Eating Behaviour and Body Mass Index of Patients with Severe Mental Illness Attending a Tertiary Hospital, Kochi, Kerala.

Background: Persons with severe mental illness are at increased risk of overweight and obesity both from the illness itself and from its treatment. Purpose: This study aimed to examine the eating behaviour and Body Mass Index (BMI) of patients with severe mental illness and to correlate these two variables. Methods: This descriptive cross sectional study was conducted at the psychiatry outpatient department of a tertiary hospital, Kochi, among 100 patients with severe mental illness who reported for follow up. Patients were interviewed individually after ethical procedures, using Personal information schedule and Three Factor Eating Questionnaire Revised-18, a standardized measure of eating behaviours. Anthropometric measurements were taken and BMI was calculated as per the WHO guideline for Asians. Results: The mean age and BMI of the sample were 49.5± 15.24 and 26.08 ± 4.79 kg/m2 respectively. Cognitive restraint was found to be the most frequently used eating behaviour (48%). Only 39% of the subjects had normal body weight. Overweight and obesity were observed in 39% and 19% respectively. BMI was positively correlated with uncontrolled eating (r=0.244, p<0.015), emotional eating (r=0.223, p<0.026) and eating behavior total score (r=0.293, p<0.003). Uncontrolled eating was high in patients who are non-vegetarian, taking thyroid medications and who reported parental obesity (p<0.05). Stepwise linear regressions revealed parental obesity as the most significant predictor of BMI (F=4.198, p<0.002). Conclusion: The chronic mentally ill require counseling and education about the role of eating behaviours in overweight and obesity and the ways of reducing body weight.

Management of Registered Patients with Severe Mental Illness in Jinshan District, Shanghai / 中国康复理论与实践

Objective To analyze the status quo of patients with severe mental illness in Jinshan district, Shanghai, and provide sci-entific evidence for strengthening the prevention and treatment of them. Methods The data of severe mental illness until March 1st, 2016 were derived from the national database and analysis system, and were used for statistical analysis. Results A total of 4778 patients with severe mental illness were registered. Among them, 54.40% suffered from schizo-phrenia, patients aged 18 to 59 years old (67.73%) accounted for the vast majority, 86.44% only got junior high school education or below, 40.46% were unmarried or divorced, 76.50% patients choose outpatient department as a way to see doctor, and 15.11% patients did not take any treatment. Conclusion The prevention of severe mental illness has become the important gambit for this district. The proportion of patients choosing appropriate way to visit doctor is relatively low. The management of patients with severe men-tal diseases needs to be strengthened to promote the recovery of patients and social stability.

Validation of the Mental Illness Sexual Stigma Questionnaire (MISS-Q) in a sample of Brazilian adults in psychiatric care / Validação do Questionário de Estigma Sexual na Doença Mental (MISS-Q) em uma amostra de adultos brasileiros em atendimento psiquiátrico

ABSTRACT Objective We evaluated the psychometric properties of a new instrument "Mental Illness Sexual Stigma Questionnaire" (MISS-Q). Methods We interviewed 641 sexually active adults (ages 18-80) attending public outpatient psychiatric clinics in Rio de Janeiro about their stigma experiences. Results Nine factors were extracted through exploratory factor analysis (EFA) and labeled: 'individual discrimination by others'; 'staff willingness to talk about sexuality'; 'staff and family prohibitions'; 'sexual devaluation of self'; 'perceived attractiveness'; 'mental illness concealment'; 'perceived sexual role competence'; 'withdrawal'; and 'locus of social-sexual control'. 'Withdrawal' and 'locus of social-sexual control' showed poor psychometric properties and were excluded from further analysis. The remaining seven factors had high factorial loadings (.39 to .86), varying from sufficient to optimal reliability (Ordinal α ranged from .57 to .88), and good convergent and discriminant validity. Conclusions The resulting MISS-Q is the first instrument assessing mental illness sexual stigma with demonstrated psychometric properties. It may prove useful in reducing stigma, protecting sexual health, and promoting recovery.

