Lora Humphrey Beebe

EFFECTS OF EXERCISE ON MENTAL AND PHYSICAL HEALTH PARAMETERS OF PERSONS WITH SCHIZOPHRENIA

Although the benefits of exercise are well documented, few published research studies have examined exercise in persons with schizophrenia. This pilot examined a 16-week walking program for outpatients diagnosed with schizophrenia (N = 10). Six-minute walking distance, body mass index, percent body fat and severity of psychiatric symptoms were measured. Experimental participants in the walking group experienced significant reductions in body fat (p = 0.03) compared to a control group not participating in the exercises during the same time period. Experimental participants also had greater aerobic fitness, lower body mass indexes, and fewer psychiatric symptoms than controls at the conclusion of the program. Research is needed to identify effective exercise interventions and feasible delivery modalities for persons with schizophrenia in community settings.

Preventing Depression in High-Risk College Women: A Report of an 18-month Follow-up

Abstract The authors tested the long-term effectiveness of a cognitive-behavioral group intervention in reducing depressive symptoms, decreasing negative thinking, and enhancing self-esteem in 92 college women aged 18 to 24 years who ere at risk for clinical depression. The women were randomly assigned to either an experimental or a no-treatment control group. The experimental group participated in a 6-week cognitive-behavioral intervention that targeted identification and reduction of negative thinking, using such techniques as thought stopping and affirmations. Data on depressive symptoms, self-esteem, and negative thinking were collected before the intervention and at intervals of 1, 6, and 18 months postintervention. The women in the intervention group experienced a greater decrease in depressive symptoms and negative thinking and a greater increase in self-esteem than those in the control group. The beneficial effects continued over an 18-month follow-up period. These findings support the importance of thought stopping and affirmations as prevention interventions with at-risk college women.

Negative thinking mediates the effect of self-esteem on depressive symptoms in college women.

BACKGROUND One of every three women between 18 and 24 years of age may be significantly depressed. Younger women have shown increasing rates of unipolar depression since the 1950s, and the average age of onset continues to decline. OBJECTIVES To examine the prevalence and correlates of high depressive symptoms in single college women 18 to 24 years of age. Negative thinking was posited to mediate the relationship between self-esteem and depressive symptoms. METHODS A sample of 246 women was recruited from a university student body. Each woman completed a survey that included the Center for Epidemiologic Studies-Depression Scale, the Beck Depression Inventory, the Rosenberg Self-esteem Scale, the Crandell Cognitions Inventory, and the Automatic Thoughts Questionnaire. RESULTS Of the women, 35% had high depressive symptoms. Negative thinking mediated the relationship between self-esteem and depressive symptoms. However, self-esteem also showed a weak direct effect on depressive symptoms. CONCLUSION The findings suggest that negative thinking may play an important role in the development of depressive symptoms in college women.

PARENTAL BONDING: A KEY FACTOR FOR MENTAL HEALTH OF COLLEGE WOMEN

The purpose of this study was to investigate the relationship of parental bonding to the mental health of college women aged 18 to 24 years. A cross-sectional study of a volunteer sample of 246 college women was conducted. Data on depressive symptoms, negative thinking, self-esteem, and parental bonding were collected via self-report. Maternal care was the strongest predictor of all four mental health indices. Paternal overprotection predicted scores of three of the four mental health measures. Women with optimal maternal and paternal bonding profiles (high care/low overprotection) had fewer depressive symptoms, less negative thinking, and higher self-esteem than women with other bonding profiles. The findings have implications for prevention, screening, and intervention to enhance the mental health of college women.

Telenursing intervention increases psychiatric medication adherence in schizophrenia outpatients.

BACKGROUND: Promoting medication adherence is a critical issue in optimizing both physical and mental health in persons with schizophrenia. Average antipsychotic medication adherence is only 50%; few studies have examined nonpsychiatric medication adherence. Psychosocial interventions with components of problem solving and motivation have shown promise in improving adherence behaviors. OBJECTIVES: This study examines telephone intervention problem solving (TIPS) for outpatients with schizophrenia. TIPS is a weekly, provider-initiated, proactive telenursing intervention designed to help persons with schizophrenia respond to a variety of problems, including adherence problems. STUDY DESIGN : The authors completed objective measures of adherence to psychiatric and nonpsychiatric medications in 29 community-dwelling persons with schizophrenia, monthly for 3 months. STUDY RESULTS : Persons receiving TIPS had significantly higher objective adherence to psychiatric medications throughout the study period, F(1, 20) = 5.47, p = .0298. CONCLUSIONS: Clinicians should consider using TIPS as an adjunct to face-to-face appointments to support adherence in persons at risk. J Am Psychiatr Nurses Assoc, 2008; 14(3), 217–224. DOI: 10.1177/1078390308318750

