Sheppard Pratt

Baltimore, MD, United States

Sheppard Pratt

Baltimore, MD, United States

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Dickerson F.B.,Sheppard Pratt | Yu A.,Johns Hopkins Medical Institutions | Dalcin A.,Johns Hopkins University | Jerome G.J.,Johns Hopkins University | And 7 more authors.
Journal of Dual Diagnosis | Year: 2013

Cigarette smoking is the most preventable cause of disease and death in the U.S. We examined the prevalence of smoking and the association between smoking status and health characteristics in persons with serious mental illness. Methods: A total of 291 overweight or obese adults with serious mental illness were enrolled in a behavioral weight loss trial. Cigarette smoking, cooccurring medical diagnoses, dietary intake, blood pressure, cardiovascular fitness, body mass index, quality of life, and psychiatric symptoms were assessed at baseline in 2008 through 2011. Fasting glucose and lipid markers were measured from blood samples. Cardiovascular risk profile was calculated based on the global Framingham Health Study Risk Equation. Results: A total of 128 (44%) of participants were current smokers or had smoked in the previous year. The smokers had significantly higher diastolic blood pressure and blood triglyceride levels, and lower high-density lipoprotein cholesterol than the nonsmokers, adjusted for age, sex, education level, and diagnosis. They were more likely to have a history of emphysema and had a 10-year cardiovascular disease risk of 13.2%, significantly higher than the 7.4% in the nonsmokers. The smokers also had elevated ratings of psychopathology on the Behavior and Symptom Identification Scale (BASIS-24). Smokers did not differ from nonsmokers in cardiovascular fitness, body mass index, depression, quality of life, or other comorbid medical diagnoses. There was no characteristic in which smokers appeared healthier than nonsmokers. Conclusions: The prevalence of smoking in this contemporary cohort of individuals with serious mental illness who were motivated to lose weight was more than twice that in the overall population. Smokers had more indicators of cardiovascular disease and poorer mental health than did nonsmokers. The high burden of comorbidity in smokers with serious mental illness indicates a need for broad health interventions. Copyright © Taylor & Francis Group, LLC.


Horner R.H.,University of Oregon | Kincaid D.,University of South Florida | Sugai G.,University of Connecticut | Lewis T.,University of Missouri | And 6 more authors.
Journal of Positive Behavior Interventions | Year: 2014

Scaling of evidence-based practices in education has received extensive discussion but little empirical evaluation. We present here a descriptive summary of the experience from seven states with a history of implementing and scaling School-Wide Positive Behavioral Interventions and Supports (SWPBIS) over the past decade. Each state has been successful in establishing at least 500 schools using SWPBIS across approximately a third or more of the schools in their state. The implementation elements proposed by Sugai, Horner, and Lewis (2009) and the stages of implementation described by Fixsen, Naoom, Blase, Friedman, and Wallace (2005) were used within a survey with each element assessed at each stage by the SWPBIS coordinators and policy makers in the seven states. Consistent themes from analysis of the responses were defined and confirmed with the surveyed participants. Results point to four central areas of state “capacity” as being perceived as critical for a state to move SWPBIS to scale (administrative leadership and funding, local training and coaching capacity, behavioral expertise, and local evaluation capacity), and an iterative process in which initial implementation success (100–200 demonstrations) is needed to recruit the political and fiscal support required for larger scaling efforts. © Hammill Institute on Disabilities 2013.


Dickerson F.,Sheppard Pratt | Dalcin A.,Johns Hopkins University | Goldsholl S.,Johns Hopkins University | Enriquez M.O.,Johns Hopkins University | And 4 more authors.
Psychiatric Rehabilitation Journal | Year: 2016

Objective: The purpose of this study was to describe perceptions of weight loss strategies, benefits, and barriers among persons with serious mental illness who lost weight in the ACHIEVE behavioral weight loss intervention. Methods: Semistructured interviews with 20 ACHIEVE participants were conducted and analyzed using an inductive coding approach. Results: Participants perceived tailored exercise sessions, social support, and dietary strategies taught in ACHIEVE-such as reducing portion sizes and avoiding sugar-sweetened beverages-as useful weight loss strategies. Health benefits, improved physical appearance, self-efficacy, and enhanced ability to perform activities of daily living were commonly cited benefits of intervention participation and weight loss. Some participants reported challenges with giving up snack food and reducing portion sizes, and barriers to exercise related to medical conditions. Conclusions and Implications for Practice: There is emerging evidence that behavioral weight loss interventions can lead to clinically meaningful reductions in body weight among persons with serious mental illness. The perspective of persons with serious mental illness regarding strategies for, benefits of, and barriers to weight loss during participation in behavioral weight loss programs provide insight into which elements of multicomponent interventions such as ACHIEVE are most effective. The results of this study suggest that tailored exercise programs, social support, and emphasis on nonclinical benefits of intervention participation, such as improvements in self-efficacy and the ability to participate more actively in family and community activities, are promising facilitators of engagement and success in behavioral weight loss interventions for the population with serious mental illness. © 2016 American Psychological Association.


