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Keller-Varady K, Haufe S, Schieffer E, Kerling A, Tegtbur U, Kahl KG. Personalized training as a promoter for physical activity in people with depressive disorder-a randomized controlled trial in Germany. Front Psychiatry 2023; 14:1158705. [PMID: 37457780 PMCID: PMC10338920 DOI: 10.3389/fpsyt.2023.1158705] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Adopting an active lifestyle is an important goal, but can be difficult to achieve for people with depressive disorders. Current guidelines recommend the integration of physical activity in the multimodal treatment of depressive disorders. However, the possibilities to provide individual support for physical activities are frequently limited. The aim of our study was to examine how physical activity can be increased in a real-world setting by combining physical training and psychological interventions. Materials and methods In this randomized-controlled interventional study, 31 outpatients diagnosed with moderate to severe depression were recruited from the region of Hannover. The intervention group (n = 16) was offered six weekly individual sessions lasting between 60 and 90 min with a sports scientist, including Motivational Interviewing and accompanied exercise activities. The control group (n = 15) received a written booklet with information on steps toward becoming more active. Moderate-to-vigorous physical activity (MVPA) as the primary outcome was analyzed using activity sensors before and after the 6-week intervention, and 3 months subsequently. Secondary outcomes included the Six-Minute Walk Test (6MWT), Sit-to-Stand test (STS), and mental health assessed with self-rating questionnaires. Results In the intervention group, MVPA increased significantly between baseline and the first follow-up and remained at an increased level at the second follow-up in comparison to decreased levels in the control group (difference of 15.5 min/day between groups over time, SE = 6.2 min/day, 95%-CI[2.7, 28.3], p = 0.020). The increased activity level was associated with markers of increased fitness (6MWT and STS) in the intervention group. Both groups showed comparable improvements in depressive symptoms, while the number of patients receiving antidepressants increased in the control group and decreased in the intervention group. Two patients dropped out of the intervention group during the trial. Conclusion The intervention proved to be a feasible and effective aid to promote a physically active lifestyle for patients diagnosed with depression. Furthermore, the higher level of physical activity was maintained for the follow-up period. Given the success of the approach evaluated in this project, individual support for physical activity should be investigated in larger sample sizes and potentially be considered in the multimodal treatment of depression. Clinical trial registration [https://clinicaltrials.gov/], identifier [DRKS00023257].
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Affiliation(s)
- Katriona Keller-Varady
- Department of Rehabilitation and Sports Medicine, Hannover Medical School, Hannover, Germany
| | - Sven Haufe
- Department of Rehabilitation and Sports Medicine, Hannover Medical School, Hannover, Germany
| | - Elisabeth Schieffer
- Department of Rehabilitation and Sports Medicine, Hannover Medical School, Hannover, Germany
| | - Arno Kerling
- Department of Rehabilitation and Sports Medicine, Hannover Medical School, Hannover, Germany
| | - Uwe Tegtbur
- Department of Rehabilitation and Sports Medicine, Hannover Medical School, Hannover, Germany
| | - Kai G. Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
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2
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Suen YN, Lee EHM, Lam COB, Hui CLM, Chan SKW, Chang WC, Chen EYH. Evaluating a pilot community-based FITMIND exercise programme for psychosis in Hong Kong. BMC Psychiatry 2023; 23:385. [PMID: 37259084 DOI: 10.1186/s12888-023-04901-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/25/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Exercise interventions can improve clinical symptoms and cognition in patients with psychosis in addition to their physical health. However, their benefits may not be maximally generalised to those who cannot access gymnasium facilities, which were commonly required previously. This study evaluated a 12-week community exercise programme named FITMIND, which aims to help patients with psychosis establish exercise habits through easy-to-learn aerobic exercise and yoga, with the support of trained volunteers. METHOD This study analysed the profiles of 49 patients with psychosis who were referred by the case manager of the early psychosis programme in the public hospital in Hong Kong or enrolled in the programme through the project website. The outcome measures were working memory, physical activity (PA) participation, quality of life, and mood symptoms. RESULTS At baseline, seven participants (14.3%) met the recommendation of the PA for severe mental illnesses. After the 12-week programme, participants demonstrated significant improvement in vigorous-intensity PA, moderate-to-vigorous PA, compliance with international guidelines for PA, and mood symptoms. CONCLUSION The FITMIND exercise programme is a feasible community-based intervention that can improve PA participation and mood in patients with psychosis. Further systematic studies are needed to examine the long-term beneficial effects of the programme.
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Affiliation(s)
- Yi Nam Suen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Edwin Ho Ming Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Christina Oi Bun Lam
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Christy Lai Ming Hui
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Sherry Kit Wa Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Wing Chung Chang
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China.
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3
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Goessl CL, VanWormer JJ, Pathak RD, Ellerbeck EF, Kurz DL, Befort CA. Weight change and mental health status in a behavioral weight loss trial. J Affect Disord 2023; 334:302-306. [PMID: 37156276 DOI: 10.1016/j.jad.2023.04.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 04/12/2023] [Accepted: 04/29/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Obesity, depression, and anxiety often co-occur, but research on weight change and mental health status is limited. This analysis examined how the mental component score (MCS-12) from the Short Form health survey changed over 24 months in weight loss trial participants with vs. without treatment seeking for affective symptoms (TxASx) and by weight change quintiles. METHODS Participants with complete data (n = 1163) were analyzed from enrollees in a cluster-randomized, behavioral weight loss trial in rural U.S. Midwestern primary care practices. Participants received a lifestyle intervention with different delivery models, including in-clinic individual, in-clinic group, or telephone group counseling visits. Participants were stratified by baseline TxASx status and 24-month weight change quintiles. Mixed models were used to estimate MCS-12 scores. RESULTS There was a significant group-by-time interaction at the 24-month follow-up. The largest 0-24 month increase in MCS-12 scores (+5.3 points [12 %]) was observed in participants with TxASx who lost the most weight during the trial, while the largest decrease in MCS-12 scores (-1.8 points [-3 %]) was observed in participants without TxASx who gained the most weight (p < 0.001). LIMITATIONS Notable limitations included self-reported mental health, the observational analytical design, and a largely homogenous source population, as well as the possibility of reverse causation biasing some findings. CONCLUSIONS Mental health status generally improved, particularly among participants with TxASx who experienced significant weight loss. Those without TxASx who gained weight, however, had a decline in mental health status over 24 months. Replication of these findings is warranted.
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Affiliation(s)
- Cody L Goessl
- Marshfield Clinic Research Institute, Center for Clinical Epidemiology & Population Health, Marshfield, WI, USA; Marshfield Clinic-Marshfield Medical Center, Department of Occupational Medicine, Marshfield, WI, USA
| | - Jeffrey J VanWormer
- Marshfield Clinic Research Institute, Center for Clinical Epidemiology & Population Health, Marshfield, WI, USA.
| | - Ram D Pathak
- Marshfield Clinic-Marshfield Medical Center, Department of Endocrinology, Marshfield, WI, USA
| | - Edward F Ellerbeck
- University of Kansas Medical Center, Department of Population Health, Kansas City, KS, USA
| | - Daniel L Kurz
- University of Kansas Medical Center, Department of Population Health, Kansas City, KS, USA
| | - Christie A Befort
- University of Kansas Medical Center, Department of Population Health, Kansas City, KS, USA
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4
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Healthy choices, healthy changes: A randomized trial of incentives to promote healthy eating and exercise in people with schizophrenia and other serious mental illnesses. Schizophr Res 2023; 255:1-8. [PMID: 36933290 DOI: 10.1016/j.schres.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 01/12/2023] [Accepted: 03/03/2023] [Indexed: 03/20/2023]
Abstract
INTRODUCTION People with schizophrenia and other serious mental illnesses (SMI) represent a concerning health disparity population, with 10-30 fewer years of life compared to the general population, mainly from high rates of cardiovascular disease (CVD). Preventing CVD is possible with exercise and diet interventions, but only 50 % of participants in clinical trials achieve reduction in CVD risk. This study assessed whether cash incentives improved weight loss, cardiovascular endurance, and/or mortality risk when added to one of four healthy lifestyle programs (gym membership, Weight Watchers membership, the InSHAPE program, InSHAPE + Weight Watchers). METHODS From 2012 to 2015, 1348 overweight or obese adults with SMI enrolled in a study using equipoise stratified randomization. Participants were randomly assigned to intervention, then to cash incentives, or not, for participation (gym and/or Weight Watchers), with baseline and quarterly assessments for 12 months. We examined effects of the interventions, key covariates, and incentives, using generalized linear models. RESULTS Main effects of randomization to receive cash incentives was not significant for any outcome; whereas total amount of incentives was significantly associated with all three primary outcomes (weight loss, cardiovascular endurance, mortality risk), mainly for participants in the InSHAPE+WW group who received additional cash incentives. CONCLUSIONS Incentives may be effective at preventing CVD and improving health outcomes for people with SMI, especially in the context of intensive support for healthy lifestyle behaviors. Policy changes are required to increase access to healthy lifestyle programming and more research is needed to establish the optimal amount of incentives for people with SMI. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02515981.
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Koomen LEM, van der Horst MZ, Deenik J, Cahn W. Lifestyle interventions for people with a severe mental illness living in supported housing: A systematic review and meta-analysis. Front Psychiatry 2022; 13:966029. [PMID: 36386997 PMCID: PMC9650385 DOI: 10.3389/fpsyt.2022.966029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/05/2022] [Indexed: 12/05/2022] Open
Abstract
Although supported housing facilities (SHF) appear to be an ideal setting for supporting people with severe mental illness (SMI) to obtain a healthier lifestyle, little is known about the effects of lifestyle interventions in SHF and the factors contributing to successful implementation. We performed a systematic review and meta-analysis to assess the effect of lifestyle interventions on mental and physical health in people with SMI in SHF, and reviewed which intervention factors contribute to successful implementation. A meta-analysis using a random effects model was undertaken. Discussions were reviewed to identify factors that foster successful implementation. Of 7401 identified studies, 9 RCTs (n = 1260) were included for the systematic review and 8 (n = 1187) for the meta-analysis. Improvements in weight (n = 3), BMI (n = 1), 6-Min Walk Test (n = 1) and metabolic criteria (n = 2) were seen. In the meta-analysis we only found a small effect for a decrease in waist circumference. Reviewing factors involved with the implementation showed that the most successfully implemented interventions were multidisciplinary and integrated into standard care. In conclusion, we found limited evidence for the effectiveness of lifestyle interventions on physical health for those living in SHF. To reliably examine the effects on mental and physical health, more studies with high involvement of staff and participants are needed.
