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Amiri S, Mahmood N, Javaid SF, Khan MAB. The Effect of Lifestyle Interventions on Anxiety, Depression and Stress: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Healthcare (Basel) 2024; 12:2263. [PMID: 39595461 PMCID: PMC11594078 DOI: 10.3390/healthcare12222263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Revised: 10/29/2024] [Accepted: 11/08/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND/OBJECTIVES Depression, anxiety, and stress are common mental health issues that affect individuals worldwide. This systematic review and meta-analysis examined the effectiveness of various lifestyle interventions including physical activity, dietary changes, and sleep hygiene in reducing the symptoms of depression, anxiety, and stress. Using stress as an outcome and conducting detailed subgroup analyses, this study provides novel insights into the differential effects of lifestyle interventions across diverse populations. METHODS Five databases were systematically searched: PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar, for gray literature searches. Keywords were used to search each database. The search period was from the conception of the databases until August 2023 and was conducted in English. For each analysis, Hedges' g was reported with a 95% confidence interval (CI) based on the random-effects method. Subgroups were analyzed and heterogeneity and publication bias were examined. RESULTS Ninety-six randomized clinical trial studies were included in this meta-analysis. Lifestyle interventions reduced depression (Hedges g -0.21, 95% confidence interval -0.26, -0.15; p < 0.001; I2 = 56.57), anxiety (Hedges g -0.24, 95% confidence interval -0.32, -0.15; p < 0.001; I2 = 59.25), and stress (-0.34, -0.11; p < 0.001; I2 = 61.40). CONCLUSIONS Lifestyle interventions offer a more accessible and cost-effective alternative to traditional treatments and provide targeted benefits for different psychological symptoms.
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Affiliation(s)
- Sohrab Amiri
- Spiritual Health Research Center, Lifestyle Institute, Baqiyatallah University of Medical Sciences, Tehran 17166, Iran;
| | - Nailah Mahmood
- Division of Health Research, Lancaster University, Lancaster LA1 4YW, UK;
| | - Syed Fahad Javaid
- Health and Wellness Research Group, Department of Psychiatry and Behavioral Sciences, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain 15551, United Arab Emirates
| | - Moien AB Khan
- Health and Wellness Research Group, Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain 15551, United Arab Emirates
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Speyer H, van Os J. Engaging in healthy life activities is inherently valuable. Lancet Psychiatry 2024; 11:398-399. [PMID: 38670128 DOI: 10.1016/s2215-0366(24)00131-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Affiliation(s)
- Helene Speyer
- Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen 2900, Denmark.
| | - Jim van Os
- Department of Psychiatry, Utrecht University Medical Centre, Utrecht, Netherlands
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Strube W, Wagner E, Luykx JJ, Hasan A. A review on side effect management of second-generation antipsychotics to treat schizophrenia: a drug safety perspective. Expert Opin Drug Saf 2024; 23:715-729. [PMID: 38676922 DOI: 10.1080/14740338.2024.2348561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/24/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Effective side effects management present a challenge in antipsychotic treatment with second-generation antipsychotics (SGAs). In recent years, most of the commonly used SGAs, except for clozapine, have been shown to differ only slightly in their effectiveness, but considerably regarding perceived side effects, safety profiles, and compatibility to preexisting medical conditions. AREAS COVERED The current state of available evidence on side-effect management in SGA treatment of patients with schizophrenia spectrum disorders (SSD) is reviewed. In addition, current guideline recommendations are summarized, highlighting evidence gaps. EXPERT OPINION SGA safety and side effects needs to be considered in treatment planning. Shared decision-making assistants (SDMA) can support patients, practitioners and relatives to orient their decisions toward avoiding side effects relevant to patients' adherence. Alongside general measures like psychosocial and psychotherapeutic care, switching to better tolerated SGAs can be considered a relatively safe strategy. By contrast, novel meta-analytical evidence emphasizes that dose reduction of SGAs can statistically increase the risk of relapse and other unfavorable outcomes. Further, depending on the type and severity of SGA-related side effects, specific treatments can be used to alleviate induced side effects (e.g. add-on metformin to reduce weight-gain). Finally, discontinuation should be reserved for acute emergencies.
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Affiliation(s)
- Wolfgang Strube
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Augsburg, Augsburg, Germany
| | - Elias Wagner
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Augsburg, Augsburg, Germany
- Evidence-based psychiatry and psychotherapy, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Jurjen J Luykx
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Outpatient second opinion clinic, GGNet Mental Health, Warnsveld, The Netherlands
| | - Alkomiet Hasan
- Department of Psychiatry, Psychosomatics and Psychotherapy, University of Augsburg, Augsburg, Germany
- DZPG (German Center for Mental Health), partner site München/Augsburg, Augsburg, Germany
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Jønsson ABR, Brodersen JB, Reventlow S, Svanholm C, Møller A, Kousgaard MB. General practitioners' experiences of providing somatic care for patients with severe mental illness: a qualitative study. BMC PRIMARY CARE 2024; 25:96. [PMID: 38519880 PMCID: PMC10958876 DOI: 10.1186/s12875-024-02338-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 03/11/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Patients dealing with severe mental illnesses (SMI) often face suboptimal clinical outcomes and higher mortality rates due to a range of factors, including undetected physical health conditions. The provision of care for individuals with SMI is frequently disjointed, as they engage with diverse healthcare providers. Despite this fragmentation, primary care, particularly general practitioners (GPs), assumes a pivotal role in the care of SMI patients. Our study aimed to delve into the first-hand experiences of GPs in delivering somatic care to SMI patients, concentrating on the challenges they encounter and the strategies they employ to navigate these difficulties. METHODS We conducted in-depth interviews with fifteen GPs, utilizing a semi-structured interview guide, supplemented by ethnographic observations during clinical consultations in general practice. Through inductive coding, interview transcripts and observational field notes were systematically analysed using interpretative phenomenological analysis (IPA). The findings were then deliberated upon within the author group. RESULTS GPs revealed that managing the chronic somatic care of SMI patients posed significant challenges. These challenges encompassed the multifaceted needs of patients, their behavior tied to symptoms, a lack of care continuity, and overarching time constraints. To tackle these challenges, the GPs had devised various strategies. However, all participants underscored the critical importance of having adequate time to properly prepare for, conduct, and follow up on consultations. CONCLUSION The GPs' interactions with SMI patients brought numerous challenges, although treating these patients were concurrently acknowledged as vital and fulfilling. The findings suggest that increased allocated time in general practice consultations for patients with SMI is important to support the somatic treatment requirements of this patient group.
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Affiliation(s)
- Alexandra Brandt Ryborg Jønsson
- Center for General Practice, University of Copenhagen, Copenhagen, Denmark.
- Department of People and Technology, Roskilde University, Roskilde, Denmark.
- Department of Community Health, The Arctic University of Norway, Tromsø, Norway.
| | - John Brandt Brodersen
- Center for General Practice, University of Copenhagen, Copenhagen, Denmark
- Department of Community Health, The Arctic University of Norway, Tromsø, Norway
- Research Unit for General Practice, Region Zealand, Denmark
| | - Susanne Reventlow
- Center for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Christina Svanholm
- Center for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Anne Møller
- Center for General Practice, University of Copenhagen, Copenhagen, Denmark
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Ganeshalingam AA, Uhrenholt NG, Arnfred S, Gæde PH, Bilenberg N, Frystyk J. Home-based Intervention with Semaglutide Treatment of Neuroleptic-Related Prediabetes (HISTORI): protocol describing a prospective, randomised, placebo controlled and double-blinded multicentre trial. BMJ Open 2024; 14:e077173. [PMID: 38503415 PMCID: PMC10953037 DOI: 10.1136/bmjopen-2023-077173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 03/04/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION Subjects with schizophrenia have a 2-3 fold higher mortality rate than the general population and a reduced life expectancy of 10-20 years. Approximately one-third of this excess mortality has been attributed to obesity-related type 2 diabetes (T2D) and to cardiovascular disease. Glucagon-like peptide-1 (GLP-1) analogues increase satiety and delay gastric emptying, thereby reducing food intake and weight. GLP-1 analogues also exert beneficial effects on cardiovascular outcomes in high-risk patients with T2D.Our aim is to investigate whether 30 weeks add-on treatment with the GLP-1 analogue semaglutide can reduce HbA1c sufficiently to reverse pre-diabetes and the metabolic syndrome in overweight schizophrenic patients. METHODS AND ANALYSIS We will perform a 30 week, two-armed, multicentre, superiority, double-blinded, randomised trial investigating the effect of weekly injections of semaglutide versus placebo in mental health facilities in Region of Southern Denmark and Region of Zealand, Denmark. In total, 154 adults with schizophrenia spectrum disease, aged 18-60 years treated with second generation antipsychotic treatment, HbA1c 39-47 mmol/mol and body mass index >27 kg/m2 will be randomised to injections of 1.0 mg semaglutide or placebo. The primary outcome is changes in HbA1c. Secondary outcomes encompass metabolic measures, psychotic symptoms and quality of life. Exploratory outcomes encompass insulin sensitivity, cardiovascular risk profile, medication adherence, general well-being and physical activity. ETHICS AND DISSEMINATION This study will be carried out in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. This research has obtained approval from both the Danish Medicines Agency and The Regional Committees on Health Research Ethics for Southern Denmark. TRIAL REGISTRATION NUMBER NCT05193578 European Clinical Trials Database Number (EudraCT) 2020-004374-22, Regional Ethical Committee number S-20200182.
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Affiliation(s)
- Ashok Ainkaran Ganeshalingam
- Endocrine Research Unit, Department of Endocrinology, Odense University Hospital & Department of Clinical Research, Faculty of Health, Odense Universitetshospital, Odense, Denmark
- Department of Internal Medicine, Lillebaelt Hospital - University Hospital of Southern Denmark, Kolding, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Nicolai Gundtoft Uhrenholt
- Psychiatry West, Region Zealand, Research Unit West, Slagelse, Denmark, Slagelse, Denmark
- Department of Child and Adolescent Mental Health Odense, Mental Health Services, University of Southern Denmark, Odense, Denmark
| | | | - Peter Haulund Gæde
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
| | - Niels Bilenberg
- Department of Child and Adolescent Mental Health Odense, Mental Health Services, University of Southern Denmark, Odense, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Jan Frystyk
- Endocrine Research Unit, Department of Endocrinology, Odense University Hospital & Department of Clinical Research, Faculty of Health, Odense Universitetshospital, Odense, Denmark
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Kanofsky JD, Viswanathan S, Wylie-Rosett J. Lifestyle Coaching May Be an Effective Treatment for Schizophrenia. Am J Lifestyle Med 2024; 18:156-161. [PMID: 38559781 PMCID: PMC10979723 DOI: 10.1177/15598276221142307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
This commentary critiques the Danish CHANGE trial, which evaluated 3 levels of outpatient intervention intensity, in a group of outpatients with obesity and schizophrenia. Neither adding care coordination with weekly nurse contacts alone nor combining this treatment with assertive community lifestyle coaching as compared to treatment as usual improved outcomes, which included cardiovascular disease risk calculation, cardiorespiratory fitness, weight, and self-reported behaviors such as smoking, physical activity, and diet. The CHANGE trial investigators appear strongly averse to recommending the development and implementation of lifestyle medicine programs as a major component when treating outpatients with severe mental disorders. The potential dismissal of lifestyle medicine as a component of treatment for severe mental disorders is problematic. Valuable lessons can be learned from more thoroughly analyzing secondary outcomes such as medical and psychiatric hospitalization rates and total health care cost. The CHANGE trial data analysis needs to be expanded beyond the focus on changes in weight and serum cholesterol. Insulin resistance and high refined carbohydrate intake may be major factors in determining both the medical and psychiatric clinical course of schizophrenia. Assertive community lifestyle coaching is a novel treatment modality. Evidence strongly suggests assertive community lifestyle coaching substantially decreases both psychiatric and medical hospitalization rates.
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Affiliation(s)
- Jacob Daniel Kanofsky
- Bronx Psychiatric Center, Bronx, NY, USA (JDK); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA (JDK); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA (SV, JWR); and New York Regional Center for Diabetes Translational Research, Albert Einstein College of Medicine, Bronx, NY, USA (JWR)
| | - Shankar Viswanathan
- Bronx Psychiatric Center, Bronx, NY, USA (JDK); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA (JDK); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA (SV, JWR); and New York Regional Center for Diabetes Translational Research, Albert Einstein College of Medicine, Bronx, NY, USA (JWR)
| | - Judith Wylie-Rosett
- Bronx Psychiatric Center, Bronx, NY, USA (JDK); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA (JDK); Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA (SV, JWR); and New York Regional Center for Diabetes Translational Research, Albert Einstein College of Medicine, Bronx, NY, USA (JWR)
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Sampogna G, Luciano M, Di Vincenzo M, Toni C, D’Ambrosio E, Rampino A, Rossi A, Rossi R, Amore M, Calcagno P, Siracusano A, Niolu C, Dell’Osso L, Carpita B, Fiorillo A. Physical activity influences adherence to pharmacological treatments in patients with severe mental disorders: results from the multicentric, randomized controlled LIFESTYLE trial. Front Pharmacol 2023; 14:1285383. [PMID: 38152689 PMCID: PMC10752611 DOI: 10.3389/fphar.2023.1285383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/20/2023] [Indexed: 12/29/2023] Open
Abstract
Introduction: Poor adherence to pharmacological treatment is frequent in people with severe mental disorders and it often causes lack of effectiveness of many psychotropic drugs. Thus, efforts should be made to improve adherence to pharmacological treatments in patients with these disorders. Methods: In this paper, based on the LIFESTYLE randomized, controlled multicentric trial, we aim to: 1) assess the level of adherence in a real-world sample of patients with severe mental disorders; 2) evaluate differences in treatment adherence according to patients' socio-demographic and clinical characteristics; 3) evaluate the impact of an innovative psychosocial intervention, on patients' adherence to treatments. The Lifestyle Psychosocial Group Intervention consists of group sessions, focused on different lifestyle behaviours, including healthy diet; physical activity; smoking habits; medication adherence; risky behaviours; and regular circadian rhythms. At end of each session a 20-min moderate physical activity is performed by the whole group. Results: The sample consists of 402 patients, mainly female (57.1%, N = 229), with a mean age of 45.6 years (±11.8). Less than 40% of patients reported a good adherence to pharmacological treatments. Adherence to treatments was not influenced by gender, age, diagnosis and duration of illness. At the end of the intervention, patients receiving the experimental intervention reported a significant improvement in the levels of adherence to treatments (T0: 35.8% vs. T3: 47.6%, p < 0.005). Patients practicing moderate physical activity reported a two-point improvement in the levels of adherence [odds ratio (OR): 1,542; 95% confidence intervals (CI): 1,157-2,055; p < 0.001], even after controlling for several confounding factors. Discussion: The experimental lifestyle intervention, which can be easily implemented in the routine clinical practice of mental health centres, was effective in improving adherence to pharmacological treatments.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Matteo Di Vincenzo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Claudia Toni
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Enrico D’Ambrosio
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Bari, Italy
| | - Antonio Rampino
- Department of Translational Biomedicine and Neuroscience, University of Bari Aldo Moro, Bari, Italy
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Mario Amore
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Pietro Calcagno
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Cinzia Niolu
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Liliana Dell’Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Barbara Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
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Stogios N, Humber B, Agarwal SM, Hahn M. Antipsychotic-Induced Weight Gain in Severe Mental Illness: Risk Factors and Special Considerations. Curr Psychiatry Rep 2023; 25:707-721. [PMID: 37755655 DOI: 10.1007/s11920-023-01458-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 09/28/2023]
Abstract
PURPOSE OF REVIEW Weight gain is a disconcerting issue experienced by patients treated with antipsychotics (APs). This review summarizes current knowledge on the prevalence, etiology, and risk factors for antipsychotic-induced weight gain (AIWG), and evidence for interventions, including special considerations. RECENT FINDINGS Predisposing risk factors for AIWG include lack of prior AP exposure, sex, and age. AP dose and duration of exposure are additional treatment-related factors that may contribute to this issue. Among current approaches to target AIWG, metformin has the most evidence to support its use, and this is increasingly reflected in clinical guidelines. While lifestyle approaches are recommended, cost-effectiveness and scalability represent limitations. More research is needed to identify newer treatment options and inform clinical recommendations for AIWG. Concerns around scope of practice in psychiatry to address AIWG and related comorbidities will require enhanced training opportunities and interdisciplinary collaborations, as well as updated position statements/practice guidelines emphasizing prevention.
