Community lifestyle interventions – making them work in schizophrenia

Disseminating the messages of ACHIEVE - ACHIEVE-D

Gail Daumit, Johns Hopkin’s University Medical School, Baltimore, MD, described the adaptation of the successful ACHIEVE program, an evidence-based, weight loss intervention targeted at those with serious mental illnesses (SMI), for delivery by community health program staff. ¹ 

A modified, shorter version of ACHIEVE was devised and tested in a mini-pilot study to assess its acceptability both to those with SMI (n=14) and to the staff at one community-based psychiatric rehabilitation center who would be implementing it. Any effect on lifestyle behavior among participants was also assessed.

ACHIEVE-D - feasible and acceptable

ACHIEVE-D was feasible and acceptable, both to staff and patients. Furthermore, sedentary behavior and food cravings were reduced. However, both groups agreed that weight measurements were too frequent and triggered stress – something to be modified as the program is further rolled-out.

Weight measurements were too frequent and triggered stress

MIDAS – Multi-component Intervention for Diabetes in Adults with Serious Mental Illness

Dilip Jeste, University of California at La Jolla, CA, described the challenges of managing people with schizophrenia at risk of, or living with, Type 2 diabetes in Board-and-Care facilities. Such residential care homes are ideal for interventional studies such as MIDAS: whether a care home is amendable to change and whether the Activities’ Manager employed there can - and wants to - be trained essentially as the residents’/patients’ therapist becomes very apparent.

MIDAS comprises four components; education, dietary interventions, increased physical activity and smoking cessation. Activities’ Managers were trained to offer twice weekly sessions for 6 months offering support in these key areas. Additionally, cooks working in the facility are coached in the preparation of healthier meals – and taking second helpings was discouraged. Residents were assessed throughout, and for 6 months following cessation of, the MIDAS intervention including monitoring of blood markers of Type 2 diabetes.

MIDAS well received

The MIDAS intervention was well received by residents and Activities Managers: 96% of all intended MIDAS sessions occurred and residents attended a mean of 65% of sessions. Knowledge about health eating and daily activity levels also increased.

Although there were challenges, small but meaningful changes in diabetic signals were achieved

There were challenges but, as Dr Jeste explained, small but meaningful changes in diabetic signals suggest the MIDAS approach works.

App-based approach to diabetes prevention

Dr Ginger Nicol, Washington University School of Medicine in St Louis, MO, sought to devise a preventative, app-based program for young people based on the Diabetes Prevention Program. The app was developed to use mobile technology to support live health coaching, and was trialed on 28 young people with psychiatric disorders.

Overall, lessons were learned in the way apps should be developed to support the needs of young people with schizophrenia. For instance, too many prompts were not good for fragile patients. Even its look and functionality make a difference to its acceptability. Further developments are awaited.

Clinical decision support tool improves cardiovascular outcomes in schizophrenia

Trialing of a clinician-facing, electronic health record-based, clinical decision support tool for improving total modifiable cardiovascular (CV) disease risk was presented by Dr Rebecca Rossom, University of Minnesota Medical School, St. Paul. MN.  A total of 8922 patients with schizophrenia, bipolar disease and schizoaffective disorder were recruited to this cluster randomized control trial involving 78 primary care clinics.  

An 11% decrease in total modifiable CV risk at 12 months – the primary outcome of the study – was reported in those aged 18-29 years. This finding is particularly encouraging given emerging evidence of improved lifelong outcomes when CV health issues are addressed earlier in those with serious mental illness.

An 11% decrease in total modifiable cardiovascular risk at 12 months was seen in those aged 18-29 years