RESUMO Objetivo Avaliamos as propriedades psicométricas de um novo instrumento "Mental Illness Sexual Stigma Questionnaire" (MISS-Q; Questionário de Estigma Sexual na Doença Mental). Métodos Entrevistamos 641 adultos sexualmente ativos (18 a 80 anos), frequentando clínicas psiquiátricas ambulatoriais públicas no Rio de Janeiro sobre suas experiências de estigma. Resultados Foram extraídos nove fatores por meio da análise exploratória fatorial e rotulados: 'discriminação individual por parte de outros'; 'disposição pessoal para falar sobre sexualidade'; proibições pessoais e familiares; 'desvalorização sexual de si mesmo'; 'percepção de atratividade'; 'dissimulação da doença mental'; 'percepção da competência de papel sexual'; 'retirada'; e 'locus de sociosexual ao controle'. 'Retirada' e 'locus de controle social-sexual' mostraram propriedades psicométricas fracas e foram excluídos da análise posterior. Os sete fatores restantes tinham altas cargas fatoriais (0,39 a 0,86), variando de suficiente até confiabilidade ótima (Ordinal α variou de ,57 a ,88), e boa validade convergente e discriminante. Conclusões O resultante MISS-Q é o primeiro instrumento que avalia o estigma sexual da doença mental com propriedades psicométricas demonstradas. Pode ser útil na redução do estigma, proteção da saúde sexual e promoção à recuperação.

Outcomes of inpatients with severe mental illness: a naturalistic descriptive study

Objective: To describe and evaluate the response and predictors of remission during inpatient treatment in a psychiatric unit in a general hospital based on symptomatology, functionality, and quality of life (QoL). Methods: Patients were admitted to a psychiatric unit in a tertiary general hospital in Brazil from June 2011 to December 2013 and included in the study if they met two of the severe mental illness (SMI) criteria: Global Assessment of Functioning (GAF) ≤ 50 and duration of service contact ≥ 2 years. Patients were assessed by the Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impression (CGI) Severity Scale , GAF, the World Health Organization Quality of Life Instrument – Abbreviated version (WHOQOL-Bref), and specific diagnostic scales. Results: A total of 239 patients were included. BPRS mean scores were 25.54±11.37 at admission and 10.96±8.11 at discharge (p < 0.001). Patients with manic episodes (odds ratio: 4.03; 95% confidence interval: 1.14-14.30; p = 0.03) were more likely to achieve remission (CGI ≤ 2 at discharge) than those with depressive episodes. Mean length of stay was 28.95±19.86 days. All QoL domains improved significantly in the whole sample. Conclusion: SMI patients had marked improvements in symptomatic and functional measures during psychiatric hospitalization. Patients with manic episodes had higher chance of remission according to the CGI.

Parenting in Children and Adolescents with Psychosis.

Need and Purpose of review: Psychotic symptoms appear in children and adolescents in the most crucial years, during the individual’s career development. The challenges faced by parents of psychotic children are in dealing with their disruptive behaviours, negative symptoms, cognitive deficits, delusions and hallucinations. This paper presents an overview of the childhood psychosis and how parenting can be done effectively for this population. Methods: Articles were retrieved from the Medline, Cochrane database, Google Scholar, Medscape; using the search terms ‘parenting and childhood psychosis’, and ‘childhood psychoses; and standard textbooks were consulted. Main conclusions: Educating parents how to recognize early symptoms, explaining treatment adherence, side effects of medications along with non-pharmacological measures like dealing with expressed emotions, lowering expectations, enhancing social supports, healthy lifestyle, and making patients independent. Awareness, early identification and effective parenting for psychosis may help bridge the wide gap between scarce skilled mental health professionals, inefficient resources and large paediatric population.

Factors Related with Schizophrenia Relapse and Management / 中国康复理论与实践

@#Objective To explore the factors related with relapse of patients with schizophrenia, and to assess the effect of management on this population. Methods 368 patients who were first episode and hospitalization in 2007 were recruited, and investigated with the Live Events Scale (LES), Social Support Rating Scale (SSRS). They were divided into control group (only antipsychotic treatment, n=184) and management group (severe mental illness management, n=184) and accepted the management for 5 years. Results The single factor regression showed that age, marriage and family history were not related with schizophrenia relapse (P>0.05). Gender, duration of untreated psychosis (DUP) and negative life events were risk factors of relapse (P<0.05); Education, medication adherence and social support were protective factors of relapse (P<0.05). Multivariate regression analysis showed that medication adherence, social support and negative life events were the main factors related with relapse (P<0.05). The rate of relapse was lower in the management group than in the control group (P<0.05). Conclusion Medication adherence, social support and negative life events are the main factors related with relapse. Management on the schizophrenia is one of the most important ways to reduce schizophrenia relapse.

