The Prescription of Non-Pharmacological Interventions to Mitigate Second Generation Antipsychotic Induced Weight Gain

According to the Substance Abuse and Mental Health Services Administration 5.9% of all adults in Utah had a serious mental illness (SMI) during 2008-2012, which is greater than the national rate. As of 2012, approximately 9.6 million adults live with a SMI in the United States SMI is the result of severe impairment related to the symptoms of psychotic disorders, bipolar disorders, and major depressive disorder. Individuals who live with SMI have a higher mortality rate than those without a mental illness and have a life expectancy of 12-20 years shorter than their counterparts. Side effects from medication management potentially contribute to the incidences of metabolic changes seen with individuals with serious mental illness. Serious mental illnesses such as schizophrenia and bipolar disorder require lifelong treatment. More often than not, antipsychotic medications become part of the medication regimen. Second-generation antipsychotic (SGA) medications are the most prescribed of the antipsychotic drug class and used to treat these disorders. This class is favorable due to the efficacy and decreased incidence of extrapyramidal side effects in comparison to the first generation antipsychotic medications. Unfortunately, weight gain and metabolic syndrome are linked to SGAs. There is a link between metabolic syndrome and cardiovascular-related morbidity and mortality. Despite the benefits of prescribing this medication class, prescribers must also consider the significant weight gain and subsequent metabolic sequelae associated with this class of medication such as obesity, diabetes, metabolic syndrome, and cardiovascular changes. The purpose of this project is to examine the utilization of lifestyle interventions during medication evaluations by mental health providers when prescribing SGAs to patients. Objectives of the project included the following: Increasing provider knowledge of providers of resources regarding the utility of lifestyle interventions to mitigate potential SGA-induced weight gain; enhancing patient education of lifestyle interventions by mental health providers; and dissemination of the results of this project to mental health providers at the Utah Psychiatric APRN Council. Implementation steps included several discussions with providers and unit staff to solicit knowledge related to patient education on lifestyle interventions. These discussions revealed knowledge gaps regarding currently available but unused resources on the unit. These resources were available to nursing staff throughout the duration of patient admission and complimentary to discharge teaching. To reinforce the utilization of these resources, this project included the development of an evidenced-based presentation for prescribers on the use of non-pharmacological approaches in the prevention of SGA-induced weight gain. The current provider prescriptive checklist required condensing and reformatting to allow for ease of use in utilizing current evidence-based recommendations. A paper and pencil pre- post- questionnaire design provided data to measure perceived usefulness of the revised prescriptive checklist and provider perceptions of the presented material. A presentation to providers at the Utah Psych APRN Council meeting included the methods, results, and future recommendations of this project.