What Community Living Problems Do Persons With Schizophrenia Report During Periods of Stability

PURPOSE This article describes problems reported by persons with schizophrenia while stable. DESIGN AND METHODS This descriptive study followed 12 outpatients with at least 6 months without psychiatric hospitalization for 3 months in the community. FINDINGS. The most frequently reported problems were missed appointments and loneliness. Anxiety was the most commonly reported psychiatric symptom. No participant reported any psychotic symptoms, but participants reported conflict at home. PRACTICE IMPLICATIONS Medication- and appointment-adherence monitoring are ongoing priorities, as are the provision of interventions designed to support adherence. Stable persons with schizophrenia are poised to garner maximum benefit from support like family education and social skills training.

Obesity in Schizophrenia: Screening, Monitoring, and Health Promotion

PURPOSE This paper reviews risks, assessments, antipsychotic medication choices, and lifestyle interventions for obesity in persons with schizophrenia. CONCLUSIONS Antipsychotic medication is the most important treatment choice. Simple diet teaching must take into account the cognitive limitations of clients with schizophrenia. After medical clearance is obtained, moderate exercise can be encouraged. Education about exercise benefits may increase motivation. PRACTICE IMPLICATIONS Nurses would be remiss to ignore the physical health effects of obesity in schizophrenia. Practitioners must choose psychiatric medications and provide health education, health promotion, and appropriate referrals to optimize quality of life for this group.

TIPS: telephone intervention--problem solving for persons with schizophrenia.

A prospective experimental design was used to examine whether face-to-face meetings designed to establish rapport had an effect on the verbal responses of persons with schizophrenia in subsequent Telephone Intervention—Problem Solving (TIPS). Verbal responsiveness was operationalized as length of telephone conversation, number of feeling statements expressed, and number of one-word responses. Experimental participants met with the TIPS provider twice during hospitalization, while controls did not meet with the TIPS provider. All subjects received TIPS weekly from a psychiatric nurse for six weeks after hospital discharge. Compared to controls, experimental participants conversed longer at every measurement point, and significantly longer during weeks one through three. Experimental participants were approximately twice as likely to make a feeling statement as those in the control group. These data suggest that psychiatric nurses who would like to employ TIPS to support clients in the community should plan for at least two face-to-face interventions to establish rapport prior to initiating TIPS.

Problems in Community Living Identified by People with Schizophrenia

1. Problems in community living were identified by a group of people with schizophrenia who received a telephone nursing intervention after discharge from a state psychiatric facility. 2. The most frequently reported problems were medication side effects, financial concerns, and anxiety. 3. A telephone nursing intervention has the potential to reduce the negative effects of stressors on people with schizophrenia living in the community.

A Pilot Study Describing Physical Activity in Persons with Schizophrenia Spectrum Disorders (SSDS) after an Exercise Program

Despite the well known mental and physical health benefits of exercise, persons with schizophrenia spectrum disorders remain sedentary. While the exercise barriers (i.e., lack of motivation, poor concentration, sedative effects of medication, poverty, and lack of access to exercise education/programs) of persons with SSDs are numerous, lack of motivation is considered foremost among them. Exercise interventions have been shown to improve exercise behavior, but there is a need for longitudinal documentation of physical activity after interventions conclude. This pilot study describes the physical activity level of 22 persons with SSDs 14 to 34 (mean 22) months after the conclusion of an exercise intervention provided in a randomized controlled trial (RCT). Eighteen months after the RCT, 22 participants wore pedometers daily for one week without altering their activity. Experimental participants walked more steps and covered more distance on average than control participants on six of the seven days. This pilot study is among the first to document the physical activity level of persons with SSDs after exercise intervention. While our findings confirm the low activity level of persons with SSDs reported by others, experimental participants demonstrated higher activity levels than controls on most days. Future studies should increase the sample size and recruit participants from multiple sites to enhance power and generalizability.