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Affiliation(s)
- Nicolette Stogios
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen Street West, Toronto, ON, M6J 1H3, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Bailey Humber
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen Street West, Toronto, ON, M6J 1H3, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Sri Mahavir Agarwal
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen Street West, Toronto, ON, M6J 1H3, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada
| | - Margaret Hahn
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), 1051 Queen Street West, Toronto, ON, M6J 1H3, Canada.
- Institute of Medical Science, University of Toronto, Toronto, Canada.
- Department of Psychiatry, University of Toronto, Toronto, Canada.
- Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada.
- Department of Pharmacology, University of Toronto, Toronto, Canada.
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Jønsson ABR, Martiny FHJ, Søndergaard MK, Brodersen JB, Due TD, Nielsen MH, Bakkedal C, Bardram JE, Bissenbakker K, Christensen I, Doherty K, Kjellberg P, Mercer SW, Reventlow S, Rozing MP, Møller A. Introducing extended consultations for patients with severe mental illness in general practice: Results from the SOFIA feasibility study. BMC PRIMARY CARE 2023; 24:206. [PMID: 37798651 PMCID: PMC10552249 DOI: 10.1186/s12875-023-02152-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/05/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND People with a severe mental illness (SMI) have shorter life expectancy and poorer quality of life compared to the general population. Most years lost are due to cardiovascular disease, respiratory disease, and various types of cancer. We co-designed an intervention to mitigate this health problem with key stakeholders in the area, which centred on an extended consultations for people with SMI in general practice. This study aimed to1) investigate general practitioners' (GPs) experience of the feasibility of introducing extended consultations for patients with SMI, 2) assess the clinical content of extended consultations and how these were experienced by patients, and 3) investigate the feasibility of identification, eligibility screening, and recruitment of patients with SMI. METHODS The study was a one-armed feasibility study. We planned that seven general practices in northern Denmark would introduce extended consultations with their patients with SMI for 6 months. Patients with SMI were identified using practice medical records and screened for eligibility by the patients' GP. Data were collected using case report forms filled out by practice personnel and via qualitative methods, including observations of consultations, individual semi-structured interviews, a focus group with GPs, and informal conversations with patients and general practice staff. RESULTS Five general practices employing seven GPs participated in the study, which was terminated 3 ½ month ahead of schedule due to the COVID-19 pandemic. General practices attempted to contact 57 patients with SMI. Of these, 38 patients (67%) attended an extended consultation, which led to changes in the somatic health care plan for 82% of patients. Conduct of the extended consultations varied between GPs and diverged from the intended conduct. Nonetheless, GPs found the extended consultations feasible and, in most cases, beneficial for the patient group. In interviews, most patients recounted the extended consultation as beneficial. DISCUSSION Our findings suggest that it is feasible to introduce extended consultations for patients with SMI in general practice, which were also found to be well-suited for eliciting patients' values and preferences. Larger studies with a longer follow-up period could help to assess the long-term effects and the best implementation strategies of these consultations.
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Affiliation(s)
- A B R Jønsson
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Health and Society, Department of People and Technology, Roskilde University, Roskilde, Denmark
- Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway
| | - F H J Martiny
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
- Center for Social Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
| | - M K Søndergaard
- The Research Unit for General Practice, University of Southern Denmark, Odense, Denmark
| | - J B Brodersen
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway
- Primary Health Care, Region Zealand, Denmark
| | - T D Due
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M H Nielsen
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - C Bakkedal
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - J E Bardram
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - K Bissenbakker
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - I Christensen
- The Danish Centre for Social Science Research, Copenhagen, Denmark
| | - K Doherty
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - P Kjellberg
- The Danish Centre for Social Science Research, Copenhagen, Denmark
| | - S W Mercer
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Denmark
| | - S Reventlow
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M P Rozing
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - A Møller
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Sass MR, Danielsen AA, Köhler-Forsberg O, Storgaard H, Knop FK, Nielsen MØ, Sjödin AM, Mors O, Correll CU, Ekstrøm C, Vinberg M, Nielsen J, Vilsbøll T, Fink-Jensen A. Effect of the GLP-1 receptor agonist semaglutide on metabolic disturbances in clozapine-treated or olanzapine-treated patients with a schizophrenia spectrum disorder: study protocol of a placebo-controlled, randomised clinical trial (SemaPsychiatry). BMJ Open 2023; 13:e068652. [PMID: 36720576 PMCID: PMC9890830 DOI: 10.1136/bmjopen-2022-068652] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/10/2023] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Clozapine and olanzapine are some of the most effective antipsychotics, but both are associated with weight gain and relevant metabolic disturbances, including pre-diabetes and diabetes. Non-pharmacological/behavioural interventions have had limited effects counteracting these adverse effects. Semaglutide, a glucagon-like peptide 1 receptor agonist, is approved for the treatment of type 2 diabetes and obesity. We will investigate the long-term effects of add-on treatment with semaglutide once a week versus placebo once a week on the metabolic status in pre-diabetic (glycated haemoglobin A1c (HbA1c) 35-47 mmol/mol (5.4%-6.4%) and diabetic (HbA1c 48-57 mmol/mol (6.5%-7.4%)) patients diagnosed with a schizophrenia spectrum disorder who initiated clozapine or olanzapine treatment within the last 60 months. METHODS AND ANALYSIS This is a 26-week, double-blinded, randomised, placebo-controlled trial. Altogether, 104 patients diagnosed with a schizophrenia spectrum disorder, aged 18-65 years, with pre-diabetes or diabetes will be randomised to injections of 1.0 mg semaglutide once a week or placebo for 26 weeks. The primary endpoint is change from baseline in HbA1c. Secondary endpoints include changes in body weight, hip and waist circumference and plasma levels of insulin, glucagon, glucose, and C-peptide, insulin sensitivity, beta cell function, hepatic function, fibrosis-4 score, lipid profile, incretin hormones, bone markers, body composition, bone density, proteomic analyses and oxidative stress markers. Together with alcohol, tobacco and drug use, potential effects on the reward value of a sweet-fat stimulus, psychopathology, level of activity and quality of life will also be assessed. ETHICS AND DISSEMINATION This study is approved by the Danish Medicines Agency and the regional scientific ethics committee of the Capital Region of Denmark (committee C, #H-20019008) and will be carried out in accordance with International Council for Harmonisation Good Clinical Practice guidelines and the Helsinki Declaration. The results will be disseminated through peer-review publications and conference presentations. TRIAL REGISTRATION NUMBER NCT04892199.
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Affiliation(s)
- Marie Reeberg Sass
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Capital Region of Denmark Mental Health Services, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Aalkjær Danielsen
- Psychiatry, Psychosis Research Unit, Aarhus University Hospital Skejby, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ole Köhler-Forsberg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Psychiatry, Psychosis Research Unit, Aarhus Universitetshospital Skejby, Aarhus, Denmark
| | - Heidi Storgaard
- Center for Clinical Metabolic Research, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Filip K Knop
- Center for Clinical Metabolic Research, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Mette Ødegaard Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Mental Health Centre Glostrup, Copenhagen University Hospital, Capital Region of Denmark Mental Health Services, Glostrup, Denmark
| | - Anders Mikael Sjödin
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Ole Mors
- Psychiatry, Psychosis Research Unit, Aarhus University Hospital Skejby, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Christoph U Correll
- Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine at Hofstra University, Hempstead, New York, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Claus Ekstrøm
- Department of Biostatistics, University of Copenhagen Department of Public Health, Copenhagen, Denmark
| | - Maj Vinberg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Psychiatric Center North Zeeland, Copenhagen University Hospital, Capital Region of Denmark Mental Health Services, Hillerød, Denmark
| | - Jimmi Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Mental Health Centre Glostrup, Copenhagen University Hospital, Capital Region of Denmark Mental Health Services, Glostrup, Denmark
| | - Tina Vilsbøll
- Center for Clinical Metabolic Research, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
- Clinical Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Anders Fink-Jensen
- Mental Health Centre Copenhagen, Copenhagen University Hospital, Capital Region of Denmark Mental Health Services, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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11
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Kilvert A, Fox C. Health inequalities and diabetes. PRACTICAL DIABETES 2023. [DOI: 10.1002/pdi.2435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
| | - Charles Fox
- Honorary Lecturer, Leicester Diabetes Centre Leicester UK
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12
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Strunz M, Jiménez NP, Gregorius L, Hewer W, Pollmanns J, Viehmann K, Jacobi F. Interventions to Promote the Utilization of Physical Health Care for People with Severe Mental Illness: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:126. [PMID: 36612457 PMCID: PMC9819522 DOI: 10.3390/ijerph20010126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The main contributor to excess mortality in severe mental illness (SMI) is poor physical health. Causes include unfavorable health behaviors among people with SMI, stigmatization phenomena, as well as limited access to and utilization of physical health care. Patient centered interventions to promote the utilization of and access to existing physical health care facilities may be a pragmatic and cost-effective approach to improve health equity in this vulnerable and often neglected patient population. OBJECTIVE/METHODS In this study, we systematically reviewed the international literature on such studies (sources: literature databases, trial-registries, grey literature). Empirical studies (quantitative, qualitative, and mixed methods) of interventions to improve the utilization of and access to medical health care for people with a SMI, were included. RESULTS We identified 38 studies, described in 51 study publications, and summarized them in terms of type, theoretical rationale, outcome measures, and study author's interpretation of the intervention success. CONCLUSIONS Useful interventions to promote the utilization of physical health care for people with a SMI exist, but still appear to be rare, or at least not supplemented by evaluation studies. The present review provides a map of the evidence and may serve as a starting point for further quantitative effectiveness evaluations of this promising type of behavioral intervention.
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Affiliation(s)
| | | | - Lisa Gregorius
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany
| | - Walter Hewer
- Klinikum Christophsbad, 73035 Göppingen, Germany
| | | | - Kerstin Viehmann
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich Heine University Duesseldorf, 40225 Duesseldorf, Germany
| | - Frank Jacobi
- Psychologische Hochschule Berlin, 10179 Berlin, Germany
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13
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Fridén L, Hultsjö S, Lydell M, Jormfeldt H. Relatives' experiences of an equine-assisted intervention for people with psychotic disorders. Int J Qual Stud Health Well-being 2022; 17:2087276. [PMID: 35698741 PMCID: PMC9310814 DOI: 10.1080/17482631.2022.2087276] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2022] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aim of this study was to describe relatives' experiences of an equine-assisted intervention for people with psychotic disorders. METHODS The study has a qualitative and descriptive design. Ten semi-structured interviews were performed with relatives of people with a psychotic disorder who had participated in an equine-assisted intervention. A conventional content analysis was used to analyse the data. RESULT The overall category "Being with the horses strengthens health capabilities" summarizes the four identified subcategories "The horses contribute to a context with a common focus", "Interaction with the horses enhances self-confidence and motivation", "The interplay with the horses nurtures positive emotions" and "Being with the horses encourages physical activity". CONCLUSIONS The result of this study contributes to the growing body of research about the potential outcomes of equine-assisted interventions. The result also indicates that equine-assisted interventions may improve health capabilities among people with psychotic disorders. The generated knowledge may be useful in mental health services when developing equine-assisted interventions.
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Affiliation(s)
- Linda Fridén
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Sally Hultsjö
- Department of Psychiatry, Region Jönköping County, Sweden and Department of Health, Medicine and Caring Sciences, Division of Nursing and Reproductive Health, Linköping University, Linköping, Sweden
| | - Marie Lydell
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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14
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Brown C, Cook JA, Jonikas JA, Steigman PJ, Burke-Miller J, Hamilton MM, Rosen C, Tessman DC, Santos A. Nutrition and Exercise for Wellness and Recovery: A Randomized Controlled Trial of a Community-Based Health Intervention. Psychiatr Serv 2022; 74:463-471. [PMID: 36377367 DOI: 10.1176/appi.ps.202200038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The purpose of this study was to examine the efficacy of the Nutrition and Exercise for Wellness and Recovery (NEW-R) intervention for improving competency and behaviors related to diet, physical activity, and weight management. METHODS Participants with psychiatric disabilities were recruited from four community mental health agencies and a hospital-based psychiatric outpatient clinic and randomly assigned to the NEW-R intervention (N=55) or control condition (N=58). Outcome measures included the Perceived Competence Scale, Health-Promoting Lifestyle Profile (HPLP), and weight change; random-effects regression models were used. A follow-up analysis examined the interactions of group, time, and site. RESULTS Fifty of the 55 intervention participants and 57 of the 58 control participants completed the study. The two groups did not differ significantly on any measured baseline characteristic. The intervention group had statistically significant improvements, compared with the control group, in perceived competence for exercise and healthy eating, total HPLP score, and scores on two HPLP subscales (nutrition and spiritual growth). No significant difference between groups was found for weight loss. A study condition × time × site effect was observed: at the three sites where mean weight loss occurred, NEW-R participants lost significantly more weight than did control participants. CONCLUSIONS NEW-R offers promise as an intervention that can initiate the change to healthy lifestyle behaviors and boost perceived competence in a healthy lifestyle. It may also be effective for weight loss when administered in supportive settings.
