Kathleen Smith

Bio: Kathleen Smith is an academic researcher from Tennessee Wesleyan College. The author has contributed to research in topics: Randomized controlled trial & Psychological intervention. The author has an hindex of 3, co-authored 3 publications receiving 40 citations.

Effect of a Telephone Intervention on Measures of Psychiatric and Nonpsychiatric Medication Adherence in Outpatients With Schizophrenia Spectrum Disorders.

Abstract: Telephone intervention may address the need for problem-solving interventions to improve medication adherence in patients with schizophrenia spectrum disorders (SSDs). The current randomized controlled trial examined the effect of weekly telephone intervention problem solving (TIPS) on quantitative measures of psychiatric and nonpsychiatric medication adherence over 6 months in 105 stable outpatients with SSDs. Independent samples t test revealed no significant differences in psychiatric or nonpsychiatric pill count adherence between groups at 6 months; however, 54.7% of experimental participants versus 32.7% of controls had serum antipsychotic levels within therapeutic range at 6 months (χ2 = 5.2, df = 1, p = 0.023). The current study extends the literature on adherence in patients with SSDs by describing a clinical sample of stable outpatients over 6 months and examining adherence to psychiatric and nonpsychiatric medications. [Journal of Psychosocial Nursing and Mental Health Services, 55(1), 29-36.].

Psychosocial Interventions for People With Both Severe Mental Illness and Substance Misuse

Abstract: Over 50% of people with a severe mental illness also use illicit drugs and/or alcohol at hazardous levels. This review is based on the findings of 32 randomized controlled trials which assessed the effectiveness of psychosocial interventions, offered either as one-off treatments or as an integrated or nonintegrated program, to reduce substance use by people with a severe mental illness. The findings showed that there was no consistent evidence to support any one psychosocial treatment over another. Differences across trials with regard to outcome measures, sample characteristics, type of mental illness and substance used, settings, levels of adherence to treatment guidelines, and standard care all made pooling results difficult. More quality trials are required that adhere to proper randomization methods; use clinically valuable, reliable, and validated measurement scales; and clearly report data, including retention in treatment, relapse, and abstinence rates. Future trials of this quality will allow a more thorough assessment of the efficacy of psychosocial interventions for reducing substance use in this challenging population.

Exercise therapy improves mental and physical health in schizophrenia: a randomised controlled trial

Abstract: Objective The objective of this multicenter randomised clinical trial was to examine the effect of exercise versus occupational therapy on mental and physical health in schizophrenia patients. Method Sixty-three patients with schizophrenia were randomly assigned to 2 h of structured exercise (n = 31) or occupational therapy (n = 32) weekly for 6 months. Symptoms (Positive and Negative Syndrome Scale) and cardiovascular fitness levels (Wpeak and VO2peak), as assessed with a cardiopulmonary exercise test, were the primary outcome measures. Secondary outcome measures were the Montgomery and Asberg Depression Rating Scale, Camberwell Assessment of Needs, body mass index, body fat percentage, and metabolic syndrome (MetS). Results Intention-to-treat analyses showed exercise therapy had a trend-level effect on depressive symptoms (P = 0.07) and a significant effect on cardiovascular fitness, measured by Wpeak (P < 0.01), compared with occupational therapy. Per protocol analyses showed that exercise therapy reduced symptoms of schizophrenia (P = 0.001), depression (P = 0.012), need of care (P = 0.050), and increased cardiovascular fitness (P < 0.001) compared with occupational therapy. No effect for MetS (factors) was found except a trend reduction in triglycerides (P = 0.08). Conclusion Exercise therapy, when performed once to twice a week, improved mental health and cardiovascular fitness and reduced need of care in patients with schizophrenia.

The importance of self-determined motivation towards physical activity in patients with schizophrenia.

Abstract: There is a need for theoretically-based research on the motivational processes linked to the commencement and continuation of physical activity in patients with schizophrenia. Within the Self-Determination Theory (SDT) framework, we investigated the SDT tenets in these patients by examining the factor structure of the Behavioral Regulation in Exercise Questionnaire-2 (BREQ-2) and by investigating associations between motivation and PA. The secondary aim was to study differences in motivation according to gender, educational level, treatment setting and disease stage. A total of 129 patients (44♀) with schizophrenia agreed to participate. Exploratory factor analysis showed sufficient convergence with the original factor for amotivation, external and introjected regulation, while identified and intrinsic regulations loaded on a single factor which we labeled “autonomous regulation”. Significant positive correlations were found between the total physical activity score and the subscales amotivation (r=−0.44, P<0.001), external regulation (r=−0.27, P<0.001), and autonomous regulation (r=0.57, P<0.001). Outpatients reported more external (P<0.05) and introjected (P<0.05) regulations than inpatients. Our results suggest that patients' level of self-determination may play an important role in the adoption and maintenance of health promoting behaviors in patients with schizophrenia.

Psychosocial interventions for people with both severe mental illness and substance misuse (Review)

Abstract: Background: Even low levels of substance misuse by people with a severe mental illness can have detrimental effects. Objectives: To assess the effects of psychosocial interventions for reduction in substance use in people with a serious mental illness compared with standard care. Search methods: The Information Specialist of the Cochrane Schizophrenia Group (CSG) searched the CSG Trials Register (2 May 2018), which is based on regular searches of major medical and scientific databases. Selection criteria: We included all randomised controlled trials (RCTs) comparing psychosocial interventions for substance misuse with standard care in people with serious mental illness. Data collection and analysis: Review authors independently selected studies, extracted data and appraised study quality. For binary outcomes, we calculated standard estimates of risk ratio (RR) and their 95% confidence intervals (CIs) on an intention-to-treat basis. For continuous outcomes, we calculated the mean difference (MD) between groups. Where meta-analyses were possible, we pooled data using a random-effects model. Using the GRADE approach, we identified seven patient-centred outcomes and assessed the quality of evidence for these within each comparison. Main results: Our review now includes 41 trials with a total of 4024 participants. We have identified nine comparisons within the included trials and present a summary of our main findings for seven of these below. We were unable to summarise many findings due to skewed data or because trials did not measure the outcome of interest. In general, evidence was rated as low- or very-low quality due to high or unclear risks of bias because of poor trial methods, or inadequately reported methods, and imprecision due to small sample sizes, low event rates and wide confidence intervals.