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Aouira N, Khan S, Heussler H, Haywood A, Karaksha A, Bor W. Understanding the Perspective of Youths on Undergoing Metabolic Monitoring While on Second-Generation Antipsychotics: Challenges, Insight, and Implications. J Child Adolesc Psychopharmacol 2023; 33:279-286. [PMID: 37504897 DOI: 10.1089/cap.2023.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Introduction: Prescription of second-generation antipsychotics (SGAs) in youths is rapidly increasing globally, despite the potential for significant adverse effects and long-term health consequences. A known adverse reaction resulting from SGAs is metabolic syndrome (MS). Youths exposed to antipsychotics are at higher risk than adults for adverse drug reactions, including adverse events such as MS (with weight gain as the most significant adverse outcome) and other long-term endocrinological abnormalities. This study aimed to explore the experiences of young patients on factors impacting barriers to metabolic monitoring of SGAs and the strategies to address those barriers thereby providing further guidance on policy and service delivery. Methods: Semi-structured interviews were conducted with patients (youths who were prescribed SGAs) who attended Child and Youth Mental Health Services. The interviews focused on barriers to monitoring and strategies to enhance rates of monitoring that could be customized across study sites. Results: Young patients revealed that none of them had any concerns or objections to receiving anthropometric metabolic measurements. However, they seemed concerned to undergo blood tests as part of the metabolic monitoring process. Specifically, youths cited their fear of the needles as barrier to undergo the required blood tests. Youths have also reported that their dislike to healthy foods and exercise being the most common challenge they face while trying to engage in a healthy lifestyle to manage the SGAs resulted weight gain. Conclusion: Prescribers are recommended to actively engage young patients about the expected SGAs-induced adverse effects, the importance of conducting metabolic monitoring, and how to prevent and minimize the expected adverse effects from the start of initiating SGAs. This could be a vital step toward a successful treatment as the insight of youths into the details of the chosen treatment can play a significant role into treatment adherence and recovery.
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Affiliation(s)
- Nisreen Aouira
- School of Pharmacy and Medical Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Sohil Khan
- School of Pharmacy and Medical Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Mater Research Institute-The University of Queensland, Brisbane, Australia
- Prasanna Institute of Public Health and Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Helen Heussler
- Mater Research Institute-The University of Queensland, Brisbane, Australia
- Children's Health Queensland Hospital and Health Services, South Brisbane, Australia
| | - Alison Haywood
- School of Pharmacy and Medical Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Mater Research Institute-The University of Queensland, Brisbane, Australia
| | - Abdullah Karaksha
- School of Pharmacy and Medical Sciences, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - William Bor
- Mater Research Institute-The University of Queensland, Brisbane, Australia
- Children's Health Queensland Hospital and Health Services, South Brisbane, Australia
- Child and Youth Mental Health Service, Centre for Children's Health Research, Queensland Health, Brisbane, Australia
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2
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Nicol G, Jansen M, Haddad R, Ricchio A, Yingling MD, Schweiger JA, Keenoy K, Evanoff BA, Newcomer JW. Use of an Interactive Obesity Treatment Approach in Individuals With Severe Mental Illness: Feasibility, Acceptability, and Proposed Engagement Criteria. JMIR Form Res 2022; 6:e38496. [PMID: 36512399 PMCID: PMC9795399 DOI: 10.2196/38496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/16/2022] [Accepted: 09/02/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Digital and mobile health interventions are increasingly being used to support healthy lifestyle change, including in certain high-risk populations such as those with severe mental illnesses (SMIs). Life expectancy in this population lags 15 years behind counterparts in the general population, primarily due to obesity-related health conditions. OBJECTIVE We tested the feasibility and usability of a 12-week interactive obesity treatment approach (iOTA) to adults with chronic SMIs (depression, bipolar disorder and schizophrenia spectrum disorder) receiving treatment in community settings. The iOTA incorporates short message service (SMS) text messages to supplement monthly in-person health coaching. METHODS Factors hypothesized to be associated with weight change were illness severity and treatment engagement. Severe psychiatric symptoms were defined as baseline Clinical Global Impression severity