Using motivational techniques to reduce cardiometabolic risk factors in long term psychiatric inpatients: a naturalistic interventional study

Petter Andreas Ringen; Ragnhild S Falk; Bjørnar Antonsen; Ann Faerden; Asgeir Mamen; Eline B Rognli; Dag K Solberg; Egil W Martinsen; Ole A Andreassen

doi:10.1186/s12888-018-1832-6

Using motivational techniques to reduce cardiometabolic risk factors in long term psychiatric inpatients: a naturalistic interventional study

BMC Psychiatry. 2018 Aug 15;18(1):255. doi: 10.1186/s12888-018-1832-6.

Authors

Petter Andreas Ringen¹, Ragnhild S Falk², Bjørnar Antonsen³, Ann Faerden⁴, Asgeir Mamen⁵, Eline B Rognli⁶, Dag K Solberg⁷, Egil W Martinsen⁸, Ole A Andreassen⁹

Affiliations

¹ Division of Mental Health and Addiction, Oslo University Hospital and NORMENT, KG Jebsen Centre, University of Oslo, Ullevål Hospital, P.O.Box 4956, 0424, Nydalen, Oslo, Norway. p.a.ringen@medisin.uio.no.
² Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, P.O.Box 4950, 0424, Nydalen, Oslo, Norway.
³ Department of Psychiatry, Lovisenberg Diaconal Hospital, P.O.Box 4970, 0440, Nydalen, Oslo, Norway.
⁴ Division of Mental Health and Addiction, Oslo University Hospital and NORMENT, KG Jebsen Centre, University of Oslo, Ullevål Hospital, P.O.Box 4956, 0424, Nydalen, Oslo, Norway.
⁵ Kristiania University College, P.O.Box 1190, 0107, Sentrum, Oslo, Norway.
⁶ Division of Mental Health and Addiction, Oslo University Hospital, Ullevål Hospital, P.O.Box 4956, 0424, Nydalen, Oslo, Norway.
⁷ Skjelfoss Psychiatric Center, Lukas Foundation and Center for Psychopharmacology Diakonhjemmet Hospital, Postboks 23, 0319, Vinderen, Oslo, Norway.
⁸ Division of Mental Health and Addiction, Oslo University Hospital and University of Oslo, Ullevål Hospital, P.O.Box 4956, 0424, Nydalen, Oslo, Norway.
⁹ NORMENT, KG Jebsen Centre, Oslo University Hospital, and University of Oslo, Ullevål Hospital, Building 49, P.O. Box 4956, 0424, Nydalen, Oslo, Norway.

Abstract

Background: People with severe mental illness have markedly reduced life expectancy; cardiometabolic disease is a major cause. Psychiatric hospital inpatients have elevated levels of cardiometabolic risk factors and are to a high degree dependent of the routines and facilities of the institutions. Studies of lifestyle interventions to reduce cardiometabolic risk in psychiatric inpatients are few. The current study aimed at assessing the feasibility and effects of a lifestyle intervention including Motivational Interviewing (MI) on physical activity levels, cardiometabolic risk status and mental health status in psychotic disorder inpatients.

Methods: Prospective naturalistic intervention study of 83 patients at long term inpatient psychosis treatment wards in South-Eastern Norway. Patients were assessed 3-6 months prior to, at start and 6 months after a life-style intervention program including training of staff in MI, simple changes in routines and improvements of facilities for physical exercise. Assessments were done by clinical staff and included level of physical activity, motivation, life satisfaction, symptom levels (MADRS, AES-C, PANSS, and GAF) as well as anthropometric and biochemical markers of cardiometabolic risk. A mixed model was applied to analyze change over time.

Results: A total of 88% of patients received MI interventions, with a mean of 2.5 MI interventions per week per patient. The physical activity level was not increased, but activity level was positively associated with motivation and negatively associated with positive symptoms. Triglyceride levels and number of smokers were significantly reduced and a significant decrease in symptom levels was observed.

Conclusions: The current results suggest that a simple, low cost life-style intervention program focusing on motivational change is feasible and may reduce symptoms and improve lifestyle habits in psychosis patients in long term treatment facilities. Similar programs may easily be implemented in other psychiatric hospitals.

Trial registration: ClinicalTrials.gov . NCT03528278 , date of registration: 05/16/2018 (retrospectively registered).

Keywords: Cardiometabolic; Cardiovascular; Inpatient; Intervention; Lifestyle; Motivation; Physical activity; Psychosis; Schizophrenia.

Publication types

Pragmatic Clinical Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cardiovascular Diseases / epidemiology
Cardiovascular Diseases / prevention & control*
Cardiovascular Diseases / psychology
Exercise / physiology
Exercise / psychology
Female
Humans
Inpatients / psychology
Male
Mental Disorders / epidemiology
Mental Disorders / psychology
Mental Disorders / therapy*
Metabolic Diseases / epidemiology
Metabolic Diseases / prevention & control*
Metabolic Diseases / psychology
Middle Aged
Motivational Interviewing / methods*
Norway / epidemiology
Occupational Therapy / methods
Prospective Studies
Retrospective Studies
Risk Factors
Risk Reduction Behavior*
Time Factors

Associated data

ClinicalTrials.gov/NCT03528278