Analyzing the Hospitalization Expense and Management Status of Severe Mental Illness / 中国卫生经济

Objective: To analyze the hospitalization expense and management status of severe mental illness, and to provide evidences for rational controls of medical expenses and the management of the patients. Methods:Collecting patients with severe mental illness from 2005 to 2012, analyzing the changing trends of hospitalization cost and management status with descriptive analysis, and use multiple linear regression to analyze the influence factors. Results: The average stay is 51 days, average medical costs by person and by day are RMB 8 319.69 and 169.02; treatment costs, drug costs and bed care costs are the main proportion. The medical costs were significantly affected by prolonged days of hospitalization, age, numbers of hospital admissions, nursing level and admitting diagnosis. The largest proportion of management system is schizophrenia, which counted 74.03% of current patients and the poverty incidence rate is 50.62%. Conclusions: Increasing the financial compensation to patients with severe mental illness, shorting hospital stay, strengthening the screening of patients with severe mental illness and incorporated into the management system would help to reduce the economic burden of the patients.

The violence risk assessment of the community patients with severe mental illness and Logistic regression analysis on associated factors / 中华行为医学与脑科学杂志

Objective To assess the violence risk levels of the community patients with severe mental illness and Analyze the associated factors.Methods A working group composed of psychiatrists,community police,FIMITIC staff,community physicians,neighborhood or village committee members was established.501 community patients with severe mental illness were evaluated with Violence Risk Assessment Scale by working group.While the data of the general demograpbic,medical history and violence history was investigated.Logistic regression analysis was used to explore the factors associated with violence.Results In 501 patients,risk levels of grade 0:124cases (24.8％),grade 1:165 cases (32.9％),grade 2:118 cases (23.5％),grade 3:59 cases (11.8％),grade 4:28 cases (5.6％) and grade 5:7 cases (1.4％).Logistic regression analysis showed four significant risk factors,which were schizophrenia (OR 4.139),no taking medicine (OR 6.883),unstable condition (OR 234.534) the number of previous violence(OR 3.457) (P ＜ 0.05).Logistic regression equation:Logit (severe violence) =-8.511 + 1.420 (schizophrenia) + 1.929 (no taking medicine) + 5.458 (unstable condition) +1.241 (the number of previous violence).Conclusion The results of violence risk assessment and risk factors have directive significance for management of community patients with severe mental illness.

El programa de atención psiquiátrica dirigido a enfermos mentales sin hogar / The mental health unit for the homeless mentally ill

El presente artículo tiene como objetivo describir un programa de salud mental innovador que desde mayo de 2003 se viene realizando en la ciudad de Madrid. El objetivo del mismo es atender, acudiendo a su entorno, a las personas sin hogar que padecen enfermedades mentales graves y servir de puente hacia los servicios sociosanitarios de la red general a los que normalmente no tiene acceso. Se describen los modelos teóricos para esta atención (outreach, tratamiento comunitario asertivo y modelo de recuperación) y el trabajo diario que se realiza; así como, las dificultades y barreras que se enfrentan en un trabajo de estas características.

The aim of this article is to describe an innovative mental health unit running in Madrid city since May 2003. The main purposes of this unit is to provide sociosanitary attention, going to their own enviroment- the streets-, to all those homeless persons suffering severe mental disorders. This unit provide a transitional care and engagment to mainstream social and sanitary services that usually they can't reach. It's described the theoretical models sustaining this work (outreach, Assertive Community treatment and Recovery) and also the team's daily practices. As well we described some of the challenges and barriers to face working in this particular job.

A review: association of preventable medical conditions, healthy nutrition, the ingestion of psychotropic medication and people who suffer from severe mental illnesses

A major concern about the increase of metabolic disorders rates associated with medication use to treat severe mental illnesses (SMI) exit. In fact, several studies suggested an association of body fat distribution with cardiovascular disease, diabetes, etc. On the other hand, psychotropic medications have come to play an increasingly central role in the treatment of psychiatric disorders and many patients consuming psychotropic drugs as medication tend to become obese and they are sensitive to the diseases mentioned above. In addition, it has been associated that a healthy and equilibrated food intake could help to prevent diseases. In this review we will address the effects of psychotropic medication intake and how this relates to obesity, risk of cardiovascular diseases of patients who suffer from severe mental illnesses. It will also evaluate the potential use of healthy diets and exercise to improve the well being of the patient

The psychosocial rehabilitation (PSR) for severely mentally ills in Malaysia: The past and present

This paper discusses the evolution of PSR development for people with severe mental illness since the early 20th century in Malaysia. The various aspects of PSR include the activities, service target, the treatment settings, factors contributed to the development and the challenges that have been faced are also described along with the evolution, comparing the past and present. It is learned that despite of many challenges, PSR in Malaysia has now continued to progress with increasing supports from the stakeholders and is in keeping with the current PSR concept.

