Authors (including presenting author) :
Ng PY, Cheng PS, Hui WY, Ip KW, Shum CM
Affiliation :
Community Psychiatric Services, Kwai Chung Hospital, KWC
Introduction :
Second Generation Antipsychotic (SGA) is commonly used to treat patients with Server mental Illness (SMI) because of lower risk of extra-pyramidal side effects and better effect in alleviating the negative symptoms and affective symptoms as well. However, SGA causes higher risks of metabolic side effect such as weight gain and higher incidence of cardiovascular disease (Usher, Park, Foster, & Buetter, 2012). In 2019, COC(Psy.) recommended to have regular monitoring on bodyweight, blood glucose level and blood lipid level for this group of patients. Strategies of management of metabolic side effects should be considered to minimize the potential adverse outcomes related to the use of SGA. Under the care of Community Psychiatric Services(CPS) in Kwai Chung Hospital (KCH), around 16% of patients are taking SGA. However, there is a lack of structured intervention for meeting the needs of this group of patients in the community. Thus, a pilot evidence-based program “Non-pharmacological intervention in improving BMI for patients with SMI who are receiving SGA in community” is developed in CPS.
Objectives :
To implement an evidence-based lifestyle modification program and evaluate the effectiveness in improving the BMI of patients who are diagnosed with SMI and taking SGA.
Methodology :
Literature review was conducted based on the Johns Hopkins Nursing Evidence Based Practice framework. The program was designed according to the evidence summary identified, which is comprised of six individual sessions and subsequent booster sessions to empower the patients on the management of pharmacological effects, address the belief on drug and weight management, and foster the behavioral changes of lifestyles. The sessions were conducted through home visits or interviews or phone contacts. A booklet with information of diet control, quick reference of physical activities and basic medication information was given to the patients as reference. During the program delivery, the patients were also encouraged to use the provided food and physical diary for daily record. The inclusion criteria were Asian adults, aged 18-64, overweight or obese (BMI≧23), SMI and, receiving SGA. Patients with comorbid diagnosis of eating disorder, substance abuse, cognitive impairment, cardiovascular disease or diabetes mellitus were excluded. BMI, body weight and waist circumference were measured at baselinbe,3, 6-month interval. Prior to the program implementation, briefing sessions to all case managers in CPS were conducted to ensure the interventions would be delivered effectively.
Result & Outcome :
A total of 110 individuals was recruited from CPS of KCH from March, 2021 onward. Pre- and post- program outcome measurements were collected. As at 31st December, 2022, 96 patients (87.3%) completed the program. At the three-month follow-up, 63 patients (65.6 %) had a mean weight loss of 1.62kg. The BMI decreased was 0.61 in average at three-month follow-up. The reduction of waist circumference was 1.5 cm in average. At the six-month follow-up, 68 patients (70.8%) lost a mean of 2.12 kg. The BMI decreased was 0.8 at the six-month follow-up. The reduction of waist circumference was 2.55cm in average. The outcomes were similar to the results found in the literature, in which 1.15kg to 1.77kg weight loss from baseline to the six-month follow-up (Gurusamy, et al, 2018). However, weight gain was found in 23.9% of the patient (n=23) at the six-month follow-up. Limitations such as restriction of variety of exercise during COVID-19 and increased time of home stay with increased intake of snacks were identified. Booster sessions were further provided for ongoing review and psychological support to overcome the barriers encountered. The pilot program has shown to have promising positive effect in improving the BMI for patients with SMI who are receiving SGA in community.
