Measures to support positive lifestyle changes in people with schizophrenia

Summary

Schizophrenia is a chronic, debilitating mental disorder. On average, life expectancy is 15 years shorter for men and 12 years shorter for women than for the rest of the population. Factors such as smoking, alcohol/drug abuse, inadequate diet and lack of physical activity contribute to a high degree of coexisting conditions, such as type 2 diabetes and cardiovascular diseases.

SBU’s assessment of the state of knowledge

• A combination of behavioural measures to promote physical activity and healthy eating habits yields only a minor decrease in body weight and BMI, and a minor improvement in quality of life for persons with schizophrenia. There are no studies to determine whether this effect persists for more than twelve months. It is unclear whether the level of physical activity is affected.
• Behavioural measures to promote physical activity have a negligible effect on body weight and BMI, level of physical activity and quality of life for people with schizophrenia. There are no studies investigating only interventions to promote healthy eating habits.
• The smoking cessation drugs bupropion and varenicline increase abstinence in people with schizophrenia. However, there are no studies with follow-up of longer than six months’ duration. The benefit of bupropion in reducing smoking in this group is unclear. While nicotine patches have proved effective in studies of smokers in the general population, there are far too few studies on people with schizophrenia to be able to assess the effect.
• People with schizophrenia who are dependent on or abuse alcohol use the alcohol drugs naltrexone, acamprosate, disulfiram and nalmefene. While these drugs have been shown to be effective in other patients who are dependent on or abuse alcohol, there are too few studies on patients with schizophrenia to be able to draw any conclusions.
• There are no published studies of the cost effectiveness of behavioural measures to promote physical activity and a healthy diet, nor of drug treatment to promote abstinence and limit alcohol dependence and abuse.
• SBU’s report from 2012 showed that the care of people with schizophrenia and schizophrenic conditions was in many ways inferior to that received by others, even though their need was at least as great. This patient group thus risks discrimination in terms of equal access to healthcare. The healthcare system should avoid allowing the problems caused by the disorder to impair access to or opportunities for other care, including help with lifestyle changes. Nor should people with schizophrenia be neglected in comparison with patient groups who are better able to assess their needs and seek healthcare.