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To celebrate Nurse’s Day 2019, nurses from throughout McLean Hospital came together for the annual McLean Hospital nurse’s conference. Held on Friday, May 10, in Pierce Hall on the Belmont campus, the event explored obesity and metabolic syndrome among individuals with psychiatric disorders and discussed what’s new in psychiatric neurotherapeutics at the hospital.
The program opened with a talk by Ariana Chao, PhD, CRNP, FNP-BC, titled “Obesity in Psychiatric Patients.” An assistant professor at the University of Pennsylvania School of Nursing and the Perelman School of Medicine, Chao presented a wide-ranging discussion of the prevalence of obesity among patients with psychiatric disorders and the various mechanisms that contribute to weight issues for this population.
Chao stated that “there is a strong link between obesity and conditions such as depression, schizophrenia, and bipolar disorder.” In fact, she reported that individuals with serious mental illness are 50% more likely to be obese than the general population and live between 10 and 20 fewer years.
Chao said that there is a “chicken and egg” conundrum behind these startling numbers, as researchers investigate “which came first?”—the obesity that contributed to mental illness or the mental illness that led to obesity. She reported that lifestyle factors affecting people with serious mental illness, including “poor diets, sleep disorders, poor self-esteem, and low rates of physical activity,” can often lead to obesity. In addition, social determinants, like limited access to health services, food insecurity, and mental health stigma can also contribute to weight issues among this population.
However, Chao explained, many drugs used to treat individuals with psychiatric illnesses can also lead to weight gain. She cited studies showing weight increases among some individuals who take second generation psychiatric medications, and she discussed how certain drug interactions can contribute to obesity.
Given the severity of the problem and the complexity of the underlying causes, Chao discussed ways that nurses and other mental health professionals can better help patients with severe mental illness deal with obesity and weight-related issues. She stressed the use of people-first language, the need for better monitoring and goal setting, and the importance of positive feedback.
Building on Chao’s talk, a group of McLean Hospital nursing researchers presented findings from a series of studies on metabolic syndrome, which they defined as a group of interrelated conditions stemming from obesity. Paula Bolton, MS, CNP, ANP-BC, Peggy Knight, PhD, PMHCNS-BC, and Lynne M. Kopeski, MSN, PMHCNS-BC, discussed studies that touched on different aspects of metabolic syndrome and nursing practices. The studies looked into risk factors, screening tools, and the impact of various nursing interventions to reduce the risk of metabolic syndrome in individuals with severe mental illness. Other studies investigated how well psychiatric nurses understood metabolic syndrome and attitudes and barriers to care among mental health professionals working with patients who need physical as well as mental health care. Finally, the researchers presented findings from a survey that sought to assess the current state of care for people with metabolic conditions who also have mental health concerns.
In summing up the findings, Bolton said that the best way to provide care for mental health patients who also have metabolic conditions is “integration of health care—but it doesn’t seem to be happening.” She called for a system in which primary care clinicians are embedded in mental health care settings to ensure that all of an individual’s mental health and physical health needs are met.
Bolton returned to lead the conference’s afternoon session, “What’s New in Psychiatric Neurotherapeutics?” Teresa Henderson, BSN, RN, Courtney Miller, AD, RN, and Cecilia Rush, BSN, RN, discussed several neurotherapeutic services offered at McLean, including electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), and ketamine infusion. The afternoon presentation also included a talk—along with a lively question and answer session—on intranasal esketamine, a newly developed method for administering ketamine to patients with treatment-resistant depression.
In describing the psychiatric neurotherapeutics programs at McLean, Bolton said that the “safety and comfort” of patients is essential. “Keeping the patient at the center of care can be a challenge,” she said, “and trying to involve patients in the care process is something we work hard at.”
Part of that effort involves the “art as therapy” program at McLean’s Ketamine Service. Sarah Anderson, BS, MHS, who runs the effort, said that the patients have responded enthusiastically to the program. She explains that the program encourages individuals undergoing treatment to color in coloring books or create original artworks on their own in a variety of mediums.
She said that although many patients create “original and beautiful work” in the program,“the process is more important than the product.” Anderson presented examples of patient artwork currently displayed in an art gallery at the program and explained the sense of pride and accomplishment many patients feel when their work is featured in the gallery.