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Hossain MI, Haque M, Akter M, Sharmin S, Ahmed A. Blood-brain barrier disruption and edema formation due to prolonged starvation in wild-type mice. Brain Circ 2024; 10:145-153. [PMID: 39036296 PMCID: PMC11259321 DOI: 10.4103/bc.bc_88_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/11/2024] [Accepted: 01/29/2024] [Indexed: 07/23/2024] Open
Abstract
INTRODUCTION Different types of diseases have been treated by restricted caloric intake or fasting. Although during this long time, fasting protective measures, for example, supplements, are given to the patients to protect vital organs such as the liver and kidney, little attention is given to the brain. The current research aims to investigate hypoglycemia due to prolonged fasting disrupts blood-brain barrier (BBB) in mice. MATERIALS AND METHODS Immunohistochemistry (IHC) and in situ hybridization (ISH) techniques were used to examine the expression of different genes. Evans blue extravasation and wet-dry technique were performed to evaluate the integrity of BBB and the formation of brain edema, respectively. RESULTS We confirmed that hypoglycemia affected mice fasting brain by examining the increased expression of glucose transporter protein 1 and hyperphosphorylation of tau protein. We subsequently found downregulated expression of some genes, which are involved in maintaining BBB such as vascular endothelial growth factor (VEGF) in astrocytes and claudin-5 (a vital component of BBB) and VEGF receptor (VEGFR1) in endothelial cells by ISH. We also found that prolonged fasting caused the brain endothelial cells to express lipocalin-2, an inflammatory marker of brain endothelial cells. We performed Evans blue extravasation to show more dye was retained in the brain of fasted mice than in control mice as a result of BBB disruption. Finally, wet-dry method showed that the brain of prolonged fasted mice contained significantly higher amount of water confirming the formation of brain edema. Therefore, special attention should be given to the brain during treatment with prolonged fasting for various diseases. CONCLUSIONS Our results demonstrated that hypoglycemia due to prolonged fasting disrupts BBB and produces brain edema in wild-type mice, highlighting the importance of brain health during treatment with prolonged fasting.
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Affiliation(s)
- M. Ibrahim Hossain
- Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Mehjabeen Haque
- Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Maria Akter
- Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Sabrina Sharmin
- Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Asif Ahmed
- Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka, Bangladesh
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2
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Alliende LM, Mittal VA. Weight stigma interventions as future avenues for stigma resistance: comment on Dubreucq et al. Psychol Med 2023:1-3. [PMID: 37144389 DOI: 10.1017/s0033291723000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- L M Alliende
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - V A Mittal
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
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3
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Sawyer C, Hassan L, Guinart D, Agulleiro LM, Firth J. Smoking Cessation Apps for People with Schizophrenia: How Feasible Are m-Health Approaches? Behav Sci (Basel) 2022; 12:bs12080265. [PMID: 36004836 PMCID: PMC9405387 DOI: 10.3390/bs12080265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The large health disparities among those diagnosed with schizophrenia urgently need to be addressed. These disparities are partially caused by adverse health behaviours such as smoking. Smoking cessation apps vary in efficacy across various populations, and there are concerns regarding the accessibility and usability of apps for people with schizophrenia. Objective: This review identifies and examines the feasibility of using apps for smoking cessation in people with schizophrenia. Methods: A non-systematic narrative literature review of smoking cessation apps for individuals with schizophrenia was performed. Results: Eight studies were included in this review. Conclusion: Smoking cessation apps can be acceptable and feasible, but may need to be tailored to the needs of people with schizophrenia. Key messages: (1) Smoking cessation apps could be acceptable and feasible for use in people with schizophrenia; (2) Lack of motivation was perceived as the main potential barrier with regard to people with schizophrenia engaging with smoking cessation apps; (3) In order to improve motivation of people diagnosed with schizophrenia, apps could include games, rewards, and/or social support; (4) Smoking cessation apps with a simple interface seem to be beneficial for this population; (5) Apps may need to be tailored to consider this population's mental health needs.
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Affiliation(s)
- Chelsea Sawyer
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK; (C.S.); (L.H.)
| | - Lamiece Hassan
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK; (C.S.); (L.H.)
| | - Daniel Guinart
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, CIBERSAM, 08003 Barcelona, Spain;
- Institute for Behavioral Science, Feinstein Institutes for Medical Research, Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, New York, NY 11549, USA
| | | | - Joseph Firth
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK; (C.S.); (L.H.)
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
- Correspondence:
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Burrows T, Teasdale S, Rocks T, Whatnall M, Schindlmayr J, Plain J, Latimer G, Roberton M, Harris D, Forsyth A. Effectiveness of dietary interventions in mental health treatment: A rapid review of reviews. Nutr Diet 2022; 79:279-290. [PMID: 35796181 PMCID: PMC9545734 DOI: 10.1111/1747-0080.12754] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 05/16/2022] [Accepted: 05/24/2022] [Indexed: 12/30/2022]
Abstract
Aim This rapid review of reviews aimed to determine the extent of research undertaken on the effectiveness of dietary interventions for individuals with a mental disorder. Methods Three databases (MEDLINE, Embase, Cochrane Reviews and Cochrane Trials) were searched to February 2021 for systematic reviews including experimental studies assessing the effectiveness of dietary interventions with physical or mental health related outcomes in adults or children with one or more of: severe mental illness, depression or anxiety, eating disorders, or substance use disorder. Results are presented descriptively. Results The number of included reviews was 46 (67% in severe mental illness, 20% in depression and anxiety, 7% in eating disorders, and 7% in substance use disorders). Most reviews were published since 2016 (59%), and included studies conducted in adults (63%). Interventions in the eating disorders and severe mental illness reviews were predominantly education and behaviour change, whereas interventions in the substance use disorders, and depression and anxiety reviews were predominantly supplementation (e.g. omega‐3). Twenty‐eight and twelve of the reviews respectively reported mental health and dietary outcomes for one or more included studies. Most reviews in severe mental illness, and depression and anxiety reported conclusions supporting the positive effects of dietary intervention, including positive effects on weight‐related or mental health outcomes, and on mental health outcomes, respectively. Conclusions A larger number of systematic reviews were identified which evaluated dietary interventions in individuals with severe mental illness, and depression and anxiety, compared with substance use disorders, and eating disorders. Dietary intervention is an important component of the treatment that should be available to individuals living with mental disorders, to support their physical and mental health.
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Affiliation(s)
- Tracy Burrows
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Food and Nutrition Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Scott Teasdale
- School of Psychiatry, UNSW Sydney, Kensington, New South Wales, Australia.,Mindgardens Neuroscience Network, Sydney, New South Wales, Australia
| | - Tetyana Rocks
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, Deakin University, Geelong, Victoria, Australia
| | - Megan Whatnall
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Food and Nutrition Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Julia Schindlmayr
- Dietitians Australia, Deakin, Australian Capital Territory, Australia
| | - Janice Plain
- Mental Health Drug and Alcohol, Northern Sydney Local Health District, North Ryde, New South Wales, Australia
| | - Georgina Latimer
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University, Hawthorn, Victoria, Australia
| | - Michelle Roberton
- Victorian Centre of Excellence in Eating Disorders, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Deanne Harris
- Tamworth Rural Referral Hospital, Hunter New England Health, Tamworth, New South Wales, Australia
| | - Adrienne Forsyth
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
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5
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Oliveira ECD, Barbosa GC, Corrente JE, Komuro JE, Papini SJ. Oat bran in cardiovascular risk control in mental disorder. Rev Bras Enferm 2021; 73 Suppl 1:e20190277. [PMID: 32490954 DOI: 10.1590/0034-7167-2019-0277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 12/05/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the effect of oat bran supplementation on cardiovascular risk components of patients with mental disorders. METHOD A before-and-after study, no control group. Cardiovascular risk indicators were assessed at baseline (M0), 90 (M1), 180 days (M2) and 180 days after supplementation (M3). RESULTS Of the 45 patients admitted to a psychiatric institution using antipsychotics, more than two thirds had high cardiovascular risk assessed by abdominal obesity. Forty-six point seven percent were overweight and 31.1% metabolic syndrome. Oat bran was effective in reducing serum cholesterol (M0-M1), HDL-cholesterol (M1-M2), triglycerides (M1-M2), (M2-M3) and (M1-M3). In M3, there was a statistical difference for all indicators evaluated. CONCLUSION Oat bran supplementation was effective in improving triglyceride, total cholesterol and HDL-cholesterol levels, suggesting that it is a therapeutic option for cardiovascular risk control in patients with psychiatric disorders.
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Affiliation(s)
| | | | | | - Jéssica Emy Komuro
- Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, São Paulo, Brazil
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6
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Fernández-Abascal B, Suárez-Pinilla P, Cobo-Corrales C, Crespo-Facorro B, Suárez-Pinilla M. In- and outpatient lifestyle interventions on diet and exercise and their effect on physical and psychological health: a systematic review and meta-analysis of randomised controlled trials in patients with schizophrenia spectrum disorders and first episode of psychosis. Neurosci Biobehav Rev 2021; 125:535-568. [PMID: 33503476 DOI: 10.1016/j.neubiorev.2021.01.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 01/01/2021] [Accepted: 01/04/2021] [Indexed: 12/22/2022]
Abstract
Patients with non-affective psychosis often lead unhealthy lifestyles. We performed a systematic review and meta-analysis on non-pharmacological RCTs for improvement of diet and physical activity in non-affective psychosis patients, including first-episode psychosis. A variety of outcomes was analysed, including metabolic, psychopathology, cognitive, functional and quality of life outcomes. Fifty-nine studies were included. An improvement in anthropometric measurements (BMI, weight, waist circumference) was observed post-intervention, persisting after follow-up. Post-intervention benefit was found also for psychotic symptoms severity (also persisting after follow-up), many cognitive domains and physical and global functioning and quality of life. Conversely, no effect was observed in relation to most blood metabolites, blood pressure and non-psychotic psychopathology and spontaneous physical activity. Improvement was generally larger for interventions including exercise, especially moderate/vigorous aerobic exercise, but follow-up maintenance was greater for psychotherapy interventions. Sensitivity analyses limited to chronic stages of psychosis and low risk of bias studies produced comparable results. Further studies are needed to design optimized interventions in this vulnerable population.
