartmouth, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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Sugawara N, Sagae T, Yasui-Furukori N, Yamazaki M, Shimoda K, Mori T, Sugai T, Matsuda H, Suzuki Y, Ozeki Y, Okamoto K, Someya T. Effects of nutritional education on weight change and metabolic abnormalities among patients with schizophrenia in Japan: A randomized controlled trial. J Psychiatr Res 2018; 97:77-83. [PMID: 29220825 DOI: 10.1016/j.jpsychires.2017.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/24/2017] [Accepted: 12/01/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Patients with schizophrenia have a higher prevalence of metabolic syndrome (MetS) than the general population. Minimizing weight gain and metabolic abnormalities in a population with an already high prevalence of obesity is of clinical and social importance. This randomized controlled trial investigated the effect of monthly nutritional education on weight change and metabolic abnormalities among patients with schizophrenia in Japan. METHODS From July 2014 to December 2014, we recruited 265 obese patients who had a DSM-IV diagnosis of schizophrenia or schizoaffective disorder. Participants were randomly assigned to a standard care (A), doctor's weight loss advice (B), or an individual nutritional education group (C) for 12 months. The prevalence of MetS and body weight were measured at baseline and 12 months. RESULTS After the 12-month treatment, 189 patients were evaluated, and the prevalence of MetS based on the ATP III-A definition in groups A, B, and C was 68.9%, 67.2%, and 47.5%, respectively. Group C showed increased weight loss (3.2 ± 4.5 kg) over the 12-month study period, and the change in weight differed significantly from that of group A; additionally, 26.2% of the participants in group C lost 7% or more of their initial weight, compared with 8.2% of those in group A. CONCLUSION Individual nutrition education provided by a dietitian was highly successful in reducing obesity in patients with schizophrenia and could be the first choice to address both weight gain and metabolic abnormalities induced by antipsychotic medications.
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Affiliation(s)
- Norio Sugawara
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira City, Tokyo, 187-8551, Japan; Department of Neuropsychiatry, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki City, Aomori, 036-8562, Japan; Japanese Society of Clinical Neuropsychopharmacology, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan.
| | - Toyoaki Sagae
- Department of Health and Nutrition, Yamagata Prefectural Yonezawa University of Nutrition Sciences, 6-15-1 Torimachi, Yonezawa City, Yamagata, 992-0025, Japan; Japan Psychiatric Dietetic Association, 4-11-11 Komone, Itabashi-ku, Tokyo, 173-0037, Japan
| | - Norio Yasui-Furukori
- Department of Neuropsychiatry, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki City, Aomori, 036-8562, Japan; Japanese Society of Clinical Neuropsychopharmacology, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan
| | - Manabu Yamazaki
- Japan Psychiatric Hospital Association, 3-15-14 Shibaura, Minato-ku, Tokyo, 108-8554, Japan
| | - Kazutaka Shimoda
- Japanese Society of Clinical Neuropsychopharmacology, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan; Department of Psychiatry, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Takao Mori
- Japan Psychiatric Hospital Association, 3-15-14 Shibaura, Minato-ku, Tokyo, 108-8554, Japan
| | - Takuro Sugai
- Japanese Society of Clinical Neuropsychopharmacology, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan; Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Hiroshi Matsuda
- Japan Psychiatric Hospital Association, 3-15-14 Shibaura, Minato-ku, Tokyo, 108-8554, Japan
| | - Yutaro Suzuki
- Japanese Society of Clinical Neuropsychopharmacology, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan; Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Yuji Ozeki
- Japanese Society of Clinical Neuropsychopharmacology, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan; Department of Psychiatry, Dokkyo Medical University School of Medicine, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Kurefu Okamoto
- Japan Psychiatric Hospital Association, 3-15-14 Shibaura, Minato-ku, Tokyo, 108-8554, Japan
| | - Toshiyuki Someya
- Japanese Society of Clinical Neuropsychopharmacology, 2 Sanbancho, Chiyoda-ku, Tokyo, 102-0075, Japan; Department of Psychiatry, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510, Japan
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183
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Mezquida G, Savulich G, Garcia-Rizo C, Garcia-Portilla MP, Toll A, Garcia-Alvarez L, Bobes J, Mané A, Bernardo M, Fernandez-Egea E. Inverse association between negative symptoms and body mass index in chronic schizophrenia. Schizophr Res 2018; 192:69-74. [PMID: 28412089 DOI: 10.1016/j.schres.2017.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 03/15/2017] [Accepted: 04/01/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND We investigated whether negative symptoms, such as poor motivation or anhedonia, were associated with higher body mass index (BMI) in stable patients with schizophrenia chronically treated with antipsychotic medication. METHODS 62 olanzapine- or clozapine-treated patients with illness duration of at least four years were selected from an international multicenter study on the characterization of negative symptoms. All participants completed the Brief Negative Symptom Scale (BNSS) and the Positive and Negative Syndrome Scale (PANSS). Bivariate correlations between BMI and negative symptoms (BNSS) were explored, as well as multiple regression analyses. We further explored the association of two principal component factors of the BNSS and BMI. Subsidiary analyses re-modeled the above using the negative symptoms subscale of the PANSS and the EMSLEY factor for negative symptoms for convergent validity. RESULTS Lower negative symptoms (BNSS score) were associated with higher BMI (r=-0.31; p=0.015). A multiple regression analysis showed that negative symptoms (BNSS score) and age were significant predictors of BMI (p=0.037). This was mostly driven by the motivation/pleasure factor of the BNSS. Within this second factor, BMI was negatively associated with anhedonia (r=-0.254; p=0.046) and asociality (r=-0.253; p=0.048), but not avolition (r=-0.169; p=0.188). EMSLEY score was positively associated with BNSS (r=0.873, p<0.001), but negatively associated with BMI (r=-0.308; p=0.015). The association between PANSS and BMI did not reach significance (r=-224, p=0.080). CONCLUSIONS We conclude that lower negative symptoms were associated with higher BMI (assessed using both the BNSS and EMSLEY) in chronic stable schizophrenia patients, mostly due to lower anhedonia and asociality levels.
