Few Smokers with Serious Mental Illness Get Help to Kick Habit

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Among American adults who have a serious mental illness such as schizophrenia, bipolar disorder, or clinical depression, 57 percent are smokers. In contrast, only 15 percent of all U.S. adults smoke.

Many with psychiatric problems want to quit smoking. But psychiatrists and caseworkers typically don’t prescribe medications to help them or refer them to services aimed at smoking cessation, according to a new study from researchers at Washington University School of Medicine and BJC Behavioral Health in St. Louis.

“Patients with serious mental illness die an average of 25 years younger than people who don’t have these problems, and smoking is a big factor,” said Li-Shiun Chen, M.D., an assistant professor of psychiatry and the study’s first author.

“Smoking is a common and serious problem for our patients, and although smoking rates have been decreasing in the general population, the rates remain very high in this vulnerable population.”

Traditionally, psychiatric wards were among the few places in hospitals where smoking was allowed. Psychiatrists used to feel it was acceptable to allow seriously ill patients to smoke since the key focus in treatment was psychosis or depression.

“But in the past few years, research has shown that smoking cessation is beneficial to the mental health of psychiatric patients,” said Laura Jean Bierut, M.D., the Alumni Endowed Professor of Psychiatry and the study’s senior author.

“When they stop smoking, it decreases the risk of recurrent depressive episodes that can lead to hospitalization. It also decreases the amount of medication they need.

”Our understanding has evolved. Twenty years ago, doctors might have thought that continuing to smoke didn’t have mental health repercussions, but now we know better.”

The researchers surveyed 213 patients with psychiatric illnesses who were treated at one of four BJC Behavioral Health clinics in and near St. Louis. The researchers found that 82 percent of the patients who smoked were interested in trying to quit; 44  percent said they would like to take medication to help them quit, but only 13 percent were receiving treatment.

Meanwhile, 25 percent said they desired counseling to help them quit, but only five percent were receiving it, according to the study’s findings.

An anonymous survey of mental health providers found that 91 percent of psychiatrists and 84 percent of caseworkers had the impression that their patients had no interest in quitting or reducing the amount they smoked.

“There is quite a disconnect between the two groups,” said Chen, who also is a staff psychiatrist at BJC Behavioral Health. “Our goal is to realign the desires of patients and the perspectives of the physicians who treat them.”

One example of the disconnect involved the use of electronic cigarettes. Chen said that about half of the surveyed patients who were smokers expressed an interest in using electronic cigarettes as a step toward quitting and that 22 percent reported that they already were using electronic cigarettes to kick the habit.

“The high use of electronic cigarettes is a sign that many of these patients are trying to change their smoking behavior,” she said.

A potential problem, however, is that it’s not clear whether electronic cigarettes help people quit. And some researchers believe that use of electronic cigarettes could lead patients with serious mental illness to smoke electronic cigarettes while continuing to use traditional cigarettes.

“It would be better to use proven therapies with patients who want to quit than to keep our fingers crossed that their use of electronic cigarettes might help them stop smoking,” Bierut said.

To determine whether patients smoke and whether they want help kicking the habit, the clinics at BJC Behavioral Health now ask patients to fill out surveys about smoking every time they come in for appointments. The questionnaires then are given to physicians and caseworkers before the appointments begin.

“We want the providers to be aware of patient-reported treatment needs and smoking behaviors,” Chen said.

“We want the psychiatrists and caseworkers to know whether their patients have expressed a wish to stop smoking so that they can refer them to counseling or provide them with prescriptions for nicotine lozenges, patches, or other medications that may help these patients quit smoking. We think those fairly simple changes really could pay off in a big way.”

As the new approach is implemented, Chen, Bierut and their colleagues plan to track smoking rates to see whether more patients with serious mental illnesses are able to quit successfully and, eventually, whether quitting smoking helps them live longer, healthier lives.

The study was published in the Community Mental Health Journal.

Source: Washington University School of Medicine

PHOTO: Li-Shiun Chen, M.D., (left) meets with a patient at a BJC Behavioral Health Clinic. Chen led a study that found that although many smokers with serious mental illnesses would like to quit smoking, many psychiatrists and caseworkers aren’t aware of their patients’ wishes and, consequently, haven’t prescribed medications or referred them to services to help them stop smoking. Credit: Robert Boston.

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January 1, 2017 at 02:07AM

Why Some People Doubt Global Warming

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As winter wallops the nation, global warming may be the last thing on most people’s minds.

“The local weather conditions people experience likely play a role in what they think about the broader climate,” said Utah State University researcher Peter Howe. “Climate change is causing record-breaking heat around the world, but the variability of the climate means that some places are still reaching record-breaking cold. If you’re living in a place where there’s been more record cold weather than record heat lately, you may doubt reports of climate change.”

Howe notes that people’s beliefs about climate change are driven by many factors, but a new study in which he participated suggests weather events in your own backyard may be an important influence.