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Affiliation(s)
- Blanca Fernández-Abascal
- Department of Psychiatry, University Hospital Marqués de Valdecilla, IDIVAL, Santander, 39011, Spain.
| | - Paula Suárez-Pinilla
- Department of Psychiatry, University Hospital Marqués de Valdecilla, IDIVAL, Santander, 39011, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, 28029, Spain.
| | | | - Benedicto Crespo-Facorro
- Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocío - IBiS, Sevilla, 41013, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Marta Suárez-Pinilla
- Department of Neurodegenerative Disease, Institute of Neurology, University College of London, London, WC1N 3AX, UK.
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Nonmedical Interventions for Schizophrenia: A Review of Diet, Exercise, and Social Roles. Holist Nurs Pract 2020; 34:73-82. [PMID: 32049694 DOI: 10.1097/hnp.0000000000000369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Schizophrenia is a major mental illness with a disease course that is influenced by lifestyle. The risk-benefit ratio for alternative interventions is more favorable than for antipsychotics in long-term treatment. Dietary interventions may target autoimmune features, vitamin or mineral deficiencies, abnormal lipid metabolism, gluten sensitivity, or others. Examples of interventions involving diet, physical activity, or physical processes or social interventions including talk therapy exist in the literature. Notwithstanding, the general utility of these types of interventions remains inconclusive, awaiting long-term randomized trials. A perspective that separates the cause of the disease from its symptoms may be helpful in treatment planning and is warranted to distinguish between short-term and long-term recovery goals.
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8
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European Psychiatric Association (EPA) guidance on prevention of mental disorders. Eur Psychiatry 2020; 27:68-80. [DOI: 10.1016/j.eurpsy.2011.10.004] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Revised: 10/11/2011] [Accepted: 10/19/2011] [Indexed: 12/18/2022] Open
Abstract
AbstractThere is considerable evidence that various psychiatric conditions can be prevented through the implementation of effective evidence-based interventions. Since a large proportion of lifetime mental illness starts before adulthood, such interventions are particularly important during childhood and adolescence. Prevention is important for the sustainable reduction of the burden of mental disorder since once it has arisen, treatment can only reduce a relatively small proportion of such burden. The challenge for clinicians is to incorporate such interventions into non-clinical and clinical practice as well as engaging with a range of other service providers including public health. Similar strategies can be employed in both the European and global contexts. Promotion of mental well-being can prevent mental disorder but is also important in the recovery from mental disorder. This guidance should be read in conjunction with the EPA Guidance on Mental Health Promotion. This guidance draws on preparatory work for the development of England policy on prevention of mental disorder which used a wide range of sources.
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9
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Hahn M, Agarwal SM, Ahsan ZA, Lockwood JT, Duncan MJ, Takeuchi H, Cohn T, Taylor VH, Remington G, Faulkner GEJ. Pharmacological interventions for reduction of weight gain in people with schizophrenia. Hippokratia 2019. [DOI: 10.1002/14651858.cd013338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Margaret Hahn
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada
| | - Sri Mahavir Agarwal
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada
| | - Zohra A Ahsan
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada
| | - Jonathan T Lockwood
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada
| | - Markus J Duncan
- University of British Columbia; School of Kinesiology; 2146 Health Sciences Mall Room 4606 Vancouver Canada
| | - Hiroyoshi Takeuchi
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada
| | - Tony Cohn
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada
| | - Valerie H Taylor
- Women's College Hospital, University of Toronto; Department of Psychiatry; 7th Floor, Women's College Hospital 76 Grenville Street Toronto Ontario Canada M5S 1B2
| | - Gary Remington
- Centre for Addiction and Mental Health, University of Toronto; Complex Care and Recovery; 250 College Street Toronto Ontario Canada
| | - Guy E J Faulkner
- University of British Columbia; School of Kinesiology; 2146 Health Sciences Mall Room 4606 Vancouver Canada
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10
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Sreeraj VS, Masali M, Shivakumar V, Bose A, Venkatasubramanian G. Clinical Utility of Add-On Transcranial Direct Current Stimulation for Binge Eating Disorder with Obesity in Schizophrenia. Indian J Psychol Med 2018; 40:487-490. [PMID: 30275626 PMCID: PMC6149297 DOI: 10.4103/ijpsym.ijpsym_551_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Over the recent years, there has been an increasing application of noninvasive brain stimulation techniques such as transcranial direct-current stimulation (tDCS) to modify eating behaviors in healthy population and persons with eating disorders. tDCS is a noninvasive, neuromodulatory intervention which is well-tolerated and safe. In this case report, we describe the successful application of add-on tDCS in a patient with schizophrenia to reduce the craving for food that in turn, helped in reversing the weight gain.
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Affiliation(s)
- Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Manjunath Masali
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Venkataram Shivakumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Anushree Bose
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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11
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Dean DJ, Bryan AD, Newberry R, Gupta T, Carol E, Mittal VA. A Supervised Exercise Intervention for Youth at Risk for Psychosis: An Open-Label Pilot Study. J Clin Psychiatry 2017; 78:e1167-e1173. [PMID: 29178684 PMCID: PMC5995728 DOI: 10.4088/jcp.16m11365] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 06/05/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE A rapidly accumulating body of research suggests that exercise can improve symptoms and well-being in patients suffering from psychosis. Exercise may also promote neurogenesis in the hippocampus, a structure that plays an important role in the pathophysiology of psychosis. To date, there has not been an intervention focused on exercise prior to the onset of psychosis, a critical time for prevention of more serious illness. METHODS In this pilot study, 12 young adults at ultrahigh risk (UHR) for psychosis were enrolled in a 12-week open-label exercise intervention. Participants were randomly assigned to exercise 2 or 3 times each week and exercised between 65% and 85% of maximum oxygen capacity (Vo2max) for 30 minutes each session under the supervision of an exercise physiologist. Positive and negative symptoms, social and role functioning, performance on neurocognitive tests, cardiovascular fitness, and hippocampal structure and functional connectivity were evaluated before and after the trial. RESULTS A total of 9 participants completed the exercise intervention. Participants showed improved positive and negative symptoms and social and role functioning; improvement in multiple areas of cognition; and increased functional connectivity between the left hippocampus and occipital cortex after 12 weeks of exercise. CONCLUSIONS The results of this study suggest that exercise interventions are feasible in a UHR sample and may promote improvement in clinical, social, and cognitive domains as well as changes to brain function in regions impacted by the development of psychosis. These findings set the stage for an ongoing phase 2 randomized controlled trial. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02155699.
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Affiliation(s)
- Derek J Dean
- University of Colorado at Boulder, Department of Psychology and Neuroscience, Center for Neuroscience, 345 UCB, Boulder, CO 80309-0345.
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
- Center for Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Angela D Bryan
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
- Center for Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Raeana Newberry
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Tina Gupta
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
| | - Emily Carol
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
- Center for Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Vijay A Mittal
- Department of Psychology, Northwestern University, Evanston, Illinois, USA
- Department of Psychiatry, Northwestern University, Chicago, Illinois, USA
- Institute for Policy Research, Northwestern University, Evanston, Illinois, USA
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA
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12
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Quirk H, Crank H, Harrop D, Hock E, Copeland R. Understanding the experience of initiating community-based physical activity and social support by people with serious mental illness: a systematic review using a meta-ethnographic approach. Syst Rev 2017; 6:214. [PMID: 29070081 PMCID: PMC5655959 DOI: 10.1186/s13643-017-0596-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 10/02/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND People with long-term serious mental illness live with severe and debilitating symptoms that can negatively influence their health and quality of life, leading to outcomes such as premature mortality, morbidity and obesity. An interplay of social, behavioural, biological and psychological factors is likely to contribute to their poor physical health. Participating in regular physical activity could bring symptomatic improvements, weight loss benefits, enhanced wellbeing and when undertaken in a community-based group setting can yield additional, important social support benefits. Yet poor uptake of physical activity by people with serious mental illness is a problem. This review will systematically search, appraise and synthesise the existing evidence that has explored the experience of community-based physical activity initiation and key features of social support within these contexts by adults with schizophrenia, bipolar affective disorder, major depressive disorder or psychosis using the meta-ethnography approach. This new understanding may be key in designing more acceptable and effective community-based group PA programmes that meet patients' need and expectations. METHODS This will be a systematic review of qualitative studies using the meta-ethnography approach. The following databases will be searched: ASSIA, CINAHL, Cochrane Central Register of Controlled Trials, EMBASE, Health Technology Assessment Database, MEDLINE, PsycINFO, Sociological Abstracts, SPORTDiscus and Web of Science. Grey literature will also be sought. Eligible studies will use qualitative methodology; involve adults (≥18 years) with schizophrenia, bipolar affective disorder, major depressive disorder or psychosis; will report community-based group physical activity; and capture the experience of physical activity initiation and key features of social support from the perspective of the participant. Study selection and assessment of quality will be performed by two reviewers. Data will be extracted by one reviewer, tabled, and checked for accuracy by the second reviewer. The meta-ethnography approach by Noblit and Hare (Meta-ethnography: synthesizing qualitative studies 11, 1988) will be used to synthesise the data. DISCUSSION This systematic review is expected to provide new insights into the experience of community-based group physical activity initiation for adults who have a serious mental illness to inform person-centred improvements to the management of serious mental illness through physical activity. SYSTEMATIC REVIEW REGISTRATION The protocol has been registered on the International Prospective Register of Systematic Reviews (PROSPERO) on 22/03/2017; (registration number CRD42017059948 ).
