People with severe mental illness are dying years earlier than the general population, largely from preventable physical conditions like heart disease and diabetes. This project tackles two linked drivers of that early death: poor physical health and cannabis use. People with schizophrenia face a threefold higher risk of diabetes, yet their metabolic problems are poorly managed. Meanwhile, regular cannabis use increases the risk of developing schizophrenia up to sixfold and worsens outcomes for those already ill. No practical, evidence-based programmes exist to reduce cannabis use in this group, and existing health promotion interventions are too lengthy and expensive. The researchers will run four linked studies. First, they will track 300 people with first-episode psychosis for a year to see how lifestyle and cannabis use affect metabolic syndrome and symptom severity. Second, they will develop a tailored health promotion intervention targeting substance use, smoking, diet, and exercise. Third, they will test this intervention in a randomised controlled trial against standard care, measuring cost-effectiveness and quality of life. Fourth, they will pilot an assertive diabetes outreach service for people with both severe mental illness and diabetes, aiming to reduce blood sugar levels by at least 0.5 percent. If successful, this work could produce a practical, cost-effective programme that NHS mental health teams can deliver routinely—closing a gap that currently shortens lives.
View original technical description
SECTION 8 AIMS: To develop culturally appropriate, innovative, and effective programmes to achieve better physical and mental health in people with severe mental illness (SMI), by improving lifestyle choices and decreasing illicit drug use. SECTION 9 BACKGROUNDThe physical health of people with SMI is very poor, resulting in markedly increased mortality rates. The metabolic syndrome, a constellation of cardiovascular (CVD) risk factors including central obesity, dyslipidaemia, hyperglycaemia and hypertension, increases long-term morbidity and death and is highly prevalent in people with SMI. Additionally, while there is a 3-fold excess of diabetes in schizophrenia, the management of metabolic syndrome and diabetes is poor in those with SMI. The huge implications of this, in terms of morbidity, mortality, quality of life and cost make improving physical health in SMI a national priority. Cannabis is the most commonly used illicit drug in the UK, and the concentration of the active compound is rising. Regular cannabis increases the risk of schizophrenia up to 6-fold, and on-going use leads to more relapses, poor compliance, and longer duration of illness. Unfortunately, there are no established practical treatment programmes to reduce substance use in SMI. Newly developed programmes are promising, but lengthy, complex and expensive. A more practical alternative is needed. ; SECTION 10 RESEARCH PLANSStudy 1 A prospective one-year study of physical health and substance use outcomes in 300 people with a first episode psychosis. The main hypotheses are:-1. People with first episode psychosis with less healthy lifestyle habits are at greater risk for metabolic syndrome at 1 year.2. People with first episode psychosis who take cannabis will have more psychotic symptoms 1 year later than non-users.Study 2 Development, validation and manualisation of a health promotion intervention (HPI). The aim of the HPI is to modify lifestyle factors which impact negatively on health in SMI: substance use, smoking, obesity, poor nutrition and lack of exercise.Study 3 Randomised Controlled Trial assessing the cost-effectiveness of the above intervention (HPI), tailored to individual needs, in promoting mental and physical health. We propose a two-arm RCT comparing the cost-effectiveness of combining usual CMHT care with a one-year HPI as described above vs. usual CMHT care alone in improving health at 1-year. The main hypothesis is:People with established psychosis who receive the HPI plus usual care will have greater quality of life and more quality-adjusted life years compared to usual care alone.Study 4 A feasibility study of an assertive intervention to improve diabetes control in people with diabetes mellitus and severe mental illness (SMI). We plan to test an assertive and intensive multidisciplinary diabetes care outreach service to help people with SMI and diabetes reduce their glycosylated haemoglobin (HbA1c), a standard marker of glycaemic control, by at least 0.5% over 12 months.11 RESEARCH TEAM The team has a spread of expertise in research, development and health promotion across psychosis, drug abuse, and medical disorders. It includes the internationally most widely cited schizophrenia researcher, a service user, a manager, and experts in physical health; diabetes; health economics; psychological interventions and health promotion.12 RESEARCH ENVIRONMENT South London and Maudsley NHS Trust and the Institute of Psychiatry (IoP) together comprise the largest concentration of expertise in psychiatric research and development in Europe. The IoP received a 6* rating in the RAE. The IoP Psychosis Interdisciplinary Research Group is the most cited group in schizophrenia research outside the USA and has considerable experience in trials of novel interventions and in rolling them out to become part of routine care.13 ANTICIPATED OUTPUTS This proposal will produce a better understanding of the frequency and development of metabolic syndrome in
Plain English summaries and category classifications on this site are generated by AI and may not perfectly reflect the original research.
Is something wrong? Let us know