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Affiliation(s)
- Lisanne E M Koomen
- Department of Psychiatry, UMC Utrecht, Utrecht, Netherlands.,Lister, Utrecht, Netherlands
| | - Marte Z van der Horst
- Department of Psychiatry, UMC Utrecht, Utrecht, Netherlands.,GGnet, Warnsveld, Netherlands
| | - Jeroen Deenik
- Department of Psychiatry, UMC Utrecht, Utrecht, Netherlands.,GGz Centraal, Amersfoort, Netherlands.,School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Wiepke Cahn
- Department of Psychiatry, UMC Utrecht, Utrecht, Netherlands.,Altrecht, Utrecht, Netherlands
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6
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Schnitzer K, Cather C, Zvonar V, Dechert A, Plummer R, Lowman K, Pachas G, Potter K, Evins AE. Patient Experience and Predictors of Improvement in a Group Behavioral and Educational Intervention for Individuals With Diabetes and Serious Mental Illness: Mixed Methods Case Study. J Particip Med 2021; 13:e21934. [PMID: 33576747 PMCID: PMC7910121 DOI: 10.2196/21934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/12/2020] [Accepted: 12/24/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In a previous study, participation in a 16-week reverse integrated care and group behavioral and educational intervention for individuals with diabetes and serious mental illness was associated with improved glycemic control (hemoglobin A1c) and BMI. To inform future implementation efforts, more information about the effective components of the intervention is needed. OBJECTIVE The goal of this study is to identify the aspects of the intervention participants reported to be helpful and to evaluate the predictors of outcomes. METHODS This study involved qualitative evaluation and post hoc quantitative analysis of a previous intervention. Qualitative data were collected using semistructured interviews with 69% (24/35) of the individuals who attended 1 or more group sessions and 35% (9/26) of the individuals who consented but attended no sessions. Quantitative mixed effects modeling was performed to test whether improved diabetes knowledge, diet, and exercise or higher group attendance predicted improved hemoglobin A1c and BMI. These interview and modeling outcomes were combined using a mixed methods case study framework and integrated thematically. RESULTS In qualitative interviews, participants identified the application of health-related knowledge gained to real-world situations, accountability for goals, positive reinforcement and group support, and increased confidence in prioritizing health goals as factors contributing to the success of the behavioral intervention. Improved knowledge of diabetes was associated with reduced BMI (β=-1.27, SD 0.40; P=.003). No quantitative variables examined were significantly associated with improved hemoglobin A1c levels. CONCLUSIONS In this mixed methods analysis of predictors of success in a behavioral diabetes management program, group participants highlighted the value of positive reinforcement and group support, accountability for goals set, and real-world application of health-related knowledge gained. Improved diabetes knowledge was associated with weight loss.
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Affiliation(s)
- Kristina Schnitzer
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Corrine Cather
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, United States.,Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Vanya Zvonar
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, United States.,Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Alyson Dechert
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Rachel Plummer
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Kelsey Lowman
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Gladys Pachas
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, United States
| | - Kevin Potter
- Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, United States.,Department of Biostatistics, Massachusetts General Hospital, Boston, MA, United States
| | - Anne Eden Evins
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA, United States
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7
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Avery N, Patterson S. Physical Health in Public Mental Health Care: A Qualitative Study Employing the COM‐B Model of Behaviour to Describe Views and Practices of Australian Psychologists. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Natalie Avery
- Royal Brisbane and Women's Hospital, Metro North Mental Health, Metro North Hospital and Health Service,
- Charles Sturt University,
| | - Sue Patterson
- Royal Brisbane and Women's Hospital, Metro North Mental Health, Metro North Hospital and Health Service,
- Griffith University,
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8
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Fisher E, Wood SJ, Upthegrove R, Aldred S. Designing a feasible exercise intervention in first-episode psychosis: Exercise quality, engagement and effect. Psychiatry Res 2020; 286:112840. [PMID: 32062521 DOI: 10.1016/j.psychres.2020.112840] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/30/2020] [Accepted: 02/02/2020] [Indexed: 02/04/2023]
Abstract
First-episode psychosis (FEP) is the first presentation of a psychotic disorder that usually propagates during early adulthood. FEP represents an important early intervention point to attenuate the metabolic risks associated with psychosis and its treatment. Exercise has potential to improve metabolic and functional outcome, but engaging this population in regular exercise is typically difficult. Promoting enjoyment and attendance may improve participation. 22 men with FEP were randomised to a 12-week intervention of exercise training, or treatment as usual. Exercise was pre-standardised based on measures of heart rate to assess intensity. Symptoms of psychosis were assessed, alongside measures of quality of life, disability and habitual activity. The study observed 83% attendance at exercise sessions, with target intensity attained. There were clinically meaningful decreases in PANSS positive (17.31%) and general psychopathology (10.98%) scores and exercise was protective of negative score increase observed in the control group (13.89%). Assessment of disability declined after training (12.65%) compared with a 20.78% increase in controls. This study demonstrated that engagement of FEP patients in an intervention of high quality exercise was possible. Positive changes in psychopathology scores and disability show that the benefits of regular exercise are achievable with a potential positive impact on clinical presentation.
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Affiliation(s)
- Emily Fisher
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, B15 2TT, U.K
| | - Stephen J Wood
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Melbourne VIC 3052, Australia; School of Psychology, University of Birmingham, Edgbaston, B15 2TT, U.K.; Centre for Youth Mental Health, University of Melbourne, VIC 3010, Australia
| | - Rachel Upthegrove
- Institute for Mental Health, University of Birmingham, Edgbaston, B15 2TT, U.K.; Department of Psychiatry, University of Birmingham, Edgbaston, B15 2TT, U.K
| | - Sarah Aldred
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, B15 2TT, U.K.; Institute for Mental Health, University of Birmingham, Edgbaston, B15 2TT, U.K..
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9
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Mazoruk S, Meyrick J, Taousi Z, Huxley A. The effectiveness of health behavior change interventions in managing physical health in people with a psychotic illness: A systematic review. Perspect Psychiatr Care 2020; 56:121-140. [PMID: 31131451 DOI: 10.1111/ppc.12391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 04/02/2019] [Accepted: 04/14/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE People living with psychotic illness disproportionately experience more comorbidities and have a markedly shorter life expectancy compared to the general population. This review evaluates the effectiveness of health behavior change interventions in improving health outcomes in this group. DESIGN AND METHODS All studies included objective physical health measures or health behaviors as the main outcome measures and experimental design with baseline and follow-up quantitative data. Only studies of moderate and strong quality were included. Narrative synthesis was undertaken. FINDINGS Included studies utilized a range of methodological designs and outcome measures. The majority reported significant intervention effect on most outcome measures. PRACTICE IMPLICATIONS Health behavior change interventions can be effective in improving health outcomes in people with psychotic illness, with the potential benefit of improved psychiatric outcomes.
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Affiliation(s)
- Sabina Mazoruk
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Jane Meyrick
- Department of Health and Social Sciences, University of the West of England, Bristol, UK
| | - Zohra Taousi
- Department of Community Psychiatry, Hertfordshire Partnership University NHS Foundation Trust, St Albans, Hertfordshire, UK
| | - Adam Huxley
- Change Grow Live, Department of Psychology, Hatfield, Hertfordshire, UK
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10
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Gyllensten AL, Ovesson MN, Hedlund L, Ambrus L, Tornberg Å. To increase physical activity in sedentary patients with affective - or schizophrenia spectrum disorders - a clinical study of adjuvant physical therapy in mental health. Nord J Psychiatry 2020; 74:73-82. [PMID: 31560246 DOI: 10.1080/08039488.2019.1669706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose: To understand if physical therapy in addition to individualized psychiatric specialist treatment could aid sedentary patients with schizophrenia spectrum disorders or affective spectrum disorders to become more physically active and also to identify assessments suitable for measuring physical activity, physical function and movement motivation.Materials and methods: In a longitudinal, clinical study 18 sedentary patients that filled inclusion criteria were consecutively included. The patients were diagnosed with affective disorders (n = 10) or schizophrenia spectrum disorders (n = 8).Results: Fifteen patients fulfilled the 6-month treatment. The affective group significantly improved physical activity, walking capacity, physical function, exercise habits and attitudes. The schizophrenia spectrum group significantly improved the attitudes to the body and movements but did not increase their physical activity. Instruments to study physical activity, physical function and movement motivation were identified.Conclusion: The study revealed that physical therapy in addition to individualized psychiatric specialist treatment might be an aid for the patients to become more physically active. Patients with affective disorders reached recommended levels of moderate physical activity according to World Health Organization guidelines. Sedentary patients with schizophrenia spectrum disorders revealed positive attitude-changes, but no behavioral change.
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Affiliation(s)
| | - Maria N Ovesson
- Department of Psychiatry, Lund University Hospital, Lund, Sweden
| | - Lena Hedlund
- Department of Psychiatry, Malmö University, Malmö, Sweden
| | - Livia Ambrus
- Department of Clinical Sciences, Section of Psychiatry, Clinical Psychiatric Research Center, Lund University, Region Skåne, Sweden
| | - Åsa Tornberg
- Department of Health Sciences, Lund University, Lund, Sweden
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11
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Korman N, Fox H, Skinner T, Dodd C, Suetani S, Chapman J, Parker S, Dark F, Collins C, Rosenbaum S, Siskind D. Feasibility and Acceptability of a Student-Led Lifestyle (Diet and Exercise) Intervention Within a Residential Rehabilitation Setting for People With Severe Mental Illness, GO HEART (Group Occupation, Health, Exercise And Rehabilitation Treatment). Front Psychiatry 2020; 11:319. [PMID: 32411024 PMCID: PMC7198865 DOI: 10.3389/fpsyt.2020.00319] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/31/2020] [Indexed: 12/20/2022] Open
Abstract
PURPOSE People with severe mental illness (SMI) experience poor physical health and premature mortality, contributed significantly by modifiable lifestyle risk factors such as poor nutrition, low cardiorespiratory fitness, and physical inactivity. Lifestyle interventions can reduce cardiometabolic risk and confer a range of other positive mental and physical health benefits. We assessed the feasibility, acceptability, safety, and preliminary effectiveness of a lifestyle (combined dietary and exercise) intervention lead by senior exercise and dietetics students in a residential mental health rehabilitation setting. DESIGN Single arm, prospective study evaluating outcomes pre and post a 10-week dietary and exercise intervention. METHOD People with SMI from three residential rehabilitation units participated in a mixed aerobic and resistance training exercise intervention three times per week that was combined with a dietary intervention (six individual and group sessions). Primary outcome considerations were feasibility (recruitment, retention, and participation rates), acceptability, and adverse events. Secondary outcomes were preliminary effectiveness; (functional exercise capacity, volume of exercise, and metabolic markers), psychiatric symptoms, quality of life, and attitudes to exercise. RESULTS Forty-two participants were recruited (92% primary diagnosis of schizophrenia). Intervention feasibility was supported by high levels of recruitment (68%), retention (77%), and participation (70% exercise, 65% diet sessions); and the absence of serious adverse events. Significant improvements in functional exercise capacity, volume of exercise, general psychiatric symptoms, and negative psychotic symptoms occurred. Anthropometric and metabolic blood markers did not change. While the intervention was acceptable to participants, motivation for and perceived value of exercise reduced over 10 weeks. CONCLUSIONS A brief pragmatic student-led lifestyle intervention integrated into usual mental health care was feasible, acceptable, safe, and scalable across two additional mental health residential rehabilitation sites, and resulted in physical and mental health improvements. Increased frequency of dietary sessions and length of dietary intervention may improve metabolic outcomes in the future. People with SMI living in residential rehabilitation units should have access to lifestyle programs to address modifiable lifestyle risk factors. While this brief intervention was feasible and acceptable, this study highlights some of the challenges associated with maintaining motivation for healthy lifestyles for people with SMI. Longer term investigation of real-world lifestyle interventions is warranted, together with additional interventions that may support people with SMI to sustain motivation to address lifestyle factors. CLINICAL TRIAL REGISTRATION The trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), Unique Identifier: ACTRN 12618000478213, http://www.anzctr.org.au Universal trial number (UTN)-U1111-1211-4009.