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Affiliation(s)
- Helen Quirk
- Centre for Sport and Exercise Science, Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Hall, Collegiate Crescent, Sheffield, S10 2BP, UK.
| | - Helen Crank
- Centre for Sport and Exercise Science, Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Hall, Collegiate Crescent, Sheffield, S10 2BP, UK
| | - Deborah Harrop
- Centre for Health and Social Care Research, Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, UK
| | - Emma Hock
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Robert Copeland
- Centre for Sport and Exercise Science, Faculty of Health and Wellbeing, Sheffield Hallam University, Collegiate Hall, Collegiate Crescent, Sheffield, S10 2BP, UK.,The National Centre for Sport and Exercise Medicine, Sheffield, UK
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Hsu CC, Liang CS, Tai YM, Cheng SL. Incongruent changes in heart rate variability and body weight after discontinuing aerobic exercise in patients with schizophrenia. Int J Psychophysiol 2016; 109:132-137. [DOI: 10.1016/j.ijpsycho.2016.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 07/18/2016] [Accepted: 08/24/2016] [Indexed: 11/30/2022]
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14
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Zimbron J, Khandaker GM, Toschi C, Jones PB, Fernandez-Egea E. A systematic review and meta-analysis of randomised controlled trials of treatments for clozapine-induced obesity and metabolic syndrome. Eur Neuropsychopharmacol 2016; 26:1353-1365. [PMID: 27496573 DOI: 10.1016/j.euroneuro.2016.07.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 07/04/2016] [Accepted: 07/19/2016] [Indexed: 12/20/2022]
Abstract
Metabolic complications are commonly found in people treated with clozapine. Reviews on the management of this problem have generally drawn conclusions by grouping different types of studies involving patients treated with various different antipsychotics. We carried out a systematic review and meta-analysis of pharmacological and non-pharmacological treatments for clozapine-induced obesity or metabolic syndrome. Two researchers independently searched PubMed and Embase for randomised controlled trials (RCTs) of treatments for clozapine-induced obesity or metabolic syndrome. All other types of studies were excluded. We only included RCTs where more than 50% of participants were taking clozapine. We identified 15 RCTs. Effective pharmacological treatments for clozapine-induced obesity and metabolic syndrome include metformin, aripiprazole, and Orlistat (in men only). Meta-analysis of three studies showed a robust effect of metformin in reducing body mass index and waist circumference but no effects on blood glucose, triglyceride levels, or HDL levels. In addition, there is limited evidence for combined calorie restriction and exercise as a non-pharmacological alternative for the treatment of clozapine-induced obesity, but only in an in-patient setting. Rosiglitazone, topiramate, sibutramine, phenylpropanolamine, modafinil, and atomoxetine have not shown to be beneficial, despite reports of efficacy in other populations treated with different antipsychotics. We conclude that randomised-controlled trial data support the use of metformin, aripiprazole, and Orlistat (in men only) for treating clozapine-induced obesity. Calorie restriction in combination with an exercise programme may be effective as a non-pharmacological alternative. Findings from trials in different populations should not be extrapolated to people being treated with clozapine.
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Affiliation(s)
- Jorge Zimbron
- Department of Psychiatry, University of Cambridge, UK; Elizabeth House, Fulbourn Hospital, Fulbourn, Cambridge, CB21 5EF, UK.
| | - Golam M Khandaker
- Department of Psychiatry, University of Cambridge, UK; Elizabeth House, Fulbourn Hospital, Fulbourn, Cambridge, CB21 5EF, UK
| | - Chiara Toschi
- Department of Neuropsychiatry, University College London, Gower Street, London, WC1E 6BT, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, UK
| | - Emilio Fernandez-Egea
- Department of Psychiatry, University of Cambridge, UK; Elizabeth House, Fulbourn Hospital, Fulbourn, Cambridge, CB21 5EF, UK; Behavioural and Clinical Neuroscience Institute (BCNI), University of Cambridge, UK
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15
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Prioste A, Fonseca H, Pereira CR, Sousa P, Gaspar P, do Céu Machado M. Pathways between BMI and adherence to weight management in adolescence. Int J Adolesc Med Health 2016; 29:/j/ijamh.ahead-of-print/ijamh-2016-0018/ijamh-2016-0018.xml. [PMID: 27155002 DOI: 10.1515/ijamh-2016-0018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 03/12/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND In order to understand the mechanisms involved in how overweight adolescents adhere to weight management and perceive its benefits, a few variables have been identified, namely, body mass index (BMI), body self-esteem (BSE) and positive perspective of life (PPL). METHODS In a sample of 112 adolescents, we investigated whether BMI would predict adolescents' self-efficacy/adherence (SEA) to weight management and perception of its benefits. A structural equation modeling approach was chosen. We hypothesized that perceived quality of life (PQL) would mediate the relationships between BMI and SEA and between BMI and perception of benefits (PB). RESULTS The results suggested that BMI is not directly associated with SEA and PB. However, PQL was identified as a mediator between BMI and SEA and PB. CONCLUSION These findings bring important implications for understanding overweight adolescents' adherence to weight management. There is evidence that adolescents' adherence to weight management and PB are not predicted by their BMI. However, it has been shown that PQL mediates this process. For a long time, health professionals have been too focused on BMI. Time has come to be more focused on quality of life and how to improve it.
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16
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Twyford J, Lusher J. Determinants of exercise intention and behaviour among individuals diagnosed with schizophrenia. J Ment Health 2016; 25:303-309. [PMID: 26743313 DOI: 10.3109/09638237.2015.1124399] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The Theory of Planned Behaviour (TPB) has been applied to understand exercise behaviour in the general population with little consideration to individuals diagnosed with a psychiatric disability, despite physical inactivity among them presenting a significant risk of cardiovascular disease and other physical and mental health problems. This study tested the applicability of the TPB in the prediction of exercise intention and behaviour among people with schizophrenia. METHOD Using a cross-sectional research design, 214 participants (105 diagnosed with schizophrenia and 109 community controls) completed a questionnaire measuring TPB components, self-efficacy, health professional support and exercise behaviour. RESULTS Those with schizophrenia walked significantly more than the general population, but did significantly less moderate to strenuous exercise. Among those with schizophrenia, self-efficacy, perceived behavioural control and health professional support predicted 33.4% of the variance in intention to exercise. Exercise behaviour was predicted by self-efficacy and fruit and vegetable intake. CONCLUSION It is hoped that these findings will prompt health practitioners to respond to these low levels of exercise among individuals diagnosed with schizophrenia by providing support and exercise programmes that enhance self-efficacy.
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Affiliation(s)
- Jessica Twyford
- a Faculty of Life Sciences and Computing , School of Psychology, London Metropolitan University , London , UK
| | - Joanne Lusher
- a Faculty of Life Sciences and Computing , School of Psychology, London Metropolitan University , London , UK
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17
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Wärdig RE, Foldemo A, Hultsjö S, Lindström T, Bachrach-Lindström M. An Intervention with Physical Activity and Lifestyle Counseling Improves Health-Related Quality of Life and Shows Small Improvements in Metabolic Risks in Persons with Psychosis. Issues Ment Health Nurs 2016; 37:43-52. [PMID: 26818932 DOI: 10.3109/01612840.2015.1092187] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This research studied the effects of a lifestyle intervention on health-related quality of life (HRQoL) and metabolic risk factors in persons with psychosis, using a longitudinal intervention design with a matched reference sample. In participants in the intervention group, scores on the EQ-VAS, which measured HRQoL, improved from 57.6 to 63.3 (SD = 17.8) (p = 0.05), and HDL cholesterol concentration increased from 1.03 to 1.11 (0.19) mmol/l. (p = 0.02). There was no significant change in body weight among participants. The results of this study indicate that a lifestyle intervention based on group meetings improves HRQoL in patients with psychosis and provides small improvements in metabolic risk factors.
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Affiliation(s)
- Rikard Erik Wärdig
- a Linköpings University , Department of Nursing Sciences, Department of Health and Sciences , Linköping , Sweden
| | - Anniqa Foldemo
- a Linköpings University , Department of Nursing Sciences, Department of Health and Sciences , Linköping , Sweden
| | - Sally Hultsjö
- b Jönköping University , School of Welfare , Jönköping , Sweden
| | - Torbjörn Lindström
- c Linköpings University , Department of Internal Medicine and Health Sciences , Linköping , Sweden
| | - Margareta Bachrach-Lindström
- a Linköpings University , Department of Nursing Sciences, Department of Health and Sciences , Linköping , Sweden
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18
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Gross J, Vancampfort D, Stubbs B, Gorczynski P, Soundy A. A narrative synthesis investigating the use and value of social support to promote physical activity among individuals with schizophrenia. Disabil Rehabil 2015; 38:123-50. [PMID: 25786476 DOI: 10.3109/09638288.2015.1024343] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To review and synthesise the literature detailing the use of social support to facilitate physical activity participation in individuals with schizophrenia. METHOD A systematic review of major electronic databases was conducted to identify literature regarding the use of social support to promote physical activity among people with schizophrenia. A narrative synthesis was undertaken in four stages, including development of a theory, developing a preliminary synthesis, exploring relationships and assessing the robustness of the synthesis. RESULTS From a total of 110 studies, 23 met the inclusion criteria including 883 individuals with schizophrenia. Informational support was the most documented form of social support, followed by emotional, esteem and tangible. Providers included research personnel, healthcare professionals, family members and peers. Details of the content of the different dimensions of functional support are given. Social support appears to have an important role to help individuals with schizophrenia initiate, comply and adhere with exercise interventions. Social support may have an indirect benefit on weight maintenance. However, due to the limitations of the selected literature, it was difficult ascertain what the (in)direct benefit of social support are on health outcomes. CONCLUSIONS Social support appears to play a pivotal role in initiating physical activity as well as ensuring compliance and adherence to physical activity. Future research is required to investigate the optimal type and mode of delivery of social support on health outcomes. IMPLICATIONS FOR REHABILITATION Limited evidence is available that considers the role, value and use of social support within physical activity interventions for individuals with schizophrenia. Social support appears most likely to aid an individual's initiation, adherence and compliance to physical activity interventions. There may be an indirect benefit of social support on maintaining or enhancing health outcomes.