The study, conducted with researchers from Boston University, the George Washington University, and the University of Oxford, was published in the Proceedings of the National Academy of Sciences.

Howe, an assistant professor of human-environment geography in Utah State University’s Department of Environment and Society and the Utah State University Ecology Center, generated the public opinion dataset used in the analysis.

The collected information is based on a statistical model of more than 12,000 survey respondents across the nation from 2008 to 2013 collected by the Yale Project on Climate Change Communication and George Mason Center for Climate Change Communication.

“We found that places with more record high temperatures than lows have more residents who believe the planet is warming,” he said. “Conversely, in places with more record low temperatures, more people tend to doubt global warming.”

The study notes part of this dichotomy may be because early terminology used to describe climate change suggested the earth was simply warming, rather than changing in innumerable ways.

“One of the greatest challenges to communicating scientific findings about climate change is the cognitive disconnect between local and global events,” added Michael Mann of George Washington University. “It’s easy to assume that what you experience at home must be happening elsewhere.”

The scientists note the importance of differentiating between weather, the temperatures of a relatively short period of time, such as a season, and climate, the average temperature over a period of 25 or 30 years. Emphasizing the different between weather and climate may help the scientific community more effectively explain climate change, they say.

“Our work highlights some of the challenges of communicating about climate change, and the importance of situating people’s experiences at the local level within the larger global context,” Howe said.

Source: Utah State University

 
Photo: A new study finds local weather may play an important role in Americans’ beliefs about climate change. Credit: Mark Buckawicki.

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January 1, 2017 at 01:04AM

Mouse Study: Inactivity in Obesity May be Tied to Dopamine Receptors

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Just in time for New Year’s resolutions, a new study has revealed why so many of us seem to have a hard time sticking to a workout routine — and it’s not just about extra weight. The findings, published in the journal Cell Metabolism, show that in obese mice, physical inactivity results from altered dopamine receptors rather than excess body fat.

“We know that physical activity is linked to overall good health, but not much is known about why people or animals with obesity are less active,” said the study’s senior author, Dr. Alexxai V. Kravitz, an investigator in the Diabetes, Endocrinology, and Obesity Branch at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

“There’s a common belief that obese animals don’t move as much because carrying extra body weight is physically disabling. But our findings suggest that assumption doesn’t explain the whole story.”

Kravitz, who has a background in studying Parkinson’s disease, began conducting obesity research a few years ago. He was struck by similarities in behavior between obese mice and Parkinsonian mice. Based on these observations, he questioned whether obese mice were inactive due to a dysfunction in their dopamine systems.

“Other studies have connected dopamine signaling defects to obesity, but most of them have looked at reward processing — how animals feel when they eat different foods,” Kravitz said.

“We looked at something simpler: dopamine is critical for movement, and obesity is associated with a lack of movement. Can problems with dopamine signaling alone explain the inactivity?”

For the study, mice were given either a standard diet or an unhealthy, high-fat diet for 18 weeks. Beginning in the second week, the mice on the unhealthy diet had higher body weight. By the fourth week, these mice spent less time moving and got around much more slowly when they did move.

However, an important finding was that the mice on the high-fat diet moved less before they gained the majority of the weight, suggesting that the excess weight alone was not responsible for the lack of movement.

The scientists analyzed six different components in the dopamine signaling pathway and discovered that the obese, inactive mice had deficits in the D2 dopamine receptor.

“There are probably other factors involved as well, but the deficit in D2 is sufficient to explain the lack of activity,” said Dr. Danielle Friend, first author and former postdoctoral fellow at NIDDK.

The researchers also looked at the link between inactivity and weight gain, to determine whether it was causative. By studying lean mice that were engineered to have the same defect in the D2 receptor, they found that those mice did not gain weight more readily on a high-fat diet, despite their lack of inactivity, suggesting that weight gain was compounded once the mice start moving less.

“In many cases, willpower is invoked as a way to modify behavior,” Kravitz said. “But if we don’t understand the underlying physical basis for that behavior, it’s difficult to say that willpower alone can solve it.”

Uncovering the physiological reasons for why people with obesity are less active can help reduce some of the stigma they face, said Kravitz. His upcoming research will focus on how unhealthy eating affects dopamine signaling. The researchers also want to determine how quickly mice recover to normal activity levels once they begin to eat a healthy diet and lose weight.

Source: Cell Press

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January 1, 2017 at 12:21AM

How to Make 2017 A Better Year

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Tapping into Social Support May be Best Way to Improve Health

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When it comes to our health, drawing in more social support — particularly from close family and friends — may be a more effective strategy than increasing interaction or visits with physicians or other healthcare workers, according to a new study published in the New England Journal of Medicine.

“Most health care interventions are designed for the individual patient, but there’s a growing body of research that shows how health care organizations can use social engagement strategy to enhance health for patients who want to be involved in group activities or team competitions aimed at improving health,” said co-author Roy Rosin, MBA, chief innovation officer at Penn Medicine.

