Treatment response to the RENEW weight loss intervention in schizophrenia: impact of intervention setting.

BACKGROUND: Individuals with serious mental illness have high rates of obesity and a need for specialized weight loss intervention programs. This study examines the efficacy of the RENEW weight loss intervention and examines the impact of the intervention setting on outcomes. METHOD: 136 individuals with serious mental illness from 4 different settings were randomly assigned to receive the RENEW weight loss intervention or a control condition of treatment as usual. The RENEW intervention is a one year program that includes an intensive, maintenance and intermittent supports phase. RESULTS: The intervention group experienced a modest weight loss of 4.8 lbs at 3 months, 4.1 lbs at 6 months and a slight weight gain of 1.5 lbs at 12 months. The control group gained a total of 6.2 lbs at 12 months. However when settings were examined separately the responder sites had a weight loss of 9.4 lbs at 3 months, 10.9 lbs at 6 months and 7 lbs at 12 months. DISCUSSION: These results suggest that the settings in which individuals receive services may act as a support or hindrance toward response to weight loss interventions. The concept of the obesogenic environment deserves further examination as a factor in the success of weight loss programs.

Psychogenic nonepileptic seizures: a pilot study of a brief educational intervention.

PURPOSE: Attending to psychological support and education from the time of diagnosis will assist patients in their acceptance of the need for psychological services. DESIGN AND METHODS: An intervention was provided at the time of diagnosis of psychogenic nonepileptic seizures. This randomized control pilot study examined outcomes 6-8 weeks after discharge from the hospital. FINDINGS: All subjects in the treatment group made and/or kept an appointment with a psychotherapist or psychiatrist within 6-8 weeks of discharge from the hospital as compared with 50% of the control group. PRACTICE IMPLICATIONS: This supportive approach assists patients to accept the functional or nonorganic nature of their symptoms and the need for psychological services.

Objective and subjective sleep disturbances in individuals with psychiatric disabilities.

Sleep disturbances are common complaints in individuals with psychiatric disabilities, frequently occurring at onset and with exacerbation of illness. A small descriptive study of community-based overweight individuals (N = 9) completed the Pittsburgh Sleep Quality Index, wore an ActiGraph and kept a sleep diary for 7 to 14 days. All but two participants had poor sleep efficiency based on actigraphy scores, an objective measure of sleep. These scores were in agreement with the Pittsburgh Sleep Quality Index, a self-report measure, in all but one participant. The findings indicate the Pittsburgh Sleep Quality Index is a comprehensive measure to use in assessing sleep in individuals who have psychiatric disabilities.

Geospatial study of psychiatric mental health-advanced practice registered nurses (PMH-APRNs) in the United States.

OBJECTIVE: The objectives of this study were to identify geographic regions with shortages of psychiatric mental health-advanced practice registered nurses (PMH-APRNs), describe rural-urban differences in the distribution of PMH-APRNs, and discuss implications of the uneven geographic distribution. METHODS: The data source was a complete listing, provided by the American Nurses Credentialing Center, of the employment zip codes of certified PMH-APRNs during 2007 (N=10,452). Geographic information science techniques and spatial statistics were used to conduct a cluster analysis of the spatial distribution of PMH-APRNs. RESULTS: After adjustment for population on the basis of U.S. census reports, statistically significant clusters of counties with high and low density of PMH-APRNs, an indicator of uneven accessibility, were identified. Rural-urban differences in the distribution were also illustrated. CONCLUSIONS: The interdisciplinary approach, including both mapping and statistical analyses, identified shortage areas and provided the groundwork for directing future education, clinical practice, and public policy initiatives.

Weight loss intervention for people with serious mental illness: a randomized controlled trial of the RENEW program.

OBJECTIVE: This study assessed phases one and two of a three-phase weight-loss program called RENEW--Recovering Energy Through Nutrition and Exercise for Weight Loss--among individuals with serious mental illness at four mental health centers. RENEW provides meal replacements twice daily and intensive instruction in nutrition and meal preparation, exercise, and goal setting for three months followed by three months of maintenance. METHODS: Individuals grouped by the psychiatric medication they took were assigned randomly to RENEW or to a control group. RESULTS: Participants who completed RENEW (N=47) had lost more weight on average than had the control group (N=42) at three and six months (weight loss of 5.3 and 4.4 pounds, respectively, versus weight gain of .1 pounds and weight loss of .9 pounds, respectively; F=5.74, df=2 and 82, p=.005). Results did not vary on the basis of type of medication. CONCLUSIONS: Weight loss programs that address cognitive impairments that may accompany serious mental illness can be effective.

Learning potential as a predictor of skill acquisition in people with serious mental illness.

