Rikard Wärdig

Preventing the Development of Metabolic Syndrome in People with Psychotic Disorders—Difficult, but Possible: Experiences of Staff Working in Psychosis Outpatient Care in Sweden

The aim of this study was to explore mental health staffs’ experiences of assisting people with psychotic disorders to implement lifestyle changes in an effort to prevent metabolic syndrome. Qualitative interviews were conducted with 12 health care professionals working in psychosis outpatient care in Sweden. Data were analysed using a qualitative content analysis. The results illustrate that implementation of lifestyle changes among people with psychotic disorders was experienced as difficult, but possible. The greatest obstacles experienced in this work were difficulties due to the reduction of cognitive functions associated with the disease. Guidelines available to staff in order to help them identify and prevent physical health problems in the group were not always followed and the content was not always relevant. Staff further described feelings of uncertainty about having to motivate people to take anti-psychotic medication while simultaneously being aware of the risks of metabolic deviations. Nursing interventions focusing on organising daily routines before conducting a more active prevention of metabolic syndrome, including information and practical support, were experienced as necessary. The importance of healthy eating and physical activity needs to be communicated in such a way that it is adjusted to the persons cognitive ability, and should be repeated over time, both verbally and in writing. Such efforts, in combination with empathic and seriously committed community-based social support, were experienced as having the best effect over time. Permanent lifestyle changes were experienced as having to be carried out on the patients terms and in his or her home environment.

Health-related quality of life and metabolic risk in patients with psychosis.

UNLABELLED Improved Health-related quality of life (HRQoL) is an alternative treatment goal for individuals with psychosis, who have up to two times greater prevalence of type 2 diabetes, hypertension and obesity than the general population. AIM to compare HRQoL in patients with psychosis, especially schizophrenia, with a reference sample and explore the relationship between HRQoL and metabolic risk factors in these patients. METHODS a prospective cohort study was carried out in specialized psychiatric outpatient departments in Sweden. The patients were invited consecutively. A prospective population-based study of public health in the south-east of Sweden served as reference group. Patients were assessed with psychiatric questionnaires that included Global Assessment of Functioning (GAF). Health-related quality of life was assessed using the questionnaire EQ5D, both for patients and the population, and several other health status outcomes were used. RESULTS At 73%, schizophrenia and schizoaffective disorder were the most common diagnoses in the patient group. The results in patients (n=903) and population (n=7238) showed significant differences in lower EQ5D among patients. According to the definition by the International Diabetes Federation (IDF), elevated blood pressure was the only metabolic risk associated with lower HRQoL in patients. Raised LDL-cholesterol levels were also significantly related to lower HRQoL. CONCLUSION patients suffering from psychosis had significantly lower HRQoL regarding all components in EQ5D, except for the pain/discomfort component. Almost half of the patient group met the criteria for metabolic syndrome. According to the IDF criteria, elevated blood pressure was the only metabolic risk factor that had an impact on HRQoL.

Prerequisites for a healthy lifestyle-experiences of persons with psychosis.

The purpose of this study is to explore prerequisites for a healthy lifestyle as described by individuals diagnosed with psychosis. Forty participants who had performed a lifestyle intervention focusing on physical activities and lifestyle education were interviewed. Conventional content analysis was used. The results are described in two categories: (1) Individual Prerequisites and (2) Being a Part of Society. The individuals said that they got stuck in a state of planning without taking action. It was pointless to make a bigger effort because the psychotic disorder could, at any time, worsen the prerequisites. They also said that they wanted to live like everybody else and therefore tried to adopt a normal lifestyle. Future interventions or professional support by mental health nurses and other health care givers should target the transition from planning to action to achieve a healthy lifestyle, and should help the individual to taking part in society.

An Intervention with Physical Activity and Lifestyle Counseling Improves Health-Related Quality of Life and Shows Small Improvements in Metabolic Risks in Persons with Psychosis

This research studied the effects of a lifestyle intervention on health-related quality of life (HRQoL) and metabolic risk factors in persons with psychosis, using a longitudinal intervention design with a matched reference sample. In participants in the intervention group, scores on the EQ-VAS, which measured HRQoL, improved from 57.6 to 63.3 (SD = 17.8) (p = 0.05), and HDL cholesterol concentration increased from 1.03 to 1.11 (0.19) mmol/l. (p = 0.02). There was no significant change in body weight among participants. The results of this study indicate that a lifestyle intervention based on group meetings improves HRQoL in patients with psychosis and provides small improvements in metabolic risk factors.