1. Suitability and Tolerability of Mindfulness-Oriented Interventions in Older and Younger Psychiatric Inpatients: A Pilot Study
Katerina Nikolitch, MD1, Natalie Strychowsky, BSc1, Ching Yu, MD, MSc1, Vincent Laliberté, MD, MSc1,
Marilyn Segal, MD1, Karl Looper, MD, MSc.1, Soham Rej, MD, MSc.1,2
1. Geri-PARTy Research Group, Dept. of Psychiatry, Jewish General Hospital, McGill University; 2. Dept. of Psychiatry, University of Toronto
Background:
Results:
Clinical Variables and their Association with Benefiting from the mindfulness-oriented intervention (continued)
Mindfulness-based interventions have gained increasing popularity in recent years; however, formal therapy, including mindfulness-oriented modalities, is rarely offered to acutely hospitalized psychiatric inpatients. Very little data is available on the feasibility of therapeutic interventions on psychiatric wards, and nearly none on the suitability and tolerability of mindfulness-oriented interventions in psychiatric inpatients.
Moreover, it is unknown which factors contributing to inpatients being able to engage and benefit from mindfulness-oriented therapy during psychiatric hospitalization.
40 patients took part in the offered mindfulness interventions. Average age was 51.9 and 62.5% (n=25) were over age 50. Average length of admission was 50.1 days and mean admission length prior to first intervention was 27.4 days.
Half of the patients benefitted from the interventions (50%, n=20). However, one of the demographic or diagnostic variables were associated with benefiting from the therapeutic interventions, including length of admission prior to participating, primary and comorbid psychiatric diagnosis, and medical comorbidities. A non-significant trend towards positive outcome of the intervention (2=3.243, p=0.07) was noted for patients with Cluster C personality traits or disorders, although this subsample was very small (n=3).
Variable
Benefited from the intervention
(n = 20)
Did not benefit from the intervention
Statistic
((df),p)
Psychosis
65.0% (n=13)
75.0% (n=15)
2=0.48, p=0.49
Schizophrenia
45.0%(n=9)
60.0% (n=12)
2=0.90, p=0.34
Bipolar Disorder
10.0% (n=2)
15.0% (n=3)
2=0.23, p=0.63
Unipolar or Bipolar Depression
20.0% (n=4)
2=0.00, p=1.0
Mania
5.0% (n=1)
2=0.36, p=0.55
Any personality disorder or traits
44.4% (n=8)
21.1%(n=4)
2=2.31, p=0.13
Self-reported mood score prior to intervention (0= worst, 10=best mood)
6.68 (2.19)
5.41 (2.40)
U=67.0, p=0.22
Number of medical comorbidities 
1.95 (3.02)
2.50 (2.12)
U=152.0, p=0.20
Intervention Characteristics
Type of mindfulness-oriented intervention exposure
2=8.68, p=0.013
Mindful Eating
35.0% (n=7) -
Tai Chi
Body Scan
25.0% (n=5)
45.0% (n=9)
Methods:
All patients hospitalized at the inpatient psychiatric ward, Jewish General Hospital in Montreal between January and April 2014 were offered three kinds of mindfulness-oriented interventions offered as part of regular occupational therapy on the ward.
The intervention types included modified Body Scan, Tai Chi, and Mindful Eating. Sessions lasted 10 minutes. The body scan comprised a therapist-led mindful focus on each body part in succession. Tai Chi included seated Tai Chi exercises. Mindful eating sessions included eating a grape, chip, or candy twice – “as usual” the first time (quickly, without attention), and mindfully the second time, noticing smell, flavour, and texture.
Patients were given a brief questionnaire pre- and post-session, containing a simplified Mood Likert scale on 1-10, as well as questions on thoughts and emotions. Verbal comments made to the therapist and/or during discussion, and whether a patient was able to stay until the end of the intervention, were also recorded.
Demographic and diagnostic variables, including, age, sex, marital status, length of admission, days on the ward to first intervention, primary diagnosis, comorbid psychiatric diagnoses (including personality traits or disorders), and medical comorbidities were collected via chart review.
Data from each patient’s first available session was used. Benefiting from the intervention was defined as: 1) improved pre-post mood scores and tolerating the intervention to the end, 2) in the absence of recorded mood scores, positive comments of the intervention and tolerating the intervention to the end. Chi-squared Test was calculated for nominal variables and Mann-Whitney U Test for nonparametric continuous variables.
Association of Demographic and Clinical Variables with Benefiting from the mindfulness-oriented intervention (n =40)
Variable
Benefited from the intervention
(n = 20)
Did not benefit from the intervention
Statistic
((df),p)
Age (years)
51.1 (14.8)
52.0 (18.6)
U=179.5, p=0.58
Female Gender
50.0% (n=10)
55.0% (n=11)
2=0.10, p=0.75
Married 
15.0% (n=3)
30.0% (n=6)
2=1.29, p=0.26
Working
20.0% (n=4)
2=0, p=1.0
Living independently
70.0% (n=14)
75.0% (n=15)
2=0.13, p=0.72
Total length of hospitalization (days)
49.9 (41.0)
49.8 (40.3)
U=190.0, p=0.80
Length of stay less than 2 weeks
2=0.173, p=0.68
Length of hospitalization prior to mindfulness-oriented activity
25.2 (33.3)
29.5 (36.5)
U=163.0, p=0.82
Conclusions:
Overall, brief mindfulness-oriented interventions can be well-tolerated by acutely ill psychiatric inpatients. Age did not affect suitability and tolerability, indicating that mindfulness-oriented therapy can also be offered to psychiatric inpatients aged >50.
In clinical practice, offering a non-pharmacological intervention is frequently questioned if a patient is recently hospitalized and not yet stabilized. Our data indicate that inpatients can tolerate and benefit from brief mindfulness-oriented therapy. It further appears that tai chi or similar active/physically-involving mindfulness interventions (e.g. walking meditation) may be more suitable for this population.
Perhaps most importantly, patients with psychosis (the majority of our sample) may also be suitable candidates for such interventions.
This is the first study to assess factors that may impact the suitability and tolerability of mindfulness-oriented therapy in acutely hospitalized psychiatric patients. More studies would be needed to expand these findings.