Twenty-five individuals with serious mental illness completed a grocery shopping skills intervention and a test-train-test version of the Wisconsin Card Sorting Test (WCST), which yielded indices of static performance and learning potential. WCST learning potential predicted skill acquisition beyond the static index of traditional WCST performance.

Safety considerations when promoting exercise in individuals with serious mental illness.

Histories and physical exams, completed prior to starting a weight loss program, showed that 52% (N=106) had high risk for coronary artery disease (CAD), 40% had difficulty performing a tandem gait (indicator of balance), and 30% had an existing musculoskeletal disorder. These risks are realistic concerns when recommending exercise and/or walking.

Descriptive study of shared decision making about lifestyle modifications with individuals who have psychiatric disabilities.

BACKGROUND: Shared decision making (SDM) is a process of active participation by clients with practitioners in weighing the risks and benefits of treatments. It has not been extended to decisions about making lifestyle modifications. OBJECTIVE: Describe how frequently health lifestyle behaviors are addressed in 15- to 20-minute medicine clinic visits with individuals who have psychiatric disabilities and how often SDM is used in reaching decisions. DESIGN: Content analysis of 98 audiotaped transcripts from practitioner and client medicine clinic visits. RESULTS: The most frequently discussed lifestyle behaviors discussed were sleep (89%) and diet (61%). SDM, defined as sharing information and options about behavior by either or both practitioner and client and affirmation of a decision by both, occurred 48 times (44%) when a problem existed. CONCLUSION: Discussion of lifestyle behaviors along with use of SDM in negotiating changes in behavior is feasible in a 15- to 20-minute visit.

The prevalence of night eating syndrome and binge eating disorder among overweight and obese individuals with serious mental illness.

The prevalence of night eating syndrome (NES) and binge eating disorder (BED) was assessed among overweight and obese, weight-loss-seeking individuals with serious mental illness (SMI). Sixty-eight consecutive overweight (BMI > or = 25 kg/m(2)) and obese (BMI > or = 30 kg/m(2)) individuals with SMI (mean age = 43.9 years; mean BMI = 37.2 kg/(2); 67.6% Caucasian, 60.3% female) who were enrolled in a group behavioral weight loss treatment program were assessed at baseline for NES and BED with clinician-administered diagnostic interviews. Using conservative criteria, 25.0% met criteria for NES, 5.9% met criteria for BED, and only one participant met criteria for both NES and BED. This is the first study to find that obese individuals with SMI, compared with previously studied populations, are at significantly greater risk for NES, but are not at greater risk for BED. Stress, sleep, and medication use might account for the high prevalence of NES found in this population.

National survey of psychiatric mental health advanced practice nursing: the adequacy of educational preparation: voices of our graduates.

BACKGROUND: Little is known about the fit between practice and graduate education from the perspective of psychiatric mental health advanced practice registered nurses (PMH APRNs). OBJECTIVE: With the purpose of addressing this gap in our knowledge, an e-mail survey that was sent to certified PMH APRNs included a query "Did your program prepare you for your role?" and an open-ended follow-up question: "Please explain how your graduate program did not prepare you adequately for your role?" DESIGN: Descriptive survey. RESULTS: Although 70% of respondents reported satisfaction with their educational programs, content analysis of the comments indicated that the most pressing concerns related to instructional content about psychopharmacology, the practice of prescribing and psychiatric diagnosing, and that there was a perception of a disconnect between the role they were prepared for and their role in the present-day world of work. CONCLUSIONS: The findings reinforce the need for the PMH nursing specialty to further define the optimal methods for preparing APRNs for the full scope of psychiatric services they are licensed to provide as the size of the PMH APRN workforce increases.

Correlates of insider and outsider conceptualizations of recovery.

OBJECTIVE: The concept of recovery can be based on the self report of the individual experiencing the phenomenon ("insider" perspective) or objectively measured by clinicians and researchers ("outsider perspective"). The purpose of this study was to examine the relations among insider (hope and empowerment) and outsider (symptoms and cognition) variables of recovery. METHODS: 66 individuals with schizophrenia, bipolar disorder or major depression were administered the Brief Psychiatric Rating Scale, a battery of cognitive measures, The Hope Scale and The Empowerment Scale. RESULTS: For symptoms, depression and anxiety had the strongest relationships with hope and empowerment. Cognition was associated with a subset of activist oriented empowerment subscales. There were strong relationships among the hope and empowerment measures but few relationships among symptoms and cognition. CONCLUSIONS: Relationships exist between insider and outsider conceptualizations of recovery in that symptoms and cognition are associated with some aspects of hope and empowerment.

Learning proficiency on the Wisconsin Card Sorting Test in people with serious mental illness: what are the cognitive characteristics of good learners?