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Affiliation(s)
- Julia Gross
- a Department of Physiotherapy , School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham , Birmingham , UK
| | - Davy Vancampfort
- b Department of Neurosciences , University Psychiatric Centre, KU Leuven , Kortenberg , Belgium .,c Department of Rehabilitation Sciences , KU Leuven , Leuven , Belgium
| | - Brendon Stubbs
- d School of Health and Social Care, University of Greenwich , London , UK , and
| | - Paul Gorczynski
- e Department of Sport and Exercise Science , University of Portsmouth , Portsmouth , Hampshire , UK
| | - Andrew Soundy
- a Department of Physiotherapy , School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham , Birmingham , UK
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19
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Happell B, Platania-Phung C, Scott D, Stanton R. Predictors of Nurse Support for the Introduction of the Cardiometabolic Health Nurse in the Australian Mental Health Sector. Perspect Psychiatr Care 2015; 51:162-70. [PMID: 24957751 DOI: 10.1111/ppc.12077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 04/22/2014] [Accepted: 05/29/2014] [Indexed: 11/28/2022] Open
Abstract
PURPOSE A cardiometabolic specialist nursing role could potentially improve physical health of people with serious mental illness. DESIGN AND METHODS A national survey of Australian nurses working in mental health settings investigated predictors of support for the role. FINDINGS Predictors included belief in physical healthcare neglect, interest in training; higher perceived value of improving physical health care. PRACTICE IMPLICATIONS The findings suggest that nurses see the cardiometabolic health nurse role as a promising initiative for closing gaps in cardiometabolic health care and skilling other nurses in mental health. However, as the majority of variance in cardiometabolic health nurse support was unexplained, more research is urgently needed on factors that explain differences in cardiometabolic health nurse endorsement.
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Affiliation(s)
- Brenda Happell
- Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, Central Queensland University, Rockhampton, Queensland, Australia
| | - Chris Platania-Phung
- Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, Central Queensland University, Rockhampton, Queensland, Australia
| | - David Scott
- Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, Central Queensland University, Rockhampton, Queensland, Australia
| | - Robert Stanton
- Institute for Health and Social Science Research, Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, Central Queensland University, Rockhampton, Queensland, Australia
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20
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Hilton NZ, Ham E, Lang C, Harris GT. Weight Gain and Its Correlates Among Forensic Inpatients. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:232-8. [PMID: 26174527 PMCID: PMC4484692 DOI: 10.1177/070674371506000505] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 07/01/2014] [Indexed: 12/13/2022]
Abstract
OBJECTIVE We investigated changes in weight, body mass index (BMI), and other indices of the metabolic syndrome in forensic inpatients. Weight gain associated with newer antipsychotics (APs) is well established in the general psychiatric population. METHODS We examined the medical records of 291 men admitted to a forensic hospital at admission and again at discharge or 365 days later if still in hospital. We also recorded diagnosis and smoker status on admission and quantified psychotropic treatment and adherence, physical activity, and daytime occupation during the hospitalization. RESULTS On admission, 33% were obese and 22% of the 106 patients for whom sufficient data were available met criteria for metabolic syndrome. Among patients staying at least 30 days, 60% were weighed again before discharge but repeated blood pressure and waist circumference measures were uncommon, even among those at greatest risk. The 122 forensic inpatients with sufficient information gained an average of 12% of their body weight and 40% increased by at least 1 BMI category, gaining an average of 3.67 kg per month. Weight gain was associated with duration of time and was not attributable to being underweight on admission, diagnosis of schizophrenia, atypical AP treatment, medication adherence, or having been a smoker. CONCLUSIONS Patients gained weight during forensic hospitalization independent of medication use. We recommend further research using consistent measurement and wider sampling of both metabolic syndrome indicators and its individual and systemic causes in forensic populations.
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Affiliation(s)
- N Zoe Hilton
- Associate Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario; Senior Research Scientist, Waypoint Research Institute, Penetanguishene, Ontario
| | - Elke Ham
- Research Psychometrist, Waypoint Research Institute, Penetanguishene, Ontario
| | - Carol Lang
- Research Psychometrist, Waypoint Research Institute, Penetanguishene, Ontario
| | - Grant T Harris
- (Adjunct) Associate Professor, Department of Psychology, Queen’s University, Kingston, Ontario; (Adjunct) Associate Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario
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21
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Kaltsatou A, Kouidi E, Fountoulakis K, Sipka C, Theochari V, Kandylis D, Deligiannis A. Effects of exercise training with traditional dancing on functional capacity and quality of life in patients with schizophrenia: a randomized controlled study. Clin Rehabil 2014; 29:882-91. [PMID: 25525065 DOI: 10.1177/0269215514564085] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 11/22/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To examine the effects of an eight-month exercise training programme with Greek traditional dancing on functional capacity and quality of life in patients with schizophrenia. DESIGN Randomized controlled trial. SETTING Sports Medicine Laboratory. SUBJECTS A total of 31 patients, aged 59.9 ± 14.1 years. INTERVENTIONS They were randomly assigned either to a Greek traditional dancing programme (Group A) or to a sedentary control group (Group B). MAIN MEASURES A functional capacity assessment was performed at baseline and the end of the study. Global Assessment of Functioning Scale and Positive and Negative Syndrome Scale were also used. Quality of life was examined using the Quality of Life and Satisfaction questionnaire. RESULTS After the eight months, Group A increased walking distance in the 6-minute walk test (328.4 ± 35.9 vs. 238.0 ± 47.6 m), sit-to-stand test (19.1 ± 1.8 vs. 25.1 ± 1.4 seconds), Berg Balance Scale score (53.1 ± 2.1 vs. 43.2 ± 6.7), lower limbs maximal isometric force (77.7 ± 25.7 vs. 51.0 ± 29.8 lb), Positive and Negative Syndrome Scale total score (77.0 ± 23.1 vs. 82.0 ± 24.4), Global Assessment of Functioning Scale total score (51.3 ± 15.5 vs. 47.7 ± 13.3) and Quality of Life total score (34.9 ± 5.2 vs. 28 ± 4.5), compared with Group B. CONCLUSIONS Our results demonstrate that Greek traditional dances improve functional capacity and quality of life in patients with schizophrenia.
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Affiliation(s)
- A Kaltsatou
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - E Kouidi
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - K Fountoulakis
- 3rd Department of Psychiatry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - C Sipka
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - V Theochari
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - D Kandylis
- 3rd Department of Psychiatry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - A Deligiannis
- Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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22
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Soundy A, Freeman P, Stubbs B, Probst M, Coffee P, Vancampfort D. The transcending benefits of physical activity for individuals with schizophrenia: a systematic review and meta-ethnography. Psychiatry Res 2014; 220:11-9. [PMID: 25149128 DOI: 10.1016/j.psychres.2014.07.083] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 07/28/2014] [Accepted: 07/31/2014] [Indexed: 10/24/2022]
Abstract
A systematic review and meta-ethnographic synthesis exploring the experiences of people with schizophrenia and healthcare professionals (HCPs) towards physical activity was undertaken. Major electronic databases were searched from inception until January 2014. Studies were eligible if they considered the experiences and perceptions of people with schizophrenia or the perceptions of HCPs towards physical activity. All included studies were synthesised within a meta-ethnographic approach, including completing a methodological quality assessment. The search strategy identified 106 articles, 11 of which were included in the final analysis. Eight articles considered patients׳ experiences and perceptions, and three articles considered the experiences and perceptions of HCPs. A total of 108 patients and 65 HCPs were included. Three main themes were identified: (1) the influence of identity, culture and the environment on physical activity engagement, (2) access and barriers to participation in physical activity, and (3) the benefits of engaging in physical activity. Aspects within the built, social and political environment as well as aspects of social cognition and perceptual biases influence participation in physical activity for individuals with schizophrenia. Specific recommendations for HCPs are given to help promote physical activity in this population group.
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Affiliation(s)
- Andy Soundy
- Department of Physiotherapy, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2 TT UK.
| | - Paul Freeman
- Department of Sport and Health Sciences, University of Exeter, Exeter, Devon, UK
| | - Brendon Stubbs
- School of Health and Social Care, University of Greenwich, Southwood Site Avery Hill Road Eltham, London SE9 2UG, UK
| | - Michel Probst
- University Psychiatric Centre, KU Leuven, Kortenberg, Department of Neurosciences, KU Leuven, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium; Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, B-3001 Leuven, Belgium
| | - Pete Coffee
- School of Sport, University of Stirling, Stirling, Scotland, UK
| | - Davy Vancampfort
- University Psychiatric Centre, KU Leuven, Kortenberg, Department of Neurosciences, KU Leuven, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium; Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, B-3001 Leuven, Belgium
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23
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Shor R, Shalev A. Barriers to involvement in physical activities of persons with mental illness. Health Promot Int 2014; 31:116-23. [PMID: 25204451 DOI: 10.1093/heapro/dau078] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Participating in physical activities could be essential for reducing the multiple risk factors for health problems that persons with severe mental illness (SMI) may suffer. However, people with SMI are significantly less active than the general population. To develop knowledge about factors related to the perceived barriers hindering this population's participation in physical activities and the benefits this participation would have, a study was conducted in Israel with 86 people with mental illness living in community mental health facilities prior to their participation in a health promotion program. A mixed method was implemented and included: a scale designed to measure participants' perceptions of the barriers to and benefits of involvement in physical activities; instruments focusing on bio-psycho-social factors that may affect the level of barriers experienced; and personal interviews. The findings revealed high ranking for accessibility barriers hindering the participation in physical activities. Bio-psycho-social factors stemming from the participants' mental health, such as level of depression, were correlated with higher ranking of accessibility barriers. Bio-psycho-social factors reflecting positive mental health and health, such as positive appraisal of body weight, were correlated with lower ranking of accessibility barriers. Other barriers may include organizational and broader systemic barriers in the mental health facilities where the participants reside. These findings illuminate the need to consider the unique challenges that persons with mental illness may face in any attempt to advance their involvement in physical activity.
