Dr. Ganguli is interested in reducing the risk of cardiovascular disease and diabetes in persons with serious mental illness. Persons diagnosed with schizophrenia and other psychotic illnesses, such as bipolar disorder, typically have life expectancies that are 20-25 years shorter than the general population. The leading causes of death in these people are not related to psychiatric symptomatology, but are heart and other cardiovascular disease, similar to the general population. The prevalence of obesity, diabetes, lipid abnormalities, and other risk factors for heart disease is 2-3 times higher in this population, which undoubtedly accounts for much of the increased prevalence of, and mortality from, heart disease noted above. As such, Dr. Ganguli seeks to better understand the causes of increased risk and to develop, test, and disseminate interventions for lowering risk in this population.
Specific areas of investigation include the following: (1) Understanding the role of antipsychotic medication in contributing to obesity, insulin resistance, and lipid abnormalities in persons who need to take these medications to control psychiatric symptoms, and strategies to reduce these adverse side effects of medication. Studies include investigation of changes in glucose metabolism, inflammatory mechanisms, and lipids, as well as studies of the metabolic benefits of switching patients to more metabolically benign medications. (2) Studies of behavioural and pharmacological interventions to reduce or eliminate metabolic abnormalities, utilizing lifestyle interventions aimed at improving nutrition and physical activity patterns, as well as medications, alone or in combination with psychological interventions. And (3) translational studies of the dissemination and implementation of evidence-based interventions to improve the metabolic profile of individuals with psychotic illnesses, in the setting in which they receive treatment or social supports.
Wellness Program for Diabetes Management for Individuals Living with Serious Mental Illness
This project will be a one year randomized controlled trial examining the effectiveness of a wellness program aimed at managing diabetes in individuals living with serious mental illness. Specifically, this program will aim to reduce caloric intake and increase physical activity in overweight or obese individuals living with both psychotic illnesses and type 2 diabetes mellitus. Individuals will be randomized to receive either the wellness program or treatment as usual. It is believed that a significant weight reduction and improvement in blood sugar level control will be found in those who receive the wellness program relative to those who do not, in addition to a higher quality of life, a healthier lipid profile and other benefits.
Evaluating Self-Management of Diabetes and Serious Mental Illness in Community Housing
This study will investigate factors that facilitate and impede successful implementation and maintenance of a lifestyle intervention to promote healthy eating and physical activity, for persons with diabetes and serious mental illness, living in community housing settings. The study takes place in four homes for special care and examines the effectiveness of a lifestyle intervention for changing diet and exercise patterns. Evaluation of implementation will be based on feedback provided by staff and residents of the homes for special care. The lifestyle intervention will be evaluated by examining its impact on resident health, quality of life, and satisfaction with the intervention.
Prevention of Weight Gain in Early Psychoses
Individuals who require antipsychotic medication to treat psychiatric illness often experience side effects, such as weight gain, that can lead to additional serious physical illnesses, such as metabolic syndrome and cardiovascular disease. These illnesses, in turn, can lead to physical disabilities and shorten a person's life expectancy. This study is a randomized controlled trial investigating the effectiveness of a stepped behavioral intervention in preventing medication-related weight gain in individuals with schizophrenia spectrum disorders. Although several studies have examined pharmacological and non-pharmacological approaches for weight loss, investigations of strategies for the prevention of obesity are lacking. Thus, this study represents an important and novel approach to addressing obesity in those living with psychotic illness.