For example, the authors point to a study in which some patients with diabetes were asked to talk on the phone weekly with peers — a technique known as reciprocal mentorship — while other patients received more typical nurse-led management. The findings showed that those who worked directly with peers saw a more significant decline in glycated hemoglobin levels than those who worked with clinical staff.

The researchers believe it would be extremely helpful if health organizations arranged get-togethers with patients’ friends and family in order to draw in more social support.

“Concerns about privacy are often the reason doctors and hospitals avoid organizing social support,” said co-author David Asch, M.D., MBA, a professor of Medicine at the Perelman School of Medicine at the University of Pennsylvania and director of the Penn Medicine Center for Health Care Innovation.

“But while privacy is very important to some patients under some circumstances, more often patients would love if their friends and family helped them manage their diabetes, and those friends and family want to help people get their health under control.”

Asch explains that people are far more heavily influenced by those they encounter on a daily basis than they are by doctors and nurses whom they see only occasionally. However, these “cost-free interactions remain largely untapped when engineering social incentives for health,” said Asch. “That’s a missed opportunity.”

“Spouses and friends are more likely to be around patients when they are making decisions that affect their health — like taking a walk versus watching TV, or what to order at a restaurant. Patients are also more likely to adopt healthy behaviors — like going to the gym — when they can go with a friend,” said Asch.

The researchers define a ladder with escalating rungs of social support ranging from no social engagement — such as when a patient is expected to take medication as part of a routine, without anyone seeing them do it or holding them accountable — to a design that relies on reputational or economic incentives, and incorporates teams or other designs that hold patients accountable for their health behaviors and habits.

“Although we don’t normally think of competition or collaboration among patients are part of managing chronic diseases like high blood pressure, heart failure, or diabetes, research shows that behavior is contagious, and programs that take advantage of these naturally occurring relationships can be very effective,” said Rosin.

Source: University of Pennsylvania School of Medicine

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December 31, 2016 at 11:39PM

Hand Induction

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5 Tips on How to Get Started When There’s Work to Do

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“A feeling of aversion or attachment toward something is your clue that there’s work to be done.” – Ram Dass

Ever wake up with a feeling of dread about some project or task you’ve got on your list of things to do today? This is a common feeling that no one likes but must learn how to deal with. There are also times when the opposite is true. Sometimes you wake up knowing what you must do today and just can’t wait to get started.

Either feeling — aversion or excitement — is a clear sign that there’s work to be done and you need to do it. The way you deal with either emotion will affect not only your motivation to keep going, particularly when the going gets rough, but also the resulting outcome.

How can you turn dread or anticipation into action that makes sense, is effective, and allows you to feel a sense of accomplishment and increased self-esteem? Here are some tips to help get you started.

• Take a minute to process the emotion — and don’t be overcome by it.

No doubt the prospect of diving into a mountain of tax receipts on deadline is the last thing you want to do, or you might just be so eager to get on the road on your vacation that you slip and fall out of bed. Take a minute to process whatever emotion you’re feeling before you get up. This gives your mind time to arrive at a game plan and put your thoughts in order before you need to do the work. Be aware that conflicting emotions can occur simultaneously. That’s OK. Acknowledge them, then proceed.

• Learn to separate what’s nice from what’s necessary.

Both will not be true. You might find it pleasant to think about taking a swim in the ocean but you know that report for work demands your immediate attention. It might feel great to lounge around all day in your sweats but you’ve got clients to see, and such attire is no way to make a good impression. It’s fine to indulge yourself in thinking about what’s nice, but don’t dally. Get on with what’s necessary. The bonus here is that by dwelling briefly on what beckons gives you temporary satisfaction before you dive into the work that must be done.

• Prioritize tasks and give yourself sufficient time to complete them.

Either take projects in order or arrange them according to a prioritization that works for you. Do the most difficult one first to make some headway at it, or start with some quick and easy ones you can get out of the way so that you feel a sense of making progress. Once you finish one, cross it off your list. This is a visual reminder that effort equals accomplishment.

• If you’ve fallen behind, work out a plan that won’t overwhelm you.

Everybody gets swamped at times. Instead of tossing your hands in the air and writing off the project or task as hopeless, figure out a plan or approach that will be effective and won’t overwhelm you. This is a case where the intention to underpromise and overdeliver will pay off nicely. You’ll gradually become accustomed to the pace you’re comfortable maintaining and can better estimate the amount of time and effort specific tasks will take.

• Recognize that work — what you do — is the best way to show who and what you are.

Another way to get started with work to be done is to keep in mind that your output is a clear way to show others who and what you are. Since no two people approach a project the same way, this shows your uniqueness, talent, decision-making ability and willingness to keep going until the job is done. You want to put forth your best efforts. This requires that you jump in and act. Perseverance, willingness to accept responsibility for your output and taking pride in your accomplishments are all part of what it takes to get the job done.

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December 31, 2016 at 10:34PM