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Affiliation(s)
- G Mezquida
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Spain
| | - G Savulich
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, United Kingdom
| | - C Garcia-Rizo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - M P Garcia-Portilla
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Department of Psychiatry, University of Oviedo, Spain
| | - A Toll
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Institut de Neuropsiquiatria i Adiccions, Parc de Salut Mar, Barcelona, Spain; Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - L Garcia-Alvarez
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain
| | - J Bobes
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Department of Psychiatry, University of Oviedo, Spain
| | - A Mané
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Institut de Neuropsiquiatria i Adiccions, Parc de Salut Mar, Barcelona, Spain; Fundació Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - M Bernardo
- Barcelona Clinic Schizophrenia Unit, Neuroscience Institute, Hospital Clinic of Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Department of Medicine, University of Barcelona, Spain
| | - E Fernandez-Egea
- Department of Psychiatry and Behavioural and Clinical Neuroscience Institute, University of Cambridge, United Kingdom; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Spain; Cambridgeshire and Peterborough NHS Foundation Trust, United Kingdom.
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184
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An Economic Evaluation of a Weight Loss Intervention Program for People with Serious Mental Illnesses Taking Antipsychotic Medications. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 43:604-15. [PMID: 26149243 DOI: 10.1007/s10488-015-0669-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Individuals with serious mental illnesses suffer from obesity and cardiometabolic diseases at high rates, and antipsychotic medications exacerbate these conditions. While studies have shown weight loss and lifestyle interventions can be effective in this population, few have assessed intervention cost-effectiveness. We present results from a 12-month randomized controlled trial that reduced weight, fasting glucose, and medical hospitalizations in intervention participants. Costs per participant ranged from $4365 to $5687. Costs to reduce weight by one kilogram ranged from $1623 to $2114; costs to reduce fasting glucose by 1 mg/dL ranged from $467 to $608. Medical hospitalization costs were reduced by $137,500.
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185
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McGinty EE, Gudzune KA, Dalcin A, Jerome GJ, Dickerson F, Gennusa J, Goldsholl S, Young D, Daumit GL. Bringing an Effective Behavioral Weight Loss Intervention for People With Serious Mental Illness to Scale. Front Psychiatry 2018; 9:604. [PMID: 30515109 PMCID: PMC6256009 DOI: 10.3389/fpsyt.2018.00604] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/29/2018] [Indexed: 11/23/2022] Open
Abstract
People with serious mental illnesses (SMIs) die 10-20 years earlier than the general population, mainly due to cardiovascular disease. Obesity is a key driver of cardiovascular risk in this group. Because behavioral weight loss interventions tailored to the needs of people with SMI have been shown to lead to clinically significant weight loss, achieving widespread implementation of these interventions is a public health priority. In this Perspective, we consider strategies for scaling the ACHIEVE behavioral weight loss intervention for people with SMI, shown to be effective in a randomized clinical trial (RCT), to mental health programs in the U.S. and internationally. Given the barriers to high-fidelity implementation of the complex, multi-component ACHIEVE intervention in often under-resourced mental health programs, we posit that substantial additional work is needed to realize the full public health potential of this intervention for people with SMI. We discuss considerations for successful "scale-up," or efforts to expand ACHIEVE to similar settings and populations as those included in the RCT, and "scale-out," or efforts to expand the intervention to different mental health program settings/sub-populations with SMI. For both, we focus on considerations related (1) intervention adaptation and (2) implementation strategy development, highlighting four key domains of implementation strategies that we believe need to be developed and tested: staff capacity building, leadership engagement, organizational change, and policy strategies. We conclude with discussion of the types of future research needed to support ACHIEVE scale-up/out, including hybrid trial designs testing the effectiveness of intervention adaptations and/or implementations strategies.
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Affiliation(s)
- Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kimberly A Gudzune
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Arlene Dalcin
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Gerald J Jerome
- Department of Kinesiology, Towson University, Towson, MD, United States
| | | | - Joseph Gennusa
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Stacy Goldsholl
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Deborah Young
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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186
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Dalcin AT, Jerome GJ, Appel LJ, Dickerson FB, Wang NY, Miller ER, Young DR, Charleston JB, Gennusa JV, Goldsholl S, Heller A, Evins AE, Cather C, McGinty EE, Crum RM, Daumit GL. Need for Cardiovascular Risk Reduction in Persons With Serious Mental Illness: Design of a Comprehensive Intervention. Front Psychiatry 2018; 9:786. [PMID: 30800079 PMCID: PMC6375886 DOI: 10.3389/fpsyt.2018.00786] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 12/31/2018] [Indexed: 01/30/2023] Open
Abstract
Persons with serious mental illness (SMI) comprise a high-risk group for cardiovascular disease (CVD)-related mortality with rates at least twice those of the overall US. Potentially modifiable CVD risk behaviors (tobacco smoking, obesity, physical inactivity, unhealthy diet) and risk factors (hypertension, diabetes, dyslipidemia) are all markedly elevated in persons with SMI. Evaluations of programs implementing integrated medical care into specialty mental health settings have not shown meaningful effects on CVD risk factor reduction. Rigorously tested, innovative interventions are needed to address the large burden of CVD risk in populations with SMI. In this article, we describe the design of a comprehensive 18-month intervention to decrease CVD risk that we are studying in a randomized clinical trial in a community mental health organization with psychiatric rehabilitation programs. The individual-level intervention incorporated health behavior coaching and care coordination/care management to address all seven CVD risk behaviors and risk factors, and is delivered by a health coach and nurse. If successful, the intervention could be adopted within current integrated care models and significantly improve the physical health of persons with SMI.
