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Psychosocial Health Intervention in Schizophrenia

In patients with schizophrenia and psychotic disorders, a psychosocial health promotion intervention had little effect on cardiovascular risk indicators, but the run-in period had a positive effect on cardiometabolic risk factors. The aim of the study was to assess whether the intervention improves cardiometabolic risk factors, quality of life, and severity of illness in this population compared to treatment as usual. Outcome variables were assessed at 6 months before intervention during the run-in period, at the start of intervention, and 12 months after the intervention began. Researchers found:

  • The intervention group had 119 patients and the control group (treatment as usual) 570 patients.
  • The intervention had no significant effect on any of the outcome variables.
  • However, body mass index (BMI), waist circumference, systolic blood pressure, heart rate, HbA1c, general health, and Clinical Global Impressions Scale score improved significantly during the run-in period before the start of the active intervention.

Citation:

Westman J, Eberhard J, Gaughran FP, et al. Outcome of a psychosocial health promotion intervention aimed at improving physical health and reducing alcohol use in patients with schizophrenia and psychotic disorders (MINT). [Published online ahead of print April 9, 2019]. Schizophr Res. doi:10.1016/j.schres.2019.03.026.

Commentary:

People with serious mental illness such as schizophrenia lose, on average, 1-2 decades of life compared to the general population. Premature mortality among those with schizophrenia is largely due to cardiovascular disease that may be related to life-style factors such as high rates of smoking and sedentary behavior as well as iatrogenic factors such as antipsychotic drugs that increase risk for weight gain and diabetes as well as possible intrinsic biological risks that are evident even early in the course of psychotic illness. In spite of promising findings during a run-in period, this highly rigorous study, like several other multi-component health promotion efforts, failed to demonstrate efficacy in improving cardiometabolic risk in people with schizophrenia. As suggested by the study authors, it may be time to consider embedding biological interventions (ie, medications to lower serum lipid levels or to help with smoking cessation) into psychosocial interventions targeting cardiometabolic risk in people with serious mental illness. —Martha Sajatovic, MD, Professor of Psychiatry and of Neurology; Willard Brown Chair in Neurological Outcomes Research; Director, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center; Case Western Reserve University School of Medicine.