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Affiliation(s)
- Ron Shor
- Head of the Specialization in Psychiatric Rehabilitation, School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Mt. Scopus, Jerusalem 91905, Israel
| | - Anat Shalev
- Services for Families of Persons of Mental Illness, Ministry of Health, Beer Sheva Mental Health Center, P.O. Box 4600, Beer Sheva, Israel
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24
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Soundy A, Muhamed A, Stubbs B, Probst M, Vancampfort D. The benefits of walking for individuals with schizophrenia spectrum disorders: A systematic review. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2014. [DOI: 10.12968/ijtr.2014.21.9.410] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Andrew Soundy
- a Lecturer in Physiotherapy at the School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
| | | | - Brendon Stubbs
- a Physiotherapist at the School of Health and Social Care, University of Greenwich, UK
| | - Michel Probst
- University Psychiatric Centre, KU Leuven, Kortenberg, Department of Neurosciences, KU Leuven, Leuvensesteenweg 517, B-3070 Kortenberg, Belgium
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Tervuursevest 101, B-3001 Leuven, Belgium
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25
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McKibbin CL, Kitchen KA, Wykes TL, Lee AA. Barriers and facilitators of a healthy lifestyle among persons with serious and persistent mental illness: perspectives of community mental health providers. Community Ment Health J 2014; 50:566-76. [PMID: 24129587 PMCID: PMC3989460 DOI: 10.1007/s10597-013-9650-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The investigators used qualitative methods to examine perspectives of community mental health professionals on obesity management in adults with serious mental illness (SMI). Data from 5 focus groups were subjected to constant comparison analysis and grounded theory. Results showed that influences at individual, social, community, and societal levels impact development and maintenance of obesity. Mental health providers desired a collaborative relationship with health promotion program staff. They also believed that frequent, group-based health promotion should include participation incentives for adults with SMI and should occur over durations of at least 6-months to achieve improved health outcomes for this population.
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Affiliation(s)
- Christine L McKibbin
- Department of Psychology, Dept. 3415, University of Wyoming, 1000 E. University Ave, Laramie, WY, 82071, USA,
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26
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Niv N, Cohen AN, Hamilton A, Reist C, Young AS. Effectiveness of a psychosocial weight management program for individuals with schizophrenia. J Behav Health Serv Res 2014; 41:370-80. [PMID: 22430566 PMCID: PMC3809160 DOI: 10.1007/s11414-012-9273-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The objective of this study was to examine the effectiveness of a weight loss program for individuals with schizophrenia in usual care. The study included 146 adults with schizophrenia from two mental health clinics of the Department of Veterans Affairs. The 109 individuals who were overweight or obese were offered a 16-week, psychosocial, weight management program. Weight and Body Mass Index (BMI) were assessed at baseline, 1 year later, and at each treatment session. Only 51% of those who were overweight or obese chose to enroll in the weight management program. Participants attended an average of 6.7 treatment sessions, lost an average of 2.4 pounds, and had an average BMI decrease of 0.3. There was no significant change in weight or BMI compared to the control group. Intervention strategies that both improve utilization and yield greater weight loss need to be developed.
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Affiliation(s)
- Noosha Niv
- VA Desert Pacific MIRECC and University of California Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Los Angeles, CA, USA,
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27
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Hahn M, Remington G, Duncan MJ, Cohn T, Faulkner GEJ. Pharmacological interventions for reducing weight gain in schizophrenia. Hippokratia 2014. [DOI: 10.1002/14651858.cd011127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Margaret Hahn
- Centre for Addiction and Mental Health, University of Toronto; Complex Mental Illness; 250 College St 7th Floor Toronto Canada
| | - Gary Remington
- Centre for Addiction and Mental Health, University of Toronto; Complex Mental Illness; 250 College St 7th Floor Toronto Canada
| | - Markus J Duncan
- University of Toronto; Department of Exercise Sciences; 55 Harbord Street Toronto Ontario Canada M5S 2W6
| | - Tony Cohn
- Centre for Addiction and Mental Health; Schizophrenia Program and MAPS; 1001 Queen Street West Toronto Ontario Canada M6J1H4
| | - Guy E J Faulkner
- University of Toronto; Faculty of Kinesiology and Physical Education; 55 Harbord St Toronto Ontario Canada ON M5S 2W6
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28
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Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is often overlooked in the context of schizophrenia because its hallmark, daytime sleepiness, is so easily attributable to antipsychotic drugs. This is a special problem for women. AIMS To underscore the importance of diagnosing and treating OSA in women with schizophrenia. METHODS A review of the recent literature (search terms: Obstructive Sleep Apnoea; Schizophrenia; Women (or Gender); Obesity; Antipsychotics; Continuous Positive Airway Pressure (CPAP)) as it applies to a composite case vignette taken from the files of a specialty clinic that treats women with psychosis. RESULTS The rate of OSA in women who are both obese and postmenopausal is very similar to that of men. Family history, smoking, and the use of tobacco, alcohol and of antipsychotic medication increase the risk. Despite reluctance, patients with schizophrenia generally agree to undergo sleep studies. Compliance with CPAP is difficult, but can be aided by the physician and is, on the whole, relatively high in women. CPAP improves sleep parameters and may also improve cardiometabolic and cognitive indices, although this still needs to be more fully researched. CONCLUSION Schizophrenia and untreated OSA are both associated with high mortality rates in women as well as men.
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Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto , Ontario , Canada
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29
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Nik Jaafar NR, Midin M, Mahadevan R, Sinniah A, Rahman AHA, Ming W, Shah SA, Das S, Sidi H. Waist circumference and not body mass index as the outcome of a group weight intervention for patients with severe mental illness. Compr Psychiatry 2014; 55 Suppl 1:S60-4. [PMID: 24139853 DOI: 10.1016/j.comppsych.2013.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 08/29/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Most weight interventions among patients with severe mental illness (SMI) used body mass index (BMI) as outcome measure but excluded waist circumference (WC) although the latter is a stronger predictor of obesity complications. This study aimed to assess a weight-management program consisting of education, exercise and behavioural techniques for patients with SMI using weight parameters including WC as the outcome measures. METHODS A group intervention was carried out as part of psychiatric outpatient community service. It used structured modules on diet, exercise and related topics comprising of education and exercises sessions with a total of 12-week duration. The participants were outpatients with SMI recruited through referrals to the program by the treating doctor. The participants' body weight, BMI and WC were measured at the baseline, fortnightly and at the end of the program. RESULTS A total of 27 patients participated in the program which was carried out in 6 cycles. The pre- and post-intervention comparisons analysis of the weight parameters found a significant reduction in the WC (mean=3.878 cm+5.165, p=0.001) while no significant changes were recorded in body weight and BMI. CONCLUSION Small but significant loss in WC and possibly weight maintenance were achieved using this non-pharmacological intervention. Modest loss in WC may have an impact on reducing the risk of obesity-related health risks.
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Affiliation(s)
- Nik Ruzyanei Nik Jaafar
- Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Cheras, 56000 Kuala Lumpur, Malaysia.
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30
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Nover C, Jackson SS. Primary care-based educational interventions to decrease risk factors for metabolic syndrome for adults with major psychotic and/or affective disorders: a systematic review. Syst Rev 2013; 2:116. [PMID: 24369749 PMCID: PMC3877871 DOI: 10.1186/2046-4053-2-116] [Citation(s) in RCA: 14] [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: 06/03/2013] [Accepted: 12/05/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Individuals with major psychotic and/or affective disorders are at increased risk for developing metabolic syndrome due to lifestyle- and treatment-related factors. Numerous pharmacological and non-pharmacological interventions have been tested in inpatient and outpatient mental health settings to decrease these risk factors. This review focuses on primary care-based non-pharmacological (educational or behavioral) interventions to decrease metabolic syndrome risk factors in adults with major psychotic and/or affective disorders. METHODS The authors conducted database searches of PsychINFO, MEDLINE and the Cochrane Database of Systematic Reviews, as well as manual searches and gray literature searches to identify included studies. RESULTS The authors were unable to identify any studies meeting a priori inclusion criteria because there were no primary care-based studies. CONCLUSIONS This review was unable to demonstrate effectiveness of educational interventions in primary care. Interventions to decrease metabolic syndrome risk have been demonstrated to be effective in mental health and other outpatient settings. The prevalence of mental illness in primary care settings warrants similar interventions to improve health outcomes for this population.
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Affiliation(s)
- Cynthia Nover
- College of Social & Behavioral Sciences and Social Work, Eastern Washington University, 208 Senior Hall, Cheney, WA 99004, USA.