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Affiliation(s)
- Nicole Korman
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Harley Fox
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Tina Skinner
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Cassandra Dodd
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia
| | - Shuichi Suetani
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia
| | - Justin Chapman
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia.,Queensland Institute of Medical Research, Mental Health and Complex Disorders, Brisbane, QLD, Australia
| | - Stephen Parker
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Frances Dark
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Cheryl Collins
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Simon Rosenbaum
- School of Psychiatry, Faculty of Medicine, UNSW, Sydney, NSW, Australia
| | - Dan Siskind
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
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12
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Ashdown-Franks G, Williams J, Vancampfort D, Firth J, Schuch F, Hubbard K, Craig T, Gaughran F, Stubbs B. Is it possible for people with severe mental illness to sit less and move more? A systematic review of interventions to increase physical activity or reduce sedentary behaviour. Schizophr Res 2018; 202:3-16. [PMID: 29980329 DOI: 10.1016/j.schres.2018.06.058] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/21/2018] [Accepted: 06/23/2018] [Indexed: 01/30/2023]
Abstract
Individuals with severe mental illness (SMI) (schizophrenia-spectrum, bipolar disorder and major depressive disorder) die 10-20 years prematurely due to physical disorders such as cardiovascular disease. Physical activity (PA) is effective in preventing and managing these conditions in the general population, however individuals with SMI engage in substantially less PA and more sedentary behaviour (SB) compared to healthy counterparts. Furthermore, the effectiveness of intervening to increase PA or reduce SB in SMI populations is unknown. Therefore, we systematically reviewed studies measuring changes in PA or SB following behavioural interventions in people with SMI. A systematic search of major databases was conducted from inception until 1/3/2018 for behavioural interventions reporting changes in PA or SB in people with SMI. From 3018 initial hits, 32 articles were eligible, including 16 controlled trials (CT's; Treatment n = 1025, Control n = 1162) and 16 uncontrolled trials (n = 655). Of 16 CTs, seven (47%) reported significant improvements in PA, although only one found changes with an objective measure. Of 16 uncontrolled trials, 3 (20%) found improvements in PA (one with objective measurement). No intervention study had a primary aim of changing SB, nor did any note changes in SB using an objective measure. In conclusion, there is inconsistent and low quality evidence to show that interventions can be effective in changing PA or SB in this population. Future robust randomized controlled trials, using objectively-measured PA/SB as the primary outcome, are required to determine which behavioural interventions are effective in improving the sedentary lifestyles associated with SMI. Systematic review registration- PROSPERO registration number CRD42017069399.
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Affiliation(s)
- Garcia Ashdown-Franks
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom; Department of Exercise Sciences, University of Toronto, 55 Harbord Street, Toronto, Ontario M5S 2W6, Canada.
| | - Julie Williams
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom
| | - Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium and KU Leuven, University Psychiatric Center, Kortenberg, Belgium
| | - Joseph Firth
- NICM Health Research Institute, School of Science and Health, University of Western Sydney, Australia; Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, United Kingdom
| | - Felipe Schuch
- Universidade La Salle (Unilasalle), Canoas, Brazil; Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Kathryn Hubbard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom
| | - Tom Craig
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom
| | - Fiona Gaughran
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
| | - Brendon Stubbs
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom; South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
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13
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Stiekema APM, Looijmans A, van der Meer L, Bruggeman R, Schoevers RA, Corpeleijn E, Jörg F. Effects of a lifestyle intervention on psychosocial well-being of severe mentally ill residential patients: ELIPS, a cluster randomized controlled pragmatic trial. Schizophr Res 2018; 199:407-413. [PMID: 29503230 DOI: 10.1016/j.schres.2018.02.053] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/22/2017] [Accepted: 02/25/2018] [Indexed: 12/22/2022]
Abstract
Large studies investigating the psychosocial effects of lifestyle interventions in patients with a severe mental illness (SMI) are scarce, especially in residential patients. This large, randomized controlled, multicentre pragmatic trial assessed the psychosocial effects of a combined diet-and-exercise lifestyle intervention targeting the obesogenic environment of SMI residential patients. Twenty-nine sheltered and clinical care teams were randomized into intervention (n=15) or control (n=14) arm. Team tailored diet-and-exercise lifestyle plans were set up to change the obesogenic environment into a healthier setting, and team members were trained in supporting patients to make healthier choices. The control group received care-as-usual. The Calgary Depression Scale for Schizophrenia (CDSS), Positive and Negative Syndrome Scale (PANSS), Health of the Nation Outcome Scales (HoNOS) and the Manchester Short Assessment of Quality of Life (MANSA) were assessed at baseline and after three and twelve months. Data were available for 384 intervention and 386 control patients (48.6±12.5years old, 62.7% males, 73.7% psychotic disorder). Linear mixed model analysis showed no psychosocial improvements in the intervention group compared to care-as-usual; the intervention group showed a slightly reduced quality of life (overall) and a small increase in depressive symptoms (clinical care facilities) and psychotic symptoms (sheltered facilities). This may be due to difficulties with implementation, the intervention not being specifically designed for improvements in mental well-being, or the small change approach, which may take longer to reach an effect. Further research might elucidate what type of lifestyle intervention under what circumstances positively affects psychosocial outcomes in this population.
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Affiliation(s)
- Annemarie P M Stiekema
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, The Netherlands; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Department of Psychiatry and Neuropsychology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Anne Looijmans
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Rob Giel Research Center, Groningen, The Netherlands.
| | - Lisette van der Meer
- Department of Rehabilitation, Lentis Psychiatric Institute, Zuidlaren, The Netherlands; University of Groningen, University Medical Center Groningen, Rob Giel Research Center, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of Neuroscience, Groningen, The Netherlands
| | - Richard Bruggeman
- University of Groningen, University Medical Center Groningen, Rob Giel Research Center, Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, University Center of Psychiatry, Groningen, The Netherlands
| | - Robert A Schoevers
- University of Groningen, University Medical Center Groningen, University Center of Psychiatry, Groningen, The Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frederike Jörg
- University of Groningen, University Medical Center Groningen, Rob Giel Research Center, Groningen, The Netherlands; Research Department, Friesland Mental Health Services, Leeuwarden, The Netherlands
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14
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Waugh A, Crumlish N, Kelleher E, Forde C, Broderick J. A feasibility study of a physiotherapy-led motivational programme to increase physical activity and improve cardiometabolic risk in people with major mental illness. Gen Hosp Psychiatry 2018; 54:37-44. [PMID: 29678276 DOI: 10.1016/j.genhosppsych.2018.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/02/2018] [Accepted: 03/05/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Alice Waugh
- Department of Physiotherapy, St. James's Hospital, Dublin 8, Ireland.
| | - Niall Crumlish
- Department of Psychiatry, St. James's Hospital, Dublin 8, Ireland
| | - Eric Kelleher
- Department of Psychiatry, St. James's Hospital, Dublin 8, Ireland; Trinity College, The University of Dublin, Ireland
| | - Cuisle Forde
- Discipline of Physiotherapy, Trinity College, The University of Dublin, Ireland
| | - Julie Broderick
- Discipline of Physiotherapy, Trinity College, The University of Dublin, Ireland
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15
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Ringen PA, Falk RS, Antonsen B, Faerden A, Mamen A, Rognli EB, Solberg DK, Martinsen EW, Andreassen OA. Using motivational techniques to reduce cardiometabolic risk factors in long term psychiatric inpatients: a naturalistic interventional study. BMC Psychiatry 2018; 18:255. [PMID: 30111298 PMCID: PMC6094458 DOI: 10.1186/s12888-018-1832-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 07/30/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND People with severe mental illness have markedly reduced life expectancy; cardiometabolic disease is a major cause. Psychiatric hospital inpatients have elevated levels of cardiometabolic risk factors and are to a high degree dependent of the routines and facilities of the institutions. Studies of lifestyle interventions to reduce cardiometabolic risk in psychiatric inpatients are few. The current study aimed at assessing the feasibility and effects of a lifestyle intervention including Motivational Interviewing (MI) on physical activity levels, cardiometabolic risk status and mental health status in psychotic disorder inpatients. METHODS Prospective naturalistic intervention study of 83 patients at long term inpatient psychosis treatment wards in South-Eastern Norway. Patients were assessed 3-6 months prior to, at start and 6 months after a life-style intervention program including training of staff in MI, simple changes in routines and improvements of facilities for physical exercise. Assessments were done by clinical staff and included level of physical activity, motivation, life satisfaction, symptom levels (MADRS, AES-C, PANSS, and GAF) as well as anthropometric and biochemical markers of cardiometabolic risk. A mixed model was applied to analyze change over time. RESULTS A total of 88% of patients received MI interventions, with a mean of 2.5 MI interventions per week per patient. The physical activity level was not increased, but activity level was positively associated with motivation and negatively associated with positive symptoms. Triglyceride levels and number of smokers were significantly reduced and a significant decrease in symptom levels was observed. CONCLUSIONS The current results suggest that a simple, low cost life-style intervention program focusing on motivational change is feasible and may reduce symptoms and improve lifestyle habits in psychosis patients in long term treatment facilities. Similar programs may easily be implemented in other psychiatric hospitals. TRIAL REGISTRATION ClinicalTrials.gov . NCT03528278 , date of registration: 05/16/2018 (retrospectively registered).
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Affiliation(s)
- Petter Andreas Ringen
- Division of Mental Health and Addiction, Oslo University Hospital and NORMENT, KG Jebsen Centre, University of Oslo, Ullevål Hospital, P.O.Box 4956, 0424, Nydalen, Oslo, Norway.
| | - Ragnhild S. Falk
- 0000 0004 0389 8485grid.55325.34Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, P.O.Box 4950, 0424 Nydalen, Oslo Norway
| | - Bjørnar Antonsen
- 0000 0004 0627 3157grid.416137.6Department of Psychiatry, Lovisenberg Diaconal Hospital, P.O.Box 4970, 0440 Nydalen, Oslo Norway
| | - Ann Faerden
- Division of Mental Health and Addiction, Oslo University Hospital and NORMENT, KG Jebsen Centre, University of Oslo, Ullevål Hospital, P.O.Box 4956, 0424 Nydalen, Oslo Norway
| | - Asgeir Mamen
- grid.488488.0Kristiania University College, P.O.Box 1190, 0107 Sentrum, Oslo Norway
| | - Eline B. Rognli
- 0000 0004 0389 8485grid.55325.34Division of Mental Health and Addiction, Oslo University Hospital, Ullevål Hospital, P.O.Box 4956, 0424 Nydalen, Oslo Norway
| | - Dag K. Solberg
- 0000 0004 0512 8628grid.413684.cSkjelfoss Psychiatric Center, Lukas Foundation and Center for Psychopharmacology Diakonhjemmet Hospital, Postboks 23, 0319 Vinderen, Oslo Norway
| | - Egil W. Martinsen
- 0000 0004 0389 8485grid.55325.34Division of Mental Health and Addiction, Oslo University Hospital and University of Oslo, Ullevål Hospital, P.O.Box 4956, 0424 Nydalen, Oslo Norway
| | - Ole A. Andreassen
- NORMENT, KG Jebsen Centre, Oslo University Hospital, and University of Oslo, Ullevål Hospital, Building 49, P.O. Box 4956, 0424 Nydalen, Oslo Norway
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16
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Korman NH, Shah S, Suetani S, Kendall K, Rosenbaum S, Dark F, Nadareishvili K, Siskind D. Evaluating the Feasibility of a Pilot Exercise Intervention Implemented Within a Residential Rehabilitation Unit for People With Severe Mental Illness: GO HEART: (Group Occupational Health Exercise and Rehabilitation Treatment). Front Psychiatry 2018; 9:343. [PMID: 30100885 PMCID: PMC6072846 DOI: 10.3389/fpsyt.2018.00343] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 07/09/2018] [Indexed: 12/17/2022] Open
Abstract
Purpose: People with severe mental illness are sedentary, have high cardio-metabolic risks and significantly reduced life expectancy. Despite considerable data regarding positive physical and mental health outcomes following exercise interventions, implementation and evaluation of real-world programs is lacking. The primary aim of this study was to assess the feasibility of an exercise intervention implemented by exercise physiology (EP) students within a residential rehabilitation unit for residents with severe mental illness, together with assessment of a range of secondary physical and mental health outcomes pre- and post- the intervention. Design: Single arm, prospective pilot study evaluating outcomes pre- and post- a 10 week intervention. Method: Inactive people with severe mental illness participated in a mixed aerobic and resistance exercise intervention, three times per week for 10 weeks. Data was obtained from a sample of 16 residents with severe mental illness; primary diagnosis schizophrenia (n = 12). Primary outcomes were feasibility as assessed using recruitment, retention and participation rates, as well as reasons for withdrawal and amount of exercise achieved. Secondary outcomes included: functional exercise capacity was measured by the 6-min walk test; metabolic data obtained from anthropometric measurements; blood pressure; fasting cholesterol and blood sugar levels; and physical activity levels and mental health as assessed by self- administered questionnaires measured before and after the intervention. Results: Broad level acceptance of the program: high recruitment (81%), retention (77%), and participation (78%) rates were observed. Promising improvements in functional exercise capacity, volume of exercise, and negative symptoms was demonstrated in those who completed. Conclusions: Exercise interventions delivered by EP students in a residential rehabilitation setting for people with SMI are feasible; group setting, supervision and choice for engagement are important considerations. Evaluation of longitudinal, multi site studies, with the addition of dietary interventions within residential rehabilitation units are warranted. Addressing cost feasibility and cost effectiveness of such programs is recommended. The trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) number, Unique Identifier: ACTRN 12618000478213, http://www.anzctr.org.au Universal trial number (UTN) - U1111-1211-4009.
