Reducing Premature Mortality in the Mentally Ill Through Health Promotion Programs.

Nearly half of the U.S. adult population will have a major mental illness during their lifetimes. At any point in time, almost a fifth of all American adults have a serious mental illness (SMI). Too many in our society do not understand mental illnesses, placing the blame for the illness on those with the illness, resulting in isolation, marginalization, or incarceration of individuals with SMIs. They may experience stigma, inadequate and delayed health and mental health care, and major socioeconomic disadvantages. They may struggle with activities of daily living, lose many of their resources, and spiral down into poverty. The disadvantages and decreased ability to function experienced by individuals with SMIs lead to increased unhealthy behaviors, reduced participation in wellness-related activities, and premature morbidity and mortality. The general and physical health of individuals with SMIs poses greater challenges from both practice and research standpoints. However, health educators are poised uniquely to provide health promotion programs, conduct research, and advocate for the health and well-being of individuals with SMIs. In this review, we summarize the challenges and opportunities for health promotion in individuals with SMIs.

Mutations in B4GALNT1 (GM2 synthase) underlie a new disorder of ganglioside biosynthesis.

Glycosphingolipids are ubiquitous constituents of eukaryotic plasma membranes, and their sialylated derivatives, gangliosides, are the major class of glycoconjugates expressed by neurons. Deficiencies in their catabolic pathways give rise to a large and well-studied group of inherited disorders, the lysosomal storage diseases. Although many glycosphingolipid catabolic defects have been defined, only one proven inherited disease arising from a defect in ganglioside biosynthesis is known. This disease, because of defects in the first step of ganglioside biosynthesis (GM3 synthase), results in a severe epileptic disorder found at high frequency amongst the Old Order Amish. Here we investigated an unusual neurodegenerative phenotype, most commonly classified as a complex form of hereditary spastic paraplegia, present in families from Kuwait, Italy and the Old Order Amish. Our genetic studies identified mutations in B4GALNT1 (GM2 synthase), encoding the enzyme that catalyzes the second step in complex ganglioside biosynthesis, as the cause of this neurodegenerative phenotype. Biochemical profiling of glycosphingolipid biosynthesis confirmed a lack of GM2 in affected subjects in association with a predictable increase in levels of its precursor, GM3, a finding that will greatly facilitate diagnosis of this condition. With the description of two neurological human diseases involving defects in two sequentially acting enzymes in ganglioside biosynthesis, there is the real possibility that a previously unidentified family of ganglioside deficiency diseases exist. The study of patients and animal models of these disorders will pave the way for a greater understanding of the role gangliosides play in neuronal structure and function and provide insights into the development of effective treatment therapies.

The Rising Tide of Elderly African-American Suicides: A Call for Action.

Suicides are among the leading causes of death in elderly Americans. The problem is expected to grow with an aging population in the U.S. Suicides in African-American elderly are not well studied. This article enumerates the risk factors for suicidal behaviors in elderly African-Americans; presents an epidemiological assessment of suicides in elderly African-Americans from 2010 to 2018 with gender-specific differences, and explores public health considerations for helping to reduce the growing numbers of suicides in elderly African-Americans. Currently, there are very limited evidence-based interventions to reduce or prevent suicides in older African-Americans. This article also provides implications and recommendations for prevention practice and research that is needed to help alleviate suicides in older African-Americans.

Firearm anticipatory guidance training in psychiatric residency programs.

OBJECTIVE: Most suicides (60%) are committed with firearms, and most (80%) of individuals attempting suicide meet diagnostic criteria for mental illness. This study assessed the prevalence of firearm injury prevention training in psychiatric residency programs. METHODS: A three-wave mail survey was sent to the directors of 179 psychiatric residency programs. Outcome measures were the portion of programs offering training in anticipatory guidance for firearms safety, the content of training if offered, and the perceived benefits and barriers to providing such training. RESULTS: A total of 115 directors responded, a response rate of 64%. The vast majority (79%) reported they had not seriously thought about providing firearm injury prevention training. However, more than half (55%) reported that they routinely screened patients for firearm ownership. The directors perceived more benefits than barriers to offering such training. Additionally, the majority (62%) thought APA should provide curriculum guidelines regarding firearm injury prevention training. CONCLUSION: Psychiatrists are uniquely positioned for helping to prevent firearm suicides and homicides among the mentally ill. However, psychiatric residency programs are inadequately training residents and thereby keeping them from maximizing their roles as mental health professionals. Leadership is needed by APA to help reduce firearm violence in the United States.