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Affiliation(s)
- Catana Brown
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Judith A Cook
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Jessica A Jonikas
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Pamela J Steigman
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Jane Burke-Miller
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Marie M Hamilton
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Cherise Rosen
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Dorothy Clare Tessman
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
| | - Alberto Santos
- Department of Occupational Therapy, College of Health Sciences, Midwestern University, Glendale, Arizona (Brown); Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago (Cook, Jonikas, Steigman, Burke-Miller, Hamilton, Rosen); independent practice, Chicago (Tessman); Department of Psychiatry, DePaul Community Health Centers of New Orleans, New Orleans (Santos)
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15
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Improving physical activity and diet in patients with severe mental disorders: Results from the LIFESTYLE multicentric, real-world randomized controlled trial. Psychiatry Res 2022; 317:114818. [PMID: 36088834 DOI: 10.1016/j.psychres.2022.114818] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022]
Abstract
Aims of the present study are to test the efficacy of a lifestyle group intervention, compared to a brief psychoeducational intervention, on levels of physical activity and dietary habits in a real-world sample of patients with severe mental disorders. The study, funded by the Italian Ministry of Education, has been carried out in six Italian University psychiatric outpatient units. All patients were randomly assigned to the experimental or control group and were assessed through standardized assessment instruments at baseline and six months after randomization. Of the 401 recruited patients, 43.3% had a diagnosis of bipolar disorder, 29.9% of psychosis and 26.9% of major depression. Patients were mainly female (57%), with a mean age of 45.6±11.8 years. Treated patients have almost 8 times the likelihood to show an increase of the total MET (OR: 8.02; p < .001) and of the walking MET (OR: 7.68; p < .001) and are more likely to increase the weekly consumption of vegetables (OR= 1.98, p < .05) and to reduce that of junk food (OR:0.23; p < .05). The present study support the notion that patients with severe mental disorders can improve their lifestyle behaviours and that, with appropriate support, they can achieve a healthy living.
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16
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Huang Z, Liu X. Network Pharmacology and Molecular Docking Analysis on Targets and Mechanisms of Berberine in Atypical Antipsychotic-Induced Metabolic Syndrome. Nat Prod Commun 2022. [DOI: 10.1177/1934578x221129106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Berberine (BBR), an isoquinoline alkaloid, possesses multiply pharmacological effects as a potential therapeutic drug for antipsychotic-induced metabolic syndrome (MetS). However, the underlying therapeutic mechanisms have not been fully elucidated. In this study, we aim to investigate the possible mechanisms by identifying the key targets and biological pathways through network pharmacology and molecular docking analysis. A total of 23 overlapping targets in the intersection set among BBR, atypical antipsychotic drugs (AADs), and MetS were determined. PPI network analysis showed that 22 out of the 23 overlapping targets closely interacted with the others. The following pathway enrichment analysis and molecular docking indicated a central role of peroxisome proliferator-activated receptor-γ (PPARG) as the key target of BBR against AAD-induced MetS by acting on the PPAR signaling pathway, lipid and atherosclerosis, and AMP activated protein kinase (AMPK) signaling pathway. In addition, cytochrome P-450 2D6 (CYP2D6) could be considered as another target of BBR in ameliorating antipsychotic-induced metabolic side effects. Collectively, this study investigated the central targets and biological pathways of BBR against AAD-induced MetS from a systematic perspective, and thus brings novel insights into further understanding of the protective effects of BBR.
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Affiliation(s)
- Zhuowei Huang
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Department of Traditional Chinese Integrated Western Medicine, Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
| | - Xiaolan Liu
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, Hubei Province, China
- Department of Traditional Chinese Integrated Western Medicine, Wuhan Hospital for Psychotherapy, Wuhan, Hubei Province, China
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17
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Melamed O, Voineskos A, Vojtila L, Ashfaq I, Veldhuizen S, Dragonetti R, Carriere R, LaChance L, Kohut SA, Tulloch T, Argarwal SM, Hahn M, Mulsant BH, Selby P. Technology-enabled collaborative care for youth with early psychosis: Results of a feasibility study to improve physical health behaviours. Early Interv Psychiatry 2022; 16:1143-1151. [PMID: 35103380 DOI: 10.1111/eip.13266] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/17/2021] [Accepted: 01/18/2022] [Indexed: 12/01/2022]
Abstract
AIM Psychotic disorders are associated with excess morbidity and premature mortality. Contributing factors include tobacco smoking, low physical activity, and poor nutrition. This study tested a Technology-Enabled Collaborative Care model to improve health behaviours among youth with early psychosis. METHODS A feasibility study among youth (ages 16-29) with early psychosis in Ontario, Canada. Participants were randomized to either a health coach supervised by a virtual care team (high intensity, n = 29), or self-directed learning (low intensity, n = 23) for 12 weeks. The primary outcome was participant engagement, defined as self-perceived benefit of changing health behaviours. Secondary outcomes were measures of health behaviours and programme-use metrics. RESULTS Engagement was higher for high intensity participants for physical activity (adjusted group difference in change at 24 weeks = 3.4, CI95% = 1.9-4.9, p < .001) and nutrition (adjusted difference = 2.9, CI95% = 1.2-4.6, p = .001). No change was observed in health behaviours. Sixty two percent of participants completed 6 or more of the 12 weekly remote individualized health coaching sessions. Nine (39%) low intensity and 12 (41%) high intensity participants completed the final follow-up. CONCLUSIONS Personalized health coaching for youth with psychosis is feasible and may have sustained benefits. However, retention with this population for 12 weeks is challenging.
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Affiliation(s)
- Osnat Melamed
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Aristotle Voineskos
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Lenka Vojtila
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Iqra Ashfaq
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Scott Veldhuizen
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rosa Dragonetti
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rebecca Carriere
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Ambulatory Mental Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Laura LaChance
- McGill University, Department of Psychiatry, Montreal, Quebec, Canada
| | - Sara Ahola Kohut
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Trisha Tulloch
- SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Sri Mahavir Argarwal
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Margaret Hahn
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Selby
- Nicotine Dependence Clinic, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Addictions Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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18
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Bradley T, Campbell E, Dray J, Bartlem K, Wye P, Hanly G, Gibson L, Fehily C, Bailey J, Wynne O, Colyvas K, Bowman J. Systematic review of lifestyle interventions to improve weight, physical activity and diet among people with a mental health condition. Syst Rev 2022; 11:198. [PMID: 36085250 PMCID: PMC9462072 DOI: 10.1186/s13643-022-02067-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with a mental health condition experience an elevated risk of chronic disease and greater prevalence of health and behaviours. Lifestyle interventions aim to reduce this risk by modifying health behaviours such as physical activity and diet. Previous reviews exploring the efficacy of such interventions for this group have typically limited inclusion to individuals with severe mental illness (SMI), with a focus of impact on weight. This review assessed the efficacy of lifestyle interventions delivered in community or outpatient settings to people with any mental health condition, on weight, physical activity and diet. METHODS Eligible studies were randomised or cluster-randomised controlled trials published between January 1999 and February 2019 aiming to improve weight, physical activity or diet, for people with any mental health condition. Two reviewers independently completed study screening, data extraction and assessment of methodological quality. Primary outcome measures were weight, physical activity and diet. Secondary outcome measures were body mass index (BMI), waist circumference, sedentary behaviour and mental health. Where possible, meta-analyses were conducted. Narrative synthesis using vote counting based on direction of effect was used where studies were not amenable to meta-analysis. RESULTS Fifty-seven studies were included (49 SMI only), with 46 contributing to meta-analyses. Meta-analyses revealed significant (< 0.05) effect of interventions on mean weight loss (-1.42 kg), achieving 5% weight loss (OR 2.48), weight maintenance (-2.05 kg), physical activity (IPAQ MET minutes: 226.82) and daily vegetable serves (0.51), but not on fruit serves (0.01). Significant effects were also seen for secondary outcomes of BMI (-0.48 units) and waist circumference (-0.87cm), but not mental health (depression: SMD -0.03; anxiety: SMD -0.49; severity of psychological symptoms: SMD 0.72). Studies reporting sedentary behaviour were not able to be meta-analysed. Most trials had high risk of bias, quality of evidence for weight and physical activity were moderate, while quality of evidence for diet was low. CONCLUSION Lifestyle interventions delivered to people with a mental health condition made statistically significant improvements to weight, BMI, waist circumference, vegetable serves and physical activity. Further high-quality trials with greater consistency in measurement and reporting of outcomes are needed to better understand the impact of lifestyle interventions on physical activity, diet, sedentary behaviour and mental health and to understand impact on subgroups. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019137197.
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Affiliation(s)
- Tegan Bradley
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Elizabeth Campbell
- Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287 Australia
| | - Julia Dray
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Kate Bartlem
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Paula Wye
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Grace Hanly
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Lauren Gibson
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Caitlin Fehily
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
| | - Jacqueline Bailey
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Olivia Wynne
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Kim Colyvas
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
| | - Jenny Bowman
- University of Newcastle, University Drive, Callaghan, NSW 2308 Australia
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305 Australia
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19
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Stogios N, Maksyutynska K, Navagnanavel J, Sanches M, Powell V, Gerretsen P, Graff-Guerrero A, Chintoh AF, Foussias G, Remington G, Hahn MK, Agarwal SM. Metformin for the prevention of clozapine-induced weight gain: A retrospective naturalistic cohort study. Acta Psychiatr Scand 2022; 146:190-200. [PMID: 35726126 DOI: 10.1111/acps.13462] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Clozapine is presently the sole antipsychotic with an indication for treatment-resistant Schizophrenia, but is associated with significant weight gain and other metabolic aberrations. This retrospective chart review aimed to evaluate the effectiveness of adjunctive metformin in preventing clozapine-induced weight gain. METHODS We conducted a retrospective chart review of patients newly initiated on clozapine at the Centre for Addiction and Mental Health in Canada, from November 2014 to April 2021. Our primary outcome was body weight at 6 and 12 months after clozapine initiation. Other metabolic parameters served as secondary outcomes. RESULTS Among 396 patients (males: 71.5%, mean age: 42.8 years) initiated on clozapine, 69 were on metformin or prescribed it ≤3 months after clozapine initiation. The clozapine+metformin group demonstrated less weight gain compared with the clozapine-only group at 6 months (clozapine+metformin: -0.15 kg [SE = 1.08] vs. clozapine-only: 2.99 kg, SE = 0.54) and 12 months after clozapine initiation (clozapine+metformin: -0.67 kg, SE = 1.22 vs. clozapine-only: 4.72 kg, SE = 0.67). Adaptive changes were also observed for fasting glucose (F = 3.10, p = 0.046) and triglycerides (F = 8.56, p < 0.001) in the clozapine+metformin group compared with clozapine only. CONCLUSION In this large retrospective naturalistic cohort study, co-prescription of clozapine and metformin was associated with less weight gain and related metabolic dysfunction at 6 and 12 months after initiation versus clozapine alone. These findings provide evidence for the effectiveness of metformin in preventing clozapine-induced weight gain; larger randomized controlled trials are needed to confirm these results.
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Affiliation(s)
- Nicolette Stogios
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Kateryna Maksyutynska
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada
| | | | - Marcos Sanches
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Valerie Powell
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - Philip Gerretsen
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.,Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Ariel Graff-Guerrero
- Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.,Multimodal Imaging Group, Research Imaging Centre, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Araba F Chintoh
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - George Foussias
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Gary Remington
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Margaret K Hahn
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada
| | - Sri Mahavir Agarwal
- Schizophrenia Division, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Temerty Faculty of Medicine, Institute of Medical Science, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Banting and Best Diabetes Centre (BBDC), University of Toronto, Toronto, Canada
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20
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Pape LM, Adriaanse MC, Kol J, van Straten A, van Meijel B. Patient-reported outcomes of lifestyle interventions in patients with severe mental illness: a systematic review and meta-analysis. BMC Psychiatry 2022; 22:261. [PMID: 35418082 PMCID: PMC9006587 DOI: 10.1186/s12888-022-03854-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/11/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Lifestyle interventions for severe mental illness (SMI) are known to have small to modest effect on physical health outcomes. Little attention has been given to patient-reported outcomes (PROs). AIM To systematically review the use of PROs and their measures, and quantify the effects of lifestyle interventions in patients with SMI on these PROs. METHODS Five electronic databases were searched (PubMed/Medline, Embase, PsycINFO, CINAHL, and Web of Science) from inception until 12 November 2020 (PROSPERO: CRD42020212135). Randomised controlled trials (RCTs) evaluating the efficacy of lifestyle interventions focusing on healthy diet, physical activity, or both for patients with SMI were included. Outcomes of interest were PROs. RESULTS A total of 11.267 unique records were identified from the database search, 66 full-text articles were assessed, and 36 RCTs were included, of which 21 were suitable for meta-analyses. In total, 5.907 participants were included across studies. Lifestyle interventions had no significant effect on quality of life (g = 0.13; 95% CI = - 0.02 to 0.27), with high heterogeneity (I2 = 68.7%). We found a small effect on depression severity (g = 0.30, 95% CI = 0.00 to 0.58, I2 = 65.2%) and a moderate effect on anxiety severity (g = 0.56, 95% CI = 0.16 to 0.95, I2 = 0%). DISCUSSION This meta-analysis quantifies the effects of lifestyle interventions on PROs. Lifestyle interventions have no significant effect on quality of life, yet they could improve mental health outcomes such as depression and anxiety symptoms. Further use of patient-reported outcome measures in lifestyle research is recommended to fully capture the impact of lifestyle interventions.