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Affiliation(s)
- Nicole H. Korman
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Shelukumar Shah
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia
| | - Shuichi Suetani
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Karen Kendall
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Simon Rosenbaum
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Frances Dark
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Ketevan Nadareishvili
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia
| | - Dan Siskind
- Addiction and Mental Health Services, Metro South Health Services, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
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17
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Bruce RD, Merlin J, Lum PJ, Ahmed E, Alexander C, Corbett AH, Foley K, Leonard K, Treisman GJ, Selwyn P. 2017 HIVMA of IDSA Clinical Practice Guideline for the Management of Chronic Pain in Patients Living With HIV. Clin Infect Dis 2018; 65:e1-e37. [PMID: 29020263 DOI: 10.1093/cid/cix636] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/19/2017] [Indexed: 12/27/2022] Open
Abstract
Pain has always been an important part of human immunodeficiency virus (HIV) disease and its experience for patients. In this guideline, we review the types of chronic pain commonly seen among persons living with HIV (PLWH) and review the limited evidence base for treatment of chronic noncancer pain in this population. We also review the management of chronic pain in special populations of PLWH, including persons with substance use and mental health disorders. Finally, a general review of possible pharmacokinetic interactions is included to assist the HIV clinician in the treatment of chronic pain in this population.It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The Infectious Diseases Society of American considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Affiliation(s)
- R Douglas Bruce
- Department of Medicine, Cornell Scott-Hill Health Center and Yale University, New Haven, Connecticut
| | - Jessica Merlin
- Divisions of Infectious Diseases and Gerontology, Geriatrics and Palliative Care, University of Alabama at Birmingham
| | - Paula J Lum
- Division of HIV, Infectious Disease, and Global Medicine, University of California San Francisco
| | - Ebtesam Ahmed
- St. Johns University College of Pharmacy and Health Sciences, Metropolitan Jewish Health System Institute for Innovation in Palliative Care, New York
| | - Carla Alexander
- University of Maryland School of Medicine, Institute of Human Virology, Baltimore
| | - Amanda H Corbett
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
| | - Kathleen Foley
- Attending Neurologist Emeritus, Memorial Sloan Kettering Cancer Center, New York
| | - Kate Leonard
- Division of Neuroscience and Clinical Pharmacology, Cornell University, New York, New York
| | | | - Peter Selwyn
- Department of Family and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
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18
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Deenik J, Kruisdijk F, Tenback D, Braakman-Jansen A, Taal E, Hopman-Rock M, Beekman A, Tak E, Hendriksen I, van Harten P. Physical activity and quality of life in long-term hospitalized patients with severe mental illness: a cross-sectional study. BMC Psychiatry 2017; 17:298. [PMID: 28821287 PMCID: PMC5562976 DOI: 10.1186/s12888-017-1466-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 08/14/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Increasing physical activity in patients with severe mental illness is believed to have positive effects on physical health, psychiatric symptoms and as well quality of life. Till now, little is known about the relationship between physical activity and quality of life in long-term hospitalized patients with severe mental illness and knowledge of the determinants of behavioural change is lacking. The purpose of this study was to elucidate the relationship between objectively measured physical activity and quality of life, and explore modifiable psychological determinants of change in physical activity in long-term hospitalized patients with severe mental illness. METHODS In 184 inpatients, physical activity was measured using an accelerometer (ActiGraph GTX+). Quality of life was assessed by EuroQol-5D and WHOQol-Bref. Attitude and perceived self-efficacy towards physical activity were collected using the Physical Activity Enjoyment Scale and the Multidimensional Self Efficacy Questionnaire, respectively. Patient and disease characteristics were derived retrospectively from electronic patient records. Associations and potential predictors were analysed using hierarchical regression. RESULTS Physical activity was positively related with and a predictor of all quality of life outcomes except on the environmental domain, independent of patient and disease characteristics. However, non-linear relationships showed that most improvement in quality of life lies in the change from sedentary to light activity. Attitude and self-efficacy were not related to physical activity. CONCLUSIONS Physical activity is positively associated with quality of life, especially for patients in the lower spectrum of physical activity. An association between attitude and self-efficacy and physical activity was absent. Therefore, results suggest the need of alternative, more integrated and (peer-)supported interventions to structurally improve physical activity in this inpatient population. Slight changes from sedentary behaviour to physical activity may be enough to improve quality of life.
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Affiliation(s)
- Jeroen Deenik
- GGz Centraal, Utrechtseweg 266, 3818 EW, Amersfoort, The Netherlands. .,Faculty of Behavioural, Management and Social sciences, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, The Netherlands. .,School for Mental Health and Neuroscience Maastricht University, Minderbroedersberg 4-6, 6211 LK, Maastricht, The Netherlands.
| | - Frank Kruisdijk
- GGz Centraal, Utrechtseweg 266, 3818 EW Amersfoort, The Netherlands ,0000 0004 0435 165Xgrid.16872.3aBody@Work, TNO-VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Diederik Tenback
- GGz Centraal, Utrechtseweg 266, 3818 EW Amersfoort, The Netherlands ,0000000120346234grid.5477.1Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Universiteitsweg 99, 3584 CG Utrecht, The Netherlands
| | - Annemarie Braakman-Jansen
- 0000 0004 0399 8953grid.6214.1Faculty of Behavioural, Management and Social sciences, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Erik Taal
- 0000 0004 0399 8953grid.6214.1Faculty of Behavioural, Management and Social sciences, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
| | - Marijke Hopman-Rock
- 0000 0004 0435 165Xgrid.16872.3aBody@Work, TNO-VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands ,The Netherlands Organization for applied scientific research TNO, Schipholweg 77-89, 2316 ZL Leiden, The Netherlands ,0000 0004 0435 165Xgrid.16872.3aEMGO institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Aartjan Beekman
- 0000 0004 0435 165Xgrid.16872.3aDepartment of Psychiatry, VU University Medical Centre, A.J. Ernststraat 1187, 1081 HL Amsterdam, The Netherlands
| | - Erwin Tak
- 0000 0004 0435 165Xgrid.16872.3aBody@Work, TNO-VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands ,The Netherlands Organization for applied scientific research TNO, Schipholweg 77-89, 2316 ZL Leiden, The Netherlands
| | - Ingrid Hendriksen
- 0000 0004 0435 165Xgrid.16872.3aBody@Work, TNO-VU University Medical Centre, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands ,The Netherlands Organization for applied scientific research TNO, Schipholweg 77-89, 2316 ZL Leiden, The Netherlands
| | - Peter van Harten
- GGz Centraal, Utrechtseweg 266, 3818 EW Amersfoort, The Netherlands ,0000 0001 0481 6099grid.5012.6School for Mental Health and Neuroscience Maastricht University, Minderbroedersberg 4-6, 6211 LK Maastricht, The Netherlands
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Abstract
Depressive symptoms have debilitating effects on the physical health and functioning of people with serious mental illness. We examined change in depressive symptoms among overweight and obese adults with serious mental illness (n = 343) using data combined from two randomized trials comparing the 12-month In SHAPE program to a gym membership control condition. In SHAPE consists of a gym membership, weekly individual meetings with a fitness trainer, and instruction on healthy eating and nutrition. Depressive symptoms were measured at baseline, 3, 6, and 12 months. Change in depressive symptoms did not differ between groups, but depressive symptoms decreased over time across the entire sample (p = 0.045). At 12 months, reduced depressive symptoms were associated with clinically significant improved cardiorespiratory fitness (p = 0.030), 10% or more weight loss (p = 0.044), and cardiovascular risk reduction (p = 0.028) across both groups. Our findings suggest that participation in health promotion programs resulting in cardiovascular risk reduction may be associated with reduced depressive symptoms.
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20
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Hunt K, Stiller K. Dietetic and educational interventions improve clinical outcomes of diabetic and obese clients with mental impairment. Nutr Diet 2017; 74:236-242. [PMID: 28731608 DOI: 10.1111/1747-0080.12340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/27/2016] [Accepted: 12/03/2016] [Indexed: 12/13/2022]
Abstract
AIM The aim of this study was to evaluate the effect of dietetic and educational interventions provided to clients with type 2 diabetes (with or without obesity) or obesity-only residing in supported residential facilities and characterised by mental impairment. METHODS A retrospective audit involving the retrieval of information from medical records and databases was undertaken to evaluate the effect of dietetic and educational interventions. Clinical outcomes were weight, body mass index and glycosylated haemoglobin (HbA1c) levels. RESULTS A total of 91 clients were included, 47 with type 2 diabetes (with or without obesity) and 44 with obesity-only. All but one had schizophrenia, an intellectual disability or another psychological condition. After interventions, the diabetic subgroup demonstrated significant decreases in weight (mean [SD] initial = 101.5 [20.7], final = 97.8 [20.6] kg, P = 0.001) and body mass index (mean [SD] initial = 35.8 [8.1], final = 34.4 [7.8] kg/m2 , P = 0.001) and a non-significant decrease in HbA1c over time. The obesity-only subgroup showed no significant change in outcomes. Factors significantly negatively impacting at least one outcome included the presence of schizophrenia (P ≤ 0.017) and refusal of intervention(s) (P ≤ 0.048), whereas a significant positive impact was seen for a greater total number of visits to a dietitian or diabetes educator (P ≤ 0.024). CONCLUSIONS These results provide evidence to support the effectiveness of dietetic and educational interventions for this vulnerable client group.
