Integrating the 2013 Psychiatric Mental Health NP Competencies Into Educational Programs: Where Are We Now?

Since the introduction of the revised National Organization of Nurse Practitioner Faculties (NONPF) Nurse Practitioner Core Competencies and Population Focused Psychiatric Mental Health Nurse Practitioner (PMHNP) Competencies, a national forum took place to hear from many PMHNP program directors in the field comparing how they have integrated the lifespan competencies and the master's (MS)/or doctor of nurse practice (DNP) essentials into their curriculum. In this paper, we will report first on the major areas of change in the structure and content of the PMHNP-lifespan curriculum as well as the comments made by many faculty from across the country as to challenges and innovative strategies used to meet these challenges. We will review some of the major issues in content, pedagogy, and evaluation methods as well as examples of how these curricular elements have been infused into select programs across the country. We conclude highlighting several key areas, suggested foci for change, and how the specialty might focus attention and accelerate the significant growth we are seeing in PMHNP programs.

Glucose metabolism in patients with schizophrenia treated with atypical antipsychotic agents: a frequently sampled intravenous glucose tolerance test and minimal model analysis.

BACKGROUND: While the incidence of new-onset diabetes mellitus may be increasing in patients with schizophrenia treated with certain atypical antipsychotic agents, it remains unclear whether atypical agents are directly affecting glucose metabolism or simply increasing known risk factors for diabetes. OBJECTIVE: To study the 2 drugs most clearly implicated (clozapine and olanzapine) and risperidone using a frequently sampled intravenous glucose tolerance test. DESIGN: A cross-sectional design in stable, treated patients with schizophrenia evaluated using a frequently sampled intravenous glucose tolerance test and the Bergman minimal model analysis. SETTING: Subjects were recruited from an urban community mental health clinic and were studied at a general clinical research center. Patients Fifty subjects signed informed consent and 41 underwent the frequently sampled intravenous glucose tolerance test. Thirty-six nonobese subjects with schizophrenia or schizoaffective disorder, matched by body mass index and treated with either clozapine, olanzapine, or risperidone, were included in the analysis. MAIN OUTCOME MEASURES: Fasting plasma glucose and fasting serum insulin levels, insulin sensitivity index, homeostasis model assessment of insulin resistance, and glucose effectiveness. RESULTS: The mean +/- SD duration of treatment with the identified atypical antipsychotic agent was 68.3 +/- 28.9 months (clozapine), 29.5 +/- 17.5 months (olanzapine), and 40.9 +/- 33.7 (risperidone). Fasting serum insulin concentrations differed among groups (F(33) = 3.35; P = .047) (clozapine>olanzapine>risperidone) with significant differences between clozapine and risperidone (t(33) = 2.32; P = .03) and olanzapine and risperidone (t(33) = 2.15; P = .04). There was a significant difference in insulin sensitivity index among groups (F(33) = 10.66; P<.001) (clozapineolanzapine>risperidone) (clozapine vs risperidone, t(33) = 2.94; P = .006; olanzapine vs risperidone, t(33) = 2.42; P = .02). There was a significant difference among groups in glucose effectiveness (F(30) = 4.18; P = .02) (clozapine

An introductory clinical core course in psychiatric management: an innovative lifespan course blending all nurse practitioner majors.

TOPIC: The prevalence of anxiety, depression, substance abuse, and suicidal ideation is significant in primary care settings across the country. Nonpsychiatric nurse practitioners must be able to recognize symptoms of common psychiatric disorders, know how to treat less complex mental illnesses, and know when to refer to psychiatric mental health nurse practitioners (PMHNPs). PURPOSE: This article describes the course content, assignments, and teaching strategies used in a clinical core course in the nurse practitioner (NP) curriculum that is required for all NP majors at the University of Texas at Arlington. Psychiatric Management for Advanced Practice provides the foundation for later PMHNP major specific clinical courses. SOURCES: Development of the course content was based on NONPF Domains and Competencies for the NP, input from graduate NP faculty using a modified Delphi approach, NP student feedback, review of curriculum from other schools, and review of the literature on depression, suicide, anxiety, and substance abuse disorders in primary care settings. CONCLUSIONS: Since 1999, students from the eight different NP programs at the University of Texas at Arlington have been required to take this course. Student, faculty, and graduate feedback about this course have been consistently positive. Many NP students comment on feeling much more comfortable assessing for depression, suicide, and substance use.