Although it is widely accepted that schizophrenia and other serious mental illnesses (SMI) are associated with neurocognitive difficulties, there is great variability in neurocognitive functioning across individuals. In recent years, a growing number of schizophrenia studies have utilized the concept of learning potential to explore individual variation in cognition. Learning potential refers to the ability to benefit from instruction and is measured by assessing test performance before and after training. The present study was intended to explore the cognitive characteristics associated with learning potential in people with serious mental illness. Sixty individuals with schizophrenia, bipolar or major (unipolar) depression completed a learning potential assessment using the Wisconsin Card Sorting Test (WCST) and a battery of standard cognitive measures. Based on established criteria for WCST learner subgroups, participants were categorized as high achievers, learners or non-retainers. There were several significant cognitive differences among the three learner subgroups. Most notably, individuals who were categorized as learners on the WCST showed significantly better verbal and working memory compared to non-retainers. Secondary analyses revealed that the three SMI diagnostic groups (depression, bipolar, schizophrenia) were similar in learning potential and did not differ on any of the standard cognitive measures. This study provides support for learning potential classification in schizophrenia as well as other serious mental illnesses, and indicates that learning potential may specifically be related to verbal and working memory abilities.

A psychiatric rehabilitation approach to weight loss.

Obesity is a major problem nationwide and even more prevalent among people with psychiatric disabilities. This study examined the efficacy of a psychiatric rehabilitation weight loss program. Twenty-one individuals participated in the 12-week intervention. Another 15 individuals served as matched controls. Results indicate the intervention group improved more than the control group for weight, body mass index, waist circumference and physical activity. The intervention group lost 2.7 kg (6 lbs) and the control group gained 0.5 kg (1 lb). A weight loss program incorporating psychiatric rehabilitation principles was effective for people with psychiatric disabilities at a community based program.

Knowledge of grocery shopping skills as a mediator of cognition and performance.

OBJECTIVE: Cognitive impairments in serious mental illness are associated with poorer community outcomes; yet the mechanisms through which cognition limits functioning are unknown. This study examined knowledge of grocery shopping skills as a mediator of cognition and performance of grocery shopping skills. METHODS: Fifty-one individuals with serious mental illness were administered measures of cognition, as well as measures of knowledge and performance of grocery shopping skills. RESULTS: When knowledge of grocery shopping skills was introduced as a mechanism through which cognition influences performance, almost perfect mediation was achieved (slope of the regression dropped from B=.32 to B=.03). CONCLUSIONS: The search for mediators can improve our understanding of how cognition influences community functioning.

What constitutes advanced assessment?

As programs to prepare advanced practice nurses for primary care have flourished during the past decade, faculty aspire to teach a health assessment course that is more than a review of undergraduate work. Therefore, course faculty constructed a list of advanced assessment competencies. The purpose of this descriptive study was to validate the competencies clinical preceptors' rated as important via a mailed survey. Overall, the competencies received high mean ratings. The item receiving the highest mean score was "detects and interprets abnormalities in rate and rhythm" from the heart body system. Items within the gynecological and breast systems received the highest ratings. This study suggests a need to help advanced practice nursing students master all advanced assessment competencies on the survey.

Evaluation of the content and interaction in an online clinical conference for students in advanced psychiatric mental health nursing.

Clinical conferences have traditionally been a significant part of the education of psychiatric nurses. With the innovation and increasing popularity of Internet courses, the value of these conferences may be diluted or even lost. This study evaluates an online clinical conference for advanced psychiatric mental health students. The issues raised by students in the conferences were relevant to the objectives of the course. Content analysis of representative conferences indicated that the characteristics of involvement: personal, emotion, and metacognition, and interactivity were evident. Students reported advantages to online discussions, but acknowledged the loss of the greater spontaneity in face-to-face meetings.

The relations between cognition and the independent living skill of shopping in people with schizophrenia.

A great deal of interest has developed regarding the impact of cognitive deficits on the everyday functioning of people with schizophrenia. This study examined the relationships between cognitive functioning and the performance of a specific independent living skill (grocery shopping) in a sample of 73 individuals with schizophrenia or schizoaffective disorder. Cognitive variables included tests of verbal memory, executive functioning, verbal fluency, sustained attention and visual motor skill. Functional outcome was measured with the Test of Grocery Shopping Skills, which is an ecologically based performance measure that requires participants to shop for 10 items within an actual grocery store. Accuracy on the shopping task was significantly associated with fewer perseverative responses on the Wisconsin Card Sorting Test, better verbal memory and faster processing speed. Shopping efficiency (i.e. less redundancy) was associated with better performance on several cognitive tasks, including verbal memory, verbal fluency, sustained attention and executive functioning. Results of this study extend previous research by examining the relation between cognition and the actual performance of daily living skills under natural circumstances.