Marian W. Roman

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.

Screening Instruments for Older Adult Depressive Disorders: Updating the Evidence-Based Toolbox

The prevalence of clinically significant depressive disorders in persons 65 years of age or older in the United States has been estimated to be approximately 15%, increasing the risk for functional decline, morbidity, and mortality. Utilization of a well-chosen screening instrument has been shown to improve the rates of recognition of depressive disorders in older adults. This paper presents a targeted review of the most commonly accepted tools for case-finding of depressive disorders in older adults. After a review of the benefits and shortcomings of screening tools, the strengths, weaknesses, and utility of selected depression scales in geriatric clinical settings are discussed.

THE PROCESS OF RECOVERY: A TALE OF TWO MEN

Recovery has been identified as a focus for mental health care. Recovery requires learning to live again after a life-altering acute event or during a chronic illness, mental or physical. By analyzing within-person change over time, utilizing multiple sources of evidence, two cases illustrated particular dimensions that influenced the recovery process after stroke, within a biopsychosocial framework. Restoration of the self, through co-occurring, dual processes of grief and reconstruction, appeared to be an essential dimension in the recovery process. Suggestions for integrating this concept into current adult clinical practice are congruent with current models of disease management of several chronic conditions.

Nurturing natural resources: the ecology of interpersonal relationships in women who have thrived despite childhood maltreatment.

Childhood maltreatment and its consequences are a public health issue. There continues to be a need for improving the lives and life prospects for survivors of child abuse. The important role that positive interactions can play was evident in a large study of women who considered themselves successful despite maltreatment. Interactions of import ranged from brief encounters with strangers to enduring relationships. Two distinct motifs emerged: The “Saw something in me” and “No matter what” relationships. Findings will be discussed within the context of extant theories with possible implications for researchers, practitioners, and careful, caring adults in any setting.

Axona® (Accera, Inc): A New Medical Food Therapy for Persons with Alzheimer's Disease

Rand what is a medical food? The medical food designation is a U.S. Food and Drug Administration (FDA) category of substances intended for the clinical dietary management of a particular condition or disease. Specific criteria that must be met to receive this FDA designation include that the product must be: • A specially formulated food for oral or enteral ingestion; • For the clinical dietary management of a specific medical disorder, disease, or abnormal condition for which there are distinctive nutritional requirements • Intended to be used under physician supervision; • Made with ingredients that have “Generally Recognized as Safe” (GRAS) status; and • In compliance with FDA regulations that pertain to labeling, product claims, and manufacturing (http://www.cfsan.fda.gov/∼dms/medfguid.html). Nutritional supplements for the general public, nutrient rich healthy foods, and supplements are excluded from consideration for this designation. This would seem to beg the question: In what way does Alzheimer’s Disease (AD) have distinctive nutritional requirements? The pathology of Alzheimer’s disease (AD) is characterized by cerebral atrophy in frontal, temporal, and parietal regions. The histological changes are now well known: senile plaques, dystrophic neurites, and neurofibrillar tangles within defined areas of the brain. The advent of positron emission scanning (PET) provided evidence that the brains of persons with AD, even in its rather early stages, appeared to have a characteristic

Treatments for childhood ADHD part II: non-pharmacological and novel treatments.

In last month’s column, new pharmacologic formulations for the treatment of Childhood Attention Deficit Hyperactivity Disorder (ADHD) were discussed. This month we turn our attention to non-pharmacologic treatments for ADHD. The research literature is nearly unanimous regarding the robust effects of medication. Nevertheless, psychological and social treatments, as well as a novel neurotherapy, are important components of the ADHD toolbox.

Lessons Learned from a School for Stroke Recovery

Abstract This article reports the findings of a multiple case study tracing the long-term (3–10 years post event) recovery patterns of 8 stroke survivors who had participated in an unusually enriched recovery environment for at least 2 years. Data sources included extended interviews as well as archival records from that period. Shared aspects across cases included the following: (a) the singular importance of this social educational environment to their respective recoveries, (b) extended grief and new anxiety problems co-occurring with recovery during the first years, and (c) shared temporal patterns of recovery trajectory, including the multi-year duration of functional improvement. Findings are discussed within the context of recent research in mental health, adult education, and neuroscience. Recovery models that embrace the dynamic interplay of real-life environments, events, and goals situated in an individualized yet social context suggest the potential for an integrated recovery paradigm within the rehabilitation sciences.

L-Methylfolate (Deplin®): A New Medical Food Therapy as Adjunctive Treatment for Depression

Medical foods are nutritional supplements used to treat disease processes. Several medical foods have come to market in the past few years. Deplin R

Physical Exercise as Psychotherapeutic Strategy: How Long?? What Will It Take??

The two questions in the subtitle are often attributed to individuals responding to the suggestion to add exercise to their regimen. This month I direct these questions to practicing clinicians—When will exercise therapy be recognized and accepted as an evidence-based, prescriptive regimen for clients with depressive symptoms? Despite an accumulation of evidence supporting the positive effects of exercise and exercise training on depression and anxiety, its clinical use, whether as an adjunct or as monotherapy, is still at its beginning (Strohle, 2009). Data on the efficacy of exercise for overall health has been accruing for nearly 40 years. Kenneth Cooper, through his bestselling book entitled Aerobics (1968) advanced the idea of aerobic exercise as a preventive intervention; his Institute for Aerobics Research has been operating since 1970. Early reports on the effects of exercise on mildly depressed outpatients began to appear in medical journals later that same decade (Brown, Ramirez, & Taub, 1978; Greist et al., 1979). A well-designed controlled study of inpatients who received either occupational therapy or aerobic exercise therapy appeared in British Medical Journal in 1985 (Martinsen, Medhus, & Sandvik, 1985). Since then, in studies of persons with diagnoses ranging from minor depression to treatment resistant major depressive disorder (MDD), structured exercise therapy has repeatedly demonstrated equal or greater improvement of mood symptoms when tested opposite usual care, medication alone, or medication plus exercise.

The Recovery-Based Interprofessional Distance Education (RIDE) Rotation: Content and Rationale

A faculty team of two psychiatric nurse practitioners, an exercise physiologist, a registered dietician and a pharmacist developed the 8-week Recovery-Based Interprofessional Distance Education (RIDE) rotation for graduate students in the four disciplines. Organizing the RIDE rotation around the recovery model ensured an emphasis upon optimal health and quality of life. RIDE faculty engaged in project planning for several months before the RIDE rotation was offered to students. In this paper, we describe details of the 8-week program. Our next step will be to analyze student feedback and de-identified evaluation data from the first student cohort.