27. PRACTICAL STRATEGIES TO REDUCE PREMATURE MORTALITY AND IMPROVE HEALTH IN PEOPLE WITH SCHIZOPHRENIA: OUTCOMES IN REAL-WORLD SETTINGS

Abstract

Adults with schizophrenia spectrum disorder (SSD) die an alarming 28.5 years earlier, on average, than do adults with no mental disorder, most often from co-morbid medical conditions (e.g., heart disease, diabetes, cancer, and pulmonary disease). The cardiometabolic risk factors (CRFs) that contribute to these diseases and early mortality—smoking, obesity, hypertension, dyslipidemia, low physical activity, substance use, poor fitness and diet—are also more common in this population, and their onset is typically earlier, yet they frequently go undetected. When CRFs are identified in people with SSD, they seldom receive the needed care. When care is provided, the quality is highly variable. Iatrogenic effects of antipsychotic medications, which include weight gain and metabolic disorder, also adversely impact their health, often with rapid onset. Effective interventions to prevent and/or reduce modifiable CRFs associated with premature mortality exist for the general population but are often unavailable to people with SSD. The impact of these interventions and the degree of adaptation needed for effectiveness in people with SSD, who may experience cognitive impairment, motivational deficits, functional deficits, social isolation, few resources and limited access to healthcare, remain unknown. This symposium features research findings from four RCTs that address these critical knowledge gaps by testing practical CRF reduction strategies for people with SSD in real-world settings. Dr. Leopoldo J. Cabassa will report on an RCT of a peer-led healthy lifestyle intervention to improve diet and increase physical activity in people with SSD and other serious mental illnesses (SMI) living in supportive housing. He’ll present qualitative findings on participants’ experience of and engagement in the intervention and preliminary outcomes on weight loss, fitness and reductions in other CRFs. Dr. Gail Daumit will present results on an RCT of a comprehensive CRF risk reduction intervention for adults with SSD and other SMI in community mental health settings. The trial tests an intervention incorporating health behavior coaching and care coordination/care management to address all CRF behaviors and factors. Results for the primary outcome of cardiovascular disease measured by the global Framingham Risk Score and individual risk factor outcomes will be presented. Dr. Benjamin Druss will present preliminary findings on an RCT of mobile Personal Health Records (PHRs) as a health care quality improvement strategy for people with SSD and other SMI and one or more CRF. PHRs link medical and mental health records and provide patients information on diagnoses, medications, appointments and health goals in real-time. Findings will include the PHR’s impact on quality of care, health status and CRFs. Dr. Kelly Aschbrenner will report on an RCT of a group lifestyle intervention enhanced with digital technology versus one-on-one mobile lifestyle coaching for young adults age 18–35 with SSD and other SMI who are overweight or obese in community mental health centers. Primary outcomes are clinically significant weight loss and improved fitness. Results will include clinical and other factors that moderate intervention engagement. Dr. Jackie Curtis of UNSW Sydney, Australia, an internationally recognized expert on preventing and reducing CRFs in young adults with SSD, will synthesize the presentation findings and place them in the context of international efforts to reduce premature mortality and improve health in people with SSD.