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Affiliation(s)
- Laura M. Pape
- grid.12380.380000 0004 1754 9227Department of Health Sciences, Faculty of Science & Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Marcel C. Adriaanse
- grid.12380.380000 0004 1754 9227Department of Health Sciences, Faculty of Science & Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Jelle Kol
- grid.12380.380000 0004 1754 9227Department of Health Sciences, Faculty of Science & Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Annemieke van Straten
- grid.12380.380000 0004 1754 9227Department of Clinical, Neuro- and Developmental Psychology & Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
| | - Berno van Meijel
- grid.448984.d0000 0003 9872 5642Department of Health, Sports & Welfare, Research Group Mental Health Nursing, Inholland University of Applied Sciences, Amsterdam, The Netherlands ,grid.16872.3a0000 0004 0435 165XAmsterdam UMC (VUmc). Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.476585.d0000 0004 0447 7260Parnassia Psychiatric Institute, Parnassia Academy, The Hague, The Netherlands
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21
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Rossom RC, Crain AL, O’Connor PJ, Waring SC, Hooker SA, Ohnsorg K, Taran A, Kopski KM, Sperl-Hillen JM. Effect of Clinical Decision Support on Cardiovascular Risk Among Adults With Bipolar Disorder, Schizoaffective Disorder, or Schizophrenia: A Cluster Randomized Clinical Trial. JAMA Netw Open 2022; 5:e220202. [PMID: 35254433 PMCID: PMC8902652 DOI: 10.1001/jamanetworkopen.2022.0202] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Adults with schizophrenia, schizoaffective disorder, or bipolar disorder, collectively termed serious mental illness (SMI), have shortened life spans compared with people without SMI. The leading cause of death is cardiovascular (CV) disease. OBJECTIVE To assess whether a clinical decision support (CDS) system aimed at primary care clinicians improves CV health for adult primary care patients with SMI. DESIGN, SETTING, AND PARTICIPANTS In this cluster randomized clinical trial conducted from March 2, 2016, to September 19, 2018, restricted randomization assigned 76 primary care clinics in 3 Midwestern health care systems to receive or not receive a CDS system aimed at improving CV health among patients with SMI. Eligible clinics had at least 20 patients with SMI; clinicians and their adult patients with SMI with at least 1 modifiable CV risk factor not at the goal set by the American College of Cardiology/American Heart Association guidelines were included. Statistical analysis was conducted on an intention-to-treat basis from January 10, 2019, to December 29, 2021. INTERVENTION The CDS system assessed modifiable CV risk factors and provided personalized treatment recommendations to clinicians and patients. MAIN OUTCOMES AND MEASURES Patient-level change in total modifiable CV risk over 12 months, summed from individual modifiable risk factors (smoking, body mass index, low-density lipoprotein cholesterol level, systolic blood pressure, and hemoglobin A1c level). RESULTS A total of 80 clinics were randomized; 4 clinics were excluded for having fewer than 20 eligible patients, leaving 42 intervention clinics and 34 control clinics. A total of 8937 patients with SMI (4922 women [55.1%]; mean [SD] age, 48.4 [13.5] years) were enrolled. There was a 4% lower rate of increase in total modifiable CV risk among intervention patients relative to control patients (relative rate ratio [RR], 0.96; 95% CI, 0.94-0.98). The intervention favored patients who were 18 to 29 years of age (RR, 0.89; 95% CI, 0.81-0.98) or 50 to 59 years of age (RR, 0.93; 95% CI, 0.90-0.96), Black (RR, 0.93; 95% CI, 0.88-0.98), or White (RR, 0.96; 95% CI, 0.94-0.98). Men (RR, 0.96; 95% CI, 0.94-0.99) and women (RR, 0.95; 95% CI, 0.92-0.97), as well as patients with any SMI subtype (bipolar disorder: RR, 0.96; 95% CI, 0.94-0.99; schizoaffective disorder: RR, 0.94; 95% CI, 0.90-0.98; schizophrenia: RR, 0.92; 95% CI, 0.85-0.99) also benefited from the intervention. Despite treatment effects favoring the intervention, there were no significant differences in individual modifiable risk factors. CONCLUSIONS AND RELEVANCE This CDS intervention resulted in a rate of change in total modifiable CV risk that was 4% lower among intervention patients compared with control patients. Results were driven by the cumulative effects of incremental and mostly nonsignificant changes in individual modifiable risk factors. These findings emphasize the value of using CDS to prompt early primary care intervention for adults with SMI. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02451670.
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Affiliation(s)
- Rebecca C. Rossom
- Department of Research, HealthPartners Institute, Minneapolis, Minnesota
| | - A. Lauren Crain
- Department of Research, HealthPartners Institute, Minneapolis, Minnesota
| | | | - Stephen C. Waring
- Essentia Health and Essentia Institute of Rural Health, Duluth, Minnesota
| | | | - Kris Ohnsorg
- Department of Research, HealthPartners Institute, Minneapolis, Minnesota
| | - Allise Taran
- Essentia Health and Essentia Institute of Rural Health, Duluth, Minnesota
| | - Kristen M. Kopski
- Park Nicollet Health Services, Minneapolis, Minnesota
- Now with Medica Health Plan, Minnetonka, Minnesota
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22
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Alteration of gut microbiome in patients with schizophrenia indicates links between bacterial tyrosine biosynthesis and cognitive dysfunction. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2022; 3:283-291. [PMID: 37124355 PMCID: PMC10140391 DOI: 10.1016/j.bpsgos.2022.01.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/28/2022] [Accepted: 01/29/2022] [Indexed: 01/03/2023] Open
Abstract
Background Schizophrenia (SCZ) is a heterogeneous neuropsychiatric disorder for which current treatment has insufficient efficacy and severe adverse effects. The modifiable gut microbiome might be a potential target for intervention to improve neurobiological functions through the gut-microbiome-brain axis. Methods In this case-control study, gut microbiota of 132 patients with SCZ and increased waist circumference were compared with gut microbiota of two age- and sex-matched control groups, composed of 132 healthy individuals and 132 individuals with metabolic syndrome. Shotgun sequencing was used to characterize fecal samples at the taxonomic and functional levels. Cognition of the patients with SCZ was evaluated using the Brief Assessment of Cognition instrument. Results SCZ gut microbiota differed significantly from those of healthy control subjects and individuals with metabolic syndrome in terms of richness and global composition. SCZ gut microbiota were notably enriched in Flavonifractor plautii, Collinsella aerofaciens, Bilophila wadsworthia, and Sellimonas intestinalis, while depleted in Faecalibacterium prausnitzii, Ruminococcus lactaris, Ruminococcus bicirculans, and Veillonella rogosae. Functional potential of the gut microbiota accounted for 11% of cognition variability. In particular, the bacterial functional module for synthesizing tyrosine, a precursor for dopamine, was in SCZ cases positively associated with cognitive score (ρ = 0.34, q ≤ .1). Conclusions Overall, this study shows that the gut microbiome of patients with SCZ differs greatly from that of healthy control subjects or individuals with metabolic syndrome. Cognitive function of patients with SCZ is associated with the potential for gut bacterial biosynthesis of tyrosine, a precursor for dopamine, suggesting that gut microbiota might be an intervention target for alleviation of cognitive dysfunction in SCZ.
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23
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Lim CT, Caan MP, Kim CH, Chow CM, Leff HS, Tepper MC. Care Management for Serious Mental Illness: A Systematic Review and Meta-Analysis. Psychiatr Serv 2022; 73:180-187. [PMID: 34253036 DOI: 10.1176/appi.ps.202000473] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Persons with serious mental illness face adverse psychiatric and medical outcomes, and their care is associated with a large burden of health care costs. Care management, in which assessment, care planning, and care coordination are provided, is a common model of support, yet the evidence supporting its use among psychiatric populations is mixed. A systematic review and a meta-analysis were undertaken to determine the impact of care management on clinical outcomes, acute care utilization, cost, and satisfaction among adults with serious mental illness. METHODS A multidatabase literature search was performed. Articles were included if they compared standard outpatient care plus care management with standard outpatient care alone for adults with serious mental illness and reported on one or more predefined outcomes. Randomized controlled trials (RCTs) and other study designs were permitted for inclusion in the systematic review. The meta-analysis included only RCTs. RESULTS For the systematic review, 34 articles representing 28 unique studies were included. Fifteen of these articles, representing 12 unique studies, were included in the meta-analysis, which indicated that care management was associated with small, statistically significant improvements in psychiatric symptoms, overall quality of life (QOL), and mental QOL (Hedges' g range 0.13-0.26). In addition, care management was associated with a small, statistically significant reduction in inpatient psychiatric hospital days (Hedges' g=0.16, p=0.02). CONCLUSIONS Care management is associated with fewer psychiatric symptoms and greater QOL for persons with serious mental illness. Further work is needed to determine which components of the intervention are associated with effectiveness.
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Affiliation(s)
- Christopher T Lim
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston
| | - Marissa P Caan
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston
| | - Clara H Kim
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston
| | - Clifton M Chow
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston
| | - H Stephen Leff
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston
| | - Miriam C Tepper
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts; Department of Psychiatry, Harvard Medical School, Boston
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24
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Sampogna G, Luciano M, Di Vincenzo M, Andriola I, D'Ambrosio E, Amore M, Serafini G, Rossi A, Carmassi C, Dell'Osso L, Di Lorenzo G, Siracusano A, Rossi R, Fiorillo A. The Complex Interplay Between Physical Activity and Recovery Styles in Patients With Severe Mental Disorders in a Real-World Multicentric Study. Front Psychiatry 2022; 13:945650. [PMID: 35898630 PMCID: PMC9309609 DOI: 10.3389/fpsyt.2022.945650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Compared with the general population, people with severe mental disorders have significantly worse physical health and a higher mortality rate, which is partially due to the adoption of unhealthy lifestyle behaviors, such as heavy smoking, use of alcohol or illicit drugs, unbalanced diet, and physical inactivity. These unhealthy behaviors may also play a significant role in the personal and functional recovery of patients with severe mental disorders, although this relationship has been rarely investigated in methodologically robust studies. In this paper, we aim to: a) describe the levels of physical activity and recovery style in a sample of patients with severe mental disorders; b) identify the clinical, social, and illness-related factors that predict the likelihood of patients performing physical activity. The global sample consists of 401 patients, with a main psychiatric diagnosis of bipolar disorder (43.4%, N = 174), psychosis spectrum disorder (29.7%; N = 119), or major depression (26.9%; N = 118). 29.4% (N = 119) of patients reported performing physical activity regularly, most frequently walking (52.1%, N = 62), going to the gym (21.8%, N = 26), and running (10.9%, N = 13). Only 15 patients (3.7%) performed at least 75 min of vigorous physical activity per week. 46.8% of patients adopted sealing over as a recovery style and 37.9% used a mixed style toward integration. Recovery style is influenced by gender (p < 0.05) and age (p < 0.05). The probability to practice regular physical activity is higher in patients with metabolic syndrome (Odds Ratio - OR: 2.1; Confidence Interval - CI 95%: 1.2-3.5; p < 0.050), and significantly lower in those with higher levels of anxiety/depressive symptoms (OR: 0.877; CI 95%: 0.771-0.998; p < 0.01). Globally, patients with severe mental disorders report low levels of physical activities, which are associated with poor recovery styles. Psychoeducational interventions aimed at increasing patients' motivation to adopt healthy lifestyle behaviors and modifying recovery styles may improve the physical health of people with severe mental disorders thus reducing the mortality rates.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Matteo Di Vincenzo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Ileana Andriola
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Enrico D'Ambrosio
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, L'Aquila, Italy
| | - Claudia Carmassi
- Psychiatric Unit, Department of Clinical and Experimental Medicine, AOUP, University of Pisa, Pisa, Italy
| | - Liliana Dell'Osso
- Psychiatric Unit, Department of Clinical and Experimental Medicine, AOUP, University of Pisa, Pisa, Italy
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Rodolfo Rossi
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, L'Aquila, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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25
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Abstract
Depression and psychosis have a developmental component to their origin. Epidemiologic evidence, which we synthesize in this nonsystematic review, suggests that early-life infection, inflammation, and metabolic alterations could play a role in the etiology of these psychiatric disorders. The risk of depression and psychosis is associated with prenatal maternal and childhood infections, which could be mediated by impaired neurodevelopment. Evidence suggests linear dose-response associations between elevated concentrations of circulating inflammatory markers in childhood, particularly the inflammatory cytokine interleukin 6, and the risk for depression and psychosis subsequently in early adulthood. Childhood inflammatory markers are also associated with persistence of depressive symptoms subsequently in adolescence and early adulthood. Developmental trajectories reflecting persistently high insulin levels during childhood and adolescence are associated with a higher risk of psychosis in adulthood, whereas increased adiposity during and after puberty is associated with the risk of depression. Together, these findings suggest that higher levels of infection, inflammation, and metabolic alterations commonly seen in people with depression and psychosis could be a cause for, rather than simply a consequence of, these disorders. Therefore, early-life immuno-metabolic alterations, as well as factors influencing these alterations such as adversity or maltreatment, could represent targets for prevention of these psychiatric disorders. Inflammation could also be an important treatment target for depression and psychosis. The field requires further research to examine sensitive periods when exposure to such immuno-metabolic alterations is most harmful. Interventional studies are also needed to test the potential usefulness of targeting early-life immuno-metabolic alterations for preventing adult depression and psychosis.
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26
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Hui TT, Garvey L, Olasoji M. Improving the physical health of young people with early psychosis with lifestyle interventions: Scoping review. Int J Ment Health Nurs 2021; 30:1498-1524. [PMID: 34390119 DOI: 10.1111/inm.12922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/20/2021] [Accepted: 07/29/2021] [Indexed: 12/01/2022]
Abstract
People with mental illness experience a shorter life expectancy compared to the general population. Poor physical health trajectory emerges following the onset of psychosis and is further compounded by the initiation of antipsychotic treatment. Young people are particularly at risk as the onset of mental illness mostly occurs between the age of 12 and 25 years. This represents a crucial period for early intervention to prevent a physical ill health trajectory. Furthermore, those who are at ultra-high risk for psychosis should also be targeted for early intervention. Lifestyle interventions have been identified as the first-line physical health promotion practice for improving the physical health of people with severe mental illness. The aim of this study was to conduct a scoping review following the JBI methodological guidance on scoping reviews to explore the current literature on lifestyle intervention trialled for early psychosis, including first-episode psychosis and those who are at ultra-high risk for psychosis. This review also explores the extent of literature examining physical health literacy in this specific population. The literature search was conducted on Medline, Embase, PsycINFO and Scopus. Twenty-two studies were included for the purpose of this scoping review, 21 of which examined the effects of lifestyle interventions and one of which reported on physical health literacy. This scoping review indicates the need for co-designed lifestyle interventions with the involvement of service users, families and carers and a focus on promoting physical health literacy, social support, and an incorporation of a health behaviour change model focus on promoting autonomous motivation. The findings of this study can inform future development of a novel co-designed lifestyle intervention for the targeted population.