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Affiliation(s)
- Arlene T Dalcin
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Gerald J Jerome
- Department of Kinesiology, Towson University, Baltimore, MD, United States
| | - Lawrence J Appel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Nae-Yuh Wang
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Edgar R Miller
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Deborah R Young
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jeanne B Charleston
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Joseph V Gennusa
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Stacy Goldsholl
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Ann Heller
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - A Eden Evins
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Corinne Cather
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Emma E McGinty
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Rosa M Crum
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Gail L Daumit
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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187
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Schmitt A, Maurus I, Rossner MJ, Röh A, Lembeck M, von Wilmsdorff M, Takahashi S, Rauchmann B, Keeser D, Hasan A, Malchow B, Falkai P. Effects of Aerobic Exercise on Metabolic Syndrome, Cardiorespiratory Fitness, and Symptoms in Schizophrenia Include Decreased Mortality. Front Psychiatry 2018; 9:690. [PMID: 30622486 PMCID: PMC6308154 DOI: 10.3389/fpsyt.2018.00690] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/27/2018] [Indexed: 12/25/2022] Open
Abstract
Schizophrenia is a severe psychiatric disorder with a lifetime prevalence of about 1%. People with schizophrenia have a 4-fold higher prevalence of metabolic syndrome than the general population, mainly because of antipsychotic treatment but perhaps also because of decreased physical activity. Metabolic syndrome is a risk factor for cardiovascular diseases, and the risk of these diseases is 2- to 3-fold higher in schizophrenia patients than in the general population. The suicide risk is also higher in schizophrenia, partly as a result of depression, positive, and cognitive symptoms of the disease. The higher suicide rate and higher rate of cardiac mortality, a consequence of the increased prevalance of cardiovascular diseases, contribute to the reduced life expectancy, which is up to 20 years lower than in the general population. Regular physical activity, especially in combination with psychosocial and dietary interventions, can improve parameters of the metabolic syndrome and cardiorespiratory fitness. Furthermore, aerobic exercise has been shown to improve cognitive deficits; total symptom severity, including positive and negative symptoms; depression; quality of life; and global functioning. High-intensity interval endurance training is a feasible and effective way to improve cardiorespiratory fitness and metabolic parameters and has been established as such in somatic disorders. It may have more beneficial effects on the metabolic state than more moderate and continuous endurance training methods, but to date it has not been investigated in schizophrenia patients in controlled, randomized trials. This review discusses physical training methods to improve cardiorespiratory fitness and reduce metabolic syndrome risk factors and symptoms in schizophrenia patients. The results of studies and future high-quality clinical trials are expected to lead to the development of an evidence-based physical training program for patients that includes practical recommendations, such as the optimal length and type of aerobic exercise programs and the ideal combination of exercise, psychoeducation, and individual weight management sessions.
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Affiliation(s)
- Andrea Schmitt
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Isabel Maurus
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Moritz J Rossner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Astrid Röh
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Moritz Lembeck
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Martina von Wilmsdorff
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Shun Takahashi
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Department of Neuropsychiatry, Wakayama Medical University, Wakayama, Japan
| | - Boris Rauchmann
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Keeser
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
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188
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Barber S, Thornicroft G. Reducing the Mortality Gap in People With Severe Mental Disorders: The Role of Lifestyle Psychosocial Interventions. Front Psychiatry 2018; 9:463. [PMID: 30323773 PMCID: PMC6172296 DOI: 10.3389/fpsyt.2018.00463] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/06/2018] [Indexed: 11/22/2022] Open
Abstract
This mini-review considers the mortality gap in persons with severe mental disorder (SMD) globally. Current estimates of 10-20 years of potential life lost may be too conservative, both in high (HIC) and low and middle-income countries (LMICs). There is an emerging consensus that natural causes account for the majority of deaths in persons with SMD in both resource settings. In HICs, cardiovascular causes predominate, and can be attributed to individual, health-system and societal level risk factors. Psychosocial lifestyle interventions target behavior specific risk factors for physical ill-health. There is good evidence for tailored weight-loss programmes, but mixed evidence for smoking cessation, substance misuse and risky sexual behavior. In terms of supporting persons with SMD, nurse-led services and the utilization of peer-support are showing promise. Future research efforts must focus on effective interventions and health system models for both high and low resource settings to address this startling health inequality.
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Affiliation(s)
- Sarah Barber
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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189
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Gaughran F, Stahl D, Ismail K, Greenwood K, Atakan Z, Gardner-Sood P, Stubbs B, Hopkins D, Patel A, Lally J, Lowe P, Arbuthnot M, Orr D, Corlett S, Eberhard J, David AS, Murray R, Smith S. Randomised control trial of the effectiveness of an integrated psychosocial health promotion intervention aimed at improving health and reducing substance use in established psychosis (IMPaCT). BMC Psychiatry 2017; 17:413. [PMID: 29284438 PMCID: PMC5745644 DOI: 10.1186/s12888-017-1571-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 12/05/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND People with psychosis have a reduced life expectancy of 10-20 years, largely due to cardiovascular disease. This trial aimed to determine the effectiveness of a modular health promotion intervention (IMPaCT Therapy) in improving health and reducing cardiovascular risk in psychosis. METHODS A multicentre, two arm, parallel cluster RCT was conducted across five UK mental health NHS trusts. Community care coordinators (CC) were randomly assigned to training and supervision in delivering IMPaCT Therapy or treatment as usual (TAU) to current patients with psychosis (cluster). The primary outcome was the physical and mental health subscales of the Short form-36 (SF-36) questionnaire. RESULTS Of 104 care coordinators recruited, 52 (with 213 patients) were randomised to deliver IMPaCT therapy and 52 (with 193 patients) randomised to TAU. Of 406 patients, 318 (78%) and 301 (74%) attended 12- and 15-month follow-up respectively. IMPaCT therapy showed no significant effect on the physical or mental health component SF-36 scores versus TAU at 12 or 15 months. No effect was observed for cardiovascular risk indicators, except for HDL cholesterol, which improved more with IMPACT therapy than TAU (Treatment effect (95% CI); 0.085 (0.007 to 0.16); p = 0.034). The 22% of patients who received >180 min of IMPACT Therapy in addition to usual care achieved a greater reduction in waist circumference than did controls, which was clinically significant. CONCLUSION Training and supervising community care coordinators to use IMPaCT therapy in patients with psychosis is insufficient to significantly improve physical or mental health quality of life. The search for effective, pragmatic interventions deliverable in health care services continues. TRIAL REGISTRATION The trial was retrospectively registered with ISRCTN registry on 23/4/2010 at ISRCTN58667926 ; recruitment started on 01/03/2010 with first randomization on 09.08.2010 ISRCTN58667926 .
