nå på norsk! - ISPS Norge · Japanes e individu als, reco m mend W Ct arget < 90c m ^ or pre...
Transcript of nå på norsk! - ISPS Norge · Japanes e individu als, reco m mend W Ct arget < 90c m ^ or pre...
The HeAL Declaration
– nå på norsk!
Sunne aktive liv - flest mulige aktive leveår for unge
med psykoser
ISPS, Hamar, 29. januar 2016 ved Tove Mathiesen, psykologspesialist
kg
Months 12 24 0 48 36
Established psychosis RCT
10
5
20
15
12 kg
4 kg
3 kg
Healing is a matter of time but sometimes also a matter of opportunity Hippocrates (460 BC - 377 BC)
Start HERE
NOW! STOP natural
history
Established psychosis RCT
First episode of psychosis
12 kg
Alvarez-Jimenez et al; CNS Drugs, 2008
International Physical
Health in Youth Stream
Special Interest Group
Amsterdam 2010
Smoking
Current Smoker
Brief individual
intervention
Smoking cessation program
quitnow.info.au
Lifestyle
Poor diet
AND/OR
Sedentary lifestyle
Weight
BMI (kg/m2)
> 25
AND/OR
Weight > 5kg
Waist circumference ccccircumfere
mce gain
AND/OR
Waist > 5cm
Structured nutritional counseling and modify lifestyle
Blood Pressure
>140 systolic
AND/OR
>90 diastolic
Fasting Blood Glucose
> 5.6 mmol/L
5.6-6.9: at risk Consider metformin >7.0 DIABETES endocrine review; monitor HbA1c 3 monthly
Fasting Blood Lipids
>6.5 TChol
(>5.5 TChol if diabetic)
>2.0 Trig
Consider Statin
Fibrate for triglycerides
Polycystic ovary
syndrome
No periods for 3
months^ Acne
Hirsutism
?Normal prolactin
Consider metformin (adequate contraception if sexually active)
Obesity
Target
Smoking cessation
Target
Improve quality of diet
Contain energy intake
Daily exercise
Target
BMI 20-25 and WC <94 males* < 80cm females
Target
Fasting glucose
If diabetic: HbA1c <7%
Target
mmol/L
Consider antipsychotic switching; review medications and rationalize any polypharmacy
Target
Regular menstrual
cycle
Curtis J, Newall H, Samaras K. HETI 2011
Consider anti-
hypertensive
Target
< 140/90 mmHg
(< 130/80 if diabetic)
* for south Asians, Chinese, south and central American and Japanese individuals, recommend WC target < 90cm
^ for premenopausal women
Consider metformin
Polycystic ovary
syndrome
Keeping the Body in Mind Working Group
HeAL core working group
HeAL core working group
• David Shiers & Jackie Curtis
(co-chairs)
• Mario Alvarez Jimenez
• Debra Foley
• Helen Lester
• Eoin Killackey
• Katherine Samaras
• Philip Ward
• Stephanie Webster
Expert international advisory panel
• Jonathan Campion
• Christoph Correll
• Marc De Hert
• Richard Holt
• Alex Mitchell
• Davy Vancampfort
www.iphys.org.au
HeAL: Healthy Active Lives
an international consensus
International consensus
…unge om opplever en
psykose har den samme
forventede levealder
som jevnaldrende som
ikke har gjennomgått en
psykose
90% forstår sin risiko for å
utvikle fremtidig overvekt,
hjerte- og karsykdommer og
diabetes
75% legger ikke på seg
mer enn maks 7 % av
vekten før sykdomsdebut i
løpet av de to første årene av behandlingen
75% beholder blod-
sukker, lipidprofil og BT
innenfor normal-
variasjonen i minst to år
etter oppstart med antipsykotisk behandling.
90% mottar helsefremmende råd <30% røyker tobakk
>50% utøver aldersadekvat fysisk aktivitet, dvs. minst 150 min. ukentlig
Dersom medisiner brukes i behandlingen av
psykose, vil de bli regelmessig vurdert i
samsvar med anbefalte forskrivnings-
standarder/nasjonale retningslinjer for å
minimalisere risikoen for komplikasjoner som
overvekt, hjerte- og karsykdommer og
diabetes
Innen 5 år:
Algorithm NSW, Australia 2011
UK Lester Adaptation 2012
Investment 2014 NSW
Ontario cardiometabolic risk tool 2014
UK Lester Adaptation update 2014
NICE guidelines 2013(CG155) & 2014(CG178)
International translation of HeAL
Lester User postcard 2014
NSW Adolescent algorithm 2014
Japanese Algorithm 2014
Norge 2016 !!
