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Abstract
Besides having an unhealthy lifestyle contributing to premature mortality, inpatients with severe mental illness (SMI) use high dosages of medication. Previous research has shown improved health after lifestyle improvements in SMI. In addition, we aimed to retrospectively study whether a multidisciplinary lifestyle enhancing treatment (MULTI) was associated with changes in medication use after 18 months, as compared with patients that continued treatment as usual (TAU) and explored mediation by a change in physical activity. We conducted an observational study within a cohort of inpatients with SMI, who received MULTI (N = 65) or continued TAU (N = 49). Data on their somatic and psychotropic medications were collected, converted into defined daily dose (DDD), and analyzed using linear multilevel regression, correcting for baseline value and differences between groups in age, diagnosis, and illness severity. Compared with TAU, the DDD for psychotropic medication significantly decreased with MULTI (B = −0.55, P = 0.02). Changes in total activity did not mediate this association, suggesting that multiple components of MULTI contributed. Corrected between-group analyses for subgroups of medication were not possible due to lack of power and skewed distributions. Within-group data showed a decreased proportion of users as well as median DDD in both groups for almost all medications. In addition to previously reported health improvements after 18 months of MULTI, we observed a significant decrease in dose of psychotropic medication in MULTI compared to TAU. This first study evaluating a wide range of medications indicates a possible effect of lifestyle improvements on medication use in inpatients with SMI. Findings need to be confirmed in future controlled studies, however.
Highlights
In patients with severe mental illness (SMI), a high prevalence of metabolic risk factors [1,2,3] contribute to their poor cardiovascular health, largely contributing to a reduced life expectancy of at least 7–20 years compared to the general population [4,5,6]
After adjusting for baseline sum scores, age, diagnosis, and baseline illness severity, the association with the change in the dose of psychotropic medication remained significant in favor of multidisciplinary lifestyle enhancing treatment (MULTI)
This association was not mediated by a change in total activity counts per hour (TAC/h), as no indirect effect was found
Summary
In patients with severe mental illness (SMI), a high prevalence of metabolic risk factors [1,2,3] contribute to their poor cardiovascular health, largely contributing to a reduced life expectancy of at least 7–20 years compared to the general population [4,5,6]. Polypharmacy is very prevalent among people with SMI [15, 17] and the dosage of antipsychotic medication has only increased during the last decades for long-term hospitalized patients [18, 19]. Alongside this psychotropic medication, patients use antihypertensive, lipid-lowering, antihyperglycemic and other additional drugs if cardiovascular health issues (whether or not caused by psychotropic medication) are too severe [20,21,22,23,24]
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