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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 and Neuroscience, Kings College London, London, UK.
| | - Daniel Stahl
- 0000 0001 2322 6764grid.13097.3cBiostatistics Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Denmark Hill, London, UK
| | - Khalida Ismail
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Denmark Hill, London, UK
| | - Kathryn Greenwood
- 0000 0004 1936 7590grid.12082.39Sussex Partnership NHS Foundation Trust and School of Psychology, University of Sussex, Brighton, UK
| | - Zerrin Atakan
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Poonam Gardner-Sood
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Brendon Stubbs
- 0000 0001 2322 6764grid.13097.3cHealth Service and Population Research Department, Institute of Psychiatry, Kings College London, London, UK ,0000 0000 9439 0839grid.37640.36Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - David Hopkins
- Department of Diabetic Medicine, King’s College Hospital NHS Foundation Trust, King’s Health Partners, London, UK
| | - Anita Patel
- 0000 0001 2171 1133grid.4868.2Health Economics, Centre for Primary Care & Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - John Lally
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK ,0000 0000 9439 0839grid.37640.36National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Philippa Lowe
- Carer Expert and Chair of Trustees, Rethink Mental Illness, London, UK
| | | | | | - Sarah Corlett
- Interim Director of Public Health, London Borough Of Lambeth, London, UK
| | - Jonas Eberhard
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK ,0000 0001 0930 2361grid.4514.4Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anthony S. David
- 0000 0001 2322 6764grid.13097.3cInstitute of Psychiatry, Psychology and Neuroscience, Kings College London, Denmark Hill, London, UK
| | - Robin Murray
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Shubulade Smith
- 0000 0001 2322 6764grid.13097.3cDepartment of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Denmark Hill, London, UK ,0000 0000 9439 0839grid.37640.36Forensic Intensive Care Service, South London and Maudsley NHS Foundation Trust, London, UK
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190
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Randomised controlled trial to improve health and reduce substance use in established psychosis (IMPaCT): cost-effectiveness of integrated psychosocial health promotion. BMC Psychiatry 2017; 17:407. [PMID: 29273021 PMCID: PMC5741948 DOI: 10.1186/s12888-017-1570-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 12/05/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is mounting evidence that people with severe mental illness have unhealthy lifestyles, high rates of cardiovascular and metabolic diseases, and greater risk of early mortality. This study aimed to assess the cost-effectiveness of a health promotion intervention seeking to improve physical health and reduce substance use in people with psychosis. METHODS Participants with a psychotic disorder, aged 18-65 years old and registered on an enhanced care approach programme or equivalent were recruited from community mental health teams in six mental health trusts in England. Participants were randomisation to either standard community mental health team care (treatment as usual) or treatment as usual with an integrated health promotion intervention (IMPaCT). Cost-effectiveness and cost-utility analyses from health and social care and societal perspectives were conducted alongside a cluster randomised controlled trial. Total health and social care costs and total societal costs at 12 and 15 months were calculated as well as cost-effectiveness (incremental cost-effectiveness ratios and cost-effectiveness acceptability curves) at 15 months based on quality of life (SF-36 mental and physical health components, primary outcome measures) and quality adjusted life years (QALYs) using two measures, EQ-5D-3 L and SF-36. Data were analysed using bootstrapped regressions with covariates for relevant baseline variables. RESULTS At 12-15 months 301 participants had full data needed to be included in the economic evaluation. There were no differences in adjusted health and social care costs (£95, 95% CI -£1410 to £1599) or societal costs (£675, 95% CI -£1039 to £2388) between the intervention and control arms. Similarly, there were no differences between the groups in the SF-36 mental component (-0.80, 95% CI -3.66 to 2.06), SF-36 physical component (-0.68, 95% CI -3.01 to 1.65), QALYs estimated from the SF-36 (-0.00, -0.01 to 0.00) or QALYs estimated from the EQ-5D-3 L (0.00, 95% CI -0.01 to 0.02). Cost-effectiveness acceptability curves for all four outcomes and from both cost perspectives indicate that the probability of the health promotion intervention being cost-effective does not exceed 0.4 for willingness to pay thresholds ranging from £0-£50,000. CONCLUSIONS Alongside no evidence of additional quality of life/clinical benefit, there is also no evidence of cost-effectiveness. TRIAL REGISTRATION ISRCTN58667926 . Date retrospectively registered: 23/04/2010. Recruitment start date: 01/03/2010.
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191
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Watkins A, Rosenbaum S, Ward PB, Patching J, Denney-Wilson E, Stein-Parbury J. The Validity and Reliability Characteristics of the M-BACK Questionnaire to Assess the Barriers, Attitudes, Confidence, and Knowledge of Mental Health Staff Regarding Metabolic Health of Mental Health Service Users. Front Public Health 2017; 5:321. [PMID: 29312914 PMCID: PMC5732257 DOI: 10.3389/fpubh.2017.00321] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/14/2017] [Indexed: 12/22/2022] Open
Abstract
Background Addressing the burden of poor physical health and the subsequent gap in life expectancy experienced by people with mental illness is a major priority in mental health services. To equip mental health staff with the competence to deliver evidence-based interventions, targeted staff training regarding metabolic health is required. In order to evaluate the effectiveness of staff training regarding metabolic health, we aimed to develop a succinct measure to determine the barriers, attitudes, confidence, and knowledge of health practitioners through the development and test–retest reliability of the Metabolic-Barriers, Attitudes, Confidence, and Knowledge Questionnaire (M-BACK). Methods The M-BACK questionnaire was developed to evaluate the impact of specialized training in metabolic health care for mental health nurses. Content of the M-BACK was developed from a literature review and refined by an expert review panel and validated via a piloting process. To determine the test–retest reliability of the M-BACK, 31 nursing students recruited from the University of Notre Dame, Sydney completed the questionnaire on two separate occasions, 7 days apart. Intraclass correlation coefficients (ICCs) were calculated for the total score, as well as each of the four domains. Results Pilot testing was undertaken with a sample of 106 mental health nurses with a mean age 48.2, ranging from 24 to 63 years of age, who participated in six training courses. Questionnaire development resulted in a 16-item instrument, with each item is scored on a five-point Likert scale ranging from “strongly disagree” to “strongly agree.” Test–retest reliability of the M-BACK was completed by 30 of 31 nursing students recruited, ICCs ranged from 0.62 to 0.96. Conclusion The M-BACK is a reliable measure of the key elements of practitioner perceptions of barriers, and their knowledge, attitudes, and confidence regarding metabolic monitoring in people with mental illness. It can be used to assess the effectiveness of interventions aimed at increasing uptake of metabolic monitoring, a key component of programs to reduce the life expectancy gap in people living with severe mental illness.