Smoking
Current
Smoker
Brief
individual
intervention
Smoking
cessation
program
quitnow.info.au
Lifestyle
Poor diet
AND/OR
Sedentary
lifestyle
Weight
BMI (kg/m2) > 25
AND/OR
Weight > 5kg
Waist
circumference
ccccircumfere
mce gain
AND/OR
Waist > 5cm
Structured nutritional counseling and modify lifestyle
Blood
Pressure
>140 systolic
AND/OR
>90 diastolic
Fasting Blood
Glucose
> 5.6 mmol/L
5.6-6.9: at risk
Consider metformin
>7.0 DIABETES
endocrine review; monitor HbA1c
3 monthly
Fasting
Blood Lipids
>6.5 TChol
(>5.5 TChol if diabetic)
>2.0 Trig
Consider Statin
Fibrate for
triglycerides
Polycystic
ovary
syndrome
No periods for 3
months^ Acne
Hirsutism
?Normal prolactin
Consider metformin
(adequate
contraception
if sexually
active)
Obesity
Target
Smoking
cessation
Target
Improve
quality of diet
Contain
energy intake
Daily exercise
Target
BMI 20-25 and WC <94 males*
< 80cm females
Target
Fasting glucose
If diabetic:
HbA1c <7%
Target
mmol/L
Consider antipsychotic switching; review medications and rationalize any polypharmacy
Target
Regular
menstrual
cycle
Curtis J, Newall H, Samaras K. HETI 2011
Consider
anti-
hypertensive
Target
< 140/90
mmHg
(< 130/80 if
diabetic)
* for south Asians, Chinese, south and central American and Japanese individuals, recommend WC target < 90cm
^ for premenopausal women
Consider
metformin
Polycystic
ovary
syndrome
International collaboration
International support
Vi vil fremover utfordre ulike norske
organisasjoner til å støtte erklæringen.
Både brukerorganisasjoner og
profesjonsorganisasjoner!
Mot bedre tider?
Keeping the Body in Mind
Et 12 ukers intervensjon program for bedre
helse hos unge med en førsteepisode psykose
Andrew Watkins1, Scott Teasdale,1 Simon Rosenbaum1, Janelle Abbott1, Julio de
la Torre1, Jackie Curtis1,2, Philip B. Ward2,3 & Katherine Samaras4,5
1Bondi Early Psychosis Programme, SESLHD; 2School of Psychiatry, UNSW; 3Schizophrenia Research Unit, SWSLHD; 4Department of Endocrinology, St Vincent’s
Hospital, and 5Diabetes and Obesity Program, Garvan Institute, Sydney
Psychiatry
Evaluating an individualized lifestyle and life
skills
intervention to prevent antipsychotic-induced
weight gain in first-episode psychosis
Jackie Curtis, Andrew Watkins, Simon Rosenbaum, Scott Teasdale,
Megan Kalucy, Katherine Samaras and Philip B. Ward
Early Intervention in Psychiatry, 2015 Article first published online: 26 FEB 2015
KBIM Mål og metoder
Undersøke effektiviteten og
nytten av en flerfaglig tilnærming
til å forebygge dårlig fysisk helse
hos unge brukere i Bondi Early
Psychosis Programme.
Sammenlikne med data fra et
annet tilsvarende tidlig
intervensjonstilbud som tilbyr
“treatment as usual”.
KBIM Evaluation Schedule KBIM#____________ Name:__________________________________________________
TestChecklistforEPP.xlsx
Date Name Signature Date Name Signature Date Name Signature Date Name Signature
Referral Form n/a n/a n/a n/a n/a n/a n/a n/a n/a
Metabolic Measures
Metabolic Pathology n/a n/a n/a n/a n/a n/a
Rosenburg Self-Esteem Scale n/a n/a n/a n/a n/a n/a
Pittsburgh Sleep Quality Index n/a n/a n/a n/a n/a n/a
HONOS/LSP n/a n/a n/a n/a n/a n/a
GF: Social & Role n/a n/a n/a n/a n/a n/a
GAF or C-GAS n/a n/a n/a n/a n/a n/a
Food Questionaire
(Cancer Council)n/a n/a n/a n/a n/a n/a
IPAQ n/a n/a n/a n/a n/a n/a n/a n/a n/a
Exercise Measures n/a n/a n/a n/a n/a n/a
MARS n/a n/a n/a n/a n/a n/a
BASELINE 4 WEEKS (Due:______) 8 WEEKS (Due:______) 12 WEEKS (Due:______)
TEST
KeepingtheBodyinMindexerciseassessmentsheet
V1.0March2013 1
KBIM Exercise Assessment
Date of Test:____________________
Time:_____________Temp:________
Humidity:________ Body Mass:__________(kg)
International Physical Activity Questionnaire – Short Form
Completed: Y / N
Sub-maximal VO2
Stage Time RPM Kiloponds
(KP)
Work
Load
(W)
RPE HR BP
1
2
3
Estimated V02 max: ________L/min ________ml/min/kg
Sit-and-Reach
Trial 1_____ Trial 2______ Trial 3_____ Average _____
Handgrip
R___________(kg) L___________(kg)
Push-ups
Stage (1=wall; 2=knees; 3=toes): __________
Number achieved: __________
Crunches Number achieved in 1 minute: __________
Name:_____________________________
KBIM No._________ Sex: M / F
Age:________ Date:__________ Rest HR: _______(bpm) Wt:_________(kg)
Pred. max HR (208 – (0.7 x age))_________Seat Height (bike):_____________
Cooking Group in the Bondi Centre kitchen
Exercise coaching in the Bondi Centre gym
ABC Radio National: All in the Mind, May 18th 2013
Peer wellness coaches
80
82
84
86
88
90
92
Pre Post
Wais
t cir
cu
mfe
ren
ce (
cm
) Waist circumference
Baseline and 12-weeks follow-up
KBIM Standard care
0
20
40
60
80
100
Bondi KBIM Standard care
Percentage (%) of participants experiencing clinically significant (>7%) weight gain at 12
weeks follow-up
https://dl.dropboxusercontent.com/u/50333676/KBIM%20Final%20Cut%20
Subtitles%203.mp4
Keeping the body in mind - link til en liten video som presenterer Bondi teamet og deres
tilnærming.
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