Richard Gray

• Physical health problems, especially cardiovascular disease and metabolic disorders are far more common in people with severe mental illness (SMI) than the general population. • While there are a considerable number of studies that have examined the physical health and health behaviours of people with SMI in Western countries, there have been few studies that have done this in Asia. What this paper adds to existing knowledge? • Unhealthy body mass index (BMI) values were observed in 44% of Thai service users diagnosed with schizophrenia despite desirable levels of exercise and relatively good diets being reported by the majority of participants. • Being prescribed two or more antipsychotics was significantly associated with greater body weight and a higher BMI than in people prescribed only one antipsychotic. What are the implications for practice? • Mental health professionals in Asia should be particularly aware of the additional risks of obesity that seem to be associated with antipsychotic polypharmacy when they are promoting the physical health of people with schizophrenia. Abstract Introduction: People with schizophrenia have worse physical health than the general population, and studies in developed countries demonstrate that their health behaviours are often undesirable. However, as no similar studies have been conducted in Asian countries with emerging healthcare systems, the physical health promotion challenges in these settings is unknown. Aim: To identify and explore relationships between cardiometabolic health risks, lifestyle and treatment characteristics in people with schizophrenia in Thailand. Method: This cross-sectional study reports the baseline findings from a physical health check programme using the Thai version of the Health Improvement Profile. Results: Despite desirable levels of exercise and relatively good diets being reported by most of the 105 service users, unhealthy body mass index values were observed in 44% of participants. A BMI>23 kg/m² and central obesity was found to be most likely in women. Being prescribed antipsychotic polypharmacy was significantly associated with a higher BMI than in people prescribed monotherapy. Implications for Practice: Mental health professionals in Asia should be aware of the additional risks of obesity that are associated with 1

• We do not know much about what it is like to take these drugs from the patient's point of view. What this paper adds to existing knowledge? • We talked to 20 young people with psychosis about their experiences of taking antipsychotic drugs. • Patients relationship with medication was complex, young people found medication often to be both good and bad at the same time. • We were interested in how seemingly trivial issues – colour, taste, size, name – could be very important to young people and could result in them stopping. What are the implications for practice? • We think our study highlights the complicated internal struggles that people with first episode psychosis have with medication. • Our study highlights how Nurses and Doctors need to try and better understand what it is like to take these drugs and work collaboratively with patients to support them to make informed choices about treatment. Abstract Background: Low-dose antipsychotic medication is an important part of treatment for people experiencing a first episode of psychosis. Little is known about this group of patients' experiences of taking medication. Method: A qualitative study of pur-posively sampled young people experiencing a first episode of psychosis was carried out. A mental health nurse working in the early psychosis team interviewed participants using a structured topic guide. Interviews were subjected to thematic analysis. Results: Interviews were completed with 20 young people. Thematic analysis generated six themes: (1) the drugs do work, (2) the drugs don't work (as well as I'd like), (3) side effects, (4) the indirect effects of medication, (5) rage against the machine and (6) the not trivial issues about medication. Conclusion: Our overarching meta-theme was that young people's experience of taking antipsychotics was complex; medication was often considered good and bad at the same time. Our observations underpin the importance of helping patients think through the use of antipsychotic medication in supporting their personal recovery. 108

In the present qualitative, descriptive study, we explored Hong Kong community psychiatric nurses' (CPN) perceptions of using comprehensive physical health checks for service users diagnosed with severe mental illness (SMI). Research interviews were conducted with a purposive sample of 11 CPN in order to explore their perceptions about the use of the Health Improvement Profile (HIP) over a 1-year period. Interview data were analysed using inductive thematic analysis. The analysis revealed that the majority of CPN appreciated the comprehensive focus on the physical health of their clients and reported positive changes in their clinical practice. Many of them observed an increase in the motivation of their clients to improve their physical health, and also noted observable benefits in service users' well-being. The use of the HIP also helped the CPN identify implementation barriers, and highlighted areas of the tool that required modifications to suit the local cultural and clinical context. To our knowledge, this is the first study conducted in an Asian mental health service that explores nurses' views about using comprehensive health checks for people with SMI. The findings suggest that such approaches are viewed as being acceptable, feasible, and potentially beneficial in the community mental health setting. KEY WORDS: health behaviour change, health screening, physical health, severe mental illness.

Background: Current practice guidelines for schizophrenia care recommend that antipsychotic medication is essential for patients' long-term maintenance treatment but their non-adherence to this medication is still a main obstacle to relapse prevention. This study evaluated the effects of a motivational-interviewing-based adherence therapy for people with schizophrenia spectrum disorders. Methods: This randomised controlled trial was conducted with 134 outpatients with schizophrenia spectrum disorders; 67 of them received a six-session adherence therapy (in addition to usual care) and 67 received usual psychiatric care alone. Participants' outcome measures included symptom severity, medication adherence, hospitalisation rates, insight into illness/treatment, and functioning.

Introduction: Up to half of all stroke survivors become depressed. Poststroke depression (PSD) negatively impacts on quality of life and rehabilitation outcomes and increases risk of mortality. Depression is also common in carers, leading to poorer outcomes in survivors. Few stroke patients receive adequate care to support prevention and management of PSD. We aimed to systematically review the evidence regarding the effectiveness of family-oriented interventions to prevent and manage depression after stroke and identify components of effective interventions. Methods: A systematic review was conducted, adhering to Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Eight databases were searched, and relevant journals and reference lists were hand searched. Abstracts were screened for relevance and two authors independently assessed selected full texts against inclusion criteria. Studies were included if they (1) engaged stroke patients and their informal/family caregivers; (2) measured changes in depression due to an intervention ; and (3) were available in English. Results: Twenty-five of 2741 identified citations met the inclusion criteria. Five studies demonstrated significant reductions in depression. Commonalities across effective studies included the delivery of interventions that were structured and multicomponent, actively engaged patients and families, coordinated care, and were initiated soon after a stroke. Conclusion: Family-oriented stroke rehabilitation may reduce depression in stroke survivors and their family caregivers. More research is required to clarify the effectiveness, feasibility, and acceptability of working with families and patients living with or who may be at risk of PSD.

The UEA London Lecture - Monday 11 June, 6.30pm
Confessions of a pill pusher: Why we should take medication adherence more seriously
Prof Richard Gray
Free admission
"Simply put, if you don't take the pills then they won't work. We know how to get patients to be better at sticking with their treatment. My argument is simple, promoting medication adherence is a critical element of health promotion and one that we must take more seriously to improve the health of the nation". 

June's lecture by Prof Richard Gray, from the School of Nursing Sciences, will discuss his multidisciplinary clinical and academic work on treatment adherence. Guests will also hear from Dean of Faculty of Medicine and Health Sciences, Prof Ian Harvey.