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Affiliation(s)
- Andrew Watkins
- Keeping the Body in Mind Program, The Bondi Centre, South Eastern Sydney Local Health District, Sydney, NSW, Australia.,Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Simon Rosenbaum
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Philip B Ward
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia.,Schizophrenia Research Unit, Ingham Institute for Applied Medical Research, Liverpool, NSW, Australia
| | - Joanna Patching
- School of Nursing, University of Notre Dame, Sydney, NSW, Australia
| | | | - Jane Stein-Parbury
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
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192
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Nemani KL, Greene MC, Ulloa M, Vincenzi B, Copeland PM, Al-Khadari S, Henderson DC. Clozapine, Diabetes Mellitus, Cardiovascular Risk and Mortality: Results of a 21-Year Naturalistic Study in Patients with Schizophrenia and Schizoaffective Disorder. ACTA ACUST UNITED AC 2017; 12:168-176. [PMID: 29164928 DOI: 10.3371/csrp.knmg.111717] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The goal of this 21-year naturalistic study of clozapine-treated patients was to examine the cardiovascular risk factors following clozapine initiation and resultant mortality estimates from cardiovascular disease. Data were collected from January 1992 to February 2012 medical records from clozapine-treated patients with schizophrenia or schizoaffective disorder. Demographics, clozapine dosage and laboratory results were extracted at 12-month intervals. At clozapine initiation, the mean age of the 96 patients was 36.4 years±7.6 years; n=27 (28%) were women. The mean duration of clozapine use was 13 years. The Kaplan-Meier estimate for 21-year cardiovascular events was 29%, while the Kaplan-Meier estimate for 21-year mortality from cardiovascular disease was 10%. The mean cardiovascular risk increased during the first ten years (p<.01), while a slight decrease occurred beyond ten years (p<.01). Patients involved in cardiometabolic research showed a greater decrease in cardiovascular risk factors over 21 years (p=.05). The Kaplan-Meier estimate for 21-year all-cause mortality was 22%. Forty-one patients were diagnosed with diabetes (42.7%), compared to a nationwide prevalence of 13.7% in a similar age group. These results support the hypothesis that clozapine-treated patients are at risk for cardiovascular events and death secondary to an increased risk of medical disorders. Interventions that target weight loss, smoking cessation, and lipid profile improvement may alleviate the increased risk of cardiovascular mortality.
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193
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Mangurian C, Niu GC, Schillinger D, Newcomer JW, Dilley J, Handley MA. Utilization of the Behavior Change Wheel framework to develop a model to improve cardiometabolic screening for people with severe mental illness. Implement Sci 2017; 12:134. [PMID: 29137666 PMCID: PMC5686815 DOI: 10.1186/s13012-017-0663-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 11/01/2017] [Indexed: 12/21/2022] Open
Abstract
Background Individuals with severe mental illness (e.g., schizophrenia, bipolar disorder) die 10–25 years earlier than the general population, primarily from premature cardiovascular disease (CVD). Contributing factors are complex, but include systemic-related factors of poorly integrated primary care and mental health services. Although evidence-based models exist for integrating mental health care into primary care settings, the evidence base for integrating medical care into specialty mental health settings is limited. Such models are referred to as “reverse” integration. In this paper, we describe the application of an implementation science framework in designing a model to improve CVD outcomes for individuals with severe mental illness (SMI) who receive services in a community mental health setting. Methods Using principles from the theory of planned behavior, focus groups were conducted to understand stakeholder perspectives of barriers to CVD risk factor screening and treatment identify potential target behaviors. We then applied results to the overarching Behavior Change Wheel framework, a systematic and theory-driven approach that incorporates the COM-B model (capability, opportunity, motivation, and behavior), to build an intervention to improve CVD risk factor screening and treatment for people with SMI. Results Following a stepped approach from the Behavior Change Wheel framework, a model to deliver primary preventive care for people that use community mental health settings as their de facto health home was developed. The CRANIUM (cardiometabolic risk assessment and treatment through a novel integration model for underserved populations with mental illness) model focuses on engaging community psychiatrists to expand their scope of practice to become responsible for CVD risk, with significant clinical decision support. Conclusion The CRANIUM model was designed by integrating behavioral change theory and implementation theory. CRANIUM is feasible to implement, is highly acceptable to, and targets provider behavior change, and is replicable and efficient for helping to integrate primary preventive care services in community mental health settings. CRANIUM can be scaled up to increase CVD preventive care delivery and ultimately improve health outcomes among people with SMI served within a public mental health care system.
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Affiliation(s)
- Christina Mangurian
- Department of Psychiatry, Weill Institute for Neurosciences, UCSF at Zuckerberg San Francisco General (ZSFG), 1001 Potrero Avenue, 7M8, San Francisco, CA, 94110, USA. .,UCSF Center for Vulnerable Populations at ZSFG, San Francisco, CA, USA.