Clinical psychologists and smoking cessation: treatment practices and perceptions.

A random sample of clinical psychologists was surveyed regarding their smoking cessation practices and perceptions. A total of 352 psychologists responded (57%) to the valid and reliable questionnaire. The majority (59.1%) of psychologists did not always identify and document the smoking status of patients. The majority reported high efficacy expectations (66.4%) and low outcome expectations (55.1%) for using the 5A's smoking cessation counseling technique. Counselors that had never smoked were almost two times more likely to have higher efficacy expectations than those that were current smokers or ex-smokers (OR = 1.94, 95% CI 1.18-3.12). The factors that predicted regular use of the 5A's included the number of identified barriers, psychologists' level of self efficacy, and the urbanicity of one's practice location.

Psychiatrists' perceptions and practices in treating patients' obesity.

OBJECTIVE: This study identified psychiatrists' perceptions and practices regarding advising and treating obese patients. METHODS: Questionnaires were mailed to a national random sample of 500 members of APA. A three-wave mailing was used to maximize the return rate. The questionnaire contained items on weight control based on the Stages of Change and Health Belief models, Self-Efficacy theory, and the 5As strategy. RESULTS: A total of 236 psychiatrists responded to the survey. Most did not have any formal training during medical school on treating obese patients and three-quarters evaluated their training in psychiatric residency programs on weight loss/control issues as "not adequate at all" or "not very adequate." The majority regularly assisted their obese patients with weight management. Most psychiatrists felt confident to ask, advise, assess, assist, and arrange (5As) regarding weight loss issues and believed that doing so would result in significant weight loss. The majority were more likely to advise obese patients to lose weight when comorbid conditions were present. The most common barriers to aiding obese patients were time constraints, poor patient compliance, lack of clear guidelines and practice tools, limited medical training on the issue, and fear of offending patients. CONCLUSION: Patients can no longer afford to have their psychiatrists provide cursory assistance with obesity. Weight management training should be incorporated into psychiatric residency training and continuing education programs.

Child and adolescent psychiatrists' practices in assisting their adolescent patients who smoke to quit smoking.

OBJECTIVE: This national study examined the practices and perceptions of smoking cessation activities among child and adolescent psychiatrists. METHOD: A random sample of child and adolescent psychiatrists was identified from the membership list of the American Academy of Child and Adolescent Psychiatry and was mailed a valid and reliable 34-item questionnaire. RESULTS: A total of 184 responses (47%) were received. A plurality (48%) of psychiatrists reported being self-taught in smoking cessation techniques. A majority (67%) of psychiatrists were in the maintenance stage for asking about smoking status. However, only 19% consistently made attempts to assess willingness to quit, and 30% consistently gave messages urging the smoker to quit. The perceived number of barriers for addressing smoking was negatively correlated with psychiatrists' levels of confidence (r = -0.35, p <.001) and preparedness (r = -0.39, p <.001) in addressing smoking cessation. Estimations by the psychiatrists of youths who smoked were 61% of those with conduct disorders, 46% of those with schizophrenia, and 40% of those with attention-deficit/hyperactivity disorder. CONCLUSION: Considering the perceived high rate of patient smoking and the lack of formal training in smoking cessation, more postgraduate education is needed to adequately prepare child and adolescent psychiatrists for addressing tobacco cessation.

Psychiatrists' practices and perceptions regarding anticipatory guidance on firearms.

