Thai health improvement program helps prevent weight gain in people with early psychosis

Researchers from Australia and Thailand are calling to change the treatment methods for those experiencing early psychosis to help improve their life expectancy rates.  

The call comes as a result of a new study co-led by Professor Daniel Bressington from Charles Darwin University (CDU), Assistant Professor Dr Soontareeporn Meepring from Chulalongkorn University and Professor Richard Gray from La Trobe University.  

The study has found that lifestyle changes using a Thai Health Improvement Profile (HIP) intervention can prevent weight gain and enhance physical health in people with early psychosis.

The HIP intervention profile is a systematic health check used by clinical staff to help identify physical health related risks and unhealthy lifestyle behaviours. The profile also provides directions for intervention for identified risks and a care plan is established for the patient.

Compared with the general population, people with psychosis - meaning those diagnosed with schizophrenia spectrum disorders or bipolar disorder - have worse physical health, and have a life expectancy that is 10-15 years less than the general population.

CDU Professor in Mental Health and senior corresponding author, Professor Daniel Bressington said that rapid weight gain was very common in people with early psychosis.

“Weight gain predominately occurs in the first few months of treatment in people with early-stage psychosis and is often associated with the use of psychotropic medication but also lifestyle factors play an important role too,” Professor Bressington said.

“Unfortunately, weight gain can lead to significant health concerns such as cardiovascular disease and diabetes which contribute to shorter life expectancy.”

The study sampled over 100 patients from an outpatient clinic at a public psychiatric hospital in semi-rural Northern Thailand and was funded by The Thailand Research Fund and the Office of The Higher Education Commission, Royal Thai Government.

During the study, the HIP Interventions were carried out by a trained community psychiatric nurse with patients and an accompanying family member, with the HIP tool being used to facilitate an assessment of and communicate patients' physical health risks and unhealthy lifestyle behaviours.

The HIP consists of over 25 areas of physical health assessment including BMI, blood pressure, pulse, cholesterol check, dietary habits, bowel habits and caffeine intake.

The sessions were completed again at three, six, nine and 12-month intervals.

Professor Bressington said that significant health improvements were seen in the early psychosis patients that were provided with the HIP intervention after 12 months.

“The trial resulted in a six-fold reduction in the likelihood of developing clinically significant weight gain in Thai people with early psychosis over a 12-month period,” Professor Bressington said.

“We also saw significant reductions in waist circumference measurement and BMI in the group that received the HIP intervention.

“This shows that effective weight management interventions need to be delivered over the long-term by clinicians that routinely work in the health service to realise and maintain benefits over time.”

Working with the patient’s family was another important feature of the HIP intervention which is believed to also have contributed positively to the results.

“During the trial, the patient’s family members attended appointments and participated in the program as well,” Professor Bressington said. 

“This involvement was key to seeing success and helped ensured that the planned physical health program was adhered to.”

Study co-author, Professor Richard Gray from La Trobe University said the Thai Health Improvement Profile showed great promise for patients with psychosis at a time when the life expectancy has been falling consistently.

“Life expectancy of people with psychosis is 10-15 years less than the general population due to health problems associated with weight gain,” Professor Gray said.

“It’s estimated that one per cent of the population at some point in their lives will have psychosis, which is not a rare disease but often gets overlooked - there's a lot more that we can do.”

The paper was published in the International Journal of Nursing Studies.