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

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.

Conflict of interest statement

Authors’ information

Petter Andreas Ringen, MD, PhD: Chief consultant psychiatrist and researcher at the Oslo University Hospital. Special interest in somatic health and substance use in severe mental illness.

Ragnhild S. Falk, MSc PhD: Researcher and senior statistician at the Oslo Centre for Biostatistics and Epidemiology.

Ann Færden, MD, PhD: Psychiatrist and researcher at the Oslo University Hospital. Expertise in in negative symptoms and reduced motivation in severe mental illness.

Bjørnar Antonsen, M.D., Ph.D: Clinical doctor at the Department of Psychiatry at Lovisenberg Diaconal Hospital. Main focus of research has been long term outcome from psychotherapy for patients with personality disorders.

Asgeir Mamen, PhD: Associate Professor at Kristiania University College. Exercise physiologist with expertise in the use of physical activity in rehabilitation of substance use disorder subjects.

Eline B. Rognli, PhD: Clinical psychologist and research advisor at the Oslo University Hospital. Her area of research is substance use and psychosis. Expertise in Motivational Interviewing.

Dag K. Solberg, MD: Specialist in psychiatry and clinical pharmacology. Head of department, Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, and senior psychiatrist at Skjelfoss Psychiatric Center.

Egil W. Martinsen, MD, PhD: Professor in psychiatry, University of Oslo. Expertise in the relation between physical activity and mental health in psychiatric populations.

Ole A. Andreassen, MD, PhD: Professor in Psychiatry, University of Oslo and attending psychiatrist Oslo University Hospital. Expertise in somatic comorbidity in mental illness.

Ethics approval and consent to participate

All participants signed informed consent to participation. The study was approved by the Regional Ethics committee in South-Eastern Norway, reference number 2012/2266.

Competing interests

Prof. Ole A. Andreassen received speakers’ honoraria from Lundbeck. The other authors report no conflicts of interest.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Design: Assessment periods at each ward. Months before (M-X) and after (MX) start of interventions. Dark grey: Intervention period

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