BACKGROUND: Most suicides (60%) and homicides (67%) are committed with firearms. Additionally, 90% of homicide offenders and 80% of individuals reporting suicide behaviors meet diagnostic criteria for mental illness. Medical society guidelines support the counseling of patients regarding firearms. This study assessed psychiatrists' anticipatory guidance on firearms and their perceived roles on this topic. METHOD: A four-wave mail survey of adult psychiatrists in Ohio was conducted and analyzed. The outcome measures were the portion of psychiatrists involved in anticipatory guidance on firearm safety issues and their self-efficacy and perceived barriers regarding firearm counseling. RESULTS: Two hundred and five psychiatrists of a possible 340 (60%) responded. Almost half (45%) had never thought seriously about discussing firearm safety issues with patients. They perceived firearm safety issues to be much greater (32%) or slightly greater (37%) for mental health patients than for the general population. Psychiatrists with high efficacy expectations were twice as likely (56.5% vs 28.0%) as those with low efficacy expectations to provide firearm anticipatory guidance. Those who counseled their patients were 15 times more likely to have high outcome expectations compared to those who did not counsel their patients (93.7% vs 6.3%, respectively). CONCLUSIONS: When psychiatrists are provided with firearm information, they were significantly more likely to be involved in anticipatory guidance regarding firearms. This implies that professional societies and journals should attempt to increase the information they provide to their members regarding this topic. Psychiatrists may be in a unique position to help reduce firearm morbidity and mortality for mentally ill patients.

Tobacco training in clinical social work graduate programs.

The leading cause of preventable death, in the most vulnerable segments of society, whom social workers often counsel, is cigarette smoking. The purpose of this study was to assess tobacco smoking cessation training in clinical social work programs. A valid 21-item questionnaire was sent to the entire population of 189 clinical graduate social work programs identified by the Council on Social Work Education. A three-wave mailing process was used to maximize the return rate. Directors from 112 clinical social work programs returned completed questionnaires (61 percent). The majority (91 percent) of directors reported having never thought about offering formal smoking cessation training, and only nine of the programs (8 percent) currently provided formal smoking cessation education. The three leading barriers to offering smoking cessation education were as follows: not a priority (60 percent), not enough time (55 percent), and not required by the accrediting body (41 percent). These findings indicate that clinical social work students are not receiving standardized smoking cessation education to assist in improving the well-being of their clients. The national accrediting body for graduate clinical social work programs should consider implementing guidelines for smoking cessation training in the curriculums.

Tobacco intervention training in graduate psychiatric nursing education programs.

BACKGROUND: Tobacco use is the leading cause of preventable death, with the highest rate of cigarette smoking seen in mentally ill people. OBJECTIVE: This study assessed the content, amount of time, and educational techniques used in tobacco education training for graduate psychiatric nurses. STUDY DESIGN: A national mail survey of all graduate psychiatric nursing education programs. RESULTS: One-third of programs offered detailed (>1 hr) information on stages of change, the 5 A's and 5 R's. The majority of basic science tobacco topics were not covered or were covered briefly, and the 6 sociopolitical topics were not covered by the majority of programs. Training was by the traditional didactic method using scientific literature reviews. CONCLUSIONS: This study provides evidence of the need to improve the education of psychiatric nurses as tobacco interventionists at both the individual level and the legislative and policy formulation level. J Am Psychiatr Nurses Assoc, 2008; 14(2), 117-124. DOI: 10.1177/1078390307311973.

Psychiatrists' smoking cessation activities with Ohio community mental health center patients.

This study describes a survey of Ohio community mental health center psychiatrists' perceptions and practices regarding smoking cessation activities using the 5A's method of smoking cessation. Of the 150 psychiatrists surveyed, 80 (53%) were returned. The majority of psychiatrists reported asking their patients about cigarette smoking status as well as giving advice to quit. However, the practice of actually facilitating quit attempts (i.e. with social support, nicotine replacement therapy, referrals, and follow-up visits) was lacking. This demonstrates that although cigarette smoking in individuals with mental illness is recognized as a major problem by adult psychiatrists, too little is being done to adequately address the issue.