Preventing the Development of Metabolic Syndrome in People with Psychotic Disorders—Difficult, but Possible: Experiences of Staff Working in Psychosis Outpatient Care in Sweden

Abstract

The aim of this study was to explore mental health staffs' experiences of assisting people with psychotic disorders to implement lifestyle changes in an effort to prevent metabolic syndrome. Qualitative interviews were conducted with 12 health care professionals working in psychosis outpatient care in Sweden. Data were analysed using a qualitative content analysis. The results illustrate that implementation of lifestyle changes among people with psychotic disorders was experienced as difficult, but possible. The greatest obstacles experienced in this work were difficulties due to the reduction of cognitive functions associated with the disease. Guidelines available to staff in order to help them identify and prevent physical health problems in the group were not always followed and the content was not always relevant. Staff further described feelings of uncertainty about having to motivate people to take anti-psychotic medication while simultaneously being aware of the risks of metabolic deviations. Nursing interventions focusing on organising daily routines before conducting a more active prevention of metabolic syndrome, including information and practical support, were experienced as necessary. The importance of healthy eating and physical activity needs to be communicated in such a way that it is adjusted to the person's cognitive ability, and should be repeated over time, both verbally and in writing. Such efforts, in combination with empathic and seriously committed community-based social support, were experienced as having the best effect over time. Permanent lifestyle changes were experienced as having to be carried out on the patient's terms and in his or her home environment.

Master’s level mental health nursing competencies, a prerequisite for equal health among service users in mental health care

“…The main enabling factors to support participation in physical activity among individuals with severe mental illness have been shown to be the support of the mental health staff and organization and structure of the care organization (Hodgson et al, 2011). Master’s level mental health nurses need to have the skills to communicate lifestyle issues in such a way that it is adjusted to the person’s cognitive ability and the talent to supervise other professional groups to provide an empathic and seriously committed community-based social support (Bergqvist, Karlsson, & Fodemo et al, 2013). Master’s level mental health nurses need to be able to cooperate with health care providers, health agencies and the public in order to support the achievement of a healthy lifestyle, and support the individual with mental illness to enjoy increased social integration (Wärdig, Bachrach-Lindström, & Foldemo et al, 2013),…”

Physical activity as a therapeutic strategy in mental health: an integrative review with implication for nursing care

“…Even with most people with mental disorders knowing the importance of a healthy lifestyle, there were difficulties to change habits, because these patients had to implement these modifications and deal with and accept the psychotic symptoms. 8 Thus, the study identified that negative symptoms and cognitive alterations were the main obstacles to implement lifestyle changes in this population. Studies 8,9,18 with people with schizophrenia, an important psychotic disorder in the mental health field, confirm their low level of PA. 18 Healthy adults took, on average, between 7,000 and 13,000 steps in the first day of study, whereas the participants with that mental disorder took, on average, between 2,384 to 4,399 steps in the same time interval.…”

“…Other studies 8,13,16,17 stressed the importance of preventing metabolic syndrome in patients with mental disorders and active psychotic symptoms who take antipsychotic medications, because they have an increased risk of cardiometabolic comorbidities, including metabolic conditions such as obesity, insulin resistance, hypertension and diabetes. 16 These comorbid conditions can shorten life expectancy of people with a severe mental disorder 20% more than in people with no mental disease.…”

“…8 Even if professionals consider it important to invest in a healthier lifestyle for people with mental disorders, they stuck to the planning phase of PA practice and did not implement it. 9 The fact that mental disorders affect the patient's volition seems to be one of the reasons that lead them to this type of behavior.…”

“…8,11,12,14 Another possibility to achieve adherence to the practice of PA is the development of awareness actions on the activity's potential benefits. Information support helped raise interest and motivation in the participants of one of the studies to start practicing a certain exercise or sport activity.…”