Development of antipsychotic-induced weight gain management guidance: patient experiences and preferences - a qualitative descriptive study
Authors: Fitzgerald I , Crowley E K , Ní Dhubhlaing C , O’Dwyer S , Sahm L J 
Published: April 2024

Abstract

Introduction
It is estimated that 50% of patients with a severe mental illness (SMI) do not adhere to their medication regimen. Antipsychotic-induced weight gain (AIWG) is one of the most common reasons for patient disengagement with treatment.[1] Clinically significant weight gain has been linked to almost all antipsychotics and contributes significantly to the 2-3-fold higher rates of obesity seen in psychiatry.[2] Given the personal, social, and healthcare costs of overweight, obesity and relapse of mental illness, effectively managing AIWG is a priority for patients, clinicians, and policymakers. However, effectively managing AIWG is challenging. Sparse guidance for clinicians invariably contributes to management complexity. An important barrier to the development of high-quality AIWG management guidance is the lack of empirical research assessing patient values and preferences for management and other key guideline decision-making criteria including acceptability, feasibility, and equity considerations. Integration of patient experiences and preferences for management into guidance informing practice is essential to ensure recommendation relevance, applicability, and transferability.

Aim
To elicit the values and preferences of those with lived experience of AIWG regarding preferred management.

Methods
Qualitative descriptive methodology was used as it avoids high-level interpretation and theory development in data analysis and results in outputs that can be more readily implementable by policymakers and guideline developers. The study recruited adult outpatients attending a secondary psychiatric care setting with a diagnosis of a SMI and experience of AIWG. Purposive sampling informed recruitment whereby participants who had a diverse range of experiences of AIWG were recruited. Participants took part in online semi-structured interviews. Reflexive thematic analysis informed data analysis.

Results
Seventeen participants were recruited (24% male; mean age: 51.7 years [range: 26-66]). Participants conceptualised preferred AIWG management as being individualised, proactive, collaborative, and holistic. Participants were asked how the tenets of preferred management could be realised in practice and within clinician management guidance. Results are summarised in Figure 1.

Conclusion
Use of this research by guideline developers will provide opportunities to maximise the impact of recommendations in practice for those funding, providing, and using services. The opportunity to include a culturally diverse group was unavailable, which may limit transferability of study findings.

References
1. Semahegn A, Torpey K, Manu A et al. A. Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: A systematic review and meta-analysis. Systematic Reviews. 2020;9(1).
2. Firth J, Rosenbaum S, Galletly C et al. Protecting physical health in people with mental illness. The Lancet Psychiatry. 2019;6(8):675–712.