| | - Grace C Niu
- Department of Psychiatry, Weill Institute for Neurosciences, UCSF at Zuckerberg San Francisco General (ZSFG), 1001 Potrero Avenue, 7M8, San Francisco, CA, 94110, USA
| | - Dean Schillinger
- UCSF Center for Vulnerable Populations at ZSFG, San Francisco, CA, USA.,UCSF Department of Medicine, Division of General Internal Medicine at ZSFG, 1001 Potrero Avenue, 1320A, San Francisco, CA, 94110, USA
| | - John W Newcomer
- Department of Clinical Biomedical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, 777 Glades Road, BC-71 Rm 241, Boca Raton, FL, 33431, USA
| | - James Dilley
- Department of Psychiatry, Weill Institute for Neurosciences, UCSF at Zuckerberg San Francisco General (ZSFG), 1001 Potrero Avenue, 7M8, San Francisco, CA, 94110, USA
| | - Margaret A Handley
- UCSF Center for Vulnerable Populations at ZSFG, San Francisco, CA, USA.,UCSF Department of Medicine, Division of General Internal Medicine at ZSFG, 1001 Potrero Avenue, 1320A, San Francisco, CA, 94110, USA.,UCSF Department of Epidemiology and Biostatistics, 550 16th Street, San Francisco, CA, 64158, USA
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194
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Harvey AG, Dong L, Lee JY, Gumport NB, Hollon SD, Rabe-Hesketh S, Hein K, Haman K, McNamara ME, Weaver C, Martinez A, Notsu H, Zieve G, Armstrong CC. Can integrating the Memory Support Intervention into cognitive therapy improve depression outcome? Study protocol for a randomized controlled trial. Trials 2017; 18:539. [PMID: 29137655 PMCID: PMC5686897 DOI: 10.1186/s13063-017-2276-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/23/2017] [Indexed: 02/03/2023] Open
Abstract
Background The Memory Support Intervention was developed in response to evidence showing that: (1) patient memory for treatment is poor, (2) poor memory for treatment is associated with poorer adherence and poorer outcome, (3) the impact of memory impairment can be minimized by the use of memory support strategies and (4) improved memory for treatment improves outcome. The aim of this study protocol is to conduct a confirmatory efficacy trial to test whether the Memory Support Intervention improves illness course and functional outcomes. As a “platform” for the next step in investigating this approach, we focus on major depressive disorder (MDD) and cognitive therapy (CT). Method/design Adults with MDD (n = 178, including 20% for potential attrition) will be randomly allocated to CT + Memory Support or CT-as-usual and will be assessed at baseline, post treatment and at 6 and 12 months’ follow-up (6FU and 12FU). We will compare the effects of CT + Memory Support vs. CT-as-usual to determine if the new intervention improves the course of illness and reduces functional impairment (aim 1). We will determine if patient memory for treatment mediates the relationship between treatment condition and outcome (aim 2). We will evaluate if previously reported poor treatment response subgroups moderate target engagement (aim 3). Discussion The Memory Support Intervention has been developed to be “transdiagnostic” (relevant to a broad range of mental disorders) and “pantreatment” (relevant to a broad range of types of treatment). This study protocol describes a “next step” in the treatment development process by testing the Memory Support Intervention for major depressive disorder (MDD) and cognitive therapy (CT). If the results are promising, future directions will test the applicability to other kinds of interventions and disorders and in other settings. Trial registration ClinicalTrials.gov, ID: NCT01790919. Registered on 6 October 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2276-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Allison G Harvey
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, Berkeley, CA, 94720-1650, USA.
| | - Lu Dong
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, Berkeley, CA, 94720-1650, USA
| | - Jason Y Lee
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, Berkeley, CA, 94720-1650, USA
| | - Nicole B Gumport
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, Berkeley, CA, 94720-1650, USA
| | | | - Sophia Rabe-Hesketh
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, Berkeley, CA, 94720-1650, USA
| | - Kerrie Hein
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, Berkeley, CA, 94720-1650, USA
| | | | - Mary E McNamara
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, Berkeley, CA, 94720-1650, USA
| | - Claire Weaver
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, Berkeley, CA, 94720-1650, USA
| | - Armando Martinez
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, Berkeley, CA, 94720-1650, USA
| | - Haruka Notsu
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, Berkeley, CA, 94720-1650, USA
| | - Garret Zieve
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, Berkeley, CA, 94720-1650, USA
| | - Courtney C Armstrong
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall #1650, Berkeley, CA, 94720-1650, USA
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195
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Ma C, Avenell A, Bolland M, Hudson J, Stewart F, Robertson C, Sharma P, Fraser C, MacLennan G. Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: systematic review and meta-analysis. BMJ 2017; 359:j4849. [PMID: 29138133 PMCID: PMC5682593 DOI: 10.1136/bmj.j4849] [Citation(s) in RCA: 280] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective To assess whether weight loss interventions for adults with obesity affect all cause, cardiovascular, and cancer mortality, cardiovascular disease, cancer, and body weight.Design Systematic review and meta-analysis of randomised controlled trials (RCTs) using random effects, estimating risk ratios, and mean differences. Heterogeneity investigated using Cochran's Q and I2 statistics. Quality of evidence assessed by GRADE criteria.Data sources Medline, Embase, the Cochrane Central Register of Controlled Trials, and full texts in our trials' registry for data not evident in databases. Authors were contacted for unpublished data.Eligibility criteria for selecting studies RCTs of dietary interventions targeting weight loss, with or without exercise advice or programmes, for adults with obesity and follow-up ≥1 year.Results 54 RCTs with 30 206 participants were identified. All but one trial evaluated low fat, weight reducing diets. For the primary outcome, high quality evidence showed that weight loss interventions decrease all cause mortality (34 trials, 685 events; risk ratio 0.82, 95% confidence interval 0.71 to 0.95), with six fewer deaths per 1000 participants (95% confidence interval two to 10). For other primary outcomes moderate quality evidence showed an effect on cardiovascular mortality (eight trials, 134 events; risk ratio 0.93, 95% confidence interval 0.67 to 1.31), and very low quality evidence showed an effect on cancer mortality (eight trials, 34 events; risk ratio 0.58, 95% confidence interval 0.30 to 1.11). Twenty four trials (15 176 participants) reported high quality evidence on participants developing new cardiovascular events (1043 events; risk ratio 0.93, 95% confidence interval 0.83 to 1.04). Nineteen trials (6330 participants) provided very low quality evidence on participants developing new cancers (103 events; risk ratio 0.92, 95% confidence interval 0.63 to 1.36).Conclusions Weight reducing diets, usually low in fat and saturated fat, with or without exercise advice or programmes, may reduce premature all cause mortality in adults with obesity.Systematic review registration PROSPERO CRD42016033217.