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Faulkner G, Duncan MJ, Hahn M, Remington G, Cohn T. Behavioural interventions for reducing weight gain in schizophrenia. Hippokratia 2013. [DOI: 10.1002/14651858.cd010781] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Guy Faulkner
- University of Toronto; Faculty of Kinesiology and Physical Education; 55 Harbord St Toronto Ontario Canada On M5S 2W6
| | - Markus J Duncan
- University of Toronto; Faculty of Kinesiology and Physical Education; 55 Harbord St Toronto Ontario Canada On M5S 2W6
| | - Margaret Hahn
- Center for Addiction and Mental Health; Complex Mental Illness; 250 College St 7th Floor Toronto Canada
| | - Gary Remington
- University of Toronto; Centre for Addiction and Mental Health; 250 College St Toronto Ontario Canada M5T 1R8
| | - Tony Cohn
- Centre for Addiction and Mental Health; Schizophrenia Program and MAPS; 1001 Queen Street West Toronto Ontario Canada M6J1H4
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Happell B, Platania-Phung C, Scott D. Proposed nurse-led initiatives in improving physical health of people with serious mental illness: a survey of nurses in mental health. J Clin Nurs 2013; 23:1018-29. [PMID: 24606393 DOI: 10.1111/jocn.12371] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2013] [Indexed: 12/19/2022]
Abstract
AIMS AND OBJECTIVES To identify nurse perceptions on the potential value of general and specific nursing approaches to improving physical health outcomes of people with serious mental illness. BACKGROUND People diagnosed with serious mental illnesses experience heightened rates of physical illnesses and can be supported better via healthcare system prevention and management. Nurses working in mental health are a critical part of a system-wide approach to improving physical health care, but there is little known on their views on specific approaches within Australia (e.g. screening for risks, stigma reduction). DESIGN A national, cross-sectional and nonrandom survey study delivered online. METHODS Members of the Australian College of Mental Health Nurses (n = 643), representing nurses employed in mental healthcare services across Australia (71·6% from public mental health services). Participants were asked to rate the potential of nine nurse-based strategies for improving physical health (options: 'yes', 'no', 'not sure') and the potential value of 10 nursing and general strategies for improving physical health (rating from 'negative value' to 'significant value'). RESULTS There was a high endorsement of all nine nurse-based strategies for physical health (e.g. lifestyle programmes, screening, linking services), although there was less support for reducing antipsychotics or advocating for fewer side effects. Participants mainly viewed all strategies as of moderate to significant value, with the most promising value attached to colocation of primary and mental care services, lifestyle programmes and improving primary care services (reduce stigma, train GPs). CONCLUSIONS Australian nurses working in mental health services view a range of nurse-based strategies for improving physical healthcare services and standards as important. RELEVANCE TO CLINICAL PRACTICE Nurses collectively need to work with consumers, health agencies and the general public to further define how to organise and implement physical health integration strategies, towards more comprehensive health care of people with serious mental illness.
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Affiliation(s)
- Brenda Happell
- Institute for Health and Social Science Research, Engaged Research Chair in Mental Health Nursing, Centre for Mental Health Nursing Innovation, School of Nursing and Midwifery, Central Queensland University, Rockhampton, Queensland, Australia
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Aschbrenner KA, Mueser KT, Bartels SJ, Pratt SI. Perceived Social Support for Diet and Exercise Among Persons With Serious Mental Illness Enrolled in a Healthy Lifestyle Intervention. Psychiatr Rehabil J 2013; 36:65-71. [PMID: 23647144 PMCID: PMC5662199 DOI: 10.1037/h0094973] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE There is a lack of research on social support for health behavior change among persons with serious mental illness who face disproportionate morbidity and premature death due to cardiovascular disease. This study examined social contact and the demographic, health and clinical characteristics associated with perceived social support for diet and exercise among persons living with serious mental illness enrolled in a healthy lifestyle intervention. METHOD Baseline data from two ongoing studies of the In SHAPE healthy lifestyle intervention for persons with serious mental illness were included in this analysis (N = 158). Cross-sectional analyses examined social contact and correlates of both negative and positive experiences of social support for diet and exercise. Multiple linear regression was used to assess the relationship between demographic characteristics, symptoms, health, and social support. RESULTS The majority (80.3%) of participants reported face-to-face contact at least twice monthly with a family member or friend. Readiness to change physical activity was associated with greater criticism from family for exercise behaviors, r(64) = .29, p < .05. Depressive symptoms (β = .30, p < .01) were significantly associated with more unhealthy family eating environments while controlling for the amount of family contact (β = .27, p < .01), while readiness to change dietary portion size (β = .34, p < .01) was associated with encouragement for healthy eating from friends. CONCLUSION AND IMPLICATIONS FOR PRACTICE Participants had regular contact with significant others who were a source of both positive and negative support for healthy eating and exercise. Engaging natural supports in supporting healthy behaviors may help persons with serious mental illness initiate and maintain lifestyle change.
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Delaney KR, Robinson KM, Chafetz L. Development of integrated mental health care: critical workforce competencies. Nurs Outlook 2013; 61:384-91. [PMID: 23702474 DOI: 10.1016/j.outlook.2013.03.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 03/24/2013] [Accepted: 03/31/2013] [Indexed: 11/18/2022]
Abstract
In integrated care, a person will have his or her medical and behavioral health needs addressed within one health care system. Support for integrated models has grown with the increasing awareness of how the medical comorbidities of individuals with serious mental illness contribute to their morbidity and mortality, the prevalence of mental health problems in the general population, and the mental health issues among those with chronic medical problems. The enactment of effective integrated care will demand developing clinicians who are trained to work with mental health needs at various levels of intensity, who are capable of addressing complex comorbidities, and who operate from a person-centered approach to care. In this light we argue that given their unique skill set and clinical training, Psychiatric-Mental Health Advanced Practice Nurses could play a critical role in integrated care and present policy recommendations which support the development of the Psychiatric-Mental Health Advanced Practice Nurses role in such models.
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Abstract
Weight gain remains a well recognized yet difficult to treat adverse effect of many anti-psychotic drugs including agents of the first and second generation. The weight gain liabilities of antipsychotic drugs are partly associated with their ability to increase appetite. Most behavioral interventions for weight control remain of limited efficacy, possibly because they do not specifically target the neuroendocrine factors regulating appetite. Identifying new weight management interventions directly acting on the biochemical and neuroendocrine mechanisms of anti-psychotic induced weight gain may help to improve the efficacy of behavioral weight management programs. Such potentially specific strategies include (1) using diets which do not increase appetite despite calorie restriction; (2) countering thirst as an anticholinergic side-effect; (3) discouraging cannabis use and (4) adding metformin to a behavioral intervention. In view of our currently rather limited treatment repertoire it seems timely systematically to explore such novel options.
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Empirically Based Psychosocial Therapies for Schizophrenia: The Disconnection between Science and Practice. SCHIZOPHRENIA RESEARCH AND TREATMENT 2013; 2013:792769. [PMID: 23738068 PMCID: PMC3655636 DOI: 10.1155/2013/792769] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 04/04/2013] [Accepted: 04/05/2013] [Indexed: 11/29/2022]
Abstract
Empirically validated psychosocial therapies for individuals diagnosed with schizophrenia were described in the report of the Schizophrenia Patient Outcomes Research Team (PORT, 2009). The PORT team identified eight psychosocial treatments: assertive community treatment, supported employment, cognitive behavioral therapy, family-based services, token economy, skills training, psychosocial interventions for alcohol and substance use disorders, and psychosocial interventions for weight management. PORT listings of empirically validated psychosocial therapies provide a useful template for the design of effective recovery-oriented mental health care systems. Unfortunately, surveys indicate that PORT listings have not been implemented in clinical settings. Obstacles to the implementation of PORT psychosocial therapy listings and suggestions for changes needed to foster implementation are discussed. Limitations of PORT therapy listings that are based on therapy outcome efficacy studies are discussed, and cross-cultural and course and outcome studies of correlates of recovery are summarized.
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Liu L, Ma X, Zhao X. What do psychotic experiences mean to Chinese schizophrenia patients? QUALITATIVE HEALTH RESEARCH 2012; 22:1707-1716. [PMID: 23034777 DOI: 10.1177/1049732312460589] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In this study we explored the perceptions of Chinese patients with schizophrenia about their treatment, mental state, social relationships, and daily life throughout the psychotic episodes. A purposive sample of 16 schizophrenia patients with heterogeneous demographic backgrounds was recruited. We collected data through face-to-face semistructured interviews. We conducted a qualitative data analysis and identified three central themes inductively: (a) negative experiences, (b) sense of powerlessness, and (c) ambivalent therapeutic relationship. Several subthemes were derived under each central theme. The participants' narratives revealed a complex picture of disadvantage and difficulties throughout their psychotic episodes and rehabilitation processes. The themes identified are explored in detail, and their links with existing research and potential clinical implications are considered.
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Affiliation(s)
- Liang Liu
- Shanghai Jiao Tong University, Shanghai, China
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Jerome GJ, Dalcin AT, Young DR, Stewart KJ, Crum RM, Latkin C, Cullen BA, Charleston J, Leatherman E, Appel LJ, Daumit GL. Rationale, design and baseline data for the Activating Consumers to Exercise through Peer Support (ACE trial): A randomized controlled trial to increase fitness among adults with mental illness. Ment Health Phys Act 2012; 5:166-174. [PMID: 23471190 PMCID: PMC3587110 DOI: 10.1016/j.mhpa.2012.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The benefits of regular physical activity are particularly salient to persons with serious mental illness (SMI) who have increased prevalence of obesity, diabetes, and earlier mortality from cardiovascular disease. METHODS The Activating Consumers to Exercise through Peer Support (ACE) trial will examine the effectiveness of peer support on adherence to a 4-month pilot exercise program for adults with SMI. Design, rationale and baseline data are reported. Baseline measures included: graded treadmill test; six-minute walk; height, weight and blood pressure; body composition; fasting blood; and self-reported psychiatric symptoms. Fitness levels were compared with national data and relationships among fitness parameters, psychological factors and cardiovascular disease risk factors were examined. RESULTS There were 93 participants and 18 peer leaders recruited from community psychiatry programs with an average age of 47 years (SD 10). There were no differences in demographics (76% female, 72% African American) or mental health symptoms between participants and peer leaders. Ninety-five percent of the sample had below average fitness levels for their age and sex with average MET levels of 5.9(SD 2.2) for participants and 6.2(SD 2.3) for peer leaders. Fitness evaluated during the treadmill test and the six-minute-walk were associated (rs = 0.36, p<.001). Lower MET levels were associated with a higher BMI (rs = -0.35, p<.001) and percent body fat (rs = -0.36, p <.001). CONCLUSION The uniformly low baseline cardiovascular fitness and the association of fitness with BMI and adiposity underscore the importance of suitably tailored programs to increase physical activity among adults with SMI.