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Affiliation(s)
- Kerri Hunt
- Supported Residential Facilities Health Access Team, Sefton Park Primary Health Care Services, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Kathy Stiller
- Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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21
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Janney CA, Masheb RM, Lutes LD, Holleman RG, Kim HM, Gillon LR, Damschroder LJ, Richardson CR. Mental health and behavioral weight loss: 24-month outcomes in Veterans. J Affect Disord 2017; 215:197-204. [PMID: 28340446 DOI: 10.1016/j.jad.2017.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/30/2017] [Accepted: 03/05/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND Individuals with mental health (MH) disorders have an increased risk of being overweight/obese; however research on behavioral weight loss interventions has been limited. A priori hypothesis was that Veterans with serious mental illness (SMI) and/or affective disorders (AD) would lose significantly less weight and have a different pattern of weight loss than Veterans without these diagnoses. METHODS Secondary data analysis of ASPIRE-VA study, three-arm randomized, effectiveness weight loss trial among Veterans (n=409) categorized by MH diagnoses: 1) SMI, 2) AD without SMI, or 3) No SMI/No AD. Linear mixed-effects model analyzed weight changes from baseline thru 24 months. RESULTS SMI and AD were diagnosed in 10% (n=41) and 31% (n=125). Participants attended approximately 15 sessions from baseline to 24 months. On average, participants lost a modest amount of weight over 24 months regardless of MH diagnosis. Longitudinally, no statistically significant differences were found in weight loss patterns by MH diagnosis. Unadjusted average weight loss (kg) was 1.6±4.0 at 3 months (n=373), 1.9±6.5 at 12 months (n=361), 1.5±7.8 at 18 months (n=289), and 1.4±8.0 at 24 months (n=279). LIMITATIONS ASPIRE-VA study was not designed or powered to detect weight loss differences among MH diagnostic groups. CONCLUSIONS Veterans achieved and maintained modest weight loss, through 24 months, with the three behavioral weight loss interventions. Contrary to our hypotheses, the amount and pattern of weight loss did not differ by MH diagnosis. Greater inclusion of individuals with MH diagnoses may be warranted in behavioral weight loss interventions not specifically tailored for them.
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Affiliation(s)
- Carol A Janney
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI 48105, United States; Michigan State University College of Human Medicine - Midland Regional Campus Center, 4611 Campus Ridge Drive, Midland, MI 48670, United States.
| | - Robin M Masheb
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States; VA Connecticut Healthcare System, PRIME Center/11ACSLG, 950 Campbell Avenue, West Haven, CT 06516, United States.
| | - Lesley D Lutes
- Department of Psychology, University of British Columbia Okanagan, 3187 University Way, Kelowna, BC, Canada V1V 1V7.
| | - Robert G Holleman
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI 48105, United States.
| | - Hyungjin Myra Kim
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI 48105, United States; Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, United States.
| | - Leah R Gillon
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI 48105, United States.
| | - Laura J Damschroder
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI 48105, United States.
| | - Caroline R Richardson
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Rd, Ann Arbor, MI 48105, United States; Department of Family Medicine, University of Michigan School of Medicine, Ann Arbor, MI, United States.
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Firth J, Carney R, Pownall M, French P, Elliott R, Cotter J, Yung AR. Challenges in implementing an exercise intervention within residential psychiatric care: A mixed methods study. Ment Health Phys Act 2017; 12:141-146. [PMID: 28603555 PMCID: PMC5455809 DOI: 10.1016/j.mhpa.2017.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 04/25/2017] [Accepted: 04/25/2017] [Indexed: 11/24/2022]
Abstract
Physical exercise is increasingly recognized as an important component of psychiatric care, although the feasibility of implementing exercise in residential care settings is not well understood. We evaluated the feasibility of a 10-week intervention of weekly fitness classes (delivered by a personal trainer) and other exercise activities using a mixed-methods approach. This was offered to across four residential care services, to all 51 residents who had severe mental illness (SMI). Of these, 27.5% consented to the exercise intervention. Participants averaged 87.6 min of moderate-to-vigorous exercise per-week, although fitness classes were poorly attended, and 35.7% dropped-out over 10 weeks. Of those who completed the intervention, increased physical activity was associated with significantly reduced negative symptoms. In conclusion, implementing exercise interventions in residential psychiatric care is challenging; given that supervised exercise classes may not be appealing to many residents, while unsupervised exercise is poorly adhered to. Future interventions should consider that better tailored exercise programs are required to adequately confront motivational issues, and to account for participant preference in order to increase engagement.
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Affiliation(s)
- Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, UK
| | - Rebekah Carney
- Division of Psychology and Mental Health, University of Manchester, UK
| | - Michelle Pownall
- Five Boroughs Partnership NHS Foundation Trust, Greater Manchester, UK
| | - Paul French
- Greater Manchester West NHS Mental Health Foundation Trust, UK
- Department of Psychological Sciences, The University of Liverpool, UK
| | - Rebecca Elliott
- Division of Psychology and Mental Health, University of Manchester, UK
- Division of Neuroscience and Experimental Psychology, University of Manchester, UK
| | - Jack Cotter
- Division of Psychology and Mental Health, University of Manchester, UK
| | - Alison R. Yung
- Division of Psychology and Mental Health, University of Manchester, UK
- Greater Manchester West NHS Mental Health Foundation Trust, UK
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Olker SJ, Parrott JS, Swarbrick MA, Spagnolo AB. Weight management interventions in adults with a serious mental illness: A meta-analytic review. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2016. [DOI: 10.1080/15487768.2016.1231643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Stephen J. Olker
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Newark, New Jersey, USA
| | - James Scott Parrott
- Department of Interdisciplinary Studies, Rutgers University, Newark, New Jersey, USA
| | - Margaret A. Swarbrick
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Newark, New Jersey, USA
| | - Amy B. Spagnolo
- Department of Psychiatric Rehabilitation and Counseling Professions, Rutgers University, Newark, New Jersey, USA
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Diabetes and Cardiovascular Care Among People with Severe Mental Illness: A Literature Review. J Gen Intern Med 2016; 31:1083-91. [PMID: 27149967 PMCID: PMC4978675 DOI: 10.1007/s11606-016-3712-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 03/17/2016] [Accepted: 04/05/2016] [Indexed: 01/20/2023]
Abstract
Close to 19 million US adults have severe mental illnesses (SMI), and they die, on average, 25 years earlier than the general population, most often from cardiovascular disease (CVD). Many of the antipsychotic medications used to treat SMI contribute to CVD risk by increasing risk for obesity, type 2 diabetes, dyslipidemia, and hypertension. Based on compelling evidence, the American Diabetes Association and the American Psychiatric Association developed guidelines for metabolic screening and monitoring during use of these medications.In this manuscript, we have reviewed the evidence on diabetes and other CVD risk screening, prevalence, and management among populations with SMI. We also review differences in screening among subpopulations with SMI (e.g., racial/ethnic minorities, women, and children). We found that despite national guidelines for screening for diabetes and other cardiovascular risk factors, up to 70 % of people taking antipsychotics remain unscreened and untreated. Based on estimates that 20 % of the 19 million US adults with SMI have diabetes and 70 % of them are not screened; it is likely that over 2 million Americans with SMI have unidentified diabetes. Given that undiagnosed diabetes costs over $4,000 per person, this failure to identify diabetes among people with SMI represents a missed opportunity to prevent morbidity and translates to over $8 billion in annual preventable costs to our healthcare system.Given the high burden of disease and significant evidence of suboptimal medical care received by people with SMI, we propose several clinical and policy recommendations to improve diabetes and other CVD risk screening and care for this highly vulnerable population. These recommendations include reducing antipsychotic medication dose or switching antipsychotic medications, enhancing smoking cessation efforts, sharing electronic health records between physical and mental health care systems, and promoting integration of care.
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Farholm A, Sørensen M. Motivation for physical activity and exercise in severe mental illness: A systematic review of intervention studies. Int J Ment Health Nurs 2016; 25:194-205. [PMID: 26916699 DOI: 10.1111/inm.12214] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 12/03/2015] [Accepted: 12/09/2015] [Indexed: 11/30/2022]
Abstract
There has been increasing interest for research on motivation for physical activity (PA) and exercise among individuals with severe mental illness (SMI). The aim of this systematic review is to summarize findings from all intervention studies on PA or exercise that either include empirical data on motivational constructs or apply motivational techniques/theories in their intervention. Systematic searches of seven databases were conducted from database inception to February 2015. Studies were eligible if they: (i) included participants with SMI, (ii) had PA as part of the intervention, and (iii) reported empirical data on motivational constructs related to PA or incorporated motivational techniques/theory in their intervention. Of the 79 studies that met the inclusion criteria only one had motivation for PA as its main outcome. Nine additional interventions reported empirical data on motivational constructs. Altogether these studies yielded mixed results with respect to change in motivational constructs. Only one of those examined the association between motivation and PA, but found none. Sixty-four studies reported using motivational techniques/theory in their intervention. Motivational interviewing and goal-setting were the most popular techniques. Due to the exploratory nature of most of these studies, findings from intervention studies do not so far give very clear directions for motivational work with the patients. There is an urgent need for a more systematic theory based approach when developing strategies that target to increase engagement in PA among people with SMI.
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Dauwan M, Begemann MJH, Heringa SM, Sommer IE. Exercise Improves Clinical Symptoms, Quality of Life, Global Functioning, and Depression in Schizophrenia: A Systematic Review and Meta-analysis. Schizophr Bull 2016; 42:588-99. [PMID: 26547223 PMCID: PMC4838091 DOI: 10.1093/schbul/sbv164] [Citation(s) in RCA: 219] [Impact Index Per Article: 27.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Physical exercise may be valuable for patients with schizophrenia spectrum disorders as it may have beneficial effect on clinical symptoms, quality of life and cognition. METHODS A systematic search was performed using PubMed (Medline), Embase, PsychInfo, and Cochrane Database of Systematic Reviews. Controlled and uncontrolled studies investigating the effect of any type of physical exercise interventions in schizophrenia spectrum disorders were included. Outcome measures were clinical symptoms, quality of life, global functioning, depression or cognition. Meta-analyses were performed using Comprehensive Meta-Analysis software. A random effects model was used to compute overall weighted effect sizes in Hedges' g. RESULTS Twenty-nine studies were included, examining 1109 patients. Exercise was superior to control conditions in improving total symptom severity (k = 14, n = 719: Hedges' g = .39, P < .001), positive (k = 15, n = 715: Hedges' g = .32, P < .01), negative (k = 18, n = 854: Hedges' g = .49, P < .001), and general (k = 10, n = 475: Hedges' g = .27, P < .05) symptoms, quality of life (k = 11, n = 770: Hedges' g = .55, P < .001), global functioning (k = 5, n = 342: Hedges' g = .32, P < .01), and depressive symptoms (k = 7, n = 337: Hedges' g = .71, P < .001). Yoga, specifically, improved the cognitive subdomain long-term memory (k = 2, n = 184: Hedges' g = .32, P < .05), while exercise in general or in any other form had no effect on cognition. CONCLUSION Physical exercise is a robust add-on treatment for improving clinical symptoms, quality of life, global functioning, and depressive symptoms in patients with schizophrenia. The effect on cognition is not demonstrated, but may be present for yoga.
