Assessing the impact of long-acting injectable compared to oral antipsychotic medications on readmission to a state psychiatric hospital.

WHAT IS KNOWN ON THE SUBJECT: People living with schizophrenia spectrum disorder (SSD) have a higher death rate which is caused, in part, by poorer adherence to treatment as compared to those with other mental illnesses. Using long-acting injectable antipsychotic (LAI) medications can improve medication adherence and reduce hospitalizations for people living with SSD but are often underutilized. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: As compared to oral antipsychotic medications provided to patients with SSD at discharge from a psychiatric hospitalization, being provided with an LAI antipsychotic medication may reduce subsequent rehospitalization. Specifically, patients discharged on an atypical or second-generation LAI medication are less likely to be readmitted to the hospital when compared to those discharged on a typical first-generation oral medication. WHAT ARE THE IMPLICATIONS FOR PRACTICE: Because LAI antipsychotic medications are often underutilized as treatment options, the study findings suggest that this modality may be considered for patients with SSD when being discharged from a psychiatric hospitalization. Ideally, psychiatric-mental health nurses can educate patients about indications, benefits, and risks of using atypical or second-generation LAI antipsychotic medications during hospitalization and at discharge prevent the risk for future rehospitalizations. ABSTRACT: INTRODUCTION: People living with schizophrenia spectrum disorder (SSD) have poorer medication adherence compared to those with other mental illnesses. Long-acting injectable antipsychotic (LAI) medication use is associated with greater adherence, reduced re-hospitalizations, and improved recovery outcomes when compared to oral formulations. AIM: To compare LAI antipsychotic medication use versus oral formulations on readmission to an inpatient hospital. METHOD: Medical records (N = 707) from a state psychiatric hospital in the southern region of the United States were reviewed. Controlling for demographic variables, logistic regression analyses were used to examine LAI compared to oral formulations on readmission. RESULTS: Compared to patients discharged with oral antipsychotic medications, those with LAIs had a lower proportion of readmission rates in 6-month and 1-year periods, but not 30-day or 2-year periods. When controlling for demographic variables, those discharged with an atypical LAI had significantly lower odds of being readmitted within the 24-year period compared to those discharged on a typical oral antipsychotic. DISCUSSION: Compared to orals, LAIs do not increase and may mitigate readmissions to psychiatric hospitalization. IMPLICATIONS FOR PRACTICE: Psychiatric-mental health nurses and other professionals may recommend LAIs when indicated for those with SSD.

Assessing Tobacco Treatment Engagement in Assertive Community Treatment Programs.

OBJECTIVE: Despite high tobacco use prevalence among those with serious mental illnesses, few Assertive Community Treatment (ACT) programs provide tobacco treatment. Understanding the factors associated with the intentions to engage in tobacco treatment from both provider and consumer perspectives is important. The purpose was to examine ACT providers' intention to provide and consumer intention to engage in tobacco treatment. METHOD: A cross-sectional survey of ACT program providers (N = 51) and consumers (N = 43) from four community mental health centers. Multiple linear regression analyses were used to examine factors associated with the intentions to provide or engage in tobacco treatment from among attitudinal, subjective norms, and perceived behavioral control variables. RESULTS: Providers reported positive attitudes, high degree of perceived behavior control, and high intentions for delivering tobacco treatment, but poor perceptions of subjective norms. These results were like consumers' intentions to engage in tobacco treatment. In regression analysis, only subjective norms and perceived behavior control were significant predictors for providers' intentions to provide tobacco treatment, but there were no significant predictors of consumers' intentions to engage in tobacco treatment. Both providers and consumers endorsed poor implementation of evidence-based tobacco treatment. CONCLUSION: Poor engagement in tobacco treatment within ACT programs indicates the need for policymakers to support tobacco treatment within the services. This finding calls for training of mental and behavioral health providers while supporting tobacco-free initiatives in ACT treatment service settings.

Tobacco use behavior among adults exposed to cumulative adverse childhood experiences: A systematic review and meta analysis.

BACKGROUND: Tobacco use remains one of the most used substances among adults globally and substantially impacts individuals and society. Adverse childhood experiences (ACEs) contribute to tobacco use. However, the association between cumulative ACEs and tobacco use behaviors (TUB) has not been established in the literature. In this review, we aimed to estimate the prevalence of ACEs among adult tobacco users and evaluated the relationship between cumulative ACEs and TUB. METHODS: We identified original articles published before October 2022 by searching PubMed, CINAHL, and Psych INFO databases. Inclusion criteria were: English language, adults and used instruments assessing for cumulative ACEs defined as four or more ACEs. RESULTS: Forty-two studies, totaling 674,087 participants; predominantly cohort and cross-sectional in study design (n = 33). Exposure to 4 ≥ ACEs was significantly associated with increasing the odds of current tobacco use (n = 35), ever or former tobacco use (n = 13), tobacco use initiation, (n = 3) nicotine dependence (n = 1), and ever using electronic cigarettes (n = 1). In the meta-analysis, as compared to those without ACEs, those with 4 ≥ ACEs were twice as likely to have ever used tobacco (OR = 2.16, 95 %CI:1.73-2.70) and approximately four times more likely to have used tobacco currently (OR = 3.73, 95 %CI:2.69-5.18). CONCLUSION: The cumulative ACEs exposure can increase the risk for TUB. However, the evidence is limited primarily to cigarette use. Ongoing research into the effects of cumulative ACEs on TUB is needed to integrate trauma-informed intervention in treating tobacco use and guide public health initiatives aimed to reduce the prevalence of ACEs and TUB among adults.