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Affiliation(s)
- Gerald J Jerome
- Department of Kinesiology, Towson University, Towson, Maryland, USA ; Department of Medicine, Johns Hopkins School of Medicine, Baltimore Maryland, USA
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Aschbrenner K, Bartels S, Mueser K, Carpenter-Song E, Kinney A. Consumer perspectives on involving family and significant others in a healthy lifestyle intervention. HEALTH & SOCIAL WORK 2012; 37:207-15. [PMID: 23301434 DOI: 10.1093/hsw/hls032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This focus group study explored the potential benefits and challenges of involving family members and significant others in a healthy lifestyle program for people with serious mental illness (SMI). Six focus group interviews were conducted with a total of 30 people with SMI, who were participants in a healthy lifestyle intervention. Separate focus groups were conducted for high and low achievers in the program based on clinically significant weight loss or significant increase in fitness. Thematic analysis revealed that social support for diet and exercise was a perceived benefit to involving others in a healthy lifestyle program. Other perceived benefits were the potential to increase others' understanding of the challenges of living with mental illness and to enhance the quality of relationships. Participants identified practical and logistical concerns that could interfere with participation, including partner reliability and desirability, scheduling, and lack of financial resources. Participants in the high achiever group expressed a greater desire to involve others in exercise than did participants in the low achiever group. Programs aimed at helping people with SMI make lifestyle changes may increase their effectiveness by involving significant others. Mobilizing social support networks for health behavior change is an ideal role for social workers.
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Affiliation(s)
- Kelly Aschbrenner
- Dartmouth Center for Aging Research, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
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Abstract
The metabolic syndrome (MetS) is an increasingly prevalent condition in people with schizophrenia. It remains highly prevalent in the general population in developed countries, but recently health promotion campaigns and greater awareness of the high associated mortality rates have resulted in improvements in the rates of cardiovascular risk factors. This is not the case for people with schizophrenia who continue to have more than twice the rates of MetS and significantly higher mortality rates than the general population. Various behavioural and pharmacological interventions have been used to improve conditions that are linked to MetS, mainly smoking and obesity. This review aims to provide an update of the latest knowledge about the behavioural, pharmacological and other interventions that might help to combat this life-threatening problem in people with schizophrenia.
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Affiliation(s)
- Evangelos Papanastasiou
- CSI Lab, Department of Psychosis Studies, Institute of Psychiatry, KCL, De Crespigny Park, PO63, Denmark Hill, London SE5 8AF, UK
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Vandyk AD, Baker C. Qualitative descriptive study exploring schizophrenia and the everyday effect of medication-induced weight gain. Int J Ment Health Nurs 2012; 21:349-57. [PMID: 22404848 DOI: 10.1111/j.1447-0349.2011.00790.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Weight gain and obesity are serious side effects of the medications used to manage psychotic disorders and successful, long-term weight loss interventions are not yet available. One reason for this may be that current interventions are designed without consideration of the patient's perspective. The purpose of this study was to explore the subjective experience of weight and lifestyle from the perspective of people with schizophrenia. A qualitative, constructivist research design was used and conversational interviews were conducted with 18 purposefully recruited participants from an outpatient clinic at a psychiatric hospital in Eastern Ontario. Data were analysed according to the method of constant comparison and three central themes emerged: a life altering diagnosis, weight management as complex, and today's experiences shape tomorrow's outcomes. Weight management was seen as difficult yet important to the participants. The findings of this study provide insight into the views and opinions of the participants regarding weight and lifestyle and may be used to support the design of tailored heath initiatives for persons with mental illness.
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Xiao S, Baker C, Oyewumi LK. Psychosocial processes influencing weight management among persons newly prescribed atypical antipsychotic medications. J Psychiatr Ment Health Nurs 2012; 19:241-7. [PMID: 22074295 DOI: 10.1111/j.1365-2850.2011.01773.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The purpose was to generate a theory of the psychosocial processes influencing weight management among persons newly prescribed atypical antipsychotic medications. A grounded theory research design was used to guide the study. Semi-structured interviews were the method of data collection, and analysis was performed using constant comparison. Using theoretical sampling, a sample of 11 participants with first-episode psychosis prescribed atypical antipsychotics for at least 8 weeks, and five participants with a diagnosis of chronic schizophrenia prescribed atypical antipsychotic medication for at least 3 years were recruited from an outpatient psychiatric programme. Contextual factors influencing weight management were: accessibility to resources, unstructured lifestyle, and others' perception of weight. Conditions influencing weight management were: rapid weight gain, insatiable hunger and lack of motivation boosters. Participants' early responses to weight gain included discontinuing medications, choosing lower-calorie foods, using walking in daily activities as exercise, accepting weight gain and trying to manage weight but giving up. The consequences revealed from data analysis were contemplating weight management and not trying, as the barriers to weight management exceeded the facilitators. The theoretical framework developed in this study can assist with the understanding and management of weight gain among this unique population.
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Affiliation(s)
- S Xiao
- School of Nursing, Department of Psychiatry, Queen's University, Kingston, ON, Canada.
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Effects of sports participation on psychiatric symptoms and brain activations during sports observation in schizophrenia. Transl Psychiatry 2012; 2:e96. [PMID: 22832861 PMCID: PMC3316153 DOI: 10.1038/tp.2012.22] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Weight gain has been identified as being responsible for increased morbidity and mortality rates of schizophrenia patients. For the management of weight gain, exercise is one of the most acknowledged interventions. At the same time, exercise and sports have been recognized for their positive impact on psychiatric symptoms of schizophrenia. However, the neurobiological basis for this remains poorly understood. We aimed to examine the effect of sports participation on weight gain, psychiatric symptoms and brain activation during sports observation in schizophrenia patients. Thirteen schizophrenia patients who participated in a 3-month program, including sports participation and 10 control schizophrenia patients were studied. In both groups, body mass index (BMI), Positive and Negative Syndrome Scale (PANSS), and brain activation during observation of sports-related actions measured by functional magnetic resonance imaging were accessed before and after a 3-month interval. BMI and general psychopathology scale of PANSS were significantly reduced in the program group but not in the control group after a 3-month interval. Compared with baseline, activation of the body-selective extrastriate body area (EBA) in the posterior temporal-occipital cortex during observation of sports-related actions was increased in the program group. In this group, increase in EBA activation was associated with improvement in the general psychopathology scale of PANSS. Sports participation had a positive effect not only on weight gain but also on psychiatric symptoms in schizophrenia. EBA might mediate these beneficial effects of sports participation. Our findings merit further investigation of neurobiological mechanisms underlying the therapeutic effect of sports for schizophrenia.
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Balf G, Stewart TD, Whitehead R, Baker RA. Metabolic adverse events in patients with mental illness treated with antipsychotics: a primary care perspective. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2011; 10:15-24. [PMID: 18311417 DOI: 10.4088/pcc.v10n0104] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 10/26/2007] [Indexed: 10/20/2022]
Abstract
BACKGROUND Individuals with mental illness are at a higher risk of medical mortality than the general population, primarily due to an increased risk of cardiovascular disease. There are a number of modifiable metabolic risk factors associated with some atypical antipsychotics that warrant careful monitoring and treatment in both psychiatric and primary care practice if the risk of cardiovascular disease is to be effectively reduced. DATA SOURCES Previous guidelines have focused on awareness of metabolic risk factors in psychiatry, yet few articles have appeared in the primary care-focused journals. We present pragmatic guidelines that focus on monitoring metabolic abnormalities in primary care based on established guidelines, including joint recommendations of the American Diabetes Association, the American Psychiatric Association, the American Association of Clinical Endocrinologists, and the North American Association for the Study of Obesity, and the Mount Sinai conference. DATA SYNTHESIS All patients receiving atypical antipsychotic agents associated with metabolic adverse events should be routinely monitored for weight gain and abnormalities in blood glucose and lipid levels. Effective communication and collaboration between mental health and primary care services and better access to primary care screening and treatment for individuals with mental health problems are needed. CONCLUSION There is a clear need for awareness among primary care physicians, particularly as metabolic effects of atypical antipsychotics such as blood pressure and glucose and lipid levels are possibly best monitored in a primary care setting.