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Affiliation(s)
- Meenakshi Dauwan
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Clinical Neurophysiology and MEG Center, Neuroscience Campus, VU University Medical Center, Amsterdam, The Netherlands
| | - Marieke J H Begemann
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sophie M Heringa
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Iris E Sommer
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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McMorris T, Sweet G, Sullivan CJ, Washington NB, Brahm N. A design and focus group evaluation of dietary choices tools for an underserved population. Ment Health Clin 2016; 6:101-108. [PMID: 29955455 PMCID: PMC6007579 DOI: 10.9740/mhc.2016.03.101] [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] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: Our objective was to develop and evaluate dietary teaching tools for a select population diagnosed with a severe mental illness and limited financial ability. Patients with severe mental illnesses face many challenges, including common health comorbidities of diabetes, high blood pressure, high cholesterol, and obesity. Cognitive deficits may limit educational programming; financial resources can affect access to a healthy diet. The Integrated Multidisciplinary Program of Assertive Community Treatment (IMPACT) program, a university-based program, provides individualized services to this population. One focus is healthy nutritional choices. Methods: In Phase One, a clinical pharmacist and a first-year pharmacy resident created visual aids. These cards were given to health care providers (HCPs) to be used with IMPACT members. HCPs were asked to participate in a focus group and provide feedback. Phase Two: Based on specific focus group feedback, additional resources were created to address identified nutritional needs. Results: Phase One: Ten cards were created and distributed to the HCPs. A focus group was conducted. HCPs reported the cards were useful in opening dietary choices dialogues and were able to give more specific information on alternative choices. Phase Two: From focus group feedback, specific cards for disease states, calorie guidelines, and budget limitations were developed. HCPs immediately utilized them. Discussion: This pilot project was used to design and create educational cards to facilitate discussions on healthy or healthier dietary choices. Feedback from the HCPs participating in the focus group was positive, and they were enthusiastic about both sets of cards, particularly those pertaining to budget choices.
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Affiliation(s)
- Tressa McMorris
- PGY2 Resident, Internal Medicine, University of Oklahoma College of Pharmacy, Tulsa, Oklahoma
| | - Gary Sweet
- PharmD Candidate, University of Oklahoma College of Pharmacy, Tulsa, Oklahoma
| | | | - Nicole B Washington
- Assistant Professor, University of Oklahoma School of Community Medicine, Department of Psychiatry, Tulsa, Oklahoma. Currently: Family and Children's Services, Tulsa, Oklahoma
| | - Nancy Brahm
- Clinical Professor, University of Oklahoma College of Pharmacy, Tulsa, Oklahoma,
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McGinty EE, Baller J, Azrin ST, Juliano-Bult D, Daumit GL. Interventions to Address Medical Conditions and Health-Risk Behaviors Among Persons With Serious Mental Illness: A Comprehensive Review. Schizophr Bull 2016; 42. [PMID: 26221050 PMCID: PMC4681556 DOI: 10.1093/schbul/sbv101] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
People with serious mental illness (SMI) have mortality rates 2 to 3 times higher than the overall US population, largely due to cardiovascular disease. The prevalence of cardiovascular risk factors such as obesity and diabetes mellitus and other conditions, such as HIV/AIDS, is heightened in this group. Based on the recommendations of a National Institute of Mental Health stakeholder meeting, we conducted a comprehensive review examining the strength of the evidence surrounding interventions to address major medical conditions and health-risk behaviors among persons with SMI. Peer-reviewed studies were identified using 4 major research databases. Randomized controlled trials and observational studies testing interventions to address medical conditions and risk behaviors among persons with schizophrenia and bipolar disorder between January 2000 and June 2014 were included. Information was abstracted from each study by 2 trained reviewers, who also rated study quality using a standard tool. Following individual study review, the quality of the evidence (high, medium, low) and the effectiveness of various interventions were synthesized. 108 studies were included. The majority of studies examined interventions to address overweight/obesity (n = 80). The strength of the evidence was high for 4 interventions: metformin and behavioral interventions had beneficial effects on weight loss; and bupropion and varenicline reduced tobacco smoking. The strength of the evidence was low for most other interventions reviewed. Future studies should test long-term interventions to cardiovascular risk factors and health-risk behaviors. In addition, future research should study implementation strategies to effectively translate efficacious interventions into real-world settings.
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Affiliation(s)
- Emma E. McGinty
- Departments of Health Policy and Management and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;,*To whom correspondence should be addressed; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Room 359, Baltimore, MD 21205, US; tel: 410-614-4018, e-mail:
| | - Julia Baller
- Departments of Health Policy and Management and Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - Gail L. Daumit
- Division of General Internal Medicine, Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
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Hoffmann KD, Walnoha A, Sloan J, Buddadhumaruk P, Huang HH, Borrebach J, Cluss PA, Burke JG. Developing a Community-Based Tailored Exercise Program for People With Severe and Persistent Mental Illness. Prog Community Health Partnersh 2015; 9:213-27. [PMID: 26412763 DOI: 10.1353/cpr.2015.0045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND People with severe and persistent mental illness (SPMI) are at a greater risk of medical issues compared with the general population. Exercise has a positive effect on physical and mental health outcomes among this population in community settings. OBJECTIVES To describe community-based participatory research (CBPR) methods used to tailor an exercise program among people with SPMI, demonstrate its impact, and present lessons learned for future research. METHODS The partnership developed a project to explore the feasibility of implementing a physical activity program at a community agency among clients with SPMI. LESSONS LEARNED Data showed improved trends in mood, social support, and physical and mental health outcomes. Facilitators and barriers must be carefully considered for recruitment and retention. CONCLUSIONS A gender-specific, group-based, tailored exercise intervention developed through collaboration with a community agency serving people with SPMI using CBPR methods is feasible.
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Cigarette smoking and interest in quitting among overweight and obese adults with serious mental illness enrolled in a fitness intervention. J Nerv Ment Dis 2015; 203:473-6. [PMID: 26034872 PMCID: PMC4851338 DOI: 10.1097/nmd.0000000000000309] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study explored cigarette smoking, health status, and interest in quitting among overweight and obese adults with serious mental illness enrolled in a fitness intervention. Baseline data from two studies of the In SHAPE fitness intervention were combined. A total of 341 overweight or obese adults with serious mental illness were assessed on smoking, interest in quitting, cardiovascular fitness, lipids, body mass index, readiness to change diet, and psychiatric symptoms. Thirty-six percent (n = 122) of participants were categorized as current smokers. The majority of smokers (84%) were interested in quitting. Smokers were more likely to be younger, male, and less educated than non-smokers. Smokers had lower high-density lipoprotein cholesterol and were less ready to reduce dietary fat, after adjusting for age, gender, and education. Findings highlight the potential to address both fitness and smoking to reduce cardiovascular risk in individuals with serious mental illness.
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Knight M, Bolton P, Coakley C, Kopeski L, Slifka K. Nursing Care for Lifestyle Behavioral Change. Issues Ment Health Nurs 2015; 36:464-73. [PMID: 26241573 DOI: 10.3109/01612840.2014.997845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The purpose of this pilot study was to determine if metabolic risk factors can be stabilized or improved with weekly motivational interviewing/coaching and medical follow-up care focused on lifestyle behavioral change in individuals with serious mental illness. Individuals were followed for 18 weeks following discharge from an inpatient psychiatric service. All individuals were prescribed an antipsychotic medication and had at least two risk factors for metabolic syndrome. Weight, waist circumference, blood pressure, LDLs, triglycerides, and blood glucose levels were evaluated during the study period. In addition, each individual selected a lifestyle behavior to improve over the 18-week period. Weekly motivational interviewing, and staggered health promotion appointments were designed to keep individuals focused on health and behavior change. While some individuals showed improvement, others showed deterioration in the physiological markers for metabolic syndrome. Only a small number completed the 18-week study. The nature of current psychiatric care is focused on rapid stabilization and discharge; individuals with serious mental illness may have difficulty focusing on lifestyle behavioral change while transitioning to independent living following an acute exacerbation of mental illness.
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Affiliation(s)
- Margaret Knight
- University of Massachusetts Lowell , Nursing, Lowell, Massachusetts , USA
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Bernard P, Romain AJ, Vancampfort D, Baillot A, Esseul E, Ninot G. Six minutes walk test for individuals with schizophrenia. Disabil Rehabil 2014; 37:921-7. [DOI: 10.3109/09638288.2014.948136] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Depp CA, Strassnig M, Mausbach BT, Bowie CR, Wolyniec P, Thornquist MH, Luke JR, McGrath JA, Pulver AE, Patterson TL, Harvey PD. Association of obesity and treated hypertension and diabetes with cognitive ability in bipolar disorder and schizophrenia. Bipolar Disord 2014; 16:422-31. [PMID: 24725166 PMCID: PMC4047181 DOI: 10.1111/bdi.12200] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 09/20/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVES People with bipolar disorder or schizophrenia are at greater risk for obesity and other cardio-metabolic risk factors, and several prior studies have linked these risk factors to poorer cognitive ability. In a large ethnically homogenous outpatient sample, we examined associations among variables related to obesity, treated hypertension and/or diabetes and cognitive abilities in these two patient populations. METHODS In a study cohort of outpatients with either bipolar disorder (n = 341) or schizophrenia (n = 417), we investigated the association of self-reported body mass index and current use of medications for hypertension or diabetes with performance on a comprehensive neurocognitive battery. We examined sociodemographic and clinical factors as potential covariates. RESULTS Patients with bipolar disorder were less likely to be overweight or obese than patients with schizophrenia, and also less likely to be prescribed medication for hypertension or diabetes. However, obesity and treated hypertension were associated with worse global cognitive ability in bipolar disorder (as well as with poorer performance on individual tests of processing speed, reasoning/problem-solving, and sustained attention), with no such relationships observed in schizophrenia. Obesity was not associated with symptom severity in either group. CONCLUSIONS Although less prevalent in bipolar disorder compared to schizophrenia, obesity was associated with substantially worse cognitive performance in bipolar disorder. This association was independent of symptom severity and not present in schizophrenia. Better understanding of the mechanisms and management of obesity may aid in efforts to preserve cognitive health in bipolar disorder.
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Affiliation(s)
- Colin A Depp
- Department of Psychiatry, University of California at San Diego,VA San Diego Healthcare System, La Jolla, CA
| | - Martin Strassnig
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Christopher R Bowie
- Department of Psychology and Psychiatry, Queen’s University, Kingston, Ontario, Canada
| | - Paula Wolyniec
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD
| | - Mary H Thornquist
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD
| | - James R Luke
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD
| | - John A McGrath
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD
| | - Ann E Pulver
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD
| | | | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA,Research Service, Miami VA Medical Center, Miami, FL, USA
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Sajatovic M, Tatsuoka C, Dines P, Bialko CS, Athey M, Williams T, Cassidy KA. Patient choice as a driver of medication-switching in non-adherent individuals with bipolar disorder. Patient Prefer Adherence 2014; 8:487-91. [PMID: 24790416 PMCID: PMC4000249 DOI: 10.2147/ppa.s56790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Psychotropic-related weight gain is a common concern among patients with bipolar disorder (BD). This concern affects satisfaction with treatment and may lead to non-adherence and relapse. This was a 12-week, uncontrolled prospective trial of patient-choice-facilitated ziprasidone switching among non-adherent BD patients with weight concerns. This study was conducted from January 2011 to July 2012. METHOD Patients were asked to identify the "offending" BD medication which they believed was causing weight problems, and this agent was replaced with ziprasidone. The primary outcome was change in adherence as measured with the Tablets Routine Questionnaire (TRQ). Secondary outcomes included medication attitudes, BD symptoms, global psychopathology, social functioning, and quality of life. RESULTS The most common agents causing weight concerns were quetiapine (N=7, 23%), aripiprazole (N=4, 13%), olanzapine, lithium, and divalproex (all N=3, 10%). Adherence improved from a baseline of missing 48.6% of prescribed BD medication in the past week (44.9% in the past month) to missing 25.3% (P=0.002) of prescribed BD medication in the past week (P<0.001, in the past month) at endpoint. Medication attitudes, symptoms, functioning, and quality of life improved but there were no differences in body weight. CONCLUSION While findings must be tempered by methodological limitations such as small sample and uncontrolled design, patient-facilitated medication-switching appeared to improve adherence and BD outcomes in these non-adherent individuals. Additional studies involving patient-facilitated medication-switching and shared decision-making in BD are needed.
