Antipsychotics are the main treatment for severe mental illnesses (SMI) such as schizophrenia. Whilst they may treat the symptoms of psychosis, they are associated with significant weight gain. This weight is associated with diabetes and cardiovascular disease and contributes to a reduced life-expectancy of up to 20 years in people with SMI (1).
This research project builds on the NIHR RESOLVE study, which studied the non-pharmacological management of antipsychotic weight gain in people with SMI using a realist approach (2). One key finding was the almost complete absence of literature in people with dual diagnosis (learning disability [LD] and SMI) (3). This PhD aims to fill that research gap.
Aim:
To understand what works, for whom and in what circumstances to non-pharmacologically manage antipsychotic weight gain in people with SMI-LD dual diagnosis
Key objectives:
1. Conduct a realist review of the literature to understand what works, for whom and in what circumstances for people with SMI-LD dual diagnosis (WP [work package] 1).
2. Conduct a realist evaluation, using interviews with key stakeholders, of the findings from WP1 to develop guidance to non-pharmacologically manage the weight gain (WP2).
3. Build impact by widely disseminating the key findings and engaging with key policy-makers (WP3).
Research plan:
WP1 (month:1-12): building on previous research by supervisors (e.g., NIHR RESOLVE) realist review of academic/grey literature (develop initial programme theory: m1-2; develop search strategy: m2-4: search literature: m3-5; study selection and appraisal: m4-7; analysis: m7-10; develop programme theory/theories: m9-12).
WP2 (month:8-28): realist evaluation, using semi-structured interviews with people with dual diagnosis, clinicians and family carers, of the findings from WP1 to develop guidance for policy makers and clinicians (ethics: m8-12; recruitment: m12-16; interviews: m14-20; analysis: m18-26; write-up: m24-28).
WP3 (month:26-36): combine WP1/WP2: m26-32; produce thesis: m30-36; dissemination (e.g., academic publications, conferences, engagement with policymakers): m33-36.
References
1. Cooper SJ, Reynolds GP, Barnes TRE, England E, Haddad PM, Heald A, et al. BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment. Journal of Psychopharmacology. 2016;30(8):717-48.
2. Maidment I, Wong G, Upthegrove R, Oduola S, Robotham D, Higgs S, et al. REalist Synthesis Of non-pharmacologicaL interVEntions for antipsychotic-induced weight gain (RESOLVE) in people living with Severe Mental Illness (SMI). Systematic Reviews. 2021:1-7.
3. MacPhee M, Howe J, Habib H, Piwowarczyk E, Wong G, Ahern A, et al. Non-pharmacologicaL InterVEntions for Antipsychotic-Induced Weight Gain (RESOLVE) in People Living With Severe Mental Illness: A Realist Synthesis. Obesity Reviews. 2025;n/a(n/a):e13962.
