Behavioral Intervention to Reduce Novel Antipsychotic Medication Health Risks

降低新型抗精神病药物健康风险的行为干预

基本信息

批准号：
7270621
负责人：
Jeffrey A Kelly
金额：
$ 31.26万
依托单位：
MEDICAL COLLEGE OF WISCONSIN
依托单位国家：
美国
项目类别：
财政年份：
2006
资助国家：
美国
起止时间：
2006-09-01 至 2011-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7270621
关键词：
AIDS prevention Acute Adopted Adult Adverse effects Antipsychotic Agents Attention Attitude Behavior Behavior Therapy Behavioral Benefits and Risks Blood Glucose Blood Pressure Body Weight decreased Body fat Body mass index Caring Characteristics Cholesterol Class Clinical Cognitive Communities Condition Consumption Control Groups Daily Data Data Analyses Data Collection Depth Diabetes Mellitus Diabetic Ketoacidosis Diagnosis Diet Diet Habits Disadvantaged Disease Eating Education Educational process of instructing Effectiveness of Interventions Eligibility Determination Energy Intake Environment Environmental Risk Factor Ethnic Origin Ethnography Exercise Exhibits Expectancy Feedback Focus Groups Food Gender Goals Group Homes HIV Happiness Health High Density Lipoprotein Cholesterol Home environment Human Resources Hypertension Influentials Informed Consent Insulin Resistance Intervention Interview Knowledge Laboratories Life Life Expectancy Life Style Lipids Low-Density Lipoproteins Measures Medical Mental disorders Metabolic Methods Modeling Monitor Mood Disorders Morbidity - disease rate Multivariate Analysis Numbers Obesity Obesity associated cardiovascular disease Outcome Participant Patient Self-Report Patients Pattern Persons Pharmaceutical Preparations Phase Physical activity Physiological Population Prevalence Prevention Research Prevention intervention Procedures Psychiatric Diagnosis Pulse Pressure Pulse Rates Quality of life Race Randomized Randomized Controlled Trials Rate Relative (related person)Research Research Activity Rest Risk Risk Behaviors Risk Factors Risk Reduction Risk Reduction Behavior Running Sampling Schizophrenia Score Series Services Social support Standards of Weights and Measures Structure Symptoms Testing Time Training Treatment Efficacy Treatment Protocols Walking Week Weight Weight Gain Well in self Wisconsin atypical antipsychotic base behavior change cardiovascular disorder risk cardiovascular risk factor design diabetes risk diet and exercise environmental change environmental intervention experience fitness food surveillance health related quality of life improved medication compliance mortality motivated behavior novel nutrition peer prevent programs residence response sedentary severe mental illness skills social success therapy development

项目摘要

DESCRIPTION (provided by applicant): "Novel" or "atypical" antipsychotic medications constitute the current standard of care for the treatment of many serious mental illnesses because they target both positive and negative symptoms and have fewer extrapyramidal side effects than earlier medications. However, there is growing concern that these psychiatric benefits are offset by serious negative medical consequences related to weight gain including obesity-related cardiovascular risk, insulin resistance, diabetes, and diabetic ketoacidosis. The risk/benefit ratio of atypical antipsychotic regimens could be improved if behavioral interventions helped persons with serious mental illness to reduce weight, sustain weight loss, and achieve better fitness. HIV prevention research has shown that cognitive-behavioral small-group interventions-especially when combined with mechanisms that provide peer and structural/environmental risk reduction support-can help persons change even longstanding risk patterns. Following a period of formative ethnographic research related to intervention development, this project will evaluate the effects of a behavior change intervention modeled after approaches shown effective in the HIV prevention field. In a randomized controlled trial design, 20 community group homes providing residence to persons with serious mental illness will be assigned to either an experiemental intervention that seeks to decrease residents' weight and increase exercise, or to a time- matched attention control program. The intervention, based on social-cognitive theoretical principles, will include a 20-session small-group component conducted in each group home focused on diet and exercise. Social leaders identified in each home will be trained to support others' efforts, and environmental change supports will be introduced in the group home settings. At baseline and a 3 post-intervention followup points over 12 months, data will be collected to measure change in: (1) participants' diet and exercise patterns using self-report and observational methods including daily pedometer and food monitoring for one-week periods; (2) clinical health indicators (weight, body mass index, body fat distribution, pulse rate, and blood pressure; (3) laboratory tests measuring blood glucose, cholesterol HDL, LDL, triglicerides, and other indicators; and (4) ancillary domains including psychological well-being, health quality of life, and self- reported antipsychotic medication adherence. We hypothesize that residents in experimental condition group homes will show greater average weight loss, greater reduction in body mass index, and positive effects across other behavioral, clinical, physiological, and ancillary measures than residents in control condition group homes at each followup point. If successful, this research will identify a pratical behavioral intervention approach that may be able to offset significant medical risk factors often experienced by persons with serious mental illness, especially those on novel antipsychotic medications.

描述（由申请人提供）：“新颖”或“非典型”抗精神病药是治疗许多严重精神疾病的当前护理标准，因为它们针对的是正症状和阴性症状，而锥体外副作用却少于早期的药物。但是，人们越来越担心这些精神病益处被与体重增加有关的严重负面医学后果所抵消，包括与肥胖相关的心血管风险，胰岛素抵抗，糖尿病和糖尿病性酮症酸中毒。如果行为干预措施帮助患有严重精神疾病的人减轻体重，减轻体重并实现更好的健康状况，则可以改善非典型抗精神病药疗法的风险/益处比率。艾滋病毒预防研究表明，认知行为的小组干预措施 - 尤其是与提供同伴和结构/结构/环境风险降低的机制相结合时，即使是长期存在的风险模式，也可以改变人们。在经过一段与干预发展有关的形成性民族志研究之后，该项目将评估以在HIV预防领域有效的方法建模的行为变化干预措施的效果。在随机对照试验设计中，为患有严重精神疾病的人提供住所的20个社区小组将被分配给试图减轻居民体重并增加运动的体验干预措施，或者将注意力匹配的注意力控制计划。基于社会认知理论原则的干预措施将包括在每个集中饮食和运动的家庭中进行的20条小组组成部分。在每个房屋中确定的社会领导者将接受培训以支持他人的努力，并且将在小组家庭环境中引入环境变化支持。在12个月内，将收集数据的基线和3个干预后的随访点，以测量以下方式的变化：（1）使用自我报告和观察方法（包括每日计步器和一周期间的食物监测）参与者的饮食和运动模式；（2）临床健康指标（体重，体重指数，体内脂肪分布，脉搏率和血压；（3）测量血糖，胆固醇HDL，LDL，Triglicerides和其他指标的实验室测试；以及（4）辅助领域，包括心理健康质量，生活中的健康质量，驻留较高的守护者，驻留于守护者的情况下，守护者的态度更高。与控制状况组中的居民相比，体重减轻，体重指数的减少和其他行为，临床，生理和辅助措施的积极作用在每个随访中，这项研究将确定一种可能会弥补患有严重精神疾病的人，尤其是对新型精神病患者的重要医疗风险。