Interventions to Improve Cardiovascular Risk Factors in People with Serious Mental Illness

Gierisch, Jennifer M.; Nieuwsma, Jason A.; Bradford, Daniel W.; Wilder, Christine M.; Mann-Wrobel, Monica C.; McBroom, Amanda J; Wing, Liz; Musty, Michael; Chobot, Megan M; Hasselblad, Vic; Williams, John W

doi:10.1037/e553762013-001

Cited by 22 publications

(29 citation statements)

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“…Our results support recent findings (14) suggesting that behavioral lifestyle-change programs can help individuals with SMI to lose weight, and extend these findings by showing that lifestyle interventions can produce changes in fasting glucose levels among individuals taking antipsychotic medications—drugs known to disrupt glucose metabolism (7, 31). Consistent with other interventions (16), STRIDE spurred clinically significant weight loss of ≥5% of initial body weight among 40% of participants.…”

Section: Discussionsupporting

confidence: 91%

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The STRIDE Weight Loss and Lifestyle Intervention for Individuals Taking Antipsychotic Medications: A Randomized Trial

Green

Yarborough

Leo

et al. 2015

AJP

186

224

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Objectives STRIDE assessed whether a lifestyle intervention, tailored for individuals with serious mental illnesses, reduced weight and diabetes risk. Methods A multi-site, parallel, two-arm randomized controlled trial in community settings and an integrated health plan. Inclusion criteria: Age ≥18; taking antipsychotic medication for ≥30 days; BMI ≥27. Exclusions: significant cognitive impairment; pregnancy/breastfeeding; recent psychiatric hospitalization, bariatric surgery, cancer, heart attack or stroke. The intervention emphasized moderate caloric reduction, DASH diet, and physical activity. Blinded staff collected data at baseline, 6, and 12 months. Results Participants (56 men, 144 women), mean age = 47.2(SD =10.6), were randomized to usual care (n =96) or a 6-month weekly group intervention plus 6 monthly maintenance sessions (n =104). 181 participants (90.5%) completed 6-month, and 170 (85%) completed 12-month assessments, without differential attrition. Participants attended 14.5 of 24 sessions over 6 months. Intent-to-treat analyses found intervention participants lost 4.4 kg more than control participants from baseline to 6 months (95% CI [−6.96 kg, −1.78 kg]), and 2.6 kg more than controls (95% CI −5.14 kg, −0.07 kg] from baseline to 12 months. At 12 months, fasting glucose levels in controls had increased from 106.0 mg/dL to 109.5 mg/dL and decreased in intervention participants, from 106.3 mg/dL to 100.4 mg/dL. No serious adverse events were study-related; medical hospitalizations were reduced in the intervention group (6.7%) compared to controls (18.8%)(χ2= 6.66, p = 0.01). Conclusions Individuals taking antipsychotic medications can lose weight and improve fasting glucose levels. Increasing reach of the intervention is an important future step. Funding Source National Institute of Diabetes and Digestive and Kidney Diseases, Grant R18DK076775 Trial Registration Clinical Trials.gov, NCT00790517; http://clinicaltrials.gov/ct2/show/NCT00790517?term=STRIDE&rank=1

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Section: Discussionsupporting

confidence: 91%

“…Lifestyle-modification programs (13, 14) are the basis for recent efforts to assist individuals with SMI in improving health and reducing cardiometabolic risks (15, 16). These programs apply behavioral approaches to weight loss and management, including education and behavioral self-management skills (17).…”

mentioning

confidence: 99%

The STRIDE Weight Loss and Lifestyle Intervention for Individuals Taking Antipsychotic Medications: A Randomized Trial

Green

Yarborough

Leo

et al. 2015

AJP

186

224

View full text Add to dashboard Cite

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“…Together with topiramate, metformin is the best‐studied medication for antipsychotic‐related cardiometabolic adverse effects. Across a number of reviews and meta‐analyses of up to 21 RCTs , metformin has also been shown to effectively prevent or reduce weight gain in subjects receiving antipsychotics, with a magnitude similar to that of topiramate, that is, approximately 2.5–3 kg less weight gain compared to the control condition over a pooled duration of about 3 months. Across these studies, metformin was associated with a low ADR risk, except for gastrointestinal side‐effects that are often mild and transient.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of adjunctive topiramate for schizophrenia: a meta‐analysis of randomized controlled trials

Zheng

Xiang

et al. 2016

Acta Psychiatr Scand

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“…However, there is a small evidence base to support integrating the prevention of noncommunicable disease risk factors, such as weight gain, in the management of people with serious mental disorders such as schizophrenia. Recent reviews 23,24 have reported modest evidence of the effectiveness of lifestyle interventions such as changes in diet and physical activity and of switching from certain antipsychotic medications to drugs such as aripiprazole that pose less risk of weight gain and other adverse effects.…”

Section: Addressing Comorbidities: the Evidencementioning

confidence: 99%

Integrating Mental Health In Care For Noncommunicable Diseases: An Imperative For Person-Centered Care

Patel

Chatterji

2015

Health Affairs

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Mental disorders such as depression and alcohol use disorders often co-occur with other common noncommunicable diseases such as diabetes and heart disease. Furthermore, noncommunicable diseases are frequently encountered in patients with severe mental disorders such as schizophrenia. The pathways underlying the comorbidity of mental disorders and noncommunicable diseases are complex. For example, mental and physical noncommunicable diseases may have common environmental risk factors such as unhealthy lifestyles, and treatments for one condition may have side effects that increase the risk of another condition. Building on the robust evidence base for effective treatments for a range of mental disorders, there is now a growing evidence base for how such treatments can be integrated into the care of people with noncommunicable diseases. The best-established delivery model is a team approach that features a nonspecialist case manager who coordinates care with primary care physicians and specialists. This approach maximizes efficiencies in person-centered care, which are essential for achieving universal health coverage for both noncommunicable diseases and mental disorders. A number of research gaps remain, but there is sufficient evidence for policy makers to immediately implement measures to integrate mental health and noncommunicable disease care in primary care platforms.

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Interventions to Improve Cardiovascular Risk Factors in People with Serious Mental Illness

Cited by 22 publications

References 0 publications

The STRIDE Weight Loss and Lifestyle Intervention for Individuals Taking Antipsychotic Medications: A Randomized Trial

The STRIDE Weight Loss and Lifestyle Intervention for Individuals Taking Antipsychotic Medications: A Randomized Trial

Efficacy and safety of adjunctive topiramate for schizophrenia: a meta‐analysis of randomized controlled trials

Integrating Mental Health In Care For Noncommunicable Diseases: An Imperative For Person-Centered Care

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