mental health and nutrition pediatric nutrition symposium february 12, 2015
TRANSCRIPT
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
