Management of Antipsychotic Medication Associated Obesity - 2

抗精神病药物相关肥胖的管理 - 2

• 批准号: 7862073
• 负责人: DONNA Ames AMES
• 金额: --
• 依托单位: VA GREATER LOS ANGELES HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-01 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7862073
• 关键词: Address; Adherence; Adopted; Adverse effects; Advocate; Ambulatory Care Facilities; American Psychiatric Association; Antipsychotic Agents; Appointment; Asorbicap; Behavior Therapy; Behavioral; Body Weight decreased; Cardiovascular system; Caregivers; Caring; Cholesterol; Community Integration; Control Groups; Coronary Arteriosclerosis; Cost Savings; Counseling; Country; Data Analyses; Development; Diabetes Mellitus; Diagnostic; Diagnostic and Statistical Manual; Diet; Disabled Persons; Disease; Education; Effectiveness; Emotional; Equilibrium; Exercise; Family; Family Relationship; Financial cost; Food; Freedom; Friendships; Funding; Grant; Health; Health Personnel; Healthcare; Healthcare Systems; Heart Diseases; Impaired cognition; Independent Living; Individual; Intervention; Interview; Knowledge; Lead; Life Style; Lipids; Los Angeles; Measures; Medical; Medical center; Mental Health; Mental disorders; Mentally Ill Persons; Metabolic; Metabolic syndrome; Methods; Mission; Modeling; Monitor; Morbidity - disease rate; Motivation; National Institute of Mental Health; Neurobehavioral Manifestations; Obesity; Outcome; Overweight; Participant; Patient Monitoring; Patients; Persons; Pharmaceutical Preparations; Population; Protocols documentation; Psyche structure; Psychiatric therapeutic procedure; Psychopathology; Public Health; Quality of life; Questionnaires; Randomized; Recommendation; Recovery; Recreation; Regimen; Reporting; Research; Research Proposals; Resources; Risk; Risk Factors; Safety; Schedule; Schizophrenia; Self Management; Services; Site; Societies; Substance abuse problem; Surgeon; Surveys; Symptoms; System; Techniques; Testing; Translating; Veterans; Weight; Weight Gain; Weight maintenance regimen; Wellness Program; Work; abstracting; active method; atypical antipsychotic; base; biopsychosocial; cardiovascular risk factor; cohort; combat; cost; design; diabetes prevention program; diaries; diet and exercise; disability; empowerment; glucose tolerance; health administration; heart disease risk; hospital utilization; improved; insight; instrument; intervention program; lifestyle intervention; meetings; multi-component intervention; nutrition; patient home care; prevent; programs; prospective; psychoeducation; psychosocial; psychosocial rehabilitation; severe mental illness; skills training; success; treatment adherence; treatment as usual; treatment duration; treatment program; user-friendly; web site; weight loss intervention

DESCRIPTION (provided by applicant): Project Summary/Abstract: Introduction: Obesity and its related conditions such as diabetes and heart disease are unfortunate side effects of the medications used to treat veterans with severe mental illness. In combination, obesity and severe mental illness pose a huge public health problem. The FDA and the VA inspector general are concerned about the monitoring and safety of severely mentally ill patients taking antipsychotic medications. This research is designed to test a multi-modal approach to the problem of antipsychotic medication associated obesity over a 12-month period at 4 different VA settings. Though the MOVE program has been developed to combat obesity in the general VA population, there exists a large portion of patients with severe mental illness who cannot or will not access MOVE. This program is designed to fill the gap that usual care does not provide. This study will test this special intervention for severely mentally ill patients taking antipsychotic medications and comparing this intervention to usual care at 4 VA sites. Methods: 120 veterans from four different VA sites will be randomly assigned to either a 12 month multi-modal behavioral treatment program vs. usual care for the monitoring and treatment of medication associated obesity. The multi modal treatment approach, the Lifestyle Balance Program adopted from the federally funded Diabetes Prevention Program, is aimed at changing lifestyles and includes individual health coaching, and group classes weekly for the first 8 weeks, as well as a prescribed individualized plan for exercise and dietary changes that will result in weight loss. Additionally, counseling with caregivers on support of lifestyle changes will be provided and meal substitution will be implemented for veterans who have no control over food provided to them in institutional type settings (e.g. board and care homes). Following the initial 8 weeks, individual coaching and group booster classes will occur for the next 10 months on a monthly basis. This study will also test the ability of other VA sites to adopt a weight loss program for this particular population. Preliminary Results: This is a continuation of an ongoing program in which 120 veterans have already participated. Thus far, our preliminary results have been promising. We have observed twice the weight loss that we anticipated in the initial grant period over a year long weight loss program. We have seen improvements in certain symptoms of mental illness, as veterans appear to be more outgoing and less withdrawn. We also have seen a positive impact on veterans' well being and the quality of their lives. Additionally we have achieved with weight loss an improvement in risk factors for heart disease. This prolongs the lives of veterans with severe mental illness and translates into cost savings for veterans, their families, and society in general. This new study will determine if the success at our one site can be achieved at three additional sites. PUBLIC HEALTH RELEVANCE: Project Narrative & Significance to the VA: This work has relevance to the VA's care mission for many reasons. A great number of veterans suffer from severe mental illness. They must take antipsychotic medications that are now recognized to have several side effects associated with them including obesity, diabetes and changes in cholesterol. This risk has been recognized by he FDA and the VA Inspector General and careful monitoring of patients taking antipsychotic medications has been advocated. These side effects increase the burden of medical illness, particularly the risk of heart disease, upon veterans who are already largely disabled and stigmatized by mental illness itself. Mental illness and obesity combined together pose huge health care and emotional costs upon patients, their families, the VA, and society in general. The financial costs of both mental illness and obesity and its related conditions are in the billions of dollars to the VA Healthcare system.

