mental health and nutrition pediatric nutrition symposium february 12, 2015

Mental Health and Nutrition

Pediatric Nutrition Symposium February 12, 2015

Provincial Mental Health Metabolic Program

Nutrition and Second Generation Antipsychotics (SGAs)

Overall increase in calories Decreased satiety Elevated disinhibition with eating Increased reactivity to external eating cues

Case Study:

Patient – “Jane” 15 10/12 y.o. female with psych hx of bipolar

disorder with psychotic features with two lengthy inpatient admissions

Referred for: Rapid weight gain in hospital

“Jane” - Initial Visit

At Referral (in patient) At first clinic visit (4 months after referral due to

readmission to hospital)Weight: 75.2kgHeight: 158.5cmBMI: 29.7kg/m2 (98%ile)WC: 93cm (>90%ile)Labs: WNL (cholesterol, insulin, FBG,

prolactin)Medications: Lithium, Clopixal,

Lamotrigine, Seroquel**Clozapine introduced shortly after

referral.

Weight: 93.1kg (increase of 17.9kg)Height: 158.5cmBMI: 36.8kg/m2 (>99%ile)WC: 106cm (>90%ile)Labs: Triglycerides1.44 mmol/L, Insulin

173 pmol/LMedications: Lithium, Clopixal,

Clozapine, Metformin

Nutrition Information

Increased appetite for “starchy” and more traditional foods

Drinks juice, no pop Eats vegetables, no fruit Cupboards/freezer always “stocked” so kids

have food when parents aren’t home Patient’s motivation – very anxious with any

talk about change to food Parents just want to make teen happy

What to do??

(try hat at motivational interviewing, then…)

Set a SMART goal! S: ↓ Sausage at B M: 3x per week, 2 sausages A: Mom to help make B –

try oatmeal instead R: 7/10 T: 2 weeks by phone

And then…follow up 2 years later Clinic visits = 6 Phone and email follow up by team = 18

At Referral (in patient) At first clinic visit (4 months after referral due to readmission to

hospital)

Most recent visit (almost 2 years later)

Weight: 75.2 kgHeight: 158.5 cmBMI: 29.7 kg/m2 (98%ile)WC: 93 cm (>90%ile)Labs: WNL (cholesterol, insulin, FBG,

prolactin)Medications: Lithium, Clopixal,

Lamotrigine**Clozapine introduced shortly after

referral.

Weight: 93.1 kg (increase of 17.9kg)Height: 158.5 cmBMI: 36.8 kg/m2 (>99%ile)WC: 106cm (>90%ile)Labs: Triglycerides1.44 mmol/L,

Insulin 173 pmol/LMedications: Lithium, Clopixal,

Clozapine, Metformin

Weight: 83.3 kgHeight: 159 cmBMI: 32.9 kg/m2 (99%ile)WC: 94.5 cm (75-90 %ile)Labs: WNLMedications: Lithium, Clozapine,

Metformin

Dietary changes over 2 years:

Family changed food environment. Mostly just Sun Chips available now; sausages rarely in house.

Family worked together to help: Dad making smoothies (with beets!), Mom going to gym with patient.

Patient takes a water bottle with her everywhere Family not talking about WEIGHT all the time which

= decreased shame, guilt and eating

What works?

Family support Long term follow up (research shows that it

doesn’t really matter what you talk about, as long as the patient stays engaged in the program)

Resources:

Individual Handouts:•Appetite

•Cholesterol

•Triglycerides

•Insulin

•Prolactin

Online Resources:

For Professionals: http://www.bcmhsus.ca/resources/metabolic-

program

For Patients and Families: http://keltymentalhealth.ca/metabolic

Thank you! Questions?

Contact info:Lorrie Chow

Phone: 604-875-2345 x 7982 Email: lchow2@cw.bc.ca