Harnessing Artificial Intelligence: Strategies for Mental Health Nurses in Optimizing Psychiatric Patient Care.

This narrative review explores the transformative impact of Artificial Intelligence (AI) on mental health nursing, particularly in enhancing psychiatric patient care. AI technologies present new strategies for early detection, risk assessment, and improving treatment adherence in mental health. They also facilitate remote patient monitoring, bridge geographical gaps, and support clinical decision-making. The evolution of virtual mental health assistants and AI-enhanced therapeutic interventions are also discussed. These technological advancements reshape the nurse-patient interactions while ensuring personalized, efficient, and high-quality care. The review also addresses AI's ethical and responsible use in mental health nursing, emphasizing patient privacy, data security, and the balance between human interaction and AI tools. As AI applications in mental health care continue to evolve, this review encourages continued innovation while advocating for responsible implementation, thereby optimally leveraging the potential of AI in mental health nursing.

Smoking Cessation Barriers among Individuals with Mental Illnesses: A Qualitative Study of Patients' and Healthcare Providers' Perspectives.

In this paper we aimed to explore: (1) challenges that people with mental illnesses (MIs) describe in engaging in smoking cessation, (2) challenges that mental health providers (MHPs) perceive that people living with MIs face, and (3) how the perceived challenges are similar and/or different from both perspectives. Semi-structured interviews were used to obtain narrative data from 16 MHPs and 13 psychiatric inpatients with MIs. We identified themes purport societal, group, and individual factors may influence smoking cessation treatment engagement. The scope of the perceived challenges appeared varied in the narratives of MHPs as compared to those with MI.

Substance use outcomes among individuals with severe mental illnesses receiving assertive community treatment: A systematic review.

Assertive Community Treatment (ACT) is a multidisciplinary treatment approach to support people with severe mental illnesses (SMI) in their recovery. While the majority of ACT recipients report co-morbid substance use issues, limited reviews have evaluated the impact of receiving ACT services on substance use outcomes. The purpose of this systematic review was to evaluate the impact of ACT involvement on substance use outcomes among people with SMI. A systematic literature search was conducted including articles published prior to April 2021. Twenty-nine studies were included in this review. Of them, 15 studies implemented a controlled design (six studies demonstrated high quality) and 14 studies implemented a cohort design. From a synthesis of the reviewed studies, five areas of changes associated with substance use emerged including reduced alcohol and drug use severity, lower prevalence of alcohol and drug use, increased stage of change in substance use treatment, and fewer days of hospitalization and intoxication. Thus, future studies should examine the integration of substance use treatment services as part of ACT interventions for opportunities to enhance recovery outcomes among individuals with SMI.

The Impact of a Nurse-Led Service on Tobacco Treatment Provision Within a Psychiatric Hospital: A Time Series Study.

INTRODUCTION: Psychiatric hospitalization is an opportunity to provide evidence-based tobacco treatment to optimize cessation efforts among people living with mental illnesses (MI). The purpose of this study was to examine the effectiveness of nurse-driven initiatives to enhance tobacco treatment within an inpatient psychiatric setting. AIMS: We assessed the 4-year impact of implementing a nurse-led tobacco treatment service offered to 11,314 inpatients at admissions in a tobacco-free psychiatric facility in Kentucky. METHOD: Through a time-series design, we compared the differences in rates of screening for tobacco use and providing treatment from September to December 2015 (prior to implementing the nurse-led tobacco treatment services) to each subsequent year in a 4-year period (2016-2019). RESULTS: Approximately 60.0% of inpatients were persons using tobacco during the assessment period. Although there were no changes in tobacco use prevalence over the 4-year evaluation duration, there were significant increases in the provision of practical counseling and Food and Drug Administration-approved nicotine replacement therapies for persons using tobacco. CONCLUSIONS: Our findings support the effectiveness of implementing tobacco treatment programs at the organizational level. Psychiatric hospitalizations provide an opportunity to optimize nurse-driven efforts to deliver tobacco treatment to people with MI. Similar models of nurse-led tobacco treatment services can be adopted within inpatient and other mental and behavioral health settings.

Evaluating Simulation-Based Tobacco Treatment Scenarios for Providers Delivering Treatment for People Living With Mental Illnesses.

