一项针对患有精神疾病和抗精神病药物相关肥胖症的退伍军人的行为干预随机对照多中心研究。
A Randomized, Controlled Multisite Study of Behavioral Interventions for Veterans with Mental Illness and Antipsychotic Medication-Associated Obesity.
作者信息
Erickson Zachary D, Kwan Crystal L, Gelberg Hollie A, Arnold Irina Y, Chamberlin Valery, Rosen Jennifer A, Shah Chandresh, Nguyen Charles T, Hellemann Gerhard, Aragaki Dixie R, Kunkel Charles F, Lewis Melissa M, Sachinvala Neena, Sonza Patrick A, Pierre Joseph M, Ames Donna
机构信息
Research Service at VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Mental Health Service at VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd. B151H, Los Angeles, CA, 90073, USA.
出版信息
J Gen Intern Med. 2017 Apr;32(Suppl 1):32-39. doi: 10.1007/s11606-016-3960-3.
BACKGROUND
Weight gain and other metabolic sequelae of antipsychotic medications can lead to medication non-adherence, reduced quality of life, increased costs, and premature mortality. Of the approaches to address this, behavioral interventions are less invasive, cost less, and can result in sustained long-term benefits.
OBJECTIVE
We investigated behavioral weight management interventions for veterans with mental illness across four medical centers within the Veterans Affairs (VA) Healthcare System.
DESIGN
We conducted a 12-month, multi-site extension of our previous randomized, controlled study, comparing treatment and control groups.
PARTICIPANTS
Veterans (and some non-veteran women) diagnosed with mental illness, overweight (defined as having a BMI over 25), and required ongoing antipsychotic therapy.
INTERVENTIONS
One group received "Lifestyle Balance" (LB; modified from the Diabetes Prevention Program) consisting of classes and individual nutritional counseling with a dietitian. A second group received less intensive "Usual Care" (UC) consisting of weight monitoring and provision of self-help.
MAIN MEASURES
Participants completed anthropometric and nutrition assessments weekly for 8 weeks, then monthly. Psychiatric, behavioral, and physical assessments were conducted at baseline and months 2, 6, and 12. Metabolic and lipid laboratory tests were performed quarterly.
KEY RESULTS
Participants in both groups lost weight. LB participants had a greater decrease in average waist circumference [F(1,1244) = 11.9, p < 0.001] and percent body fat [F(1,1121) = 4.3, p = 0.038]. Controlling for gender yielded statistically significant changes between groups in BMI [F(1,1246) = 13.9, p < 0.001]. Waist circumference and percent body fat decreased for LB women [F(1,1243) = 22.5, p < 0.001 and F(1,1221) = 4.8, p = 0.029, respectively]. The majority of LB participants kept food and activity journals (92%), and average daily calorie intake decreased from 2055 to 1650 during the study (p < 0.001).
CONCLUSIONS
Behavioral interventions specifically designed for individuals with mental illness can be effective for weight loss and improve dietary behaviors. "Lifestyle Balance" integrates well with VA healthcare's patient-centered "Whole Health" approach. ClinicalTrials.gov identifier NCT01052714.
背景
抗精神病药物导致的体重增加及其他代谢后遗症可导致药物治疗依从性降低、生活质量下降、成本增加和过早死亡。在解决这一问题的方法中，行为干预侵入性较小、成本较低，且可带来持续的长期益处。
目的
我们在退伍军人事务部（VA）医疗保健系统的四个医疗中心，对患有精神疾病的退伍军人进行了行为体重管理干预研究。
设计
我们对之前的随机对照研究进行了为期12个月的多中心扩展研究，比较治疗组和对照组。
参与者
被诊断患有精神疾病、超重（定义为体重指数超过25）且需要持续接受抗精神病治疗的退伍军人（以及一些非退伍军人女性）。
干预措施
一组接受“生活方式平衡”（LB；改编自糖尿病预防计划），包括课程和与营养师的个人营养咨询。另一组接受强度较低的“常规护理”（UC），包括体重监测和提供自助服务。
主要测量指标
参与者在8周内每周完成人体测量和营养评估，之后每月进行一次。在基线以及第2、6和12个月进行精神、行为和身体评估。每季度进行代谢和血脂实验室检查。
关键结果
两组参与者均体重减轻。接受“生活方式平衡”干预的参与者平均腰围下降幅度更大[F(1,1244)=11.9，p<0.001]，体脂百分比下降幅度更大[F(1,1121)=4.3，p=0.038]。在控制性别因素后，两组之间的体重指数变化具有统计学意义[F(1,1246)=13.9，p<0.001]。接受“生活方式平衡”干预的女性腰围和体脂百分比均下降[分别为F(1,1243)=22.5，p<0.001和F(1,1221)=4.8，p=0.029]。大多数接受“生活方式平衡”干预的参与者记录了饮食和活动日志（92%），在研究期间平均每日卡路里摄入量从2055千卡降至1650千卡（p<0.001）。
结论
专门为患有精神疾病的个体设计的行为干预对减肥有效，并可改善饮食行为。“生活方式平衡”与VA医疗保健以患者为中心的“整体健康”方法很好地结合。ClinicalTrials.gov标识符：NCT01052714。
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