Imran S. Khawaja, MBBS

Psychiatric patients are at high risk of becoming obese—with rates up to 63% in schizophrenia and 68% in bipolar disorder.¹ Moreover, weight gain from psychotropics is associated with medication nonadherence.

Psychiatrists can suggest and encourage lifestyle changes that will help patients lose weight. The 8 behaviors described below can help patients become more active and take steps toward a healthier lifestyle.

Keep a food diary. Ask patients to keep a written record of everything they eat or drink in a day. Encourage them to learn about healthy foods and look up the calories of common foods using food packaging, pocket books listing calorie counts, and online sources.

Start walking. Pedometers could motivate patients to exercise regularly and reach goals of taking a certain number of steps each day. A physically healthy individual should walk approximately 10,000 steps per day. Scheduling daily walks also provides structure for your patients.

Plan meals and eat mindfully. Advise your patients to schedule meals and eat mindfully. This means keeping your full attention on eating by noticing the smell, taste, and texture of food. Encourage patients to eat slowly, enjoy every bite, and avoid eating while watching television or when occupied by another activity.

Have a healthy snack before a meal. Eating a serving of boiled vegetables or a piece of fruit such as an apple before a meal can satisfy hunger and reduce food intake.

Increase fluid intake. Feeling hungry might be a signal that the body needs more fluid. Advise patients to drink water, avoid beverages that contain sugar, and limit fruit juice to 4 to 8 ounces per day.

Obtain support from family and friends. Loved ones can reinforce a patient’s weight loss efforts by not eating high-calorie food in front of the patient and buying only healthy snacks such as fruits and vegetables.

Improve nutrition. Advise patients to:

• eat at least 3 meals and 2 to 3 healthy snacks per day
  
• choose lean meats and whole grains
  
• eat 5 servings of fruits and vegetables daily
  
• avoid eating after 7 Pm or 3 to 4 hours before bedtime.
  

Monitor weight regularly. Digital scales give more precise measurements, which can prompt patients to reduce food intake when they notice weight gain. Frequent feedback can help facilitate behavior changes necessary for weight loss.

Patients often need help setting appropriate weight loss goals because achieving their ideal weight may not be possible. Losing 10% of body weight usually is a realistic goal that can improve their health.

Psychiatric patients are at high risk of becoming obese—with rates up to 63% in schizophrenia and 68% in bipolar disorder.¹ Moreover, weight gain from psychotropics is associated with medication nonadherence.

Psychiatrists can suggest and encourage lifestyle changes that will help patients lose weight. The 8 behaviors described below can help patients become more active and take steps toward a healthier lifestyle.

Keep a food diary. Ask patients to keep a written record of everything they eat or drink in a day. Encourage them to learn about healthy foods and look up the calories of common foods using food packaging, pocket books listing calorie counts, and online sources.

Start walking. Pedometers could motivate patients to exercise regularly and reach goals of taking a certain number of steps each day. A physically healthy individual should walk approximately 10,000 steps per day. Scheduling daily walks also provides structure for your patients.

Plan meals and eat mindfully. Advise your patients to schedule meals and eat mindfully. This means keeping your full attention on eating by noticing the smell, taste, and texture of food. Encourage patients to eat slowly, enjoy every bite, and avoid eating while watching television or when occupied by another activity.

Have a healthy snack before a meal. Eating a serving of boiled vegetables or a piece of fruit such as an apple before a meal can satisfy hunger and reduce food intake.

Increase fluid intake. Feeling hungry might be a signal that the body needs more fluid. Advise patients to drink water, avoid beverages that contain sugar, and limit fruit juice to 4 to 8 ounces per day.

Obtain support from family and friends. Loved ones can reinforce a patient’s weight loss efforts by not eating high-calorie food in front of the patient and buying only healthy snacks such as fruits and vegetables.

Improve nutrition. Advise patients to:

• eat at least 3 meals and 2 to 3 healthy snacks per day
  
• choose lean meats and whole grains
  
• eat 5 servings of fruits and vegetables daily
  
• avoid eating after 7 Pm or 3 to 4 hours before bedtime.
  

Monitor weight regularly. Digital scales give more precise measurements, which can prompt patients to reduce food intake when they notice weight gain. Frequent feedback can help facilitate behavior changes necessary for weight loss.

Patients often need help setting appropriate weight loss goals because achieving their ideal weight may not be possible. Losing 10% of body weight usually is a realistic goal that can improve their health.

Psychiatric patients are at high risk of becoming obese—with rates up to 63% in schizophrenia and 68% in bipolar disorder.¹ Moreover, weight gain from psychotropics is associated with medication nonadherence.

Psychiatrists can suggest and encourage lifestyle changes that will help patients lose weight. The 8 behaviors described below can help patients become more active and take steps toward a healthier lifestyle.

Keep a food diary. Ask patients to keep a written record of everything they eat or drink in a day. Encourage them to learn about healthy foods and look up the calories of common foods using food packaging, pocket books listing calorie counts, and online sources.