score of >5. Criterion engagement was defined as a text messaging response rate >80% during the first 4 weeks of treatment. Disordered eating, assessed with the Loss of Control Over Eating Scores, was also evaluated. Participants provided qualitative data, further informing assessment of intervention feasibility, usability, and acceptability. RESULTS A total of 26 participants were enrolled. The mean age was 48.5 (SD 15.67) years; 40% (10/26) were Black and 60% (15/26) female. Participants with lower symptom severity and adequate engagement demonstrated significantly decreased weight (F1,16=22.54, P<.001). Conversely, high symptom severity and lower text message response rates were associated with trend-level increases in weight (F1,7=4.33, P=.08). Loss-of-control eating was not observed to impact treatment outcome. Participants voiced preference for combination of live health coaching and text messaging, expressing desire for personalized message content. CONCLUSIONS These results demonstrate the feasibility of delivering an adapted iOTA to SMI patients receiving care in community settings and suggest testable criteria for defining sufficient treatment engagement and psychiatric symptom severity, two factors known to impact weight loss outcomes. These important findings suggest specific adaptations may be needed for optimal treatment outcomes in individuals with SMI.
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Affiliation(s)
- Ginger Nicol
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Madeline Jansen
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Los Angeles David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Rita Haddad
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, United States
| | - Amanda Ricchio
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, United States
| | - Michael D Yingling
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, United States
| | - Julia A Schweiger
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, United States
| | - Katie Keenoy
- Washington University School of Medicine, St. Louis, MO, United States
| | - Bradley A Evanoff
- Division of General Medical Sciences, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - John W Newcomer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, United States
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3
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Nicol GE, Jansen M, Ricchio A, Schweiger JA, Keenoy K, Miller JP, Morrato E, Guo Z, Evanoff B, Newcomer JW. Adaptation of a Mobile Interactive Obesity Treatment Approach for Early Severe Mental Illness: Mixed Methods Implementation and Pilot Randomized Controlled Trial Protocol (Preprint). JMIR Res Protoc 2022. [DOI: 10.2196/42114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
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4
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Haddad R, Badke D'Andrea C, Ricchio A, Evanoff B, Morrato EH, Parks J, Newcomer JW, Nicol GE. Using Innovation-Corps (I-Corps™) Methods to Adapt a Mobile Health (mHealth) Obesity Treatment for Community Mental Health Settings. Front Digit Health 2022; 4:835002. [PMID: 35721796 PMCID: PMC9197731 DOI: 10.3389/fdgth.2022.835002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background We employed Innovation Corps (I-Corps™) methods to adaptation of a mobile health (mHealth) short-message-system (SMS) -based interactive obesity treatment approach (iOTA) for adults with severe mentall illness receiving care in community settings. Methods We hypothesized "jobs to be done" in three broad stakeholder groups: "decision makers" (DM = state and community clinic administrators), "clinician consumers" (CC = case managers, peer supports, nurses, prescribers) and "service consumers" (SC = patients, peers and family members). Semistructured interviews (N = 29) were recorded and transcribed ver batim and coded based on pragmatic-variant grounded theory methods. Results Four themes emerged across groups: education, inertia, resources and ownership. Sub-themes in education and ownership differed between DM and CC groups on implementation ownership, intersecting with professional development, suggesting the importance of training and supervision in scalability. Sub-themes in resources and intertia differed between CC and SC groups, suggesting illness severity and access to healthy food as major barriers to engagement, whereas the SC group identified the need for enhanced emotional support, in addition to pragmatic skills like menu planning and cooking, to promote health behavior change. Although SMS was percieved as a viable education and support tool, CC and DM groups had limited familiarity with use in clinical care delivery. Conclusions Based on customer discovery, the characteristics of a minimum viable iOTA for implementation, scalability and sustainability include population- and context-specific adaptations to treatment content, interventionist training and delivery mechanism. Successful implementation of an SMS-based intervention will likely require micro-adaptations to fit specific clinical settings.
