Investigating the interplay between physical and mental health in patients with psychosis
A joint CLAHRC Oxford and Oxford BRC project is examining the barriers between mental health and good physical health for patients with psychosis, starting at the earliest stages of the Early Intervention in Psychosis pathway, to prevent weight gain.
People with a first episode of psychosis entering in to Early Intervention in Psychosis (EIP) services at risk of weight gain.
Excess weight in patients with serious mental health problems is a major health, social, and economic problem for health authorities in the UK. This is reflected in the high prevalence of obesity, cardiovascular disease and diabetes in patients with psychosis.
This project is examining the barriers between mental health and good physical health for patients with psychosis, starting at the earliest stages of the Early Intervention in Psychosis pathway, to prevent weight gain.
This project aims to:
- Improve our theoretical understanding of the causes of weight gain and barriers to weight loss in patients with psychosis. This includes assessing the interplay between physical, behavioural, psychological and social factors in patients during the first 12 weeks of antipsychotic medication prescription, the time period associated with both distressing psychotic experiences, initial treatment and rapid weight gain. This will contribute to firstly developing a theoretical model of the causes of weight gain and barriers to treatment, and secondly an effective treatment intervention
- Understand the preferences of people with psychosis for different approaches to losing weight. loss interventions. Focus groups/interviews will be conducted with three groups: 1) patients in the first 12 weeks of antipsychotic treatment; 2) patients with chronic obesity and ongoing psychotic experiences, 3) healthcare / weight loss strategy providers.
This project will work through multiple research themes in both the NIHR CLAHRC Oxford and the NIHR Oxford Biomedical Research Centre.
Patients with psychosis have a reduced life expectancy by 14.5 years, with people with schizophrenia having a 3.5 times higher annual risk of mortality compared to other people (Hayes et al 2017). Thus, physical health is a key target in NICE guidelines for schizophrenia and Early Intervention in Psychosis services.
There are a number of potential causes of excess weight in patients with psychosis, including:
- The nature of the illness and medication: In particular symptoms of paranoia, distress, apathy and social withdrawal. Treatment with atypical antipsychotics lead to rapid weight gain, with 80% patients gaining greater than 7% body mass within first year, and 4-9kg weight gain in the first 12 weeks of medication use,
- The 'Obesogenic' environment: all factors are increased in those with schizophrenia, with reduced physical activity, poor diet, reduced social contact and support, and poverty; and
- Barriers between physical and mental healthcare: those with schizophrenia have reduced access to physical health treatments, with issues including lack of accessibility, diagnostic overshadowing, and stigma.
NICE recommendations for the treatment of obesity are based on strong evidence from clinical trials of dietary and lifestyle interventions. However, people with severe mental illness (SMI) are often excluded from these trials. There have been recent trials of interventions in patients with SMI, however these have not proved successful (e.g. Osborn et al, 2018; Gossage-Worrall et al, 2016).
A significant factor is the poor engagement in these programmes, with greater than half of people dropping out of the studies. We do not yet understand the barriers to successful treatment for these patients. Given the rapid weight gain during the initial period of antipsychotic treatment we hypothesise that there are distinct factors which require investigation in order to develop a better theoretical understanding of weight gain in people with early psychosis in order to inform future treatment developments and uptake.
This work is intended to advance our theoretical understanding of mechanisms in order to develop new and effective treatments for testing in future clinical trials.