What is known about the determinants of developing antipsychotic-induced metabolic syndrome and interventions to address them for community dwelling adults: a scoping review protocol

Abstract

IntroductionAntipsychotics are the primary treatment for severe mental health conditions. Whilst antipsychotics are effective at improving psychiatric outcomes, approximately 80% of people will experience metabolic syndrome (MS), characterised by weight gain, lipid disturbance and glucose dysregulation. Antipsychotic-induced MS is associated with a two-fold increased risk of developing coronary heart disease and a five-fold risk of developing type 2 diabetes.Gender, ethnic background, age, and family history are reported non-modifiable determinants of developing antipsychotic-induced MS and provide an indication of who is at highest risk. However, it is not clear what is known about which determinants are most significant to inform targeting interventions for high-risk individuals.Antipsychotics induce an increase in calorie intake and sedentary behaviour changes, which have been linked to MS. Behavioural determinants are modifiable and provide potential intervention targets, however, the extent to which they have been studied and targeted is unclear.Non-pharmacological interventions target behavioural determinants, and the literature describes the testing of their application to prevent and treat antipsychotic-induced MS. Few studies report clinically significant attenuation of MS, and the preferred healthcare setting to deliver an intervention is yet to be established.Methods and AnalysisThis review will adhere to the Joanna Briggs Institute guidance for scoping reviews and the PRISMA-ScR checklist. Relevant electronic databases and grey literature will be searched. Qualitative, quantitative and mixed method study designs, and evidence syntheses will be considered. Two reviewers will independently screen titles and abstracts; full text screening will be undertaken by one reviewer with a 10% sample checked by another. Data will be extracted and synthesised to address the research objectives.DiscussionThis review will scope and describe the evidence about what is known about the modifiable and non-modifiable determinants of developing antipsychotic-induced MS in community dwelling adults, the non-pharmacological interventions that have previously been implemented to prevent and/or treat antipsychotic-induced MS, and the preferred context for delivery of such interventions. The review will highlight gaps in knowledge and help inform future research. The findings will be disseminated via publication in peer-reviewed journals.