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Affiliation(s)
- Ting Ting Hui
- Department of Nursing & Allied Health, School of Health Sciences, Swinburne University of Technology Australia, Hawthorn, Victoria, Australia
| | - Loretta Garvey
- Department of Nursing & Allied Health, School of Health Sciences, Swinburne University of Technology Australia, Hawthorn, Victoria, Australia
| | - Michael Olasoji
- Department of Nursing & Allied Health, School of Health Sciences, Swinburne University of Technology Australia, Hawthorn, Victoria, Australia.,School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
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27
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Luciano M, Sampogna G, Amore M, Andriola I, Calcagno P, Carmassi C, Del Vecchio V, Dell'Osso L, Di Lorenzo G, Gelao B, Giallonardo V, Rossi A, Rossi R, Siracusano A, Fiorillo A. How to improve the physical health of people with severe mental illness? A multicentric randomized controlled trial on the efficacy of a lifestyle group intervention. Eur Psychiatry 2021; 64:e72. [PMID: 34812136 PMCID: PMC8715281 DOI: 10.1192/j.eurpsy.2021.2253] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background
People with severe mental illnesses (SMI) have a mortality rate two times higher compared to the general population, with a decade of years of life lost. In this randomized controlled trial (RCT), we assessed in a sample of people with bipolar disorder, major depressive disorder, and schizophrenia spectrum disorder, the efficacy of an innovative psychosocial group intervention compared to a brief psychoeducational group intervention on patients’ body mass index (BMI), body weight, waist circumference, Framingham and HOMA-IR indexes.
Methods
This is a multicentric RCT with blinded outcome assessments carried out in six Italian university centers. After recruitment patients were randomized to receive a 6-month psychosocial intervention to improve patients’ physical health or a brief psychoeducational intervention. All recruited patients were assessed with standardized assessment instruments at baseline and after 6 months. Anthropometric parameters and blood samples have also been collected.
Results
Four-hundred and two patients with a diagnosis of bipolar disorder (43.3%), schizophrenia or other psychotic disorder (29.9%), or major depression (26.9%) were randomly allocated to the experimental (N = 206) or the control group (N = 195). After 6 months, patients from the experimental group reported a significant reduction in BMI (odds ratio [OR]: 1.93, 95% confidence intervals [CI]: 1.31–2.84; p < 0.001), body weight (OR = 4.78, 95% CI: 0.80–28.27, p < 0.05), and waist circumference (OR = 5.43, 95% CI: 1.45–20.30, p < 0.05). Participants with impaired cognitive and psychosocial functioning had a worse response to the intervention.
Conclusions
The experimental group intervention was effective in improving the physical health in SMI patients. Further studies are needed to evaluate the feasibility of this intervention in real-world settings.
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Affiliation(s)
- Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Ileana Andriola
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Pietro Calcagno
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valeria Del Vecchio
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giorgio Di Lorenzo
- Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Barbara Gelao
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | | | - Alessandro Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rodolfo Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alberto Siracusano
- Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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28
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Schnor H, Linderoth S, Midtgaard J. Patient and Mental Health Care Professionals' Perspectives on Health Promotion in Psychiatric Clinical Practice: A Focus Group Study. Issues Ment Health Nurs 2021; 42:870-879. [PMID: 34048320 DOI: 10.1080/01612840.2021.1899349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The need to protect the physical health of people with mental illness is increasingly acknowledged. We conducted six focus groups with 14 patients and 12 mental health care professionals to explore their individual and mutual perspectives on health promotion in daily clinical practice. Three main themes: Health as a balancing act; Dilemmas for health promotion; and Ideals and responsibility for health promotion in clinical practice were identified using thematic analysis. We discuss how aligning mutual expectations and creating an authentic dialogue based on the identification of and respect for patients' individual resources can support health promotion in clinical psychiatry.
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Affiliation(s)
- Helle Schnor
- Mental Health Centre Glostrup, Glostrup, Denmark.,University College Copenhagen, Copenhagen, Denmark
| | | | - Julie Midtgaard
- Mental Health Centre Glostrup, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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29
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Managing glucose-related adverse events of antipsychotics is worth the effort. DRUGS & THERAPY PERSPECTIVES 2021. [DOI: 10.1007/s40267-021-00856-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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30
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Trab T, Attar R, Jensen SE, Grøntved S, Frøkjær JB, Polcwiartek C, Nielsen RE. Coronary artery calcium in patients with schizophrenia. BMC Psychiatry 2021; 21:422. [PMID: 34425769 PMCID: PMC8381587 DOI: 10.1186/s12888-021-03412-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/03/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Coronary heart disease (CHD) is a major cause of increased mortality rates in patients with schizophrenia. Moreover, coronary artery calcium (CAC) score is associated with CHD. We hypothesized that patients with schizophrenia have more CAC than the general population and aimed to investigate the CAC score in patients with schizophrenia compared to norms based on the general population. Additionally, this study investigated if age, sex, diabetes, dyslipidemia and smoking were associated with the CAC score. METHODS In a cross-sectional study, 163 patients with schizophrenia underwent cardiac computed tomography, and the CAC score was measured and compared to norms by classifying the CAC scores in relation to the age- and gender matched norm 50th, 75th and 90th percentiles. Logistic and linear regression were carried out to investigate explanatory variables for the presence and extent of CAC, respectively. RESULTS A total of 127 (77.9%) patients had a CAC score below or equal to the matched 50th, 20 (12.3%) above the 75th and nine (5.5%) above the 90th percentile. Male sex (P < 0.05), age (P < 0.001) and smoking (P < 0.05) were associated with the presence of CAC while age (P < 0.001) and diabetes (P < 0.01) were associated with the extent of CAC. CONCLUSIONS The amount of CAC in patients with schizophrenia follows norm percentiles, and variables associated with the CAC score are similar in patients with schizophrenia and the general population. These findings indicate that the CAC score may not be sufficient to detect the risk of CHD in patients with schizophrenia. Future studies should explore other measures of subclinical CHD, including measures of peripheral atherosclerosis or cardiac autonomic neuropathy to improve early detection and intervention. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02885792 , September 1, 2016.
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Affiliation(s)
- Trine Trab
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark.
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Rubina Attar
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Svend Eggert Jensen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Simon Grøntved
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
| | - Jens Brøndum Frøkjær
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - René Ernst Nielsen
- Department of Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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31
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Sieczkowska SM, de Lima AP, Swinton PA, Dolan E, Roschel H, Gualano B. Health Coaching Strategies for Weight Loss: A Systematic Review and Meta-Analysis. Adv Nutr 2021; 12:1449-1460. [PMID: 33339042 DOI: 10.1093/advances/nmaa159] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/01/2020] [Accepted: 11/11/2020] [Indexed: 02/07/2023] Open
Abstract
Health coaching has emerged as a potential supporting tool for health professionals to overcome behavioral barriers, but its efficacy in weight management remains unclear. We conducted a systematic review and meta-analysis to synthesize and evaluate the quality of evidence supporting the use of self-reported health coaching for weight loss. Seven electronic databases (PubMed, Web of Science, Scopus, Cochrane, Psyinfo, Virtual Health Library, and Scielo) were independently searched from inception to May 2020. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation recommendations. Any study that investigated a self-reported health coaching intervention with the goal of inducing weight loss in individuals of any age, health, or training status was considered for inclusion. Quantitative data were analyzed using multilevel hierarchical metaregression models conducted within a Bayesian framework. A total of 653 studies were screened and 38 were selected for inclusion. The quality of evidence supporting outcomes based on the entire evidence base was very low and studies were deemed to have high risk of bias. Meta-analysis of controlled studies provided evidence of an effect favoring coaching compared with usual care but was trivial in magnitude [effect size (ES)0.5: -0.09; 95% credible interval (CrI): -0.17, -0.02]. The multilevel extension of Egger's regression-intercept test indicated the existence of publication bias, whereas a sensitivity analysis based only on those studies deemed to be of high quality provided no evidence of an effect of coaching on weight loss (ES0.5: -0.04; 95% CrI: -0.12, 0.09). Considered collectively, the results of this investigation indicate that the available evidence is not of sufficient quality to support the use of self-reported health coaching as a health care intervention for weight loss. This trial was registered at Prospective Register of Systematic Reviews (PROSPERO) as CRD42020159023.
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Affiliation(s)
- Sofia Mendes Sieczkowska
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Laboratory of Assessment and Conditioning in Rheumatology; School of Medicine, FMUSP, University of Sao Paulo, Sao Paulo, SP, BR
| | - Alisson Padilha de Lima
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Laboratory of Assessment and Conditioning in Rheumatology; School of Medicine, FMUSP, University of Sao Paulo, Sao Paulo, SP, BR.,School of Physical Education, Faculty IELUSC, Joinville-SC, BR
| | - Paul Alan Swinton
- School of Health Sciences, Robert Gordon University, Aberdeen, United Kingdom
| | - Eimear Dolan
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Laboratory of Assessment and Conditioning in Rheumatology; School of Medicine, FMUSP, University of Sao Paulo, Sao Paulo, SP, BR
| | - Hamilton Roschel
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Laboratory of Assessment and Conditioning in Rheumatology; School of Medicine, FMUSP, University of Sao Paulo, Sao Paulo, SP, BR
| | - Bruno Gualano
- Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Laboratory of Assessment and Conditioning in Rheumatology; School of Medicine, FMUSP, University of Sao Paulo, Sao Paulo, SP, BR
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32
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Cernea S, Dima L, Correll CU, Manu P. Pharmacological Management of Glucose Dysregulation in Patients Treated with Second-Generation Antipsychotics. Drugs 2021; 80:1763-1781. [PMID: 32930957 DOI: 10.1007/s40265-020-01393-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Fasting hyperglycemia, impaired glucose tolerance, prediabetes, and diabetes are frequently present in patients treated with second-generation antipsychotics (SGAPs) for schizophrenia, bipolar disorder, and other severe mental illnesses. These drugs are known to produce weight gain, which may lead to insulin resistance, glucose intolerance, and metabolic syndrome, which constitute important risk factors for the emergence of diabetes. The aim of this review was to formulate therapeutic guidelines for the management of diabetes in patients treated with SGAPs, based on the association between SGAP-induced weight gain and glucose dysregulation. A systematic search in PubMed from inception to March 2020 for randomized controlled trials (RCTs) of diabetes or prediabetes in patients treated with SGAPs was performed. PubMed was also searched for the most recent clinical practice guidelines of interventions for co-morbid conditions associated with diabetes mellitus (DM) (arterial hypertension and dyslipidemia), lifestyle interventions and switching from high metabolic liability SGAPs to safer SGAPs. The search identified 14 RCTs in patients treated with SGAPs. Drug therapy using metformin as first-line therapy and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) or perhaps sodium-glucose cotransporter-2 (SGLT2) inhibitors as add-on therapy, might be preferred in these patients as well, as they favorably influence glucose metabolism and body mass index, and provide cardio-renal benefits in general to the DM population, although for the SGLT-2 inhibitors there are no RCTs in this specific patient category so far. Metformin is also useful for treatment of prediabetes. Arterial hypertension should be treated with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, and statins should be used for correction of dyslipidemia. The outcome of lifestyle-changing interventions has been disappointing. Switching from clozapine, olanzapine, or quetiapine to lower cardiometabolic-risk SGAPs, like aripiprazole, brexpiprazole, cariprazine, lurasidone, or ziprasidone, has been recommended.
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Affiliation(s)
- Simona Cernea
- Faculty of Medicine/Department M4/Internal Medicine IV, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, Romania.,Diabetes, Nutrition and Metabolic Diseases Outpatient Unit, Emergency County Clinical Hospital, Târgu Mureş, Romania
| | - Lorena Dima
- Department of Fundamental Disciplines and Clinical Prevention, Faculty of Medicine, Universitatea Transilvania, Nicolae Balcescu Str 59, Brașov, 500019, Romania.
| | - Christoph U Correll
- Charite Universitaetsmedizin, Department of Child and Adolescent Psychiatry, Berlin, and Campus Virchow-Klinikum, Mittelallee 5A, Berlin, 13353, Germany.,Department of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Department of Psychiatry and Molecular Medicine, Zucker Hillside Hospital, Northwell Health System, Glen Oaks, NY, USA
| | - Peter Manu
- Department of Psychiatry, Hofstra Northwell School of Medicine, Hempstead, NY, USA.,Department of Medicine, Hofstra Northwell School of Medicine, Hempstead, NY, USA.,South Oaks Hospital, Northwell Health System, Amityville, NY, USA
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33
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Gallagher P, Boland C, McClenaghan A, Fanning F, Lawlor E, Clarke M. Improved self-esteem and activity levels following a 12-week community activity and healthy lifestyle programme in those with serious mental illness: A feasibility study. Early Interv Psychiatry 2021; 15:367-373. [PMID: 32337860 DOI: 10.1111/eip.12965] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 02/25/2020] [Accepted: 03/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Those with serious mental illness (SMI) including both psychotic and affective disorders are recognized to have a premature mortality compared to the general population, at least in part due to elevated cardiovascular risk profile. AIM To examine the effect of a 12-week, pragmatic, sustainable, low-cost intervention involving community activity, nutritional advice and exercise that could be accessible to patients attending a community clinic. METHODS Participants (N = 35) with SMI attending a community mental health service who were considered at risk of metabolic syndrome were referred by their clinical teams to a specialized healthy activity and nutritional programme. The intervention involved participation in exercise, dietary education and targeted lifestyle advice focused on community activities. Data on physical health and clinical parameters were collected pre- and post-intervention. RESULTS Physical activity increased following the intervention along with a statistically significant increase in self-esteem scores. There was no significant reduction in body mass index or lowering of anxiety and depression scores. CONCLUSIONS It is feasible to develop a relatively low-cost, community-based physical activity programme, integrating both nutritional advice and healthy activities. This may lead to improved outcomes in cardiovascular risk profile and improved life expectancy.