Start walking. Pedometers could motivate patients to exercise regularly and reach goals of taking a certain number of steps each day. A physically healthy individual should walk approximately 10,000 steps per day. Scheduling daily walks also provides structure for your patients.

Plan meals and eat mindfully. Advise your patients to schedule meals and eat mindfully. This means keeping your full attention on eating by noticing the smell, taste, and texture of food. Encourage patients to eat slowly, enjoy every bite, and avoid eating while watching television or when occupied by another activity.

Have a healthy snack before a meal. Eating a serving of boiled vegetables or a piece of fruit such as an apple before a meal can satisfy hunger and reduce food intake.

Increase fluid intake. Feeling hungry might be a signal that the body needs more fluid. Advise patients to drink water, avoid beverages that contain sugar, and limit fruit juice to 4 to 8 ounces per day.

Obtain support from family and friends. Loved ones can reinforce a patient’s weight loss efforts by not eating high-calorie food in front of the patient and buying only healthy snacks such as fruits and vegetables.

Improve nutrition. Advise patients to:

• eat at least 3 meals and 2 to 3 healthy snacks per day
  
• choose lean meats and whole grains
  
• eat 5 servings of fruits and vegetables daily
  
• avoid eating after 7 Pm or 3 to 4 hours before bedtime.
  

Monitor weight regularly. Digital scales give more precise measurements, which can prompt patients to reduce food intake when they notice weight gain. Frequent feedback can help facilitate behavior changes necessary for weight loss.

Patients often need help setting appropriate weight loss goals because achieving their ideal weight may not be possible. Losing 10% of body weight usually is a realistic goal that can improve their health.

Partial hospitalization programs (PHPs) are a good alternative to inpatient treatment for many patients who do not pose an imminent risk of harm to themselves or others.¹ PHPs provide:

• equivalent or superior recovery-based care at a lower cost, and patients are satisfied with the treatment²
  
• clinical services such as crisis stabilization, symptom management, and structured socialization within a stable therapeutic milieu, without the increased dependence on clinicians and loss of function of hospitalization.³
  

PHPs can be used in lieu of an inpatient admission or as an intermediate step to shorten a patient’s inpatient stay. Close proximity to and coordination with an inpatient setting can facilitate transition of care and may reduce patient drop-out rates. In addition, PHPs often allow extended evaluation of psychiatric symptoms and functional ability and may help you reach difficult-to-engage patients. Keeping patients in the community might help preserve patients’ self-esteem.

PHPs focus on behavioral activation skills and encourage patients to participate in treatment planning and intervention. Using a “pressure cooker” technique, treatment encourages patients to mobilize themselves within a limited time frame.

To determine which of your patients are likely to benefit from PHPs, we use the mnemonic MOTIVATES:

Motivated. Patients who are motivated to participate in daily programs are the best candidates for this level of care.

Organized. Individuals must be able to benefit from psychoeducation and skills-building groups. Patients who are grossly psychotic or delirious are not candidates for PHPs.

Tolerate a milieu or group setting. Floridly antisocial or manic patients may be disruptive and could negatively affect the milieu.

Interested in recovery. A patient who does not want to get well or stay sober usually relapses and drops out of treatment.

Verbal. Patients who can verbalize their thoughts and feelings tend to do better, although this skill can be developed while in a PHP.

Ability. Patients must be able to participate in their vocational and social rehabilitation.

Treatment adherent. Patients who are not adherent often don’t improve in PHPs.

Experience. Look for patients who have had positive experiences with milieu treatment settings.

Safe. PHP patients must not pose an acute risk of harming themselves or others.

The Association of Ambulatory Behavioral Health encourages PHPs to embrace the concept of recovery, which encourages the patient to be an active and empowered participant in treatment. Instilling hope is one of the cornerstones of the recovery movement.

References

1. Horvitz-Lennon M, Normand SL, Gaccione P, Frank RG. Partial versus full hospitalization for adults in psychiatric distress: a systematic review of the published literature (1957-1997). Am J Psychiatry 2001;158:676-85.

2. Hoge MA, Davidson L, Hill WL, et al. The promise of partial hospitalization: a reassessment. Hosp Community Psychiatry 1992;43:345-54.

3. Dick P, Cameron L, Cohen D, et al. Day and full time psychiatric treatment: a controlled comparison. Br J Psychiatry 1985;147:250-3.

Partial hospitalization programs (PHPs) are a good alternative to inpatient treatment for many patients who do not pose an imminent risk of harm to themselves or others.¹ PHPs provide:

• equivalent or superior recovery-based care at a lower cost, and patients are satisfied with the treatment²
  
• clinical services such as crisis stabilization, symptom management, and structured socialization within a stable therapeutic milieu, without the increased dependence on clinicians and loss of function of hospitalization.³
  

PHPs can be used in lieu of an inpatient admission or as an intermediate step to shorten a patient’s inpatient stay. Close proximity to and coordination with an inpatient setting can facilitate transition of care and may reduce patient drop-out rates. In addition, PHPs often allow extended evaluation of psychiatric symptoms and functional ability and may help you reach difficult-to-engage patients. Keeping patients in the community might help preserve patients’ self-esteem.