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Affiliation(s)
- Chenhan Ma
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Alison Avenell
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Mark Bolland
- Bone and Joint Research Group, Department of Medicine, University of Auckland, Private Bag 92 019, Auckland 1142, New Zealand
| | - Jemma Hudson
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Fiona Stewart
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Clare Robertson
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Pawana Sharma
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Cynthia Fraser
- Health Services Research Unit, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials, University of Aberdeen, Health Sciences Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK
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196
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Hamilton AB, Farmer MM, Moin T, Finley EP, Lang AJ, Oishi SM, Huynh AK, Zuchowski J, Haskell SG, Bean-Mayberry B. Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER): a protocol for a program of research. Implement Sci 2017; 12:127. [PMID: 29116022 PMCID: PMC5678767 DOI: 10.1186/s13012-017-0658-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 10/20/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Enhancing Mental and Physical health of Women through Engagement and Retention or EMPOWER program represents a partnership with the US Department of Veterans Health Administration (VA) Health Service Research and Development investigators and the VA Office of Women's Health, National Center for Disease Prevention and Health Promotion, Primary Care-Mental Health Integration Program Office, Women's Mental Health Services, and the Office of Patient Centered Care and Cultural Transformation. EMPOWER includes three projects designed to improve women Veterans' engagement and retention in evidence-based care for high-priority health conditions, i.e., prediabetes, cardiovascular, and mental health. METHODS/DESIGN The three proposed projects will be conducted in VA primary care clinics that serve women Veterans including general primary care and women's health clinics. The first project is a 1-year quality improvement project targeting diabetes prevention. Two multi-site research implementation studies will focus on cardiovascular risk prevention and collaborative care to address women Veterans' mental health treatment needs respectively. All projects will use the evidence-based Replicating Effective Programs (REP) implementation strategy, enhanced with multi-stakeholder engagement and complexity theory. Mixed methods implementation evaluations will focus on investigating primary implementation outcomes of adoption, acceptability, feasibility, and reach. Program-wide organizational-, provider-, and patient-level measures and tools will be utilized to enhance synergy, productivity, and impact. Both implementation research studies will use a non-randomized stepped wedge design. DISCUSSION EMPOWER represents a coherent program of women's health implementation research and quality improvement that utilizes cross-project implementation strategies and evaluation methodology. The EMPOWER Quality Enhancement Research Initiative (QUERI) will constitute a major milestone for realizing women Veterans' engagement and empowerment in the VA system. EMPOWER QUERI will be conducted in close partnership with key VA operations partners, such as the VA Office of Women's Health, to disseminate and spread the programs nationally. TRIAL REGISTRATION The two implementation research studies described in this protocol have been registered as required: Facilitating Cardiovascular Risk Screening and Risk Reduction in Women Veterans: Trial registration NCT02991534 , registered 9 December 2016. Implementation of Tailored Collaborative Care for Women Veterans: Trial registration NCT02950961 , registered 21 October 2016.
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Affiliation(s)
- Alison B. Hamilton
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
| | - Melissa M. Farmer
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
| | - Tannaz Moin
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
| | - Erin P. Finley
- South Texas Veterans Health Care, San Antonio, TX USA
- University of Texas Health Science Center, San Antonio, TX USA
| | - Ariel J. Lang
- VA San Diego Healthcare System, San Diego, CA USA
- University of California San Diego, San Diego, CA USA
| | - Sabine M. Oishi
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
| | - Alexis K. Huynh
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
| | - Jessica Zuchowski
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
| | - Sally G. Haskell
- VA Connecticut Healthcare System, West Haven, CT USA
- Yale School of Medicine, Yale University, New Haven, CT USA
| | - Bevanne Bean-Mayberry
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA USA
- Veterans Affairs Health Services Research and Development Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
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197
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Abstract
Mental health service users (MHSUs) have elevated rates of cardiometabolic disturbance. Improvements occur with physical activity (PA) programs. We report the development and evaluation of three innovative peer-developed and peer-led PA programs: 1) walking; 2) fitness; and 3) yoga. Qualitative evaluation with 33 MHSUs in British Columbia, Canada, occurred. These programs yielded improvements for participants, highlighted by powerful narratives of health improvement, and improved social connections. The feasibility and acceptability of innovative peer-developed and peer-led programs were shown. Analyses revealed concepts related to engagement and change. Relating core categories, we theorize effective engagement of MHSUs requires accessibility on three levels (geographic, cost, and program flexibility) and health behavior change occurs within co-constituent relationships (to self, to peers, and to the wider community). This study highlights the benefits of peer involvement in developing and implementing PA programs and provides a theoretical framework of understanding engagement and behavior change in health programs for MHSUs.
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198
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Black DR. Preparing the workforce for integrated healthcare: A systematic review. SOCIAL WORK IN HEALTH CARE 2017; 56:914-942. [PMID: 28862917 DOI: 10.1080/00981389.2017.1371098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Integrated healthcare is recommended to deliver care to individuals with co-occurring medical and mental health conditions. This literature review was conducted to identify the knowledge and skills required for behavioral health consultants in integrated settings. A review from 1999 to 2015 identified 68 articles. Eligible studies examined care to the U.S. adult population at the highest level of integration. The results provide evidence of specific knowledge of medical and mental health diagnoses, screening instruments, and intervention skills in integrated primary care, specialty medical, and specialty mental health. Further research is required to identify methods to develop knowledge/skills in the workforce.
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Affiliation(s)
- Denise R Black
- a College of Social Work , University of Tennessee , Knoxville , TN , USA
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199
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Janney CA, Brzoznowski KF, Richardson CR, Dopp RR, Segar ML, Ganoczy D, Mooney AJ, Emerson L, Valenstein M. Moving Towards Wellness: Physical activity practices, perspectives, and preferences of users of outpatient mental health service. Gen Hosp Psychiatry 2017; 49:63-66. [PMID: 29122150 DOI: 10.1016/j.genhosppsych.2017.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 07/16/2017] [Accepted: 07/18/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study assessed the beliefs, barriers and preferences for physical activity (PA) among users of outpatient mental health (MH) services. Outpatient discussions with MH providers were also evaluated. METHOD Between September-December 2014, patient advisors approached adult and family members in an academic MH clinic's waiting room on high volume patient visit days during peak clinic hours; 83% participated in the survey. Analyses were restricted to MH services users (n=295). RESULTS Fully 84% of respondents reported a link between PA and their mood or anxiety level and 85% wanted to be more active. Less than half currently met US PA guidelines (≥150min/week). Most (52%) reported their mood limited their involvement in PA. Only 37% reported their MH providers regularly discussed PA with them. Beliefs about the benefits of physical activity (p<0.0001), mood limiting their ability to be physically active (p=0.03), and wanting to be more physically active (p=0.02) were significant predictors of PA (min/week) in the multivariate linear regression model. CONCLUSIONS Most MH outpatients may need and want assistance in increasing PA. Patient-centered research could inform the development of PA programs in MH settings.