描述（由申请人提供）： 项目摘要/摘要：简介：肥胖及其相关疾病（例如糖尿病和心脏病）是用于治疗患有严重精神疾病的退伍军人的药物的不幸副作用。肥胖和严重的精神疾病共同构成了巨大的公共健康问题。 FDA 和 VA 监察长对服用抗精神病药物的严重精神病患者的监测和安全表示担忧。这项研究旨在在 12 个月的时间里，在 4 个不同的 VA 环境下，测试一种多模式方法来解决与抗精神病药物相关的肥胖问题。尽管 MOVE 计划是为了对抗一般退伍军人管理局人群的肥胖而开发的，但仍有很大一部分患有严重精神疾病的患者无法或不会接受 MOVE。该计划旨在填补常规护理无法提供的空白。这项研究将针对服用抗精神病药物的严重精神病患者测试这种特殊干预措施，并将这种干预措施与 4 个 VA 中心的常规护理进行比较。方法：来自 4 个不同 VA 地点的 120 名退伍军人将被随机分配接受为期 12 个月的多模式行为治疗计划与常规护理，以监测和治疗与药物相关的肥胖。多模式治疗方法，即从联邦政府资助的糖尿病预防计划中采用的生活方式平衡计划，旨在改变生活方式，包括个人健康指导、前 8 周每周一次的小组课程，以及规定的个性化锻炼和锻炼计划。饮食习惯的改变会导致体重减轻。此外，还将向护理人员提供关于支持生活方式改变的咨询，并将为无法控制机构类型环境（例如寄宿和护理院）中提供的食物的退伍军人实施膳食替代。在最初的 8 周之后，接下来的 10 个月将每月举办个人辅导和团体强化课程。这项研究还将测试其他退伍军人事务部针对这一特定人群采取减肥计划的能力。初步结果：这是一项正在进行的计划的延续，已有 120 名退伍军人参加了该计划。到目前为止，我们的初步结果是有希望的。在为期一年的减肥计划中，我们观察到体重减轻是我们在最初资助期间预期的两倍。我们已经看到精神疾病的某些症状有所改善，因为退伍军人似乎更加外向，不再孤僻。我们还看到了对退伍军人的福祉和生活质量的积极影响。此外，我们还通过减肥改善了心脏病的危险因素。这延长了患有严重精神疾病的退伍军人的生命，并为退伍军人、他们的家人和整个社会节省了费用。这项新研究将确定我们一个地点的成功是否可以在另外三个地点取得。 公共卫生相关性： 项目叙述及对 VA 的意义：由于多种原因，这项工作与 VA 的护理任务相关。许多退伍军人患有严重的精神疾病。他们必须服用抗精神病药物，目前已知这些药物具有多种副作用，包括肥胖、糖尿病和胆固醇变化。 FDA 和 VA 监察长已认识到这种风险，并提倡对服用抗精神病药物的患者进行仔细监测。这些副作用增加了退伍军人的医疗疾病负担，特别是心脏病的风险，这些退伍军人已经基本上残疾并因精神疾病本身而受到侮辱。精神疾病和肥胖加在一起给患者、他们的家人、退伍军人管理局和整个社会带来了巨大的医疗保健和情感成本。退伍军人医疗保健系统因精神疾病和肥胖及其相关病症而承受的经济损失高达数十亿美元。