Health inequalities in Psychosis

Oxford
Published Date: 25 Jan 2019

A joint CLAHRC Oxford and Oxford BRC project is examining the barriers between mental health and good physical health for patients with psychosis, starting at the earliest stages of the Early Intervention in Psychosis pathway, to prevent weight gain.

WHO? 

People with a first episode of psychosis entering in to Early Intervention in Psychosis (EIP) services at risk of weight gain.

WHAT?

This project is examining the barriers between mental health and good physical health for patients with psychosis, starting at the earliest stages of the Early Intervention in Psychosis pathway, to prevent weight gain and its associated effects on people's quality of life and mortality.

AIMS

This project aims to:

  1. Improve our theoretical understanding of the causes of weight gain and barriers to weight loss in patients with psychosis. This includes assessing the interplay between physical, behavioural, psychological and social factors. This will contribute to firstly developing a theoretical model of the causes of weight gain and barriers to treatment, and secondly an effective treatment intervention.
  2. Understand the preferences of people with psychosis for different approaches to losing weight. loss interventions.

This project will work through multiple research themes in both the NIHR CLAHRC Oxford and the NIHR Oxford Biomedical Research Centre.

WHY?

Patients with psychosis have reduced life expectancy by 14.5 years, with people with schizophrenia having a 3.5 times higher annual risk of mortality compared to other people (Hayes et al 2017). 

There are several potential causes of excess weight in patients with psychosis, including:

  • The nature of the illness and medication: In particular symptoms of paranoia, distress, apathy and social withdrawal. Some drug treatments can lead to rapid weight gain, with 80% patients gaining greater than 7% body mass within first year, and 4-9kg weight gain in the first 12 weeks of medication use;
  • Barriers between physical and mental healthcare: such as reduced access to physical health treatments, with issues including lack of accessibility, diagnostic overshadowing, and stigma.

NICE recommendations for the treatment of obesity are based on strong evidence from clinical trials of dietary and lifestyle interventions. However, people with severe mental illness (SMI) are often excluded from these trials. There have been recent trials of interventions in patients with SMI, however these have not proved successful.

A significant factor is the poor engagement in these programmes, with greater than half of people dropping out of the studies.

We do not yet understand the barriers to successful treatment for these patients. Given the rapid weight gain during the initial period of antipsychotic treatment we hypothesise that there are distinct factors which require investigation in order to develop a better theoretical understanding of weight gain in people with early psychosis in order to inform future treatment developments and uptake.

This work is intended to advance our theoretical understanding of mechanisms in order to develop new and effective treatments for testing in future clinical trials.

Link to CLAHRC Oxford Website