Self-management intervention to prevent weight gain in young patients with antipsychotic medication Johan Åhlin, Sonja Beckmann, Indre Brasaite Loreena Hill, Victoria Navarta, Eriikka Siirala

The European Academy of Nursing Science 2 Background to our project 80% of patients with psychotic mental illnesses take secondary generation antipsychotic medication (SGA)  high risk for obesity and diabetes SGA increases costs for the health care system Schizophrenic patients have 12-fold higher risk for cardiovascular disease, than general population

The European Academy of Nursing Science 3 Why our project is important 15-y reduced life expectancy compared to general population (e.g. CV disease, suicide) Onset of psychotic mental illness is mainly between the age of Gaps in literature: no evaluation of peer / family support, key characteristics of successful behavioral interventions Preventive non-pharmacological interventions for weight management can be effective, cost-efficient and beneficial, if they are offered in early stages of antipsychotic treatment.

The European Academy of Nursing Science 4 Our Aim To conduct a pilot-test of a 4 component intervention, to control weight as indicator for self-management, in individuals aged of 16 to 25 years prescribed SGA in the past 6 months. Taking action Patient / health care provider partnership Problem solving Decision making Resource utilization Taking action Patient / health care provider partnership Problem solving Decision making Resource utilization

4 components of the intervention The European Academy of Nursing Science 5 Booklet with information Illness and comorbidities, side effects of medication, contact numbers, additional links, further education programs, support groups, coping strategies… Peer support Exercise groups, cooking class, grocery shopping … Individual nurse counseling Weekly face-to-face / telephone contact with patients and family, standardized intervention process, guidelines… webBALANCE platform Interactive internet platform and APP (self-monitoring of energy intake, expenditure, weight, Wii activities … )

The European Academy of Nursing Science 6 Intervention in view of behavior change techniques and self-management support Prompt self- monitoring of behavior Provide feedback performance Prompt specific goal setting Prompt intention formation Prompt review of behavioral goals Taking action web BALANCE web BALANCE, Counseling, Peers web BALANCE, Counseling web BALANCE, Counseling Patient/health care provider partnership Counseling, Booklet Counseling Problem solving Booklet Peers Decision making Booklet, Guidelines Resource utilization Booklet

Methods Design: Single case experimental studies Sample: purposive, 4 male and 4 female Inclusion: age 16-25, prescription SGA within the last 6 months, living in community, stable psychiatric state according to diagnosis by psychiatrist Primary outcome: energy intake/expenditure in kcal/day Secondary outcomes: weight, BMI, waist circumference, clinical indicators (e.g. glucose, lipids…), adherence to the intervention Qualitative interviews before and after the intervention The European Academy of Nursing Science 7

Days Difference in energy intake and expenditure

Thank you for your attention

References Citrome L ; Vreeland B, (2008) Schizophrenia, obesity, and antipsychotic medications: what can we do? Eapen V et al (2011) Weight gain and metabolic syndrome among young patients on antipsychotic medication Humphrey L.B (2008) Obesity in Schizophrenia: Screening, Monitoring, and Health Promotion McLoughen et al (2012) Physical health & wellbeing Alvare-Jimenez (2008) Saravane D, Feve B, Frances Y, Corruble E, Lancon C, Chanson P, Maison P, Terra JL, Azorin JM; avec le soutien institutionnel du laboratoire Lilly. Drawing up guidelines for the attendance of physical health of patients with severe mental illness]. Encephale Sep;35(4): Ward et al (2013) journal of Pharmacy and therapeutics – indicate increasings costs with the medication Wagner, E. H., Austin, B. T., & Korff, M. V. (1996). Improving Outcomes in Chronic Illness. Managed Care Quarterly, 4, 2, Vandyk & Baker ( 2012) Morgan & Morgan (2009) Single case research methods for the behavioral and health sciences: London: sage The European Academy of Nursing Science 10