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Affiliation(s)
- Carol A Janney
- Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine Midland Campus, 4611 Campus Ridge Drive, Midland, MI 48670, USA; Department of Veteran Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA.
| | - Kathryn Fant Brzoznowski
- Patient and Family Centered Care Advisory Committee, Department of Psychiatry, University of Michigan, 2800 Plymouth Rd NCRC B16-242E, Ann Arbor, MI, USA.
| | - Caroline R Richardson
- Department of Family Medicine, University of Michigan, 1018 Fuller St, Ann Arbor, MI 48104-1213, USA.
| | - Richard R Dopp
- Department of Psychiatry, University of Michigan, 9D 9812 UH SPC 5120 (RRD), Ann Arbor, MI, USA.
| | - Michelle L Segar
- Sport, Health, and Activity Research and Policy Center, University of Michigan, 204 S State St, 1251 Lane Hall, Ann Arbor, MI, USA.
| | - Dara Ganoczy
- Department of Veteran Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA.
| | - Ann J Mooney
- Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI, USA.
| | - Lauren Emerson
- Department of Veteran Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA.
| | - Marcia Valenstein
- Department of Veteran Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, 2800 Plymouth Rd NCRC B16-242E, Ann Arbor, MI, USA.
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Looijmans A, Stiekema APM, Bruggeman R, van der Meer L, Stolk RP, Schoevers RA, Jörg F, Corpeleijn E. Changing the obesogenic environment to improve cardiometabolic health in residential patients with a severe mental illness: cluster randomised controlled trial. Br J Psychiatry 2017; 211:296-303. [PMID: 28982656 DOI: 10.1192/bjp.bp.117.199315] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/17/2017] [Accepted: 07/22/2017] [Indexed: 11/23/2022]
Abstract
BackgroundFor patients with severe mental illness (SMI) in residential facilities, adopting a healthy lifestyle is hampered by the obesity promoting (obesogenic) environment.AimsTo determine the effectiveness of a 12-month lifestyle intervention addressing the obesogenic environment with respect to diet and physical activity to improve waist circumference and cardiometabolic risk factors v. care as usual (Dutch Trial Registry: NTR2720).MethodIn a multisite cluster randomised controlled pragmatic trial, 29 care teams were randomised into 15 intervention (365 patients) and 14 control teams (371 patients). Intervention staff were trained to improve the obesogenic environment.ResultsWaist circumference decreased 1.51 cm (95% CI -2.99 to -0.04) in the intervention v. control group after 3 months and metabolic syndrome z-score decreased 0.22 s.d. (95% CI -0.38 to -0.06). After 12 months, the decrease in waist circumference was no longer statistically significantly different (-1.28 cm, 95% CI -2.79 to 0.23, P=0.097).ConclusionsTargeting the obesogenic environment of residential patients with SMI has the potential to facilitate reduction of abdominal adiposity and cardiometabolic risk, but maintaining initial reductions over the longer term remains challenging.
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Affiliation(s)
- Anne Looijmans
- Anne Looijmans, MSc, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Annemarie P. M. Stiekema, PhD, Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Richard Bruggeman, MD, PhD, Department of Psychiatry and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Lisette van der Meer, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Ronald P. Stolk, MD, PhD, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen; Robert A. Schoevers, MD, PhD, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen; Frederike Jörg, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Research Department, Friesland Mental Health Services, Leeuwarden; Eva Corpeleijn, PhD, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Annemarie P M Stiekema
- Anne Looijmans, MSc, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Annemarie P. M. Stiekema, PhD, Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Richard Bruggeman, MD, PhD, Department of Psychiatry and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Lisette van der Meer, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Ronald P. Stolk, MD, PhD, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen; Robert A. Schoevers, MD, PhD, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen; Frederike Jörg, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Research Department, Friesland Mental Health Services, Leeuwarden; Eva Corpeleijn, PhD, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Richard Bruggeman
- Anne Looijmans, MSc, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Annemarie P. M. Stiekema, PhD, Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Richard Bruggeman, MD, PhD, Department of Psychiatry and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Lisette van der Meer, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Ronald P. Stolk, MD, PhD, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen; Robert A. Schoevers, MD, PhD, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen; Frederike Jörg, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Research Department, Friesland Mental Health Services, Leeuwarden; Eva Corpeleijn, PhD, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lisette van der Meer
- Anne Looijmans, MSc, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Annemarie P. M. Stiekema, PhD, Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Richard Bruggeman, MD, PhD, Department of Psychiatry and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Lisette van der Meer, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Ronald P. Stolk, MD, PhD, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen; Robert A. Schoevers, MD, PhD, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen; Frederike Jörg, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Research Department, Friesland Mental Health Services, Leeuwarden; Eva Corpeleijn, PhD, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ronald P Stolk
- Anne Looijmans, MSc, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Annemarie P. M. Stiekema, PhD, Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Richard Bruggeman, MD, PhD, Department of Psychiatry and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Lisette van der Meer, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Ronald P. Stolk, MD, PhD, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen; Robert A. Schoevers, MD, PhD, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen; Frederike Jörg, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Research Department, Friesland Mental Health Services, Leeuwarden; Eva Corpeleijn, PhD, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robert A Schoevers
- Anne Looijmans, MSc, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Annemarie P. M. Stiekema, PhD, Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Richard Bruggeman, MD, PhD, Department of Psychiatry and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Lisette van der Meer, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Ronald P. Stolk, MD, PhD, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen; Robert A. Schoevers, MD, PhD, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen; Frederike Jörg, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Research Department, Friesland Mental Health Services, Leeuwarden; Eva Corpeleijn, PhD, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Frederike Jörg
- Anne Looijmans, MSc, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Annemarie P. M. Stiekema, PhD, Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Richard Bruggeman, MD, PhD, Department of Psychiatry and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Lisette van der Meer, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Ronald P. Stolk, MD, PhD, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen; Robert A. Schoevers, MD, PhD, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen; Frederike Jörg, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Research Department, Friesland Mental Health Services, Leeuwarden; Eva Corpeleijn, PhD, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Eva Corpeleijn
- Anne Looijmans, MSc, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Annemarie P. M. Stiekema, PhD, Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Richard Bruggeman, MD, PhD, Department of Psychiatry and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen; Lisette van der Meer, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren; Ronald P. Stolk, MD, PhD, Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen; Robert A. Schoevers, MD, PhD, Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen; Frederike Jörg, PhD, Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, and Research Department, Friesland Mental Health Services, Leeuwarden; Eva Corpeleijn, PhD, Department of Epidemiology and Rob Giel Research Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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