Dickerson F.,Sheppard Pratt | Stallings C.,Sheppard Pratt | Vaughan C.,Sheppard Pratt | Origoni A.,Sheppard Pratt | And 2 more authors.
Schizophrenia Research | Year: 2011

Objective: To investigate if adjunctive artemisinin, an anti-malarial compound with in vivo activity against Toxoplasma gondii, reduces symptoms or antibodies in schizophrenia. Method: N = 66 outpatients with schizophrenia were randomized to receive 100. mg of artemisinin twice a day or placebo for 10. weeks after a 2. week placebo run-in in addition to their usual psychiatric medications. Symptoms were assessed biweekly. Antibodies to toxoplasma and to gliadin, a food antigen, were assessed at the beginning and end of the trial. Results: A total of 57 participants (26 in the artemisinin arm and 31 in the placebo arm) completed the 12. weeks of the trial. The medication was well tolerated and there were no significant side effects associated with the treatment regimen. There was no significant difference in the change of positive, negative, general, or total PANSS symptoms between groups for all of the randomized patients or for just the completers. However, individuals in the artemisinin arm but not in the placebo arm had significant decreases in the levels of antibodies to gliadin (p < 0005, p > 2, respectively by paired t-test). Neither group had significant changes in antibodies to T. gondii. Conclusions: The study did not demonstrate clinical benefit of adjunctive artemisinin for schizophrenia symptoms. The finding of reduced levels of antibodies to gliadin in the artemisinin group merits further study. © 2011 Elsevier B.V.


Fond G.,University Paris Est Creteil | Boyer L.,Fondation FondaMental Fondation de cooperation scientifique en sante mentale | Boyer L.,Marseille University Hospital Center | Gaman A.,Fondation FondaMental Fondation de cooperation scientifique en sante mentale | And 17 more authors.
Journal of Psychiatric Research | Year: 2015

The association between Toxoplasma gondii seropositivity and respectively Bipolar Disorder (BD) and Schizophrenia/Schizoaffective disorder (SZ) is one of the most studied link between one pathogen and psychiatric disorders. The aim of the present study was thus to retrospectively determine if the administration of an antipsychotic and/or a mood stabilizer having known invitro Anti-Toxoplasmic Activity (TATA+) was associated with a better clinical outcome in a population of 152 BD or 114 SZ patients and seropositive for T.gondii infection compared to patients receiving a treatment without anti-toxoplasmic activity (TATA-). Methods: This multicenter study was conducted in an academic public hospital during a 3-years period between 2009 and 2011. All consecutive inpatients and outpatients with SZ or BD diagnosis with a stable treatment for more than 4 weeks were recruited. socio-demographic and clinical characteristics measured with validated scales as well as a serological status for toxoplasmic infection were included. Treatments were classified according to their invitro antitoxoplasmic activity. A multivariate model was used to determine the clinical characteristics that were significantly different between patients receiving a treatment with no antitoxoplasmic activity compared to others. Results: BD patients with positive serum antibodies against T.gondii presented more lifetime depressive episodes (p=0.048) after adjustment for age, sex and sociodemographic characteristics when treated by drug having no anti-toxo activity, compared to patients having received drugs with anti-toxo activity. A significant difference was not found in BD toxonegative patients and in SZ toxopositive or toxonegative patients. Conclusions: It seems to be of importance to consider prescribing a drug with a clear anti-toxoplasmic activity (TATA+) for BD patients seropositive to T.gondii, in particular valproate that was found as the mood stabilizer with the highest antitoxoplasmic activity. Prospective randomized controlled trials are warranted to confirm this preliminary data. © 2015 Elsevier Ltd.


Dickerson F.,Sheppard Pratt | Stallings C.,Sheppard Pratt | Vaughan C.,Sheppard Pratt | Origoni A.,Sheppard Pratt | And 3 more authors.
Journal of Nervous and Mental Disease | Year: 2011

The purpose of the study was to compare the cognitive functioning of persons with a recent onset of psychosis with schizophrenia-spectrum disorders and bipolar disorder and nonpsychiatric controls. A total of 56 persons with a schizophrenia-spectrum disorder and 60 with bipolar disorder, all with a recent onset psychosis, and 312 nonpsychiatric controls were evaluated using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Wisconsin Card Sorting Test (WCST). Comparison of the three groups through analysis of covariance indicated a significant difference among the groups for all of the cognitive variables. Pairwise contrasts of the two recent onset groups showed a significant difference favoring the bipolar disorder group on RBANS Language (p = 0.020) and Total (p = 0.050) and a marginally significant difference on RBANS Immediate Memory (p = 0.053) but not on the other RBANS variables or on the WCST. Cognitive performance is broadly impaired in recent onset psychosis, with a cognitive advantage to bipolar disorder patients compared with schizophrenia-spectrum patients. Copyright © 2011 by Lippincott Williams & Wilkins.


McKay C.E.,University of Massachusetts Medical School | Dickerson F.,Sheppard Pratt
Journal of Dual Diagnosis | Year: 2012

Objective: A relatively new approach to addressing tobacco use in mental health settings is the involvement of consumers or peers, defined as other individuals with mental health conditions, as service providers. This review examines the literature describing peer-delivered supports for tobacco cessation for adults with serious mental illness. Methods: The authors conducted a review of online databases to identify reports of tobacco cessation interventions in which peers play a key role in the provision of services to help other adults with serious mental illness to reduce or quit using tobacco. Results: Our review yielded reports of four tobacco cessation interventions for persons with serious mental illness that include peer providers. The roles of peers in these interventions include that of co-leaders of an educational smoking cessation group, individual counselors as part of a multifaceted tobacco treatment program, and peers as outreach tobacco cessation advocates. Conclusions: The roles of peers in these interventions are promising; however, more detail about the selection and experience of the peer providers, as well as the services they deliver in tobacco cessation interventions, would be helpful. In addition, rigorous research is needed to evaluate the impact of peer providers on reducing tobacco use in this population. © 2012 Copyright Taylor and Francis Group, LLC.

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