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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