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Affiliation(s)
- Martha Sajatovic
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
- Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
- Correspondence: Martha Sajatovic, Department of Psychiatry, University, Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, USA, Tel +1 216 844 2808, Fax +1 216 844 2742, Email
| | - Curtis Tatsuoka
- Department of Neurology, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Philipp Dines
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Christopher S Bialko
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Melanie Athey
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Tiffany Williams
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
| | - Kristin A Cassidy
- Department of Psychiatry, Case Western Reserve University School of Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
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Ringen PA, Engh JA, Birkenaes AB, Dieset I, Andreassen OA. Increased mortality in schizophrenia due to cardiovascular disease - a non-systematic review of epidemiology, possible causes, and interventions. Front Psychiatry 2014; 5:137. [PMID: 25309466 PMCID: PMC4175996 DOI: 10.3389/fpsyt.2014.00137] [Citation(s) in RCA: 206] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 09/12/2014] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Schizophrenia is among the major causes of disability worldwide and the mortality from cardiovascular disease (CVD) is significantly elevated. There is a growing concern that this health challenge is not fully understood and efficiently addressed. METHODS Non-systematic review using searches in PubMed on relevant topics as well as selection of references based on the authors' experience from clinical work and research in the field. RESULTS In most countries, the standardized mortality rate in schizophrenia is about 2.5, leading to a reduction in life expectancy between 15 and 20 years. A major contributor of the increased mortality is due to CVD, with CVD mortality ranging from 40 to 50% in most studies. Important causal factors are related to lifestyle, including poor diet, lack of physical activity, smoking, and substance abuse. Recent findings suggest that there are overlapping pathophysiology and genetics between schizophrenia and CVD-risk factors, further increasing the liability to CVD in schizophrenia. Many pharmacological agents used for treating psychotic disorders have side effects augmenting CVD risk. Although several CVD-risk factors can be effectively prevented and treated, the provision of somatic health services to people with schizophrenia seems inadequate. Further, there is a sparseness of studies investigating the effects of lifestyle interventions in schizophrenia, and there is little knowledge about effective programs targeting physical health in this population. DISCUSSION The risk for CVD and CVD-related deaths in people with schizophrenia is increased, but the underlying mechanisms are not fully known. Coordinated interventions in different health care settings could probably reduce the risk. There is an urgent need to develop and implement effective programs to increase life expectancy in schizophrenia, and we argue that mental health workers should be more involved in this important task.
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Affiliation(s)
- Petter Andreas Ringen
- NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo , Oslo , Norway ; Division of Mental Health and Addiction, Oslo University Hospital , Oslo , Norway
| | - John A Engh
- Division of Mental Health and Addiction, Vestfold Hospital Trust , Tønsberg , Norway
| | - Astrid B Birkenaes
- NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo , Oslo , Norway
| | - Ingrid Dieset
- NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo , Oslo , Norway ; Division of Mental Health and Addiction, Oslo University Hospital , Oslo , Norway
| | - Ole A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo , Oslo , Norway ; Division of Mental Health and Addiction, Oslo University Hospital , Oslo , Norway
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Lowndes R, Angus J, Peter E. Diabetes care and mental illness: constraining elements to physical activity and social participation in a residential care facility. Can J Diabetes 2013; 37:220-225. [PMID: 24070884 DOI: 10.1016/j.jcjd.2013.03.361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 02/25/2013] [Accepted: 03/15/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To explore barriers and constraints to physical activity, as an integral component of diabetes care, in those with serious mental illness who reside in a for-profit group home. METHODS Institutional ethnography was the approach used to explore diabetes-related care practices among 26 women in a rural residential care facility in southern Ontario. Semi-structured, in-depth interviews were conducted with residents who had diabetes as well as with care providers, field workers and health professionals. Observations and document analysis were further methods used to reveal the disjuncture between diabetes care guidelines and the actualities of living within imposed constraints of group home care. RESULTS The residents in this government-regulated group home were sedentary, obtaining approximately 10 minutes per day of low-intensity exercise. The overarching government interest in cost containment created a context of rationing that resulted in a lack of opportunities to exercise and fully participate in social life. Furthermore, group home policies regulated systems of safety, reporting and financial accountability, but did not promote health. CONCLUSIONS The findings indicate an urgent need for government financial support for quality of life initiatives and amendments to group home policies that give primacy to health promotion, illness prevention and medical management of prevalent comorbid conditions such as diabetes.
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Affiliation(s)
- Ruth Lowndes
- University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario, Canada.
| | - Jan Angus
- University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario, Canada
| | - Elizabeth Peter
- University of Toronto, Lawrence S. Bloomberg Faculty of Nursing, Toronto, Ontario, Canada
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Bartels SJ, Pratt SI, Aschbrenner KA, Barre LK, Jue K, Wolfe RS, Xie H, McHugo G, Santos M, Williams GE, Naslund JA, Mueser KT. Clinically significant improved fitness and weight loss among overweight persons with serious mental illness. Psychiatr Serv 2013; 64:729-36. [PMID: 23677386 PMCID: PMC5662189 DOI: 10.1176/appi.ps.003622012] [Citation(s) in RCA: 131] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the effectiveness of a fitness health mentor program (In SHAPE) in improving physical fitness and weight loss among overweight and obese adults with serious mental illness. METHODS A randomized controlled trial was conducted with 133 persons with serious mental illness and a body mass index (BMI) >25 who were assigned either to the In SHAPE program (one year of weekly sessions with a fitness trainer plus a fitness club membership) or to one year of fitness club membership and education. Assessments were conducted at baseline and three, six, nine, and 12 months later. RESULTS Participants had a mean baseline weight of 231.8±54.8 pounds and a mean BMI of 37.6±8.2. At 12-month follow-up, In SHAPE (N=67) compared with fitness club membership and education (N=66) was associated with three times greater fitness club attendance, twice as much participation in physical exercise, greater engagement in vigorous physical activity, and improvement in diet. Twice the proportion of participants (40% versus 20%) achieved clinically significant improvement in cardiorespiratory fitness (>50 m on the six-minute walk test). Weight loss and BMI did not differ between groups. Among In SHAPE participants, 49% achieved either clinically significant increased fitness or weight loss (5% or greater), and 24% achieved both clinically significant improved fitness and weight loss. CONCLUSIONS The In SHAPE program achieved clinically significant reduction in cardiovascular risk for almost one-half of participants at 12 months. Although the intervention showed promise in improving fitness, optimizing weight loss may require additional intensive, multicomponent dietary interventions.
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Affiliation(s)
- Stephen J Bartels
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Suite 200, Lebanon, NH 03766, USA.
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Lopresti AL, Drummond PD. Obesity and psychiatric disorders: commonalities in dysregulated biological pathways and their implications for treatment. Prog Neuropsychopharmacol Biol Psychiatry 2013; 45:92-9. [PMID: 23685202 DOI: 10.1016/j.pnpbp.2013.05.005] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 04/28/2013] [Accepted: 05/07/2013] [Indexed: 11/25/2022]
Abstract
Rates of obesity are higher than normal across a range of psychiatric disorders, including major depressive disorder, bipolar disorder, schizophrenia and anxiety disorders. While the problem of obesity is generally acknowledged in mental health research and treatment, an understanding of their bi-directional relationship is still developing. In this review the association between obesity and psychiatric disorders is summarised, with a specific emphasis on similarities in their disturbed biological pathways; namely neurotransmitter imbalances, hypothalamus-pituitary-adrenal axis disturbances, dysregulated inflammatory pathways, increased oxidative and nitrosative stress, mitochondrial disturbances, and neuroprogression. The applicability and effectiveness of weight-loss interventions in psychiatric populations are reviewed along with their potential efficacy in ameliorating disturbed biological pathways, particularly those mediating inflammation and oxidative stress. It is proposed that weight loss may not only be an effective intervention to enhance physical health but may also improve mental health outcomes and slow the rate of neuroprogressive disturbances in psychiatric disorders. Areas of future research to help expand our understanding of the relationship between obesity and psychiatric disorders are also outlined.
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Affiliation(s)
- Adrian L Lopresti
- School of Psychology, Murdoch University, Perth, Western Australia 6150, Australia.
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Goldberg RW, Reeves G, Tapscott S, Medoff D, Dickerson F, Goldberg AP, Ryan AS, Fang LJ, Dixon LB. "MOVE!" Outcomes of a weight loss program modified for veterans with serious mental illness. Psychiatr Serv 2013; 64:737-44. [PMID: 23584716 PMCID: PMC4534303 DOI: 10.1176/appi.ps.201200314] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Veterans with serious mental illness are at increased risk of obesity, sedentary lifestyle, and a host of related chronic diseases. Although evidence suggests that lifestyle interventions can help mental health consumers achieve modest weight loss, several studies have failed to show a benefit and most have concluded that significant challenges remain in delivering effective interventions. In 2006, the Veterans Health Administration introduced MOVE!, a weight management program that includes behaviorally based dietary and physical activity self-management support. This article describes modifications used to manualize MOVE! for veterans with serious mental illness and reports findings from a randomized controlled trial of the new intervention. METHODS Between January 2007 and June 2009, overweight or obese veterans with serious mental illness were randomly assigned to a six-month trial of MOVE! (N=53), which includes both individual and group sessions, or to a control condition that offered basic information about diet and exercise every month (N=56). Weight and metabolic, attitudinal, behavioral, and functional variables were measured at baseline and six months, and weight was also measured monthly. RESULTS Thirty participants in MOVE! and 41 participants in the control group completed the six-month assessment, and only seven lost 5% of their baseline weight; there was no effect of group assignment on weight loss. There were no significant group × time differences in any metabolic, dietary, physical activity, attitudinal, or functional measure. CONCLUSIONS Despite the negative findings of this study, research is crucial to identify lifestyle interventions and related supports and services to help veterans with mental illness reduce overweight and obesity.
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Affiliation(s)
- Richard W Goldberg
- Mental Illness Research, Education and Clinical Center, Veterans Affairs Capitol Health Care Network (Veterans Integrated Service Network 5), 10 North Greene St., Baltimore, MD 21201, USA.