Programa de Atención Comunitaria a niños, niñas y adolescentes con trastornos mentales severos / Community assistance programme for children and adolescents with severe mental illness

El siguiente trabajo tiene como propósito dar a conocer una experiencia de articulación entre la producción de conocimientos -resultado de la investigación académica- y la transferencia de los mismos al sistema de salud -en particular salud mental- mediante la implementación del Programa de Atención Comunitaria de Niños/as y Adolescentes en la Ciudad de Buenos Aires. Dicho Programa está destinado a niños/as y adolescentes que padecen sufrimiento psíquico severo y consultan a los Servicios de Salud Mental del subsector público de la Ciudad y ha sido el producto de la experiencia clínica institucional y de diversas investigaciones en sistemas y servicios de salud. A partir del análisis y evaluación de las dificultades y obstáculos en el funcionamiento del sistema, se diseñó e implementó un dispositivo que se propuso -desde su concepción- favorecer las posibilidades de constitución subjetiva y la integración en la comunidad de los niños, niñas y adolescentes con trastornos mentales severos. A través de un trabajo interdisciplinario, de capacitación permanente de recursos humanos y de configuración de redes intra e intersectoriales, pretende facilitar la accesibilidad y mejorar la equidad, intentando garantizar el derecho a la protección integral de la salud a los niños/as y adolescentes.

The purpose of the following paper is to present an experience which links the production of knowledge resulting from academic research, with the transmission of said knowledge to the health system -with specific reference to mental health- by means of the implementation of the Community Assistance programme for Children and/or Adolescents within the City of Buenos Aires. This programme is aimed at children and adolescents afflicted with severe psychological suffering, who consult the Mental Health Services in the public subsector of the City of Buenos Aires. It is the product of clinical institutional experience and of diverse investigations in health systems and services which showed a significant increase in the amount of consultations of children with severe and or complex mental health problems and which brought to light the lack of adequate sanitary response for these children by said sector. Based on the analysis and evaluation of the difficulties and obstacles in the functioning of the system a scheme was devised and implemented which aimed -from its beginning- to favour the possibilities of subjective constitution and integration into the community of these children and adolescents with severe mental deficiencies. By means of an interdisciplinary work consisting in the permanent training of human resources and the setup of intra and intersectional networks, it aims at facilitating accessibility and improving equality of opportunity, thus attempting to guarantee the right to a full protection of the health of children and adolescents.

The Causes of Death of the Institutionalized Population of Kkottongnae: Comparison between Severe Mental Illness Group(SMI) and Non-Severe Mental Illness Group(Non-SMI)

OBJECTIVES: Schizophrenia and other psychiatric disorder are associated with an increased risk of premature death. For decades, there have been reports of shorter life expectancy among those with severe mental illness. The purpose of this study was to compare the risk of mortality among institutionalized population, treated for severe mental illness to control group who did not have severe mental illness. METHODS: The medical records and the death certificates of 2,029 institutionalized population who had died from 1985 to 2003 in Kkottongnae were investigated. RESULTS: The mean age of the death of severe mental illness(SMI) group(51.4+/-15.3 years old) was lower than that of non-severe mental illness(non-SMI) group(65.0+/-19.3 years old) and it was statistically significant(p< 0.0001). The most causes of death among the SMI group were respiratory diseases(23.3%), infectious disease (13.0%) and digestive disease(12.3%). Also, we found that the death due to injuries of the SMI group(8.9%) were three times higher than that of non-SMI group(2.5%). The most causes of death among the non-SMI group were respiratory disease(26.3%), circulatory disease(26.2%) and neoplasm(10.8%). CONCLUSION: The SMI group demonstrated higher mortality rates compared with the rate in the non-SMI group. The finding suggests that careful intervention is needed not only for menal health but also physical health in long-term facilities.

A weight management programme for patients with severe mental illness: a pilot project in a general hospital setting in Malaysia

Objective: To describe the setting up of a pilot project on weight management programme for patients with severe mental illness (SMI) in a general hospital setting, the effectiveness of the programme on 5 patients and the feasibility of such programme to be developed in our local setting. Methods: Key staff members from relevant disciplines were involved through out the programme, which was based on dietary education, exercise and behavioural techniques. It was conducted weekly for physical exercise and biweekly for topic discussion with a total duration of 16 weeks. Results: Patients achieved means (SDs) weight loss of 1.78 (2.83) kg; BMI reduction of 0.92 (1.41) kg/m2 ; and reduction of waist circumference of 6.8 (4.97) cm. Factors associated with positive health outcome were high baseline BMI, high educational level and committed family members. Conclusion: The programme appears to be effective for patients and is feasible to be developed in Malaysian hospitals.