CVAHEC Student Project Reports

Dyveke Patrice Pratt
Freeman Scholar Program

Over the past couple of months, Talia Hoffstein and I have been working diligently trying to get our research project off the ground. Needless to say it has been a bumpy ride. Our project has changed by leaps and bounds almost weekly, but through the process I have learned much about how to develop a research project and how much work is involved. Even though our project is just starting, the work done thus far has not been trivial.

Our project started out initially as an idea to provide health and nutrition information to people with schizophrenia. This notion stemmed from a meeting with Sandy Steingard, the director of the Howard Center, where she conveyed her concern regarding obesity and related sequelae in patients taking anti-psychotic medications, most of whom have schizophrenia and are taking anti-psychotics as a treatment.

After this meeting we searched for information on this connection and found that much has been studied about weight gain in schizophrenics – to no avail – except to show that there is some correlation with anti-psychotic use and weight gain.

However, it has yet to be determined what actually causes this weigh gain. After even more searching, we discovered a pilot study that looked at perceptions of schizophrenics about their own weight and obesity related medical problems, including heart disease and diabetes. This study had initial findings that the perceptions of people with schizophrenia on anti-psychotics differed from those without this diagnosis and treatment and hypothesized that perhaps education about nutrition and healthy weight might benefit this population in preventing weight gain and associated diseases.

Armed with this information, we set out to conduct a small research project with an associated educational intervention. Our hypothesis was similar to that of the pilot study: people with schizophrenia have an altered perception of their own weight and body image.

Our initial idea was to conduct a pre-test to determine perceptions about obesity and nutrition in our research population. Next, we would develop an intervention that included nutrition education based on the initial results of the survey. After the education, a post-test would be conducted to determine if the patients’ perceptions had changed.

This idea didn’t last long. Firstly, conducting an intervention is a very difficult and time-consuming project, and time is of the essence when you are in medical school. Additionally, there were far too many confounding factors that we couldn’t control for in the study. After meeting with our advisors, we decided to do some “editing” and removed the intervention and post-test. Our new direction was to survey patients about perceptions of their own weight and body image.

Shortly thereafter, we contacted the researchers of the initial pilot study and asked if we could borrow their survey materials. Not only were they willing to lend us their survey, but wondered if UVM could be a second site for their study. They specifically were looking at body image accuracy in schizophrenic patients and correlating it with the patients’ cognitive ability, mood, and depressive status.

As exciting as this prospect seemed, we soon realized that it was entirely over our heads. Their criteria for evaluation included using rating scales we weren’t familiar with that would require strict data acquisition and more importantly a higher level of IRB approval. We decided to pare it down simply to look at body image accuracy in schizophrenics as compared to others without this diagnosis.

I spent all summer writing and re-writing the protocol in order to submit for IRB approval. The requirements for the IRB are very specific and it took a lot of time to develop an appropriate proposal. Luckily, the pilot study was generous enough to let us use their initial protocol as a template; however, much has changed from the initially proposed study. Draft after draft, we finally came up with a finished project, which was just recently submitted to IRB. We are currently awaiting a response.

So, where is the study now in terms of where we started? Actually, we have come almost full circle. In the end, we still plan to create some type of education loosely based on the finding of the surveys we administer. We will be working with the current residents of the group homes associated with the Howard Center, and if we don’t get enough volunteers, perhaps we will use the hospital as another resource.

We plan to administer a weight related survey and test body image accuracy in a maximum of 25 people in each group; one group with the diagnosis of schizophrenia and the other without this diagnosis.

Body image accuracy is determined in the following way: a figure rating scale has been developed where patients are asked to chose a drawing of a figure that accurately depicts their own image. These pictures are each associated with a pre-determined BMI.

Then, the patients’ BMIs will be calculated and it will be determined how accurate their choice was on the initial scale. The health survey is composed of eight questions to assess for awareness of weight related issues in chronically mentally ill patients. In general, the questions address patients’ insights into their own weight, their concerns about weight, weight loss strategies used in the past, and activities they would be willing to engage in to lose weight.

We plan to gather this data and hopefully support our hypothesis that perception of body image and weight does differ in schizophrenics than in others without this diagnosis.

After this, we plan to continue working with the Howard Center to develop either nutrition education materials and/or and healthier menu for those currently staying in these group homes.