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Affiliation(s)
- Rita Haddad
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Carolina Badke D'Andrea
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Amanda Ricchio
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Bradley Evanoff
- Center for Healthy Work, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Elaine H. Morrato
- Parkinson School of Health Sciences and Public Health, Loyola University of Chicago, Chicago, IL, United States
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Joseph Parks
- National Council for Mental Wellbeing, Washington, DC, United States
| | - John W. Newcomer
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
- Thriving Mind South Florida, Miami, FL, United States
| | - Ginger E. Nicol
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
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5
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Kakko K, Keskinen P, Pihlakoski L, Salmelin R, Puura K. In search of measures to improve the detection of increased cardiometabolic risk in children using second-generation antipsychotic medications. Nord J Psychiatry 2022; 76:316-322. [PMID: 34431750 DOI: 10.1080/08039488.2021.1968489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Second-generation antipsychotic medications (SGAs) are widely used in child psychiatry. SGA-induced metabolic disturbances are common in children, but monitoring practices need systematisation. The study's aims were to test an SGA-monitoring protocol, examine the distributions of metabolic measurements compared to reference values in child psychiatry patients, and determine whether using a homeostasis model for the assessment of insulin resistance (HOMA-IR) and triglyceride/high-density lipoprotein (TG/HDL) ratio could improve the detection of increased cardiometabolic risk. MATERIALS AND METHODS A systematic monitoring protocol was implemented. Weight and height, blood pressure, fasting glucose, insulin, HDL, and TG were measured at baseline and four times during follow-up. HOMA-IR, TG/HDL ratio and zBMI were calculated. Age-, gender- and BMI-specific percentile curves for HOMA-IR were used to define elevated cardiometabolic risk. RESULTS The study patients (n = 55, mean age 9.9 years) were followed for a median of 9 months. A disadvantageous, statistically significant shift, often appearing within the reference range, was seen in zBMI, TG, HDL, glucose, insulin, HOMA-IR, and TG/HDL ratio. The increase in HOMA-IR appeared earlier than individual laboratory values and was more evident than the TG/HDL ratio increase. An HOMA-IR cut point of 1.98 resulted in a sensitivity and specificity of 83%. Compared to a previous study performed in the same location, the monitoring rates of metabolic parameters improved. CONCLUSION The monitoring protocol implementation improved the monitoring of metabolic parameters in child psychiatric patients using SGAs. Using HOMA-IR as part of systematic SGA monitoring could help detect metabolic adverse effects.
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Affiliation(s)
- Kirsi Kakko
- Department of Child Psychiatry, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Päivi Keskinen
- Department of Paediatrics, Tampere University Hospital, Tampere, Finland.,Center for Child Health Research, Tampere University, Tampere, Finland
| | - Leena Pihlakoski
- Department of Child Psychiatry, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Raili Salmelin
- Department of Child Psychiatry, Tampere University Hospital, Tampere, Finland.,Faculty of Social Sciences/Health Sciences, Tampere University, Tampere, Finland
| | - Kaija Puura
- Department of Child Psychiatry, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Hickingbotham MR, Wong CJ, Bowling AB. Barriers and facilitators to physical education, sport, and physical activity program participation among children and adolescents with psychiatric disorders: a systematic review. Transl Behav Med 2021; 11:1739-1750. [PMID: 34166515 DOI: 10.1093/tbm/ibab085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Children and adolescents with heterogeneous psychiatric disorders, of whom over 50% have a second psychiatric comorbidity, have low rates of physical activity and experience unique challenges to engaging in community-based exercise programming, school-based physical education programming, and targeted physical activity interventions. This contributes to elevated rates of gross and fine motor delays, lower mood and self-regulation, and increased risk of chronic diseases such as obesity and type 2 diabetes. Perform a systematic scoping review of the literature to assess known barriers to and facilitators of engaging in physical activity programming among children and adolescents with heterogeneous and/or comorbid psychiatric disorders, in order to improve engagement among this population in real world intervention settings. Systematic Boolean diagnostic and physical activity search terms were entered into PubMed, MEDLINE, PsycINFO and Web of Science for English-language studies published between 2005 and 2020, examining barriers and facilitators for common psychiatric diagnoses and general psychiatric population's engagement in physical activity, physical education, sports, or exercise interventions. Two reviewers independently reviewed titles, abstracts and full articles to determine inclusion. A total of 5,198 articles were returned; 39 relating to children and adolescents were qualified for full-text review. After review, 24 studies were included addressing barriers and facilitators across multiple diagnoses; 7 studies were quantitative, 10 were qualitative, and 7 were mixed methods. Major barriers included low motivation, low self-efficacy, depleted parental reserve capacity, social isolation, lack of staff training, and safety concerns. Major facilitators included peer support/engagement, exergames, supportive parental behaviors, and inclusive/adaptive programming. Numerous barriers and facilitators to physical activity have been identified which should inform community, school, clinical, and research intervention program design. Further research is needed to develop effective strategies that address the challenges to inclusion that children and adolescents with heterogeneous and/or comorbid psychiatric disorders face.
