Deenik Jeroen, Tenback Diederik E, van Driel Harold F, Tak Erwin C P M, Hendriksen Ingrid J M, van Harten Peter N
GGz Centraal, Amersfoort, Netherlands.
School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.
Front Psychiatry. 2018 Dec 18;9:707. doi: 10.3389/fpsyt.2018.00707. eCollection 2018.
Besides having an unhealthy lifestyle contributing to premature mortality, inpatients with severe mental illness (SMI) use high dosages of medication. Previous research has shown improved health after lifestyle improvements in SMI. In addition, we aimed to retrospectively study whether a multidisciplinary lifestyle enhancing treatment (MULTI) was associated with changes in medication use after 18 months, as compared with patients that continued treatment as usual (TAU) and explored mediation by a change in physical activity. We conducted an observational study within a cohort of inpatients with SMI, who received MULTI ( = 65) or continued TAU ( = 49). Data on their somatic and psychotropic medications were collected, converted into defined daily dose (DDD), and analyzed using linear multilevel regression, correcting for baseline value and differences between groups in age, diagnosis, and illness severity. Compared with TAU, the DDD for psychotropic medication significantly decreased with MULTI (B = -0.55, = 0.02). Changes in total activity did not mediate this association, suggesting that multiple components of MULTI contributed. Corrected between-group analyses for subgroups of medication were not possible due to lack of power and skewed distributions. Within-group data showed a decreased proportion of users as well as median DDD in both groups for almost all medications. In addition to previously reported health improvements after 18 months of MULTI, we observed a significant decrease in dose of psychotropic medication in MULTI compared to TAU. This first study evaluating a wide range of medications indicates a possible effect of lifestyle improvements on medication use in inpatients with SMI. Findings need to be confirmed in future controlled studies, however.
除了不健康的生活方式会导致过早死亡外，患有严重精神疾病（SMI）的住院患者还会使用高剂量药物。先前的研究表明，改善生活方式后，SMI患者的健康状况有所改善。此外，我们旨在进行回顾性研究，与继续接受常规治疗（TAU）的患者相比，多学科生活方式强化治疗（MULTI）在18个月后是否与药物使用的变化相关，并探讨身体活动变化的中介作用。我们在一组SMI住院患者中进行了一项观察性研究，这些患者接受了MULTI（n = 65）或继续接受TAU（n = 49）。收集他们的躯体药物和精神药物数据，转换为限定日剂量（DDD），并使用线性多水平回归进行分析，校正基线值以及年龄、诊断和疾病严重程度方面的组间差异。与TAU相比，MULTI使精神药物的DDD显著降低（B = -0.55，P = 0.02）。总活动量的变化并未介导这种关联，这表明MULTI的多个组成部分都有作用。由于缺乏检验效能和分布偏态，无法对药物亚组进行校正后的组间分析。组内数据显示，几乎所有药物在两组中的使用者比例和DDD中位数均下降。除了先前报道的MULTI治疗18个月后健康状况有所改善外，我们还观察到与TAU相比，MULTI中精神药物的剂量显著降低。这项首次评估多种药物的研究表明，生活方式的改善可能对SMI住院患者的药物使用产生影响。然而，研究结果需要在未来的对照研究中得到证实。
