Weight Management Program for Patients With First Episode Psychosis

C. Overview Study Sample: Twelve families will be recruited from NAVIGATE, a program for first episode psychosis patients. Patients in the program and who have been prescribed antipsychotic medications will be eligible. In addition, to be eligible, one of the parents must agree to work with the patient, and agree to modify their eating, exercise and if obese, their own weight. Patients and parents must be able to read at the 8th grade level. Patients or parents with a history or evidence of current eating disorders (bulimia or anorexia or binge eating disorder) or a current alcohol or drug use disorder will be excluded.

The NAVIGATE program admits 2 to 3 patients per month. At the beginning of the study, we anticipate that there would be approximately 40-45 patients in the program with the requisite use of antipsychotic medications, and over the next five months, we would expect an additional 10-15 patients. Assuming that 50% of the patients are eligible and interested, we would have approximately 25-30 patients available for the study.

Assessments: Participants will have a baseline session in which they complete the Behavioral Choice Questionnaire that assesses the reinforcing value of food. Parents and the patients will also complete questionnaires regarding parenting, time perspective, consideration of future consequences, and have their height and weight measured. Following the baseline assessment, baseline data will be collected over a two month period, and then families will be randomized to staggered initiation of treatment in blocks of 4 families. At the end of treatment, the patient and the participating parent will receive the same assessment battery that they completed for the baseline session. They will also provide information on the implementation of the diet, exercise, and alternative reinforcement procedures. After an additional 2 months, the patient and parent will return for the final assessment using the same assessment battery, as well as the implementation data.

During the baseline, treatment and follow-up period, patients will take their weight daily with a Bluetooth scale provided by the project.

Intervention: Families will receive a 12-week FBT adapted for first episode psychosis. This will be delivered in 12 weekly meetings with a trained case manager and two "eating plan" education sessions. Both the patient with psychosis and parents are targeted for eating and activity/exercise change to ensure a change in the shared family environment, which will also help weight control in both sets of participants, as well as medical issues that accompany obesity, including glycemic control, hypertension and hyperlipidemia. If parents are not overweight/obese, they will still target improved health behaviors. They will learn about GREEN, YELLOW, and RED foods (healthy vs. unhealthy foods), energy density, glycemic index of foods, reducing serving sizes, eating less, healthy lifestyle and programmed activity programs and recording their diets and activity. Weekly sessions will involve discussion of weight loss principles presented in modules in the weight control manual, and coaching parents and patients how to implement the Traffic Light Eating Plan and healthy lifestyle techniques. At each session, participants meet with staff and attend a brief problem solving session with their case manager where they will troubleshoot any expected or encountered issues with implementing the program. As part of treatment, participants will weigh themselves daily with a Bluetooth scale.