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From our regular book review column.
Clinical Handbook of Psychological Disorders:A Step-by-Step Treatment Manual, 4th ed
Oxford Textbook of Old Age Psychiatry (4th edition of formerly named Psychiatry in the Elderly)
The American Board of Medical Specialties (ABMS) developed 6 core competencies for physicians of all specialties and a maintenance of certification (MOC) program for board-certified physicians. The MOC program incorporates the 6 competencies into 4 component areas: professional standing, self-assessment and lifelong learning, cognitive expertise, and performance in practice. These 4 components are designed to promote a cycle of lifelong learning, self-assessment and peer review, and incorporation of best practices in order to improve the quality of health care in clinical practice. The American Board of Psychiatry and Neurology is a member board of the ABMS and has adapted the competencies and MOC requirements for psychiatrists and neurologists.
Objective: Obesity is increasing at an alarming rate in the United States, as is the obesity rate in patients with schizophrenia. Our study retrospectively evaluated the effectiveness of the Solutions for Wellness and Team Solutions programs, 2 structured educational patient programs, and evaluated the effects on obesity and other metabolic markers in a large, naturalistic inpatient sample.
Method: Between September 18, 2006, and September 15, 2007, 275 inpatients with DSM-IV-TR-diagnosed chronic mental illness admitted to a tertiary care psychiatric facility were included in the 36-week comprehensive and manualized educational program for healthy lifestyles for patients with chronic mental illness incorporating psychoeducational small-group curricula. Patients were tested before and after each of three 12-week group periods by 30 knowledge-assessment questions, and metabolic markers were recorded at baseline, midpoint, and endpoint.
Results: Of the 275 included inpatients, 50.5% completed more than 5 modules, 20.4% completed less than or equal to 2 or fewer modules, and 5.1% completed all 11 modules. Significant increases in scores were observed for 7 of the 11 modules in the knowledge assessments (P' ‰<' ‰.001). Eighty-seven patients (43.72%) had a body mass index (BMI) ≥' ‰30 (indicating obesity) at the start of the program. There was a significant mean weight loss of 4.88 lb (P' ‰=' ‰.035) together with a significant decrease in mean BMI (P' ‰=' ‰.045). Patients with diabetes showed a reduction in mean weight of 5.98 lb. Significant reductions were observed in glucose and triglyceride levels (both P' ‰<' ‰.05). Patients with impaired glucose tolerance showed a significantly greater decrease in glucose level (P' ‰=' ‰.000). Sixty-nine patients (25.46%) met criteria for metabolic syndrome at baseline, and this number was reduced to 53 patients (19.56%) at endpoint; this decrease was significant (P' ‰=' ‰.027). Regarding relationship of change in knowledge after completion of the modules and metabolic changes, we found a significant correlation between reduction in weight and change in Fitness and Exercise score (r' ‰=' ‰0.62, P' ‰=' ‰.001) and a significant correlation between the change score on Nutrition/Healthy Lifestyles and change in glucose values (r' ‰=' ‰0.56, P' ‰=' ‰.001).
Conclusions: We found that a structured wellness program using a psychoeducational curriculum can be successfully implemented in a large, naturalistic psychiatric setting with unselected, chronically mentally ill inpatients. Results may help both clinicians and hospital managers to implement similar programs or to include successful components in existing programs for psychiatric patients.
Submitted: September 24, 2008; accepted January 2, 2009.
Online ahead of print: September 22, 2009.
Corresponding author: Anzalee Khan, MS, MA, Manhattan Psychiatric Center, 1 Wards Island Complex, Dunlap 15th Floor, Wards Island, NY 10035 ([email protected]).
Current Diagnosis & Treatment: Psychiatry, 2nd ed
The Clinical Handbook of Psychiatry and the Law has become a popular textbook and reference book for psychiatry residents, forensic psychiatry fellows, and psychiatrists in clinical practice. The authors have published 4 editions over 25 years, which reflects the rather rapid growth of the importance of and interest in this topic. Both Dr. Appelbaum and Dr. Gutheil are prolific writers, and this book collects their experience and wisdom into a handy volume that is densely packed with useful information.
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