Name: Julia Lappin
Positions: A/Prof, School of Psychiatry and NDARC and Clinical Director, NSW Tertiary Referral Service for Psychosis
Project story template: Improving physical health in people with psychosis through the Tertiary Referral Service for Psychosis
Can you please tell us about the project and why it is needed?
People with psychosis suffer very high rates of physical health problems, including diabetes and obesity which are major contributors to the premature mortality of up to 20 years in this population. This study, made possible through seed funding provided by the SPHERE NMHA CAG, investigates the benefits of offering a weekly injection of a drug used in diabetes treatment (dulaglutide) to people with psychosis who have risk factors for the development of diabetes. It is hoped that effective treatment of prediabetes and obesity will prevent or delay the onset of diabetes and, in turn, lead to better physical health care and outcomes in this high-needs group. The research will be conducted through A/P Lappin’s leadership as Clinical Director of the Tertiary Referral Service for Psychosis (TRSP), the NSW statewide service for optimal management of people with complex and difficult to treat psychotic illness. The TRSP offers intensive and individualised therapeutic approaches for people who live with complex psychotic disorders.
What are you hoping to achieve in this project?
The first thing we want to understand is whether it is feasible and safe to offer dulaglutide to individuals with psychosis, as this treatment has never before been used for this indication in this population. Dulaglutide is a glucagon-like peptide‑1 (GLP1) analogue delivered by injection once-weekly. It has been used for the treatment of type 2 diabetes in the general population and has been shown both to induce weight loss and to improve cardiovascular outcomes. If we can demonstrate it is safe and feasible to use in people with psychosis, there is potential to make available a new treatment to people with psychosis which may be very effective in better managing their physical health. We will also examine whether dulaglutide is effective in improving markers of disordered glucose metabolism (prediabetes) and in reducing total and central abdominal obesity.
Who are the project team?
Our team specialises in clinical research which addresses physical healthcare among patients with psychosis, specifically addressing the 20-year premature life expectancy due to metabolic and cardiovascular issues. The team comprises clinicians and researchers from a broad range of disciplines including mental health, endocrinology, pharmacology and implementation science. The SESLHD team includes Julia Lappin; Dr Patrick Bolton, Director of Clinical Services, Prince of Wales Hospital; and Professor Lin Perry, Nursing Research & Practice Development who will advise on implementation. Metabolic and endocrinology experts include Prof Kathy Samaras, an international expert in the management of diabetes in people with mental illness (St Vincent’s Clinical School and the Garvan); Dr Greg Smith, School of Medical Sciences, UNSW; Dr Tang Wong, Faculty of Medicine, UNSW; and Prof Ric Day, Faculty of Medicine, UNSW and St Vincent’s Clinical School.
What impact do you imagine the project will have?
This study provides an important first step to addressing the high rates of diabetes and obesity which lead to premature mortality among people with psychosis. We very much need evidence of feasibility and effectiveness of treatments in this population to ensure that they receive better physical health care and health outcomes. This will contribute to greater longevity and quality of life, key priorities for people with psychosis and their support networks.