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Kilbourne AM, Goodrich DE, Lai Z, Post EP, Schumacher K, Nord KM, Bramlet M, Chermack S, Bialy D, Bauer MS. Randomized controlled trial to assess reduction of cardiovascular disease risk in patients with bipolar disorder: the Self-Management Addressing Heart Risk Trial (SMAHRT). J Clin Psychiatry 2013; 74:e655-62. [PMID: 23945460 PMCID: PMC4154058 DOI: 10.4088/jcp.12m08082] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 11/07/2012] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Persons with bipolar disorder experience a disproportionate burden of medical conditions, notably cardiovascular disease (CVD), leading to impaired functioning and premature mortality. We hypothesized that the Life Goals Collaborative Care (LGCC) intervention, compared to enhanced usual care, would reduce CVD risk factors and improve physical and mental health outcomes in US Department of Veterans Affairs patients with bipolar disorder. METHOD Patients with an ICD-9 diagnosis of bipolar disorder and ≥ 1 CVD risk factor (N = 118) enrolled in the Self-Management Addressing Heart Risk Trial, conducted April 2008-May 2010, were randomized to LGCC (n = 58) or enhanced usual care (n = 60). Life Goals Collaborative Care included 4 weekly self-management sessions followed by tailored contacts combining health behavior change strategies, medical care management, registry tracking, and provider guideline support. Enhanced usual care included quarterly wellness newsletters sent during a 12-month period in addition to standard treatment. Primary outcome measures included systolic and diastolic blood pressure, nonfasting total cholesterol, and physical health-related quality of life. RESULTS Of the 180 eligible patients identified for study participation, 134 were enrolled (74%) and 118 completed outcomes assessments (mean age = 53 years, 17% female, 5% African American). Mixed effects analyses comparing changes in 24-month outcomes among patients in LGCC (n = 57) versus enhanced usual care (n = 59) groups revealed that patients receiving LGCC had reduced systolic (β = -3.1, P = .04) and diastolic blood pressure (β = -2.1, P = .04) as well as reduced manic symptoms (β = -23.9, P = .01). Life Goals Collaborative Care had no significant impact on other primary outcomes (total cholesterol and physical health-related quality of life). CONCLUSIONS Life Goals Collaborative Care, compared to enhanced usual care, may lead to reduced CVD risk factors, notably through decreased blood pressure, as well as reduced manic symptoms, in patients with bipolar disorder. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00499096.
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Affiliation(s)
- Amy M. Kilbourne
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - David E. Goodrich
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Zongshan Lai
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - Edward P. Post
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Karen Schumacher
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI
| | - Kristina M. Nord
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | | | - Stephen Chermack
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI
| | - David Bialy
- VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI
| | - Mark S. Bauer
- VA Boston Center for Organization Management and Leadership Research and Harvard Medical School; Boston, MA
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Lowndes RH, Angus JE, Peter E. Diabetes care and mental illness: the social organization of food in a residential care facility. Canadian Journal of Public Health 2013; 104:e330-4. [PMID: 24044475 DOI: 10.17269/cjph.104.3833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 06/27/2013] [Accepted: 05/26/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To explore the social organization of food provision and dietary intake in seriously mentally ill people with diabetes who reside in a for-profit group home. METHODS Institutional ethnography was used to explore diabetes-related care practices among 26 women in a rural residential care facility in southern Ontario. Semi-structured, in-depth interviews were conducted with residents with diabetes, care providers, field workers, and health professionals. Observations and document analysis were also used to understand the lack of congruence between diabetes guidelines and the possibilities for diabetes management within the confines of group home care. RESULTS Although it was mandated in group home guidelines that "Health Canada's Eating Well with Canada's Food Guide" (2007) be followed, menus were planned within the context of a limited food budget of approximately $1.91 per day per resident. Group home policies regulated systems of safety, reporting, and financial accountability, but not health promotion. Inspections carried out by the Public Health Department focused primarily on food safety during handling, preparation, and storage, and compliance to regulations regarding environmental cleanliness and infection control. CONCLUSION Resource rationing found in group home care exacerbates illness in an already marginalized group. Financial support is required to enable provision of healthy food choices, including dairy products, fresh fruits, and vegetables. Additional support is required for care of co-morbid conditions such as diabetes for associated food costs and education to improve outcomes. Group home policies must take into consideration health threats to this population and give primacy to health promotion and illness prevention.
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42
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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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43
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Kilbourne AM, Goodrich DE, Lai Z, Clogston J, Waxmonsky J, Bauer MS. Life Goals Collaborative Care for patients with bipolar disorder and cardiovascular disease risk. Psychiatr Serv 2012; 63. [PMID: 23203358 PMCID: PMC4132840 DOI: 10.1176/appi.ps.201100528] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This pilot study compared Life Goals Collaborative Care (LGCC) with enhanced treatment as usual in reducing cardiometabolic risk factors and improving outcomes for persons with bipolar disorder. METHODS Participants were randomly assigned to LGCC (N=34) or enhanced treatment as usual (N=34). LGCC included four weekly self-management sessions and monthly telephone contacts for six months thereafter. Enhanced treatment as usual included wellness mailings. Outcomes were blood pressure, body mass index (BMI), quality of life, functioning, and symptoms. RESULTS Compared with enhanced treatment as usual, LGCC was not associated with reductions in cardiometabolic risk factors in 12-month repeated-measures analyses. Among patients with a BMI of ≥30 or systolic blood pressure of ≥140, LGCC was associated with improvements in functioning (beta=-2.2 and beta=-3.8, respectively, p=.04) and reduced depressive symptoms (beta=-2.0 and -3.5, respectively, p=.04). CONCLUSIONS Further research is needed to determine whether LGCC improves outcomes for patients with elevated cardiometabolic risk.
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Affiliation(s)
- Amy M Kilbourne
- Health Services Research and Development Center for Clinical Management Research, Veterans Affairs Ann Arbor, 2215 Fuller Rd., Ann Arbor, MI 48105, USA.
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Design and rationale of a randomized controlled trial to reduce cardiovascular disease risk for patients with bipolar disorder. Contemp Clin Trials 2012; 33:666-78. [PMID: 22386799 DOI: 10.1016/j.cct.2012.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 01/06/2012] [Accepted: 02/17/2012] [Indexed: 11/23/2022]
Abstract
BACKGROUND Persons with bipolar disorder (BD) experience a disproportionate burden of medical comorbidity, notably cardiovascular disease (CVD), contributing to decreased function and premature mortality. We describe the design, rationale, and baseline findings for the Self-Management Addressing Heart Risk Trial (SMAHRT), a randomized controlled effectiveness trial of an intervention (Life Goals Collaborative Care; LGCC) designed to reduce CVD risk factors and improve physical and mental health outcomes in patients with BD. METHODS Patients with BD and at least one CVD risk factor were recruited from a VA healthcare system and randomized to either LGCC or usual care (UC). LGCC participants attended four weekly, group-based self-management sessions followed by monthly individual contacts supportive of health behavior change and ongoing medical care management. In contrast, UC participants received monthly wellness newsletters. Physiological and questionnaire assessments measured changes in CVD outcomes and quality of life (QOL) over 24 months. RESULTS Out of the 180 eligible patients, 134 patients were enrolled (74%) and 118 started the study protocols. At baseline (mean age=54, 17% female, 5% African American) participants had a high burden of clinical risk with nearly 70% reporting at least three CVD risk factors including, smoking (41%) and physical inactivity (57%). Mean mental and physical HRQOL scores were 1.5 SD below SF-12 population averages. CONCLUSION SMAHRT participants experienced substantial CVD morbidity and risk factors, poor symptom control, and decreased QOL. LGCC is the first integrated intervention for BD designed to mitigate suboptimal health outcomes by combining behavioral medicine and care management strategies.
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Casagrande SS, Dalcin A, McCarron P, Appel LJ, Gayles D, Hayes J, Daumit G. A nutritional intervention to reduce the calorie content of meals served at psychiatric rehabilitation programs. Community Ment Health J 2011; 47:711-5. [PMID: 21691819 PMCID: PMC6449692 DOI: 10.1007/s10597-011-9436-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Accepted: 06/10/2011] [Indexed: 11/29/2022]
Abstract
To assess the effectiveness of an intervention to reduce the calorie content of meals served at two psychiatric rehabilitation programs. Intervention staff assisted kitchen staff with ways to reduce calories and improve the nutritional quality of meals. Breakfast and lunch menus were collected before and after a 6-month intervention period. ESHA software was used to determine total energy and nutrient profiles of meals. Total energy of served meals significantly decreased by 28% at breakfast and 29% at lunch for site 1 (P < 0.05); total energy significantly decreased by 41% at breakfast for site 2 (P = 0.018). Total sugars significantly decreased at breakfast for both sites (P ≤ 0.001). In general, sodium levels were high before and after the intervention period. The nutrition intervention was effective in decreasing the total energy and altering the composition of macro-nutrients of meals. These results highlight an unappreciated opportunity to improve diet quality in patients attending psychiatric rehabilitation programs.
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Casagrande SS, Jerome GJ, Dalcin AT, Dickerson FB, Anderson CA, Appel LJ, Charleston J, Crum RM, Young DR, Guallar E, Frick KD, Goldberg RW, Oefinger M, Finkelstein J, Gennusa JV, Fred-Omojole O, Campbell LM, Wang NY, Daumit GL. Randomized trial of achieving healthy lifestyles in psychiatric rehabilitation: the ACHIEVE trial. BMC Psychiatry 2010; 10:108. [PMID: 21144025 PMCID: PMC3016313 DOI: 10.1186/1471-244x-10-108] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 12/13/2010] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Overweight and obesity are highly prevalent among persons with serious mental illness. These conditions likely contribute to premature cardiovascular disease and a 20 to 30 percent shortened life expectancy in this vulnerable population. Persons with serious mental illness need effective, appropriately tailored behavioral interventions to achieve and maintain weight loss. Psychiatric rehabilitation day programs provide logical intervention settings because mental health consumers often attend regularly and exercise can take place on-site. This paper describes the Randomized Trial of Achieving Healthy Lifestyles in Psychiatric Rehabilitation (ACHIEVE). The goal of the study is to determine the effectiveness of a behavioral weight loss intervention among persons with serious mental illness that attend psychiatric rehabilitation programs. Participants randomized to the intervention arm of the study are hypothesized to have greater weight loss than the control group. METHODS/DESIGN A targeted 320 men and women with serious mental illness and overweight or obesity (body mass index ≥ 25.0 kg/m2) will be recruited from 10 psychiatric rehabilitation programs across Maryland. The core design is a randomized, two-arm, parallel, multi-site clinical trial to compare the effectiveness of an 18-month behavioral weight loss intervention to usual care. Active intervention participants receive weight management sessions and physical activity classes on-site led by study interventionists. The intervention incorporates cognitive adaptations for persons with serious mental illness attending psychiatric rehabilitation programs. The initial intensive intervention period is six months, followed by a twelve-month maintenance period in which trained rehabilitation program staff assume responsibility for delivering parts of the intervention. Primary outcomes are weight loss at six and 18 months. DISCUSSION Evidence-based approaches to the high burden of obesity and cardiovascular disease risk in person with serious mental illness are urgently needed. The ACHIEVE Trial is tailored to persons with serious mental illness in community settings. This multi-site randomized clinical trial will provide a rigorous evaluation of a practical behavioral intervention designed to accomplish and sustain weight loss in persons with serious mental illness.
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Affiliation(s)
- Sarah S Casagrande
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gerald J Jerome
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,Department of Kinesiology, Towson University, Towson, Maryland, USA
| | - Arlene T Dalcin
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Cheryl A Anderson
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lawrence J Appel
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jeanne Charleston
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rosa M Crum
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA,Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA,Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Deborah R Young
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Eliseo Guallar
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kevin D Frick
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Richard W Goldberg
- VA Capitol Health Care Network (VISN 5) Mental Illness, Research, Education and Clinical Center, Baltimore, Maryland, USA,Department of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Meghan Oefinger
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Joseph Finkelstein
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joseph V Gennusa
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Oladapo Fred-Omojole
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Leslie M Campbell
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nae-Yuh Wang
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gail L Daumit
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA,Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA,Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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