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Affiliation(s)
- Peter Gallagher
- Detect Early Intervention in Psychosis Service, Dublin, Ireland.,Saint John of God Community Services CLG, Dublin, Ireland
| | - Cailín Boland
- Detect Early Intervention in Psychosis Service, Dublin, Ireland.,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Aisling McClenaghan
- Detect Early Intervention in Psychosis Service, Dublin, Ireland.,Saint John of God Community Services CLG, Dublin, Ireland
| | - Felicity Fanning
- Detect Early Intervention in Psychosis Service, Dublin, Ireland.,Saint John of God Community Services CLG, Dublin, Ireland
| | - Elizabeth Lawlor
- Detect Early Intervention in Psychosis Service, Dublin, Ireland.,Saint John of God Community Services CLG, Dublin, Ireland
| | - Mary Clarke
- Detect Early Intervention in Psychosis Service, Dublin, Ireland.,Saint John of God Community Services CLG, Dublin, Ireland.,School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
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34
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Hochman L, Moran GS, Gelkopf M, Roe D, Shadmi E. Prospectively identifying adults with serious mental illness at risk for poor physical health: The role of person reported outcomes. Int J Qual Health Care 2021; 34:ii65–ii69. [PMID: 32296822 DOI: 10.1093/intqhc/mzaa033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 02/27/2020] [Accepted: 03/16/2020] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE Persons with serious mental illnesses are at increased risk for co-occurring physical comorbidities. Patient-reported outcome measures are increasingly used in routine assessments of persons with serious mental illnesses, yet the relation of patient-reported outcome measures to physical health outcomes has not been comprehensively investigated. We examined the association between patient-reported outcome measures and self-reported physical health at 1-year follow-up. DESIGN A retrospective cohort study. SETTING Data were collected as part of the Israeli Psychiatric Rehabilitation Patient-Reported Outcome Measurement program in Israel. PARTICIPANTS A total of 2581 psychiatric rehabilitation service users assessed between April 2013 and January 2016. MAIN OUTCOME MEASURES Self-reports on two consecutive years of physical health dichotomized as poor versus good. RESULTS More than one-third of participants reported having poor physical health. Multivariate regression analysis showed that quality of life (odds ratio [OR] = 0.71; 95% confidence interval [CI]: 0.60-0.84) and lack of effect of symptoms on functioning (OR = 0.81; 95%CI: 0.74-0.89) predict subsequent physical health, controlling for all other factors. Compared to a multivariate model with personal characteristics and self-reports on physical health at baseline (Model A), the model which also included patient-reported outcome measures (Model B) showed slightly better discrimination (c-statistic: 0.74 vs. 0.76, respectively). CONCLUSIONS These results suggest that patient-reported outcome measures contribute to the prediction of poor physical health and thus can be useful as an early screening tool for people with serious mental illnesses living in the community, who are at risk of physical health problems.
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Affiliation(s)
- Limor Hochman
- The Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beersheba, Israel, 8410501
| | - Galia S Moran
- The Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beersheba, Israel, 8410501
| | - Marc Gelkopf
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 AbaKhoushy Ave. Mount Carmel, Haifa, 3498838 Israel.,Faculty of Social Welfare and Health Sciences, Center for Community Mental Health, Research, Practice and Policy, University of Haifa, 199 AbaKhoushy Ave. Mount Carmel, Haifa, 3498838 Israel
| | - David Roe
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 AbaKhoushy Ave. Mount Carmel, Haifa, 3498838 Israel.,Faculty of Social Welfare and Health Sciences, Center for Community Mental Health, Research, Practice and Policy, University of Haifa, 199 AbaKhoushy Ave. Mount Carmel, Haifa, 3498838 Israel.,Department of Clinical Medicine, Psychiatry, Aalborg University, Fredrik Bajers Vej 5, 9100 Aalborg, Denmark
| | - Efrat Shadmi
- Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 AbaKhoushy Ave. Mount Carmel, Haifa, 3498838 Israel.,Faculty of Social Welfare and Health Sciences, Center for Community Mental Health, Research, Practice and Policy, University of Haifa, 199 AbaKhoushy Ave. Mount Carmel, Haifa, 3498838 Israel.,The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 AbaKhoushy Ave. Mount Carmel, Haifa, 3498838 Israel
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35
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Fernández-Abascal B, Suárez-Pinilla P, Cobo-Corrales C, Crespo-Facorro B, Suárez-Pinilla M. In- and outpatient lifestyle interventions on diet and exercise and their effect on physical and psychological health: a systematic review and meta-analysis of randomised controlled trials in patients with schizophrenia spectrum disorders and first episode of psychosis. Neurosci Biobehav Rev 2021; 125:535-568. [PMID: 33503476 DOI: 10.1016/j.neubiorev.2021.01.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 01/01/2021] [Accepted: 01/04/2021] [Indexed: 12/22/2022]
Abstract
Patients with non-affective psychosis often lead unhealthy lifestyles. We performed a systematic review and meta-analysis on non-pharmacological RCTs for improvement of diet and physical activity in non-affective psychosis patients, including first-episode psychosis. A variety of outcomes was analysed, including metabolic, psychopathology, cognitive, functional and quality of life outcomes. Fifty-nine studies were included. An improvement in anthropometric measurements (BMI, weight, waist circumference) was observed post-intervention, persisting after follow-up. Post-intervention benefit was found also for psychotic symptoms severity (also persisting after follow-up), many cognitive domains and physical and global functioning and quality of life. Conversely, no effect was observed in relation to most blood metabolites, blood pressure and non-psychotic psychopathology and spontaneous physical activity. Improvement was generally larger for interventions including exercise, especially moderate/vigorous aerobic exercise, but follow-up maintenance was greater for psychotherapy interventions. Sensitivity analyses limited to chronic stages of psychosis and low risk of bias studies produced comparable results. Further studies are needed to design optimized interventions in this vulnerable population.
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Affiliation(s)
- Blanca Fernández-Abascal
- Department of Psychiatry, University Hospital Marqués de Valdecilla, IDIVAL, Santander, 39011, Spain.
| | - Paula Suárez-Pinilla
- Department of Psychiatry, University Hospital Marqués de Valdecilla, IDIVAL, Santander, 39011, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, 28029, Spain.
| | | | - Benedicto Crespo-Facorro
- Department of Psychiatry, School of Medicine, University Hospital Virgen del Rocío - IBiS, Sevilla, 41013, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, 28029, Spain
| | - Marta Suárez-Pinilla
- Department of Neurodegenerative Disease, Institute of Neurology, University College of London, London, WC1N 3AX, UK.
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36
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Martens N, Destoop M, Dom G. Organization of Community Mental Health Services for Persons with a Severe Mental Illness and Comorbid Somatic Conditions: A Systematic Review on Somatic Outcomes and Health Related Quality of Life. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:E462. [PMID: 33435525 PMCID: PMC7826863 DOI: 10.3390/ijerph18020462] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/11/2020] [Accepted: 12/30/2020] [Indexed: 12/20/2022]
Abstract
It is well established that persons with a severe mental illness (SMI) have a greater risk of physical comorbid conditions and premature mortality. Most studies in the field of community mental health care (CMHC) have only focused on improving cardiovascular health in people with a SMI using lifestyle approaches. Studies using organizational modifications are rather scarce. This systematic review aimed to synthesize and describe possible organizational strategies to improve physical health for persons with a SMI in CMHC. The primary outcome was Health-related Quality of Life (HR-QOL). Results suggested modest effects on quality of life and were inconsistent throughout all the included studies. Despite these findings, it appears that a more integrated approach had a positive effect on health outcomes, patient satisfaction and HR-QOL. The complexity of the processes involved in community care delivery makes it difficult to compare different models and organizational approaches. Mental health nurses were identified as possible key professionals in care organization, but no clear description of their role was found. This review could provide new insights into contributing factors for integrated care. Future research targeting the identification of the nurses' role and facilitating factors in integrated care, in order to improve treatment and follow-up of somatic comorbidities, is recommended.
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Affiliation(s)
- Nicolaas Martens
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, B-2000 Antwerp, Belgium; (M.D.); (G.D.)
- Multiversum Mental Health Services, B-2530 Boechout, Belgium
- Department of Health and Welfare, Karel De Grote University College, B-2018 Antwerp, Belgium
| | - Marianne Destoop
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, B-2000 Antwerp, Belgium; (M.D.); (G.D.)
- Multiversum Mental Health Services, B-2530 Boechout, Belgium
| | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University, B-2000 Antwerp, Belgium; (M.D.); (G.D.)
- Multiversum Mental Health Services, B-2530 Boechout, Belgium
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37
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Speyer H, Westergaard C, Albert N, Karlsen M, Stürup AE, Nordentoft M, Krogh J. Reversibility of Antipsychotic-Induced Weight Gain: A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2021; 12:577919. [PMID: 34393989 PMCID: PMC8355990 DOI: 10.3389/fendo.2021.577919] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 06/07/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIMS Weight gain is a major adverse effect of antipsychotic medication, negatively affecting physical and mental well-being. The objective of this study was to explore if dose reduction, discontinuation, switch to a partial agonist, or switch from polypharmacy to monotherapy will lead to weight loss. METHODS Controlled and uncontrolled studies reporting the effects of discontinuation, dose reduction, switch to a partial agonist, or switch from polypharmacy to monotherapy on weight were included. Primary outcome was difference in weight compared to maintenance groups based on controlled studies. Secondary outcome was change in weight from initiation of one of the included interventions until follow-up in a pre-post analysis. RESULTS We identified 40 randomized controlled trials and 15 uncontrolled studies including 12,279 individuals. The effect of the interventions, i.e. dose reduction, drug discontinuation, or switch to a partial agonis, reduced the weight with 1.5 kg (95% CI -2.03 to -0.98; P < 0.001) compared to maintenance treatment. The weight change from pre to post was a reduction of 1.13 kg (95% CI -1.36 to -0.90; P < 0.001). CONCLUSION We found a significant but small reduction in weight, suggesting that antipsychotic-induced weight gain can be reversed to some degree. Only a few studies were designed to address the question as primary outcome, which limits the generalizability of our findings.
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Affiliation(s)
- Helene Speyer
- Mental Health Centre Copenhagen, Copenhagen Research Center for Mental Health (CORE) Research Unit, Copenhagen University Hospital, Hellerup, Denmark
- *Correspondence: Helene Speyer,
| | - Casper Westergaard
- Department of First Episode Psychosis, Psychiatric Centre, Glostrup, Denmark
| | - Nikolai Albert
- Mental Health Centre Copenhagen, Copenhagen Research Center for Mental Health (CORE) Research Unit, Copenhagen University Hospital, Hellerup, Denmark
| | - Mette Karlsen
- Mental Health Centre Copenhagen, Copenhagen Research Center for Mental Health (CORE) Research Unit, Copenhagen University Hospital, Hellerup, Denmark
| | - Anne Emilie Stürup
- Mental Health Centre Copenhagen, Copenhagen Research Center for Mental Health (CORE) Research Unit, Copenhagen University Hospital, Hellerup, Denmark
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Copenhagen Research Center for Mental Health (CORE) Research Unit, Copenhagen University Hospital, Hellerup, Denmark
| | - Jesper Krogh
- Department of Endocrinology and Metabolism, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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38
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Coventry PA, Young B, Balogun-Katang A, Taylor J, Brown JVE, Kitchen C, Kellar I, Peckham E, Bellass S, Wright J, Alderson S, Lister J, Holt RIG, Doherty P, Carswell C, Hewitt C, Jacobs R, Osborn D, Boehnke J, Siddiqi N. Determinants of Physical Health Self-Management Behaviours in Adults With Serious Mental Illness: A Systematic Review. Front Psychiatry 2021; 12:723962. [PMID: 34489764 PMCID: PMC8417946 DOI: 10.3389/fpsyt.2021.723962] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/23/2021] [Indexed: 01/27/2023] Open
Abstract
Behavioural interventions can support the adoption of healthier lifestyles and improve physical health outcomes, but it is unclear what factors might drive success of such interventions in people with serious mental illness (SMI). We systematically identified and reviewed evidence of the association between determinants of physical health self-management behaviours in adults with SMI. Data about American Association of Diabetes Educator's Self-Care Behaviours (AADE-7) were mapped against the novel Mechanisms of Action (MoA) framework. Twenty-eight studies were included in the review, reporting evidence on 104 determinant-behaviour links. Beliefs about capabilities and beliefs about consequences were the most important determinants of behaviour, especially for being physically active and healthy eating. There was some evidence that emotion and environmental context and resources played a role in determining reducing risks, being active, and taking medications. We found very limited evidence associated with problem solving, and no study assessed links between MoAs and healthy coping. Although the review predominantly identified evidence about associations from cross-sectional studies that lacked validated and objective measures of self-management behaviours, these findings can facilitate the identification of behaviour change techniques with hypothesised links to determinants to support self-management in people with SMI. Systematic Review Registration: PROSPERO, registration CRD42018099553.
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Affiliation(s)
- Peter A Coventry
- Department of Health Sciences, University of York, York, United Kingdom
| | - Ben Young
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | | | - Johanna Taylor
- Department of Health Sciences, University of York, York, United Kingdom
| | | | - Charlotte Kitchen
- Department of Health Sciences, University of York, York, United Kingdom
| | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Emily Peckham
- Department of Health Sciences, University of York, York, United Kingdom
| | - Sue Bellass
- Department of Health Sciences, University of York, York, United Kingdom.,School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Judy Wright
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Sarah Alderson
- School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Jennie Lister
- Department of Health Sciences, University of York, York, United Kingdom
| | - Richard I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom
| | - Patrick Doherty
- Department of Health Sciences, University of York, York, United Kingdom
| | - Claire Carswell
- Department of Health Sciences, University of York, York, United Kingdom
| | - Catherine Hewitt
- Department of Health Sciences, University of York, York, United Kingdom
| | - Rowena Jacobs
- Centre for Health Economics, University of York, York, United Kingdom
| | - David Osborn
- Division of Psychiatry, University College London, London, United Kingdom
| | - Jan Boehnke
- Department of Health Sciences, University of York, York, United Kingdom.,School of Health Sciences, University of Dundee, Dundee, United Kingdom
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom.,Hull York Medical School, University of York, York, United Kingdom
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39
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Liao X, Ye H, Si T. A Review of Switching Strategies for Patients with Schizophrenia Comorbid with Metabolic Syndrome or Metabolic Abnormalities. Neuropsychiatr Dis Treat 2021; 17:453-469. [PMID: 33603382 PMCID: PMC7884949 DOI: 10.2147/ndt.s294521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/07/2021] [Indexed: 12/31/2022] Open
Abstract
Metabolic syndrome (MetS) in patients with schizophrenia occurs 2-3 times more frequently than in the general population. Antipsychotic medication is a primary risk factor for patients with MetS. In particular, the widely used second-generation antipsychotics can affect glucose and lipid metabolism and can induce insulin resistance and other metabolic abnormalities through various receptors. Notably, the metabolic risks of various antipsychotics may differ because of their different pharmacological affinity to MetS-related receptors. Several previous studies have shown that switching from high to low metabolic risk antipsychotics may improve patients' metabolic parameters. The current review aims to discuss the strategies for switching antipsychotic medications and the impact on metabolic abnormalities in patients with schizophrenia.
