Tag: Psychotic Disorders

Spending time in nature reduces stress

ITHACA, N.Y. – New research from an interdisciplinary Cornell team has found that as little as 10 minutes in a natural setting can help college students feel happier and lessen the effects of both physical and mental stress.

Photo by Artem Beliaikin on Pexels.com

The research, published Jan. 14 in Frontiers in Psychology, is part of a larger examination of “nature therapy” and aims to provide an easily-achievable dosage that physicians can prescribe as a preventive measure against high levels of stress, anxiety, depression and other mental health issues college students face.

“It doesn’t take much time for the positive benefits to kick in — we’re talking 10 minutes outside in a space with nature,” said lead author Gen Meredith, associate director of the Master of Public Health Program and lecturer at the College of Veterinary Medicine. “We firmly believe that every student, no matter what subject or how high their workload, has that much discretionary time each day, or at least a few times per week.”

Meredith and her co-authors reviewed studies that examined the effects of nature on people of college age (no younger than 15, no older than 30) to discover how much time students should be spending outside and what they should be doing while they’re there. They found that 10-50 minutes in natural spaces was the most effective to improve mood, focus and physiological markers like blood pressure and heart rate.

“It’s not that there’s a decline after 50 minutes, but rather that the physiological and self-reported psychological benefits tend to plateau after that,” said co-author Donald Rakow, associate professor in the School of Integrative Plant Science.

To enjoy the positive effects of being outside, students need only to be sitting or walking, the two primary activities the researchers examined in an effort to provide accessible recommendations.

“We wanted to keep this access to nature as simple and achievable as possible,” says Rakow. “While there is a lot of literature on longer outdoor programs, we wanted to quantify doses in minutes, not days.”

For Cornell students, there are a multitude of options for escaping into nature. For urban universities, research suggests that adding green elements to a built space can produce the same results. It is the time spent in nature, not necessarily nature itself, that’s beneficial.

“This is an opportunity to challenge our thinking around what nature can be,” says Meredith. “It is really all around us: trees, a planter with flowers, a grassy quad or a wooded area.”

The impetus for this work is a movement toward prescribing time in nature as a way to prevent or improve stress and anxiety, while also supporting physical and mental health outcomes. The researchers wanted to consider what “dose” would need to be prescribed to college-age students to show an effect. They are hoping that when it’s applied at universities, it becomes part of a student’s routine and is consumed in regular doses, like a pill.

“Prescribing a dose can legitimize the physician’s recommendation and give a tangible goal” says Meredith. “It’s different than just saying: ‘Go outside.’ There is something specific that a student can aim for.”

Meredith and Rakow’s co-authors include Erin Eldermire, head librarian at the Flower-Sprecher Veterinary Library; Cecelia Madsen ’12, M.P.H. ’19; Steven Shelley, M.P.H. ’19, epidemiologist at the Maine Center for Disease Control and Prevention; and Naomi Sachs, assistant professor at the University of Maryland.

New Policy Reduces Anti-Psychotic Medications in Foster Children

Photo by Michał Parzuchowski

Texas strategy reduces prescriptions without compromising care, Rutgers study finds

Rutgers researchers have found that a Texas strategy to reduce anti-psychotic medication for children can serve as a model for other state Medicaid programs.

The study was published in the Journal of the American Academy of Child & Adolescent Psychiatry.

“Youth in the United States foster care system are about five times more likely to take antipsychotic medications, a class of medications to manage their mental and behavioral health, than children in the general public,” said Thomas Mackie, assistant professor at Rutgers School of Public Health. In response, over 31 state Medicaid programs nationally are experimenting with different oversight strategies to ensure safe and judicious use of antipsychotic medications. These Medicaid programs are challenged to address these concerns while also ensuring access to antipsychotic medications in cases where these medications are clinically optimal, especially for those youth with psychosis, autism and other U.S. Food and Drug Administration–approved clinical indications.

An antipsychotic medication oversight strategy implemented in Texas included four elements: a mental health screening administered within 72 hours of the child being removed from the original caregiver; a health passport drawing on claims-based data; a psychiatric consultation line for child welfare staff, caregivers and judges; and a retrospective review of whether prescribed psychotropic medications met state best practice parameters after the antipsychotic medication was prescribed and dispensed.

The study, sought to examine whether the Texas program was effective in reducing the number of youth in foster care prescribed antipsychotic medications off-label to manage symptoms of conditions such as conduct disorders or attention hyperactivity disorders, while not decreasing use for disorders with FDA indications, such as bipolar disorder or autism spectrum disorders.

After the strategy started, the Rutgers researchers found the program resulted in roughly a 5 percent to 8 percent reduction in antipsychotic use for youth treated off-label for conditions like conduct or attention hyperactivity disorders, whereas no significant changes were found for youth treated for FDA-indicated conditions.

These findings show that the Texas program effectively reduced use of antipsychotic medications for off-label conditions where clinical concerns are greatest while not reducing antipsychotic medications for FDA-indicated conditions where stronger evidence exists for antipsychotic use among youth.

“Although the Texas model enrolled only youths in foster care, similar innovations are increasingly being extended to the general population of Medicaid-insured youth,” Mackie said.  “This study provides important new evidence suggesting that states continue to incorporate or renew the inclusion of these additional behavioral health services into Medicaid-managed care arrangements.”