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Affiliation(s)
- Madison R Hickingbotham
- Department of Public Health and Nutrition, School of Health Sciences, Merrimack College, North Andover, MA, USA
| | - Catherine J Wong
- Department of Public Health and Nutrition, School of Health Sciences, Merrimack College, North Andover, MA, USA
| | - April B Bowling
- Department of Public Health and Nutrition, School of Health Sciences, Merrimack College, North Andover, MA, USA
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7
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Bussell K, Reeves G, Hager E, Zhu S, Correll CU, Riddle MA, Sikich L. Dietary Consumption Among Youth with Antipsychotic-Induced Weight Gain and Changes Following Healthy Lifestyle Education. J Child Adolesc Psychopharmacol 2021; 31:364-375. [PMID: 34143682 PMCID: PMC8233214 DOI: 10.1089/cap.2020.0173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background: Youth treated with antipsychotic medications are high risk for weight gain, increased lipids/glucose, and development of metabolic syndrome. Little is known about the dietary intake/nutritional adequacy in this vulnerable population, and effect on weight gain. This secondary data analysis describes the baseline intake and changes in diet after receiving healthy lifestyle education/counseling over 6 months, in a sample of youth with antipsychotic-induced weight gain. Methods: The U.S. Department of Agriculture (USDA) Automated Multiple-Pass Method 24-hour dietary recall was administered to 117 youth at baseline, 3 months, and 6 months. Parent/child received personalized healthy lifestyle education sessions over 6 months. Baseline intake was compared with the USDA Recommended Daily Allowance using independent samples t-tests. Individual dietary covariates were examined for change over 6 months using longitudinal linear mixed modeling. Influence of each on body mass index (BMI) z-score change was tested in a pooled group analysis and then compared by treatment group. Results: Pooled analysis revealed baseline consumption high in carbohydrates, fat, protein, sugar, and refined grains, while low in fruit/vegetables, whole grains, fiber, and water. Change over 6 months demonstrated a statistically significant decrease in daily calories (p = 0.002), carbohydrates (p = 0.003), fat (p = 0.012), protein (p = 0.025), sugar (p = 0.008), refined grains (p = 0.008), total dairy (p = 0.049), and cheese (p = 0.027). Small increases in fruits/vegetables were not statistically significant, although the Healthy Eating Index subscores for total vegetables (p = 0.013) and dark green/orange vegetables (p = 0.034) were. No dietary covariates were predictors of change in BMI z-score. Nondietary predictors were parent weight/BMI and treatment group, with the metformin and switch groups experiencing significant decreases in BMI z-score. Conclusions: Further pediatric studies are necessary to assess the effects of antipsychotic medications on dietary intake, and test efficacy of healthy lifestyle interventions on change in nutrition. The relationship of nutrition to cardiometabolic health in this population must be further investigated. Clinical Trial Registration number: NCT02877823.