The Relationship Between Depressive Symptoms and Self-Management Behaviors in Patients With T2DM and Stage 3 CKD.

PURPOSE: This study aimed to assess the relationship of depressive symptoms with self-management by adults with type 2 diabetes mellitus and chronic kidney disease. DESIGN AND METHODS: Using a descriptive correlational design, participants completed Beck's Depression Inventory (BDI-II) and Summary of Diabetes Self-Care Activities measure. FINDINGS: Reported were energy loss, sleep change, and fatigue. Performed less were exercise, physical activity, eating vegetables, and blood checks. Significant correlations were BDI-II total score with feet checking, energy loss with feet checking and exercise, and sleep change with feet soaking. PRACTICE IMPLICATIONS: Depressive symptoms were associated to self-management behaviors that require physical energy. Assess for advancing symptoms.

Treatment and prevention of obesity: what works, what doesn't work, and what might work.

We provide a very broad conceptual overview of some of the issues involved in the treatment and prevention of obesity. Data suggest that clinicians have some ability to promote positive changes with obesity treatment. The environment, though important in influencing one's degree of adiposity, has largely transient effects that do not tend to carry over from one time to substantially later times. In contrast, the genetic influences on body mass index at any one time do tend to carry over to later times. This information influences the types of approaches that are and are not likely to be successful in terms of preventing obesity or reducing obesity on a population level. A second issue concerns the composition of weight lost. Conditional on fat loss, weight loss has been associated with an increased mortality rate (MR) whereas, conditional upon weight loss, fat loss has been associated with a decreased MR. This suggests that we should seek treatments that maximize the proportion of weight lost as fat. Third, the efficacy of current treatments is far below patients' expectations and desires. We need both to increase the efficacy of our treatments dramatically and help patients adjust their expectations so that they can take satisfaction in smaller weight losses. Perhaps, with continued efforts at enhancing treatments, we will see incremental advances in the treatment and prevention of obesity.

Triggers for self-abuse: a qualitative study.

Deliberate acts of self-abuse evoke strong feelings among nurses. The purpose of this research was to describe how self-abusing women in a locked, state psychiatric hospital defined self-abuse in the context of their lives. The social constructionist framework informed the methodology of narrative analysis. Nine women were interviewed over 3 months for a total of 43 interviews. Four themes or linkages were identified: their pleas to be listened to and receive help, specific triggers for self-abusive behavior, the causes of the self-abusive behavior, and how to stop the self-abuse. Specific triggers were identified as well as suggested nursing interventions.

An open-label trial of quetiapine for antipsychotic-induced sexual dysfunction.

This study evaluated the effect of switching outpatients with schizophrenia and antipsychotic-induced sexual dysfunction to open-label quetiapine treatment. Secondary objectives were to compare the antipsychotic and prolactin-related effects of quetiapine versus prestudy antipsychotic treatment. Eight patients with at least moderately severe antipsychotic-induced sexual dysfunction (N = 7 taking risperidone, 4-6 mg/d; N = 1 taking haloperidol, 10 mg/d) were evaluated prospectively after they switched to 6 weeks of quetiapine treatment. The assessments that we used included evaluations of sexual functioning (Arizona Sexual Experience Scale [ASEX]; McGahuey et al., 2000), psychopathology (Positive and Negative Syndrome Scale [PANSS]; Kay, Fiszbeinm, & Opler, 1997), adverse events, and plasma prolactin levels. Quetiapine was associated with clinically and statistically significant improvement in ASEX total scores (p = 0.008) and significantly decreased PANSS total scores (p = 0.03). Plasma prolactin levels tended to decrease after the transition to quetiapine (p = 0.09). Quetiapine appears to offer an option to reduce antipsychotic-induced sexual dysfunction for outpatients with schizophrenia.