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Affiliation(s)
- Gabriela Balf
- Yale-New Haven Medical Center, New Haven, Conn. ; Otsuka America Pharmaceutical, Inc., Rockville, Md. ; and Bristol-Myers Squibb, Princeton, N.J
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Attux C, Martini LC, Araújo CMD, Roma AM, Reis AF, Bressan RA. The effectiveness of a non-pharmacological intervention for weight gain management in severe mental disorders: results from a national multicentric study. BRAZILIAN JOURNAL OF PSYCHIATRY 2011; 33:117-21. [DOI: 10.1590/s1516-44462011000200005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Accepted: 01/03/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To evaluate the effectiveness of a non-pharmacological intervention for weight gain management in severe mental disorders. METHOD: An open, multicentre interventional study was conducted in 93 mental health services. Patients concerned with weight gain were included in this study and received a 12-week 1-hour group intervention focused on nutrition counseling, lifestyle, physical activity and self-esteem. Weight, waist circumference and blood pressure were measured before and after the intervention. RESULTS: 1,071 patients were enrolled in the study, and 73.9% completed the 12-week intervention. Significant weight loss (Mean difference: 0.41, CI 95%: 0.18 to 0.64, p = 0.001) and a significant BMI reduction (Mean difference: 0.13, CI 95%: 0.04 to 0.22, p = 0.006) were observed. During the intervention 37 (4.4%) patients lost > 7% of their initial weight, 780 (92.5%) maintained their weight, and 26 (3.1%) of the patients had a meaningful weight gain (> 7%). There was a significant increase in the proportion of patients undertaking physical activity after the intervention (70.8%, p < 0.001). CONCLUSION: In this 3-month open study we found a small weight and waist reduction, and increased physical activity practice, suggesting a trend towards anthropometric profile improvement. However, further randomized-controlled trials are necessary to evaluate the efficacy and clinical relevance of this psychosocial intervention for weight gain.
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Verhaeghe N, De Maeseneer J, Maes L, Van Heeringen C, Annemans L. Effectiveness and cost-effectiveness of lifestyle interventions on physical activity and eating habits in persons with severe mental disorders: a systematic review. Int J Behav Nutr Phys Act 2011; 8:28. [PMID: 21481247 PMCID: PMC3094265 DOI: 10.1186/1479-5868-8-28] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 04/11/2011] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND There is a high prevalence of overweight and obesity in persons with severe mental disorders and this has serious implications on the short and long term health outcomes of these patients. The aim of this review was to evaluate the effectiveness of lifestyle interventions targeting physical activity and eating habits in persons with severe mental disorders. Special attention was given if any of the included studies in the review also examined the cost-effectiveness of these health promotion interventions. METHODS A systematic search through the electronic databases Medline, Web of Science, CINAHL and Cohrane Library was conducted, and by hand-searching the reference lists of the retrieved articles from the electronic databases. Studies were included if they examined effectiveness and/or cost-effectiveness of lifestyle interventions targeting physical activity and eating habits in persons with severe mental disorders, with primary outcome changes in Body Mass Index and body weight. RESULTS Fourteen studies met the inclusion criteria. Weight loss and Body Mass Index decrease were observed in intervention groups in 11 studies. The difference in weight change between intervention and control groups was statistically significant in nine studies. Differences in mean Body Mass Index between intervention and control groups were statistically significant in eight studies. Five studies reported improvements in quality of life and general health. In none of the studies cost-effectiveness of lifestyle interventions was examined. CONCLUSION Further research on both effectiveness and cost-effectiveness of lifestyle interventions targeting physical activity and eating habits in persons with severe mental disorders is required to assist in the development of new health promotion interventions in this population.
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Affiliation(s)
- Nick Verhaeghe
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185 B-9000 Ghent, Belgium
| | - Jan De Maeseneer
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185 B-9000 Ghent, Belgium
| | - Lea Maes
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185 B-9000 Ghent, Belgium
| | - Cornelis Van Heeringen
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185 B-9000 Ghent, Belgium
| | - Lieven Annemans
- Faculty of Medicine and Health Sciences, Ghent University, De Pintelaan 185 B-9000 Ghent, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Laarbeeklaan 103 B-1090 Brussel, Belgium
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Ball M, Warren K, Feldman S, McMahon R, Kelly D, Buchanan R. Placebo-Controlled Trial of Atomoxetine for Weight Reduction in People with Schizophrenia Treated with Clozapine or Olanzapine. ACTA ACUST UNITED AC 2011; 5:17-25. [DOI: 10.3371/csrp.5.1.3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Prebble K, Kidd J, O'Brien A, Carlyle D, McKenna B, Crowe M, Deering D, Gooder C. Implementing and maintaining nurse-led healthy living programs in forensic inpatient settings: an illustrative case study. J Am Psychiatr Nurses Assoc 2011; 17:127-38. [PMID: 21659303 DOI: 10.1177/1078390311399094] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Healthy living programs (HLPs) within the context of mental health units are an applied response to the concerns of metabolic syndrome and the associated physical illnesses to which people with serious mental illness are susceptible. OBJECTIVE To illustrate how nurses, with other health professionals and service users, have established and maintained HLPs in two locked forensic mental health units in New Zealand. DESIGN This illustrative case study adopts a multimodal approach to data collection and analysis. Across two programs, interviews were undertaken with service users (n = 15) and staff (n = 17), minutes of meetings were analyzed for major decision points, and clinical notes were reviewed to identify which service-user health status measures (body mass index, glucose tolerance test results, blood pressure, and medication use) were recorded. RESULTS Similarities were identified in the way the HLPs were implemented and maintained by champions who advocated for change, challenged staff attitudes, secured funding, and established new systems and protocols. Successful implementation depended on involvement of the multidisciplinary team. Each program operated within a different physical environment and adopted its own philosophical approach that shaped the style of the program. The HLPs had an impact on nurses, other staff, and on the culture of the institutions. The programs raised dilemmas about restrictions and risk versus autonomy and self-management. CONCLUSION Understanding the effects of the clinical and philosophical contexts in which HLPs are established and the way challenges and benefits are affected by context has practical significance for the future development of health programs in forensic settings, prisons, and general mental health units.
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Affiliation(s)
- Kate Prebble
- School of Nursing, Faculty of Health and Medical Sciences, University of Auckland, Auckland, New Zealand.
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Roberts SH, Bailey JE. Incentives and barriers to lifestyle interventions for people with severe mental illness: a narrative synthesis of quantitative, qualitative and mixed methods studies. J Adv Nurs 2011; 67:690-708. [PMID: 21323972 DOI: 10.1111/j.1365-2648.2010.05546.x] [Citation(s) in RCA: 120] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To examine the evidence for incentives and barriers to lifestyle interventions for people with severe mental illness. BACKGROUND People with severe mental illnesses, particularly those with schizophrenia, have poorer physical health than the general population with increased mortality and morbidity rates. Social and lifestyle factors are reported to contribute to this health inequality, though antipsychotic therapy poses additional risk to long-term physical health. Many behavioural lifestyle interventions including smoking cessation, exercise programmes and weight-management programmes have been delivered to this population with promising results. Surprisingly little attention has been given to factors that may facilitate or prevent engagement with these interventions in this population. DATA SOURCES Eight electronic databases were searched [1985-March 2009] along with the Cochrane Library and Google Scholar. Electronic 'hand' searches of key journals and explosion of references were undertaken. REVIEW METHODS A narrative synthesis of qualitative, quantitative and mixed-methods studies was undertaken. RESULTS No studies were identified that specifically explored the incentives and barriers to participation in lifestyle intervention for this population. Existing literature report some possible incentives and barriers including: illness symptoms, treatment effects, lack of support and negative staff attitudes as possible barriers; and symptom reduction, peer and staff support, knowledge, personal attributes and participation of staff as possible incentives. CONCLUSIONS Healthcare professionals, in particular nurses, should consider issues that may hinder or encourage individuals in this clinical group to participate in lifestyle interventions if the full benefits are to be achieved. Further research is needed to explore possible incentives and barriers from the service users' own perspective.
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Affiliation(s)
- Seren Haf Roberts
- Research Fellow, Institute of Medical and Social Care Research (IMSCaR), Bangor University, Wrexham Technology Park, Wrexham, UK.
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Mookhoek EJ, de Vries WA, Hovens JE, Brouwers JR, Loonen AJ. Risk factors for overweight and diabetes mellitus in residential psychiatric patients. Obes Facts 2011; 4:341-5. [PMID: 22166752 PMCID: PMC6444616 DOI: 10.1159/000333420] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the prevalence of and risk factors for overweight and diabetes mellitus in long-stay psychiatric inpatients. METHOD Statistical analysis of data collected from medical, laboratory, and pharmacy files. RESULTS 80% of the 256 patients were suffering from schizophrenia or other psychotic disorders. The prevalence of diabetes mellitus was 15%. The prevalence of a disturbed glucose tolerance was 14%. Severe overweight (BMI > 30) was positively associated with the use of clozapine (odds ratio (OR) = 2.7; 95% confidence interval (CI): 1.31-5.75), but negatively with the diagnosis schizophrenia (OR = 0.4; 95% CI: 0.22-0.88). Diabetes mellitus was associated with severe overweight (OR = 3.5; 95% CI: 1.57-7.69). Caucasian patients were at a lower risk for diabetes mellitus (OR = 0.2; 95% CI: 0.08-0.54). CONCLUSIONS In residential psychiatric patients, diabetes mellitus is especially associated with overweight and non-Caucasian origin. In this survey, the use of clozapine was associated with overweight, but not directly with diabetes mellitus. Diabetes mellitus is highly prevalent, which calls for screening for diabetes mellitus at regular intervals.
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Affiliation(s)
- Evert J. Mookhoek
- Division of Pharmacotherapy and Pharmaceutical Care, Department of Pharmacy, University of Groningen
- Delta Psychiatric Centre, Poortugaal
| | | | - Johannes E.J.M. Hovens
- Delta Psychiatric Centre, Poortugaal
- Institute of Psychology, Erasmus University Rotterdam
| | - Jacobus R.B.J. Brouwers
- Division of Pharmacotherapy and Pharmaceutical Care, Department of Pharmacy, University of Groningen
| | - Anton J.M. Loonen
- Division of Pharmacotherapy and Pharmaceutical Care, Department of Pharmacy, University of Groningen
- Delta Psychiatric Centre, Poortugaal
- GGZ Westelijk Noord-Brabant, Bergen op Zoom, the Netherlands
- * Division of Pharmacotherapy and Pharmaceutical Care, Department of Pharmacy, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, the Netherlands, Tel. + 31 50 363-7576, Fax -2772,
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