Management of Antipsychotic Medication Associated Obesity - 2

描述(由申请人提供)： 项目摘要/摘要：前言：肥胖及其相关疾病，如糖尿病和心脏病，是用于治疗患有严重精神疾病的退伍军人的药物的不幸副作用。肥胖症和严重的精神疾病共同构成了一个巨大的公共健康问题。FDA和退伍军人管理局监察长对服用抗精神病药物的严重精神病患者的监测和安全性表示担忧。这项研究的目的是在4个不同的退伍军人事务部环境下，在12个月的时间里测试多模式方法来解决抗精神病药物相关的肥胖问题。尽管MOVE计划是为了对抗普通退伍军人中的肥胖而开发的，但仍有很大一部分患有严重精神疾病的患者不能或将不会使用MOVE。这项计划旨在填补通常护理所不能提供的空白。这项研究将对服用抗精神病药物的严重精神病患者测试这种特殊干预，并将这种干预与4个VA地点的常规护理进行比较。方法：来自四个不同退伍军人地点的120名退伍军人将被随机分配到12个月的多模式行为治疗计划和常规护理中，以监测和治疗药物相关性肥胖。多模式治疗方法，即从联邦资助的糖尿病预防计划中采用的生活方式平衡计划，旨在改变生活方式，包括个人健康指导，前8周每周的集体课程，以及规定的个性化锻炼和饮食改变计划，以达到减肥的目的。此外，将向照顾者提供关于支持生活方式改变的咨询，并将为在机构类型的环境(例如寄宿和疗养院)中无法控制向他们提供的食物的退伍军人实施膳食替代。在最初的8周之后，个人辅导和团体强化课程将在接下来的10个月里每月进行一次。这项研究还将测试其他退伍军人管理局网站为这一特定人群采用减肥计划的能力。初步结果：这是一项正在进行的计划的延续，已有120名退伍军人参加。到目前为止，我们的初步结果是有希望的。在为期一年的减肥计划中，我们观察到的减肥效果是最初资助期预期的两倍。我们已经看到精神疾病的某些症状有所改善，因为退伍军人似乎更外向，不那么孤僻。我们还看到了对退伍军人的福祉和生活质量的积极影响。此外，随着体重的减轻，心脏病的风险因素也有所改善。这延长了患有严重精神疾病的退伍军人的生命，并为退伍军人、他们的家人和整个社会节省了成本。这项新的研究将确定我们一个站点的成功是否可以在另外三个站点实现。

DESCRIPTION (provided by applicant): Project Summary/Abstract: Introduction: Obesity and its related conditions such as diabetes and heart disease are unfortunate side effects of the medications used to treat veterans with severe mental illness. In combination, obesity and severe mental illness pose a huge public health problem. The FDA and the VA inspector general are concerned about the monitoring and safety of severely mentally ill patients taking antipsychotic medications. This research is designed to test a multi-modal approach to the problem of antipsychotic medication associated obesity over a 12-month period at 4 different VA settings. Though the MOVE program has been developed to combat obesity in the general VA population, there exists a large portion of patients with severe mental illness who cannot or will not access MOVE. This program is designed to fill the gap that usual care does not provide. This study will test this special intervention for severely mentally ill patients taking antipsychotic medications and comparing this intervention to usual care at 4 VA sites. Methods: 120 veterans from four different VA sites will be randomly assigned to either a 12 month multi-modal behavioral treatment program vs. usual care for the monitoring and treatment of medication associated obesity. The multi modal treatment approach, the Lifestyle Balance Program adopted from the federally funded Diabetes Prevention Program, is aimed at changing lifestyles and includes individual health coaching, and group classes weekly for the first 8 weeks, as well as a prescribed individualized plan for exercise and dietary changes that will result in weight loss. Additionally, counseling with caregivers on support of lifestyle changes will be provided and meal substitution will be implemented for veterans who have no control over food provided to them in institutional type settings (e.g. board and care homes). Following the initial 8 weeks, individual coaching and group booster classes will occur for the next 10 months on a monthly basis. This study will also test the ability of other VA sites to adopt a weight loss program for this particular population. Preliminary Results: This is a continuation of an ongoing program in which 120 veterans have already participated. Thus far, our preliminary results have been promising. We have observed twice the weight loss that we anticipated in the initial grant period over a year long weight loss program. We have seen improvements in certain symptoms of mental illness, as veterans appear to be more outgoing and less withdrawn. We also have seen a positive impact on veterans' well being and the quality of their lives. Additionally we have achieved with weight loss an improvement in risk factors for heart disease. This prolongs the lives of veterans with severe mental illness and translates into cost savings for veterans, their families, and society in general. This new study will determine if the success at our one site can be achieved at three additional sites.