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Affiliation(s)
- Kristin Bussell
- Department of Family and Community Health, University of Maryland School of Nursing, Baltimore, Maryland, USA.,Department of Psychiatry and University of Maryland School of Medicine, Baltimore, Maryland, USA.,Address correspondence to: Kristin Bussell, PhD, Department of Family and Community Health, University of Maryland School of Nursing, 655 W. Lombard St., Baltimore, MD 21201, USA
| | - Gloria Reeves
- Department of Psychiatry and University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Erin Hager
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Shijun Zhu
- Department of Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, Maryland, USA
| | - Christoph U. Correll
- Department of Psychiatry, Northwell Health, The Zucker Hillside Hospital, Glen Oaks, New York, USA.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Mark A. Riddle
- Department of Psychiatry and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Linmarie Sikich
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Chapel Hill, North Carolina, USA
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8
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Nicol GE, Ricchio AR, Metts CL, Yingling MD, Ramsey AT, Schweiger JA, Miller JP, Lenze EJ. A Smartphone-Based Technique to Detect Dynamic User Preferences for Tailoring Behavioral Interventions: Observational Utility Study of Ecological Daily Needs Assessment. JMIR Mhealth Uhealth 2020; 8:e18609. [PMID: 33055063 PMCID: PMC7695533 DOI: 10.2196/18609] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/14/2020] [Accepted: 10/15/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Mobile health apps are promising vehicles for delivering scalable health behavior change interventions to populations that are otherwise difficult to reach and engage, such as young adults with psychiatric conditions. To improve uptake and sustain consumer engagement, mobile health interventions need to be responsive to individuals' needs and preferences, which may change over time. We previously created an ecological daily needs assessment to capture microprocesses influencing user needs and preferences for mobile health treatment adaptation. OBJECTIVE The objective of our study was to test the utility of a needs assessment anchored within a mobile app to capture individualized, contextually relevant user needs and preferences within the framework of a weight management mobile health app. METHODS Participants with an iOS device could download the study app via the study website or links from social media. In this fully remote study, we screened, obtained informed consent from, and enrolled participants through the mobile app. The mobile health framework included daily health goal setting and self-monitoring, with up to 6 daily prompts to determine in-the-moment needs and preferences for mobile health-assisted health behavior change. RESULTS A total of 24 participants downloaded the app and provided e-consent (22 female; 2 male), with 23 participants responding to at least one prompt over 2 weeks. The mean length of engagement was 5.6 (SD 4.7) days, with a mean of 2.8 (1.1) responses per day. We observed individually dynamic needs and preferences, illustrating daily variability within and between individuals. Qualitative feedback indicated preferences for self-adapting features, simplified self-monitoring, and the ability to personalize app-generated message timing and content. CONCLUSIONS The technique provided an individually dynamic and contextually relevant alternative and complement to traditional needs assessment for assessing individually dynamic user needs and preferences during treatment development or adaptation. The results of this utility study suggest the importance of personalization and learning algorithms for sustaining app engagement in young adults with psychiatric conditions. Further study in broader user populations is needed.