PHPs focus on behavioral activation skills and encourage patients to participate in treatment planning and intervention. Using a “pressure cooker” technique, treatment encourages patients to mobilize themselves within a limited time frame.

To determine which of your patients are likely to benefit from PHPs, we use the mnemonic MOTIVATES:

Motivated. Patients who are motivated to participate in daily programs are the best candidates for this level of care.

Organized. Individuals must be able to benefit from psychoeducation and skills-building groups. Patients who are grossly psychotic or delirious are not candidates for PHPs.

Tolerate a milieu or group setting. Floridly antisocial or manic patients may be disruptive and could negatively affect the milieu.

Interested in recovery. A patient who does not want to get well or stay sober usually relapses and drops out of treatment.

Verbal. Patients who can verbalize their thoughts and feelings tend to do better, although this skill can be developed while in a PHP.

Ability. Patients must be able to participate in their vocational and social rehabilitation.

Treatment adherent. Patients who are not adherent often don’t improve in PHPs.

Experience. Look for patients who have had positive experiences with milieu treatment settings.

Safe. PHP patients must not pose an acute risk of harming themselves or others.

The Association of Ambulatory Behavioral Health encourages PHPs to embrace the concept of recovery, which encourages the patient to be an active and empowered participant in treatment. Instilling hope is one of the cornerstones of the recovery movement.

References

1. Horvitz-Lennon M, Normand SL, Gaccione P, Frank RG. Partial versus full hospitalization for adults in psychiatric distress: a systematic review of the published literature (1957-1997). Am J Psychiatry 2001;158:676-85.

2. Hoge MA, Davidson L, Hill WL, et al. The promise of partial hospitalization: a reassessment. Hosp Community Psychiatry 1992;43:345-54.

3. Dick P, Cameron L, Cohen D, et al. Day and full time psychiatric treatment: a controlled comparison. Br J Psychiatry 1985;147:250-3.

Partial hospitalization programs (PHPs) are a good alternative to inpatient treatment for many patients who do not pose an imminent risk of harm to themselves or others.¹ PHPs provide:

• equivalent or superior recovery-based care at a lower cost, and patients are satisfied with the treatment²
  
• clinical services such as crisis stabilization, symptom management, and structured socialization within a stable therapeutic milieu, without the increased dependence on clinicians and loss of function of hospitalization.³
  

PHPs can be used in lieu of an inpatient admission or as an intermediate step to shorten a patient’s inpatient stay. Close proximity to and coordination with an inpatient setting can facilitate transition of care and may reduce patient drop-out rates. In addition, PHPs often allow extended evaluation of psychiatric symptoms and functional ability and may help you reach difficult-to-engage patients. Keeping patients in the community might help preserve patients’ self-esteem.

PHPs focus on behavioral activation skills and encourage patients to participate in treatment planning and intervention. Using a “pressure cooker” technique, treatment encourages patients to mobilize themselves within a limited time frame.

To determine which of your patients are likely to benefit from PHPs, we use the mnemonic MOTIVATES:

Motivated. Patients who are motivated to participate in daily programs are the best candidates for this level of care.

Organized. Individuals must be able to benefit from psychoeducation and skills-building groups. Patients who are grossly psychotic or delirious are not candidates for PHPs.

Tolerate a milieu or group setting. Floridly antisocial or manic patients may be disruptive and could negatively affect the milieu.

Interested in recovery. A patient who does not want to get well or stay sober usually relapses and drops out of treatment.

Verbal. Patients who can verbalize their thoughts and feelings tend to do better, although this skill can be developed while in a PHP.

Ability. Patients must be able to participate in their vocational and social rehabilitation.

Treatment adherent. Patients who are not adherent often don’t improve in PHPs.

Experience. Look for patients who have had positive experiences with milieu treatment settings.

Safe. PHP patients must not pose an acute risk of harming themselves or others.

The Association of Ambulatory Behavioral Health encourages PHPs to embrace the concept of recovery, which encourages the patient to be an active and empowered participant in treatment. Instilling hope is one of the cornerstones of the recovery movement.

References

1. Horvitz-Lennon M, Normand SL, Gaccione P, Frank RG. Partial versus full hospitalization for adults in psychiatric distress: a systematic review of the published literature (1957-1997). Am J Psychiatry 2001;158:676-85.

2. Hoge MA, Davidson L, Hill WL, et al. The promise of partial hospitalization: a reassessment. Hosp Community Psychiatry 1992;43:345-54.

3. Dick P, Cameron L, Cohen D, et al. Day and full time psychiatric treatment: a controlled comparison. Br J Psychiatry 1985;147:250-3.