Betty Vreeland

Obesity Among Those with Mental Disorders: A National Institute of Mental Health Meeting Report

The National Institute of Mental Health convened a meeting in October 2005 to review the literature on obesity, nutrition, and physical activity among those with mental disorders. The findings of this meeting and subsequent update of the literature review are summarized here. Levels of obesity are higher in those with schizophrenia and depression, as is mortality from obesity-related conditions such as coronary heart disease. Medication side effects, particularly the metabolic side effects of antipsychotic medications, contribute to the high levels of obesity in those with schizophrenia, but increased obesity and visceral adiposity have been found in some but not all samples of drug-naïve patients as well. Many of the weight-management strategies used in the general population may be applicable to those with mental disorders, but little is known about the effects of these strategies on this patient population or how these strategies may need to be adapted for the unique needs of those with mental disorders. The minimal research on weight-management programs for those with mental disorders indicates that meaningful changes in dietary intake and physical activity are possible. Physical activity is an important component of any weight-management program, particularly for those with depression, for which a substantial body of research indicates both mental and physical health benefits. Obesity among those with mental disorders has not received adequate research attention, and empirically-based interventions to address the increasing prevalence of obesity and risk of cardiovascular and metabolic diseases in this population are lacking.

Solutions for Wellness: Results of a Manualized Psychoeducational Program for Adults with Psychiatric Disorders

Objective: The growing problem of premature death in people with serious mental illness is a critical call to action. Few resources exist that can help integrate physical health into behavioral health treatment. This study examined the effectiveness of a manualized, psychoeducational wellness toolkit called the Solutions for Wellness (SFW). The study aimed to examine whether mental health consumers who volunteered to participate in an intensive group intervention with the SFW program increased knowledge about wellness and changes in attitudes/intentions to pursue healthier lifestyle choices. Methods: Thirty-four participants with mental illness participated in an intensive 10-week manualized group wellness program. The primary outcome measures were change in knowledge and attitudes/intentions. Secondary outcomes were change in body mass index (BMI), weight, systolic and diastolic blood pressure, pulse, waist circumference, hope, and clinician rating of clinical status. Pre-post changes in several of these variables were compared with a group of 31 participants who did not receive the intervention. Blood pressure, pulse, and waist circumference were collected only in the intervention group. Results: 26 participants (76%) completed the program and attended 47% of sessions. Using an intent-to-treat analysis, statistically significant pre–post improvements in knowledge (p = .001), attitudes (p = .007), BMI (p = .0066), weight (p = .0079), systolic blood pressure (p = .006), diastolic blood pressure (p = .024), and waist circumference (p = .0007) were observed. Conclusions: Compared with a group of participants who did not receive the intervention, the intervention group evidenced statistically significant improvement in knowledge about and attitudes/intentions toward making healthier lifestyle choices, weight, and BMI. In contrast, the group of participants who did not receive the intervention did not show any improvement in knowledge or attitudes, and they gained weight. In addition, the intervention group also evidenced statistically significant improvement in waist circumference and systolic and diastolic blood pressure. Randomized, controlled clinical trials of this intervention are needed.

Partial hospitalization: compatible with evidence-based and recovery-oriented treatment?

Partial hospitalization is a service modality that some have suggested is incompatible with both evidence-based and recovery-oriented treatment. The purpose of this study was to examine the accuracy of this assumption. Toward this end, a specific partial hospitalization program was examined using administrative data, self-reports regarding recovery orientation, and fidelity ratings from independent assessors. Findings support that the partial hospitalization program studied has reasonable lengths of stay, provides recovery-oriented services, and has implemented evidence-based practices. We conclude that partial hospitalization programs have the potential to become part of an evidence-based and recovery-oriented system.

Managing the Clinical Consequences of Psychiatric Illness and Antipsychotic Treatment: A Discussion of Obesity, Diabetes, and Hyperprolactinemia

Many individuals who suffer from serious and persistent mental illness also have co-occurring physical problems that are frequently misdiagnosed, underdiagnosed, or undertreated. Tragically, this population loses between 8 and 20 years of life expectancy when compared to a nonpsychiatric population. Hyperglycemia, diabetes, and weight gain have long been established as correlating with mental illness and psychotropic medications, leaving it difficult to identify which condition came first. Hyperprolactinemia is an additional consequence of select antipsychotic therapies that results in endocrine and sexual disturbances. Clinicians need to understand how to assess and manage the health risks associated with psychiatric conditions and their treatments. The psychiatric nurse is a key member of the health care team whose holistic framework can afford an opportunity to bridge the gap between mental and physical health. This article discusses the overall assessment and management of psychotropic-associated weight gain, obesity, type 2 diabetes, and hyperprolactinemia in patients with schizophrenia and bipolar disorder.

Concordance Between Measured and Self-Perceived Weight Status of Persons With Serious Mental Illness

OBJECTIVE This study investigated concordance between self-perceived and measured weight status for persons with serious mental illness. METHODS A total of 586 mental health clients assessed their weight as underweight, normal, overweight, or obese. The agreement between these self-assessments and the same categories based on measured body mass index was related to gender, ethnicity, education, age, and psychiatric diagnosis. RESULTS Three hundred consumers (51%) underestimated their weight (they thought they weighed less than they did); only 35 (6%) overestimated it. In logistic regression analyses, gender, education, and psychiatric diagnosis showed significant effects on accuracy of self-perception, but ethnicity and age did not. CONCLUSIONS People with serious mental illness are more likely than others to have weight problems, which contribute to higher rates of morbidity and mortality. However, they also tend to underestimate their weight. This gap between reality and self-perception must be addressed.