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Affiliation(s)
- Xuemei Liao
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, People's Republic of China
| | - Hui Ye
- Medical Department, Sanofi, Shanghai, People's Republic of China
| | - Tianmei Si
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, 100191, People's Republic of China
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40
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Wiedeman AM, Panagiotopoulos C, Devlin AM. Treatment-related weight gain and metabolic complications in children with mental health disorders: potential role for lifestyle interventions. Appl Physiol Nutr Metab 2020; 46:193-204. [PMID: 33226841 DOI: 10.1139/apnm-2020-0259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Over 1 million Canadian children are estimated to have a mental health disorder, which are commonly treated with medications, such as second-generation antipsychotics (SGAs). Estimates suggest that SGA prescriptions to children are increasing in Canada. Although these medications are important and lifesaving components of psychiatric treatment, they are not without side effects. For some children, SGA treatment is associated with adverse metabolic complications including rapid weight gain, dyslipidemia, elevated blood pressure, and risk for type 2 diabetes. It is not clear why these complications develop, but it is assumed that SGAs stimulate appetite and food intake, and reduce resting energy expenditure leading to weight gain and that the metabolic complications occur secondary to the weight gain. Understanding the mechanisms underlying these complications is key to being able to identify children at risk and prevent and optimize treatment. In this narrative review, we provide an overview of the literature pertaining to the weight gain and metabolic complications in children treated with SGAs, highlighting the scope of the problem and the current limited research on how diet and physical activity can be used to prevent or lessen the severity of the metabolic complications and improve the long-term health trajectories of SGA-treated children. Novelty: Children are increasingly being treated with second-generation antipsychotics for mental health disorders. Dietary and physical activity assessments are not commonly considered in clinical settings. Randomized controlled trials of lifestyle interventions are needed to determine the effectiveness of mitigating the cardiometabolic complications in second-generation antipsychotic-treated children.
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Affiliation(s)
- Alejandra M Wiedeman
- Department of Pediatrics, The University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada.,Department of Pediatrics, The University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Constadina Panagiotopoulos
- Department of Pediatrics, The University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada.,Department of Pediatrics, The University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
| | - Angela M Devlin
- Department of Pediatrics, The University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada.,Department of Pediatrics, The University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC V5Z 4H4, Canada
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41
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Abstract
Individuals diagnosed with schizophrenia or bipolar disorder have a life expectancy 15-20 years shorter than that in the general population. The rate of unnatural deaths, such as suicide and accidents, is high for these patients. Despite this increased proportion of unnatural deaths, physical conditions account for approximately 70% of deaths in patients with either schizophrenia or bipolar disorder, with cardiovascular disease contributing 17.4% and 22.0% to the reduction in overall life expectancy in men and women, respectively. Risk factors for cardiovascular disease, such as smoking, unhealthy diet and lack of exercise, are common in these patients, and lifestyle interventions have been shown to have small effects. Pharmacological interventions to reduce risk factors for cardiovascular disease have been proven to be effective. Treatment with antipsychotic drugs is associated with reduced mortality but also with an increased risk of weight gain, dyslipidaemia and diabetes mellitus. These patients have higher risks of both myocardial infarction and stroke but a lower risk of undergoing interventional procedures compared with the general population. Data indicate a negative attitude from clinicians working outside the mental health fields towards patients with severe mental illness. Education might be a possible method to decrease the negative attitudes towards these patients, thereby improving their rates of diagnosis and treatment.
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42
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Cha HY, Yang SJ. Anti-Inflammatory Diets and Schizophrenia. Clin Nutr Res 2020; 9:241-257. [PMID: 33204665 PMCID: PMC7644368 DOI: 10.7762/cnr.2020.9.4.241] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 10/02/2020] [Accepted: 10/07/2020] [Indexed: 12/13/2022] Open
Abstract
Schizophrenia is a mental illness characterized by symptoms such as hallucinations, delusions, disorganized speech, disorganized or catatonic behavior, and negative symptoms (emotional flatness, apathy, and lack of speech). It causes social and economic burdens to patients and their family. Although etiology of schizophrenia is still uncertain, dopamine dysregulation is traditionally considered as a main etiological factor of schizophrenia, which has been utilized to develop drugs for treating schizophrenia. Recently, inflammation has presented being a risk factor for schizophrenia in that neuroinflammation contributes to the pathophysiology of schizophrenia and the exacerbation of symptom severity. Various factors including diet can regulate inflammatory state. Specific foods or dietary patterns have anti- or pro-inflammatory potentials. Increased levels of pro-inflammatory cytokines and microglia activation have been reported in schizophrenia populations and were related to the pathogenesis of schizophrenia. Omega-3 fatty acids were often recommended to schizophrenia patients because of their anti-inflammatory activities. In this review, we investigate the inflammation-related pathogenesis of schizophrenia and summarize potential nutritional approaches to inhibit the manifestation of symptoms and to alleviate symptom severity using anti-inflammatory nutrients or functional components.
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Affiliation(s)
- Hee Yun Cha
- Department of Food and Nutrition, Seoul Women's University, Seoul 01797, Korea
| | - Soo Jin Yang
- Department of Food and Nutrition, Seoul Women's University, Seoul 01797, Korea
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43
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Smith J, Griffiths LA, Band M, Hird-Smith R, Williams B, Bold J, Bradley E, Dilworth R, Horne D. Early Intervention in Psychosis: Effectiveness and Implementation of a Combined Exercise and Health Behavior Intervention Within Routine Care. Front Endocrinol (Lausanne) 2020; 11:577691. [PMID: 33193094 PMCID: PMC7649318 DOI: 10.3389/fendo.2020.577691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/30/2020] [Indexed: 12/20/2022] Open
Abstract
Aim Young people with psychosis have higher rates of obesity, premature cardiovascular disease, and death compared to non-psychotic peers in the general population due to changes in metabolic regulation linked to antipsychotic medication and adverse health risk behaviors. The aim of this paper is to outline the development, implementation, and evaluation of a combined 12-week exercise and health behavior intervention delivered as part of an Early Intervention in Psychosis (EIP) routine service, within the UK. Methods Participants (n = 27) completed a 12-week combined intervention program, engaging in weekly, 90-min sessions comprising a healthy behavior education session (45 min), followed by a facilitated exercise session (45 min). Anthropometric data from participants (n = 26) were collected at baseline, 12 weeks, and 12 months post-intervention. Health behaviors and clinical measurements were assessed at baseline and 12 months. Results Mean baseline data suggests participants were at an increased health risk on entry to the program, with elevated values in mean body mass index (BMI; 70% overweight/obese), waist circumference, resting heart rate, and triglycerides. Fifty percent reported smoking daily, 64% ate < 5 fruits/vegetables per day, and 52% of participants were prescribed highly obesogenic antipsychotic medications (i.e., Olanzapine). At 12 weeks and 12 months, no changes were observed in mean BMI, waist circumference or any other clinical variable (p > 0.05). At 12 months, participants reported a positive impact on health behaviors including improved diet, increased physical activity levels, and cessation of substance use (n = 2), alcohol use (n = 2), and smoking (n = 4). Focus groups captured participant experiences, engagement with and satisfaction with the program, including challenges/barriers to program adherence. Conclusions The 12-week exercise and health behaviors program supported participants to attenuate their physical health risk which was sustained at 12-month follow-up. Self-reported positive health behavior changes are likely to have contributed to the prevention of excessive weight gain in this high-risk period. The evaluation was designed to have validity for a "real world EIP setting" and reflect the complexity of delivery to this participant group. Evaluation findings influenced subsequent commissioning of the physical health intervention as an ongoing element of routine EIP care within the participant site.
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Affiliation(s)
- Jo Smith
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
| | - Lisa A. Griffiths
- Department of Nutrition, Food and Exercise Science, Florida State University, Tallahassee, FL, United States
| | - Marie Band
- Moorfields Eye Hospital NHS Foundation Trust, London, United Kingdom
| | - Rachael Hird-Smith
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
| | - Briony Williams
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
| | - Justine Bold
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
- Centre for Medical Education, Medical School, Cardiff University, Cardiff, United Kingdom
| | - Eleanor Bradley
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
| | - Richard Dilworth
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
| | - Dominic Horne
- School of Allied Health and Community, University of Worcester, Worcester, United Kingdom
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44
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Aucoin M, LaChance L, Clouthier SN, Cooley K. Dietary modification in the treatment of schizophrenia spectrum disorders: A systematic review. World J Psychiatry 2020; 10:187-201. [PMID: 32874956 PMCID: PMC7439299 DOI: 10.5498/wjp.v10.i8.187] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/25/2020] [Accepted: 07/19/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Schizophrenia spectrum disorders impact functioning, reduce quality of life and increase the risk of physical illness and premature mortality. Nutritional intervention studies aimed at decreasing body weight have demonstrated efficacy in improving metabolic outcomes; however, few studies have explored the impact of interventions designed to modify diet on mental health outcomes.
AIM To synthesize the existing experimental studies of adjunctive diet modification as an intervention in the treatment of psychotic disorders, analyze findings related to effectiveness and safety, highlight knowledge gaps and limitations, and set forward recommendations for future research studies.
METHODS An extensive a priori search strategy was developed and the databases Embase, Embase Classic, Ovid MEDLINE were searched. Screening and data extraction were completed in duplicate. Studies included in this analysis were experimental studies of an adjunctive dietary intervention (overall dietary pattern or education on dietary change) for treatment of schizophrenia spectrum disorders. No restrictions were placed on control groups or blinding. The studies were required to report a mental health outcome.
RESULTS Twenty-five clinical trials were identified, along with two additional protocols and two meta-analyses. Nineteen of the clinical trials reported improvement in one or more mental health domain including psychosis symptoms, cognition, and quality of life. A high level of heterogeneity was found with respect to patient population, intervention, and study design. All of the studies included lifestyle or psychosocial components in addition to dietary modification. The nutrition advice provided to participants was poorly described overall and compliance was not assessed. The studies that showed benefit tended to have a smaller sample size and were less likely to be randomized but were more likely to use a group delivery intervention.
CONCLUSION Further research assessing effectiveness and efficacy of clearly reported dietary interventions is warranted, especially those using rigorous methodology, modifying diet in isolation and assessing participant compliance.
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Affiliation(s)
- Monique Aucoin
- Department of Research and Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto M2K 1E2, Canada
| | - Laura LaChance
- Department of Psychiatry, McGill University, Montreal H3A 0G4, Canada
- Centre for Addiction and Mental Health, Toronto M6R 1A1, Canada
| | - Sam N Clouthier
- Department of Research and Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto M2K 1E2, Canada
| | - Kieran Cooley
- Department of Research and Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto M2K 1E2, Canada
- Department of Public Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo 2007, Australia
- Department of Doctoral Acupuncture and Chinese Medicine, Pacific College of Health Science, San Diego, CA 92108, United States
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45
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Speyer H, Jakobsen AS, Westergaard C, Nørgaard HCB, Jørgensen KB, Pisinger C, Krogh J, Hjorthøj C, Nordentoft M, Gluud C, Correll CU. Lifestyle Interventions for Weight Management in People with Serious Mental Illness: A Systematic Review with Meta-Analysis, Trial Sequential Analysis, and Meta-Regression Analysis Exploring the Mediators and Moderators of Treatment Effects. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 88:350-362. [PMID: 31522170 DOI: 10.1159/000502293] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/19/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Serious mental illness (SMI) reduces life expectancy, primarily due to somatic comorbidity linked to obesity. Meta-analyses have found beneficial effects of lifestyle interventions in people with SMI and recommended their implementation to manage obesity. OBJECTIVE The objective of this systematic review was to assess the benefits and harms of individualized lifestyle interventions for weight in people diagnosed with SMI and to explore potential mediators and moderators of the effect. METHODS The protocol was registered at PROSPERO (CRD42016049093). Randomized clinical trials (RCTs) assessing the effect of individualized lifestyle interventions on weight management in people with SMI were included. Primary outcomes were differences in endpoint body mass index (BMI) and the proportion achieving clinically relevant weight loss (≥5%). Secondary outcomes included quality of life, cardiometabolic risk factors, and adverse effects. RESULTS We included 41 RCTs (n = 4,267). All trials were at high risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions. The experimental interventions reduced the mean difference in BMI by -0.63 kg/m2 (95% confidence interval [CI] = -1.02 to -0.23; p = 0.002; I2 = 70.7%) compared to the control groups. At postintervention follow-up (17 RCTs), the effect size remained similar but was no longer significant (BMI = -0.63 kg/m2; 95% CI = -1.30 to 0.04; p = 0.07; I2 = 48.8%). The risk ratio for losing ≥5% of baseline weight was 1.51 (95% CI = 1.07-2.13; p = 0.02) compared to the control groups. GRADE showed very low or low quality of evidence. CONCLUSION There is a statistically significant, but clinically insignificant, mean effect of individualized lifestyle interventions for weight reduction in people with SMI.
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Affiliation(s)
- Helene Speyer
- Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark,
| | - Ane Storch Jakobsen
- Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Casper Westergaard
- Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | | | | | - Charlotta Pisinger
- Research Center for Prevention and Health, Department 84-85, Glostrup University Hospital, Glostrup, Denmark
| | - Jesper Krogh
- Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Carsten Hjorthøj
- Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Merete Nordentoft
- Mental Health Center Copenhagen, Copenhagen University Hospital, Hellerup, Denmark
| | - Christian Gluud
- The Copenhagen Trial Unit, Center for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, Northwell Health, Glen Oaks, New York, USA.,Department of Psychiatry and Molecular Medicine, Hofstra Northwell School of Medicine, Hempstead, New York, USA.,Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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46
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Romain AJ, Bernard P, Akrass Z, St-Amour S, Lachance JP, Hains-Monfette G, Atoui S, Kingsbury C, Dubois E, Karelis AD, Abdel-Baki A. Motivational theory-based interventions on health of people with several mental illness: A systematic review and meta-analysis. Schizophr Res 2020; 222:31-41. [PMID: 32522465 DOI: 10.1016/j.schres.2020.05.049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 04/20/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
Motivational theory-based interventions are known to be effective for increasing physical activity (PA) in the general population but their effects in people with severe mental illness are poorly understood. Therefore, we conducted a meta-analysis on the effect of these interventions on PA and cardiometabolic risk factors. A systematic search of randomized controlled trials through 6 databases was carried out from inception to March 2019. Analyses were conducted using random-effect models. Weighted mean difference (WMD) were used as effect size when outcomes had the same units, otherwise Hedge's g was used. Fourteen articles including 2128 participants were identified. Motivational theory-based interventions were effective in increasing PA (g = 0.27, 95%CI[0.03; 0.51], p = .003), reducing weight (WMD = -1.87 kg, 95%CI[-2.98; -0.76], p = .001), body mass index (WMD = -0.82 kg/m2, 95%CI[-1.23; -0.41], p = .009), waist circumference (WMD = -1.91 cm, 95%CI[-3.63; -0.18], p = .03) and fasting glucose (g = -0.17, 95%CI[-0.34; -0.001], p = .04). Larger effect sizes were found in interventions based on only one theoretical model of motivation. In conclusion, interventions using motivational theories are effective to improve PA levels and the cardiometabolic health profile of people with severe mental illness. Systematic review registration: CRD42018104445.
