First-of-its-kind study from St Patrick’s Mental Health Services and University College Cork explores preferences and needs of those with lived experiences of weight gain from anti-psychotics.
A qualitative study from researchers within the Pharmacy Department of St Patrick’s Mental Health Services and the School of Pharmacy in University College Cork has revealed the urgent need for tailored guidelines in managing antipsychotic-induced weight gain, as findings highlight the gaps between current guidelines and practices and the needs of those taking antipsychotics.
The study, Informing the development of antipsychoticinduced weight gain management guidance: patient experiences and preferences – a qualitative descriptive study, which was published in BJPsych Open on 1 August 2024, explores how patients with lived experiences of antipsychotic-induced weight gain (AIWG) perceive and manage this challenging side-effect.
Clinically significant weight gain has been linked to almost all antipsychotic medications, prescribing of which extends to many mental health difficulties beyond psychosis, and is usually seen within weeks of starting treatment.
Managing weight gain effectively in patients with mental health difficulties who are taking
antipsychotics is crucial to ensuring their physical health is maintained. However, while limited international guidance exists, management recommendations for clinicians largely replicates recommendations for population level weight management practices, with self-led ‘lifestyle changes’ given prominence, and the use of additional medications to reduce antipsychotic-induced appetite increases considered only when other options have proven ineffective.
The development of available management recommendations has largely been informed by the expert opinion of guideline development groups, with no or minimal representation of the voice of lived experience. This study was the first of its kind to explore the management preferences of patients with experience in managing weight gain from antipsychotics and to compare this with current management algorithms informing clinicians’ practice.
A diverse range of people (n = 17) with experiences of mild to severe antipsychotic-induced weight gain and mental health difficulties including schizophrenia, bipolar affective disorder and
major depressive disorder were interviewed regarding:
• Their experiences of managing AIWG
• The acceptability, feasibility, and transferability of current management algorithms and the interventions contained within (both pharmacological and non-pharmacological)
• How patient-centred management practices can be realised within Irish healthcare settings.
Speaking about the study, Lead Researcher and Senior Pharmacist at St Patrick’s Mental Health Services, Ita Fitzgerald said: “Findings have shown that the lack of available management guidance for antipsychotic-induced weight gain remains a challenge for clinicians, with currently endorsed approaches neither being fitfor-purpose or aligned with the experiences and needs of those prescribed antipsychotics and who experience unwanted weight gain.
This study provides guidance and recommendations for ways in which a proactive, individualised, holistic, and collaborative approach to AIWG management can be practically realised both within guidelines and services. It is hoped that the publication of this study will mark a significant step towards empowering and supporting clinicians to manage the complex side effect of antipsychotic-induced weight gain in a way that is most responsive to the needs of the individual patient.”
Key Findings
1. Patient preferences for management differ significantly from that advocated for in management guidelines: Patients with AIWG describe current management guidelines as overly simplistic and lacking the flexibility required for management to be tailored towards their needs. The standardised, stepwise approach, universally recommended and focusing primarily on the use of lifestyle changes, does not reflect the realities of managing overweight or obesity caused by antipsychotics.
2. Behavioural changes are often insufficient: Many participants
reported that lifestyle changes alone were insufficient to manage AIWG. Continued recommendations from clinicians to implement lifestyle changes could worsen feelings of isolation and internalised stigma, while also reducing the likelihood of seeking help in future due to fear of stigma.
3. Individualised approaches are key: Participants emphasised that AIWG is a unique cause of weight gain and as such, requires an equally distinctive approach to management. Recommendations for management of AIWG must recognise diversity among individuals and allow for interventions to be tailored towards risk of living with overweight or obesity, individual physical and mental health capabilities and patients’ treatment preferences.
4. Need for early use of pharmacological interventions: Study participants advocated for the earlier use of pharmacological interventions, such as metformin, especially for those who are severely ill at the onset of antipsychotic treatment, have a personal or family history of living with obesity, or where appetite increases following starting an antipsychotic are severe.
Professor Laura Sahm, co-author of the study and Head of Clinical Pharmacy Practice at UCC, said: “This study represents a crucial step in recognising the importance of a patient-centred and patientinformed approach to combat antipsychotic-induced weight gain. By working collaboratively, patients and prescribers can adopt a strategy that aligns best with their shared and agreed goals of therapy.”
Based on the experiences of participants, the study recommends that current guidelines are expanded to include preventive measures and early interventions tailored to individual patient needs and risks. The study recommendations also put forward ways in which the four tenets of patient-centred management (proactive, individualised, holistic and collaborative approaches) can be enacted both within guidelines and psychiatric services.
Read our Latest Features Here
Read September IPN Here
Vote for Your Pharmacist of the Year 2024, in association with Panadol Here