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Affiliation(s)
- Ginger E Nicol
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Amanda R Ricchio
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Christopher L Metts
- Department of Pathology and Laboratory Medicine, College of Medicine, Medical University of South Carolina, Charleston, SC, United States
| | - Michael D Yingling
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Alex T Ramsey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - Julia A Schweiger
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
| | - J Philip Miller
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, United States
| | - Eric J Lenze
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States
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9
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Nicol GE, Kolko R, Lenze EJ, Yingling MD, Miller JP, Ricchio AR, Schweiger JA, Findling RL, Wilfley D, Newcomer JW. Adiposity, Hepatic Triglyceride, and Carotid Intima Media Thickness During Behavioral Weight Loss Treatment in Antipsychotic-Treated Youth: A Randomized Pilot Study. J Child Adolesc Psychopharmacol 2019; 29:439-447. [PMID: 30994376 PMCID: PMC6661918 DOI: 10.1089/cap.2018.0120] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objectives: The purpose of this pilot study was to evaluate changes in adiposity, carotid intima media thickness (CIMT), and hepatic fat content measured via magnetic resonance imaging-estimated hepatic proton density fat fraction (PDFF) in antipsychotic (AP)-treated youth versus nonpsychiatric (NP) participants during participation in a 16-week behavioral weight loss (BWL) intervention. Subjects/Methods: Overweight/obese AP-treated youth (n = 26) were randomized 2:1 to weekly treatment versus recommended care (RC) over 16 weeks. NP controls (n = 21) were assigned to weekly treatment. Dual-energy X-ray absorptiometry (DEXA)-measured adiposity, CIMT, and PDFF were measured at baseline and 16 weeks. Analyses assessed group differences in the effect of BWL on adiposity, CIMT, and PDFF. Results: BWL was well tolerated in both AP-treated and NP groups. DEXA-measured fat decreased significantly in the NP group (F[1,16] = 11.81, p = 0.003), with modest improvements in adiposity and hepatic fat in the AP-treated group, while an increase in adiposity was observed in the RC group. Significant differences in endpoint DEXA total fat (F[2,34] = 4.81, p = 0.01) and PDFF (F[2,30] = 3.60, p = 0.04) occurred across treatment groups, explained by larger improvements in NP versus RC youth in DEXA total fat (p = 0.03) and PDFF (p = 0.04). Conclusions: Intensive, family-based BWL treatment can improve whole-body adiposity and liver fat in obese youth, with decreases or attenuation of additional fat gain observed in AP-treated youth.
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Affiliation(s)
- Ginger E. Nicol
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Rachel Kolko
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, Pennsylvania
| | - Eric J. Lenze
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Michael D. Yingling
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - J. Philip Miller
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri
| | - Amanda R. Ricchio
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Julia A. Schweiger
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Robert L. Findling
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Denise Wilfley
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - John W. Newcomer
- Healthy Mind Lab, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
- Thriving Mind South Florida Behavioral Health Network, Miami, Florida
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10
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Wykes TL, Bourassa KA, Slosser AE, McKibbin CL. Community Mental Health Providers' Beliefs About Addressing Weight Loss Among Youth Clients with Serious Emotional Disturbance and Overweight/Obesity: An Elicitation Study. Community Ment Health J 2018; 54:1136-1145. [PMID: 29427055 PMCID: PMC9911299 DOI: 10.1007/s10597-018-0242-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 01/27/2018] [Indexed: 01/24/2023]
Abstract
Youth with Serious Emotional Disturbance (SED) have high rates of overweight/obesity. Factors influencing mental health provider intentions to deliver weight-related advice are unclear. This study used qualitative methodology and Theory of Planned Behavior (TPB) constructs to examine these factors. Community mental health providers serving youth with SED were recruited via convenience sampling and an online provider list. Participants completed an open-ended TPB-based questionnaire online. Content analysis identified thematic beliefs. Twenty-one providers completed the questionnaire. Providers identified behavioral beliefs (e.g., client defensiveness), normative beliefs (e.g., medical professionals), and control beliefs (e.g., limited resources) that impact decisions to provide weight-related advice. Knowledge of factors that may influence providers' delivery of weight-related advice may lead to more effective healthy lifestyle programming for youth with SED.
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Affiliation(s)
- Thomas L Wykes
- Department of Psychology, University of Wyoming, 1000 E. University Avenue, Laramie, WY, 82071, USA
| | - Katelynn A Bourassa
- Department of Psychology, University of Wyoming, 1000 E. University Avenue, Laramie, WY, 82071, USA
| | - Andrea E Slosser
- Department of Psychology, University of Wyoming, 1000 E. University Avenue, Laramie, WY, 82071, USA
| | - Christine L McKibbin
- Department of Psychology, University of Wyoming, 1000 E. University Avenue, Laramie, WY, 82071, USA.
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11
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Ayub S, Ramtekkar UP, Reiersen AM. Use of Antipsychotic Drugs for Psychotic Disorders in Children. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s40501-018-0137-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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