Background: People living with mental illnesses (PMI) experience elevated tobacco use and related morbidity and mortality. Despite the availability of effective and safe tobacco treatments along with evidence that PMI are motivated and able to quit successfully, few Mental and behavioral healthcare providers (MHPs) engage PMI in such treatment. MHPs may lack the confidence or skills to engage their clients in tobacco treatment. Currently, there are limited training modalities to prepare MHPs in delivering tobacco treatment for PMI. However, animated scenario-based simulated encounters can bridge this gap to effectively provide tailored MHP training to enhance treatment delivery. Hence, the purpose of this study was to evaluate simulated tobacco treatment education scenarios tailored to MHPs. Methods: For this evaluation, we used a pretest-posttest design to assess changes in MHPs tobacco treatment knowledge and behavioral intentions after viewing simulated treatment encounters. We developed four animated scenarios, using brief tobacco treatment interventions, simulating treatment encounters with PMI. MHPs were primarily recruited from mental or behavioral healthcare facilities and were asked to complete a web-based questionnaire. Their knowledge, views, and experiences in providing tobacco treatment were assessed prior to viewing the animated scenarios. Participants were then asked to evaluate the desirability, acceptability, and applicability of the animated scenarios; and thereafter, their knowledge of and intentions to provide evidence-based tobacco treatment (i.e., ASK, ADVISE, ASSESS, ASSIST, ARRANGE) were again assessed. Results: Participants (N = 81) were on average 41.0 years of age, mostly female (79.0%), and non-Hispanic White (86.4%). Nearly a quarter endorsed current tobacco use and few had tobacco treatment training (14.8%). Overall knowledge of tobacco treatment scores significantly increased before and after viewing the videos (M = 3.5 [SD = 1.0] to M = 4.1 [SD = 1.0], p < 0.0001). After viewing the simulated scenario videos, participants endorsed moderate to high mean scores (ranging from 4.0-4.2 on a 0 to 5 scale) on the desirability, acceptability, and applicability of the different animated scenarios. In addition, after viewing the scenarios the proportion of participants who endorsed that they intended to occasionally/very often engage clients in evidence based tobacco treatment were high for ASK (94.9%), followed by ADVISE and ASSESS (84.7% each), followed by ASSIST (81.4%), and ARRANGE (74.6%). Evaluation scores significantly differed by type of animated scenario and participants' work settings and discipline. Conclusions: These findings suggest that the use of brief animated scenarios may be a useful modality to enhance MHPs knowledge acquisition and treatment delivery intentions. Such approaches may be integrated into tobacco treatment trainings for MHPs.

Nursing Staff Attitude, Subjective Norms, Perceived Behavior Control, and Intention to Provide Tobacco Treatment in a Psychiatric Hospital.

BACKGROUND: Although the nursing staff is fundamental in assisting individuals with mental illnesses (MI) to stop tobacco use, they often have mixed feelings about providing tobacco treatment (TT) services to people with MI in inpatient psychiatric settings. OBJECTIVE: Therefore, this study aimed to understand factors associated with nursing staff's intentions to provide TT interventions for individuals diagnosed with MI in a psychiatric facility using the constructs of the theory of planned behavior (TPB). METHOD: Secondary data analysis was performed using cross-sectional data collected from 98 nursing staff who worked in a state inpatient psychiatric facility. A 15-item questionnaire was used to assess nursing staff intentions to provide TT services based on TPB constructs, including attitudes (four items), subjective norms (four items), perceived behavioral controls (four items), and intentions (three items) toward providing TT. The mean scores of each subscale ranged from 1 to 7. A logistic regression analysis was used to examine the relationship between TBP constructs and nursing staff intentions to provide TT for people with MI. RESULTS: Nursing staff had an acceptable mean score in the intentions subscale (4.34 ± 2.01). Only two constructs of TPB explained nursing staff intentions to provide TT: subjective norms (OR = 2.14, 95% CI [1.46, 3.13]) and perceived behavioral control (OR = 2.33, 95% CI [1.32, 4.12]). CONCLUSIONS: The constructs of the TPB, the subjective norms, and the perceived behavior control were able to predict nurses' intentions to provide TT for inpatients in a psychiatric setting. Accordingly, we suggest implementing policies that make TT a normative practice while supporting the confidence and competence of nurses to deliver TT in psychiatric facilities.

Quit and win contests in community-dwelling mental and behavioral health populations: A systematic review and pilot feasibility findings.

BACKGROUND: People with mental illnesses (MI) benefit from incentives to promote tobacco cessation. "Quit and Win" contests are community-based approaches that incentivize cessation. However, little is known about "Quit and Win" contest effectiveness among people with MI. AIM: To examine the utility of "Quit and Win" contests among people with MI. METHOD: This study had two phases: (a) a systematic literature review to explore the potential effectiveness of "Quit and Win" contests for people with MI and (b) a pilot feasibility study of implementing a "Quit and Win" contest among people with MI from a community mental health program (CMHP). RESULTS: In phase 1, no reviewed study specifically included people with MI in their sample. Of the four cohort and five randomized controlled studies in the review, the mean reported participant quit rates at the end of "Quit and Win" contests were 76.8% and 28.3%, respectively. In phase 2, within a CMHP, four out of seven participants completed a "Quit and Win" contest, and one individual achieved cessation. CONCLUSION: People with MI may benefit from incentive-based tobacco cessation programs. Implementing a "Quit and Win" contests within a CMHP is important and requires more studies to determine feasibility and effectiveness.