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Affiliation(s)
| | - Paquito Bernard
- University of Quebec at Montreal, Montreal, QC H2X 1Y4, Canada; Mental health University Institute of Montreal, Montreal, QC H1N 3M5, Canada
| | - Zeina Akrass
- University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC H2X0A9, Canada
| | - Samuel St-Amour
- University of Quebec at Montreal, Montreal, QC H2X 1Y4, Canada; Mental health University Institute of Montreal, Montreal, QC H1N 3M5, Canada
| | - Jean-Philippe Lachance
- Mental health University Institute of Montreal, Montreal, QC H1N 3M5, Canada; Mental health University Institute of Montreal, Montreal, QC H1N 3M5, Canada
| | - Gabriel Hains-Monfette
- University of Quebec at Montreal, Montreal, QC H2X 1Y4, Canada; Mental health University Institute of Montreal, Montreal, QC H1N 3M5, Canada
| | - Sarah Atoui
- University of Quebec at Montreal, Montreal, QC H2X 1Y4, Canada; Mental health University Institute of Montreal, Montreal, QC H1N 3M5, Canada
| | - Celia Kingsbury
- University of Quebec at Montreal, Montreal, QC H2X 1Y4, Canada; Mental health University Institute of Montreal, Montreal, QC H1N 3M5, Canada
| | - Eve Dubois
- University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC H2X0A9, Canada
| | | | - Amal Abdel-Baki
- University of Montreal, Montreal, QC H3T 1J4, Canada; University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC H2X0A9, Canada; University Hospital of Montreal, Montreal, QC H2X 0C1, Canada
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47
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Minian N, Corrin T, Lingam M, deRuiter WK, Rodak T, Taylor VH, Manson H, Dragonetti R, Zawertailo L, Melamed OC, Hahn M, Selby P. Identifying contexts and mechanisms in multiple behavior change interventions affecting smoking cessation success: a rapid realist review. BMC Public Health 2020; 20:918. [PMID: 32532233 PMCID: PMC7291527 DOI: 10.1186/s12889-020-08973-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 05/24/2020] [Indexed: 11/17/2022] Open
Abstract
Background Smoking continues to be a leading cause of preventable chronic disease-related morbidity and mortality, excess healthcare expenditure, and lost work productivity. Tobacco users are disproportionately more likely to be engaging in other modifiable risk behaviours such as excess alcohol consumption, physical inactivity, and poor diet. While hundreds of interventions addressing the clustering of smoking and other modifiable risk behaviours have been conducted worldwide, there is insufficient information available about the context and mechanisms in these interventions that promote successful smoking cessation. The aim of this rapid realist review was to identify possible contexts and mechanisms used in multiple health behaviour change interventions (targeting tobacco and two or more additional risk behaviours) that are associated with improving smoking cessation outcome. Methods This realist review method incorporated the following steps: (1) clarifying the scope, (2) searching for relevant evidence, (3) relevance confirmation, data extraction, and quality assessment, (4) data analysis and synthesis. Results Of the 20,423 articles screened, 138 articles were included in this realist review. Following Michie et al.’s behavior change model (the COM-B model), capability, opportunity, and motivation were used to identify the mechanisms of behaviour change. Universally, increasing opportunities (i.e. factors that lie outside the individual that prompt the behaviour or make it possible) for participants to engage in healthy behaviours was associated with smoking cessation success. However, increasing participant’s capability or motivation to make a behaviour change was only successful within certain contexts. Conclusion In order to address multiple health behaviours and assist individuals in quitting smoking, public health promotion interventions need to shift away from ‘individualistic epidemiology’ and invest resources into modifying factors that are external from the individual (i.e. creating a supportive environment). Trial registration PROSPERO registration number: CRD42017064430
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Affiliation(s)
- Nadia Minian
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1V7, Canada
| | - Tricia Corrin
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada
| | - Mathangee Lingam
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada
| | - Wayne K deRuiter
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada
| | - Terri Rodak
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, 1403 - 29 Street NW, Calgary, Alberta, T2N 2T9, Canada
| | - Heather Manson
- Public Health Ontario, 480 University Avenue, Toronto, Ontario, M5G 1V2, Canada
| | - Rosa Dragonetti
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada.,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1V7, Canada
| | - Laurie Zawertailo
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada.,Department of Pharmacology and Toxicology, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada
| | - Osnat C Melamed
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada
| | - Margaret Hahn
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada.,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada
| | - Peter Selby
- Centre for Addiction and Mental Health, 175 College St, Toronto, Ontario, M5T 1P7, Canada. .,Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, Ontario, M5G 1V7, Canada. .,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario, M5T 1R8, Canada. .,Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.
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48
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Daumit GL, Dalcin AT, Dickerson FB, Miller ER, Evins AE, Cather C, Jerome GJ, Young DR, Charleston JB, Gennusa JV, Goldsholl S, Cook C, Heller A, McGinty EE, Crum RM, Appel LJ, Wang NY. Effect of a Comprehensive Cardiovascular Risk Reduction Intervention in Persons With Serious Mental Illness: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e207247. [PMID: 32530472 PMCID: PMC7293000 DOI: 10.1001/jamanetworkopen.2020.7247] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE Persons with serious mental illness have a cardiovascular disease mortality rate more than twice that of the overall population. Meaningful cardiovascular risk reduction requires targeted efforts in this population, who often have psychiatric symptoms and cognitive impairment. OBJECTIVE To determine the effectiveness of an 18-month multifaceted intervention incorporating behavioral counseling, care coordination, and care management for overall cardiovascular risk reduction in adults with serious mental illness. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted from December 2013 to November 2018 at 4 community mental health outpatient programs in Maryland. The study recruited adults with at least 1 cardiovascular disease risk factor (hypertension, diabetes, dyslipidemia, current tobacco smoking, and/or overweight or obesity) attending the mental health programs. Of 398 participants screened, 269 were randomized to intervention (132 participants) or control (137 participants). Data collection staff were blinded to group assignment. Data were analyzed on the principle of intention to treat, and data analysis was performed from November 2018 to March 2019. INTERVENTIONS A health coach and nurse provided individually tailored cardiovascular disease risk reduction behavioral counseling, collaborated with physicians to implement appropriate risk factor management, and coordinated with mental health staff to encourage attainment of health goals. Programs offered physical activity classes and received consultation on serving healthier meals; intervention and control participants were exposed to these environmental changes. MAIN OUTCOMES AND MEASURES The primary outcome was the change in the risk of cardiovascular disease from the global Framingham Risk Score (FRS), which estimates the 10-year probability of a cardiovascular disease event, from baseline to 18 months, expressed as percentage change for intervention compared with control. RESULTS Of 269 participants randomized (mean [SD] age, 48.8 [11.9] years; 128 men [47.6%]), 159 (59.1%) had a diagnosis of schizophrenia or schizoaffective disorder, 67 (24.9%) had bipolar disorder, and 38 (14.1%) had major depressive disorder. At 18 months, the primary outcome, FRS, was obtained for 256 participants (95.2%). The mean (SD) baseline FRS was 11.5% (11.5%) (median, 8.6%; interquartile range, 3.9%-16.0%) in the intervention group and 12.7% (12.7%) (median, 9.1%; interquartile range, 4.0%-16.7%) in the control group. At 18 months, the mean (SD) FRS was 9.9% (10.2%) (median, 7.7%; interquartile range, 3.1%-12.0%) in the intervention group and 12.3% (12.0%) (median, 9.7%; interquartile range, 4.0%-15.9%) in the control group. Compared with the control group, the intervention group experienced a 12.7% (95% CI, 2.5%-22.9%; P = .02) relative reduction in FRS at 18 months. CONCLUSIONS AND RELEVANCE An 18-month behavioral counseling, care coordination, and care management intervention statistically significantly reduced overall cardiovascular disease risk in adults with serious mental illness. This intervention provides the means to substantially reduce health disparities in this high-risk population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02127671.
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Affiliation(s)
- Gail L. Daumit
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Arlene T. Dalcin
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | | | - Edgar R. Miller
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - A. Eden Evins
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Corinne Cather
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | - Gerald J. Jerome
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Kinesiology, Towson University, Towson, Maryland
| | - Deborah R. Young
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Jeanne B. Charleston
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Joseph V. Gennusa
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stacy Goldsholl
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Courtney Cook
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ann Heller
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emma E. McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Rosa M. Crum
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lawrence J. Appel
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nae-Yuh Wang
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Heggelund J, Vancampfort D, Tacchi MJ, Morken G, Scott J. Is there an association between cardiorespiratory fitness and stage of illness in psychotic disorders? A systematic review and meta-analysis. Acta Psychiatr Scand 2020; 141:190-205. [PMID: 31646608 DOI: 10.1111/acps.13119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Clinical staging models describe where an individual exists on a continuum from asymptomatic at-risk states (Stage 0) through to established late-stage disease (Stage 4). We applied this framework to systematically assess evidence for any associations between objectively assessed cardiorespiratory fitness (CRF) and stage of psychosis. METHOD Nine electronic databases were searched for relevant publications from inception until October 31, 2019. Pooled effect sizes (Hedges' g and 95% confidence intervals (95% CI)) were estimated for differences in CRF for studies that reported mean oxygen uptake (max, peak, or predicted VO2 in ml/kg/min). RESULTS Thirty-eight studies were eligible. Findings indicated that suboptimal CRF can be present at Stages 0 and 1. Meta-analyses of 22 studies demonstrated that CRF was significantly reduced in individuals classified between Stages 1 and 4 compared with matched or general population controls (g = -0.93; 95% CI -1.14, -0.71). Mean VO2 was decreased by 28% in Stage 4 compared with Stage 1 (34.1 vs. 24.66 ml/kg/min); the largest effect size for CRF reduction was reported between Stages 2 and 3 (g = -1.16; 95% CI -1.31, -1.03). CONCLUSIONS Although not identifying direct causal links between clinical stage and CRF, using this framework may enhance understanding of co-associations between mental and physical health markers across the entire spectrum of psychosis. Limitations include lack of research on CRF in Stages 0 and 1 alongside problems determining stage in some studies. However, impaired CRF is reported in emerging psychosis, supporting calls that early intervention programmes should address both mental and physical wellbeing.
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Affiliation(s)
- J Heggelund
- Regional Centre for Healthcare Improvement, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - D Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.,UPC KU Leuven, Leuven-Kortenberg, Belgium
| | - M J Tacchi
- Crisis Resolution and Home-Based Treatment Service, NTW NHS Trust, Newcastle, UK
| | - G Morken
- Department of Psychiatry, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - J Scott
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Academic Psychiatry, Institute of Neuroscience, Newcastle University, Newcastle, UK
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Correll CU, Sikich L, Reeves G, Johnson J, Keeton C, Spanos M, Kapoor S, Bussell K, Miller L, Chandrasekhar T, Sheridan EM, Pirmohamed S, Reinblatt SP, Alderman C, Scheer A, Borner I, Bethea TC, Edwards S, Hamer RM, Riddle MA. Metformin add-on vs. antipsychotic switch vs. continued antipsychotic treatment plus healthy lifestyle education in overweight or obese youth with severe mental illness: results from the IMPACT trial. World Psychiatry 2020; 19:69-80. [PMID: 31922663 PMCID: PMC6953545 DOI: 10.1002/wps.20714] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Antipsychotics are used for many psychiatric conditions in youth. Although developmentally inappropriate weight gain and metabolic abnormalities, which are risk factors for premature cardiovascular mortality, are especially frequent in youth, optimal strategies to reduce pediatric antipsychotic-induced overweight/obesity are unclear. The Improving Metabolic Parameters in Antipsychotic Child Treatment (IMPACT) was a randomized, parallel group, 24-week clinical trial which enrolled overweight/obese, psychiatrically stable youth, aged 8-19 years, with a DSM-IV diagnosis of severe mental illness (schizophrenia spectrum disorder, bipolar spectrum disorder or psychotic depression), at four US universities. All of them had developed substantial weight gain following treatment with a second-generation antipsychotic. The centralized, computer-based randomization system assigned participants to unmasked treatment groups: metformin (MET); antipsychotic switch (aripiprazole or, if already exposed to that drug, perphenazine or molindone; SWITCH); or continued baseline antipsychotic (CONTROL). All participants received healthy lifestyle education. The primary outcome was body mass index (BMI) z-score change from baseline, analyzed using estimated least squares means. Altogether, 127 participants were randomized: 49 to MET, 31 to SWITCH, and 47 to CONTROL. BMI z-score decreased significantly with MET (week 24: -0.09±0.03, p=0.002) and SWITCH (week 24: -0.11±0.04, p=0.003), while it increased non-significantly with CONTROL (week 24: +0.04±0.03). On 3-way comparison, BMI z-score changes differed significantly (p=0.001). MET and SWITCH were each superior to CONTROL (p=0.002), with effect sizes of 0.68 and 0.81 respectively, while MET and SWITCH did not differ. More gastrointestinal problems occurred in MET than in SWITCH or CONTROL. The data safety monitoring board closed the perphenazine-SWITCH arm because 35.2% of subjects discontinued treatment due to psychiatric worsening. These data suggest that pediatric antipsychotic-related overweight/obesity can be reduced by adding metformin or switching to a lower risk antipsychotic. Healthy lifestyle education is not sufficient to prevent ongoing BMI z-score increase.
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Affiliation(s)
- Christoph U. Correll
- Division of Psychiatric ResearchZucker Hillside HospitalNYUSA,Department of Psychiatry and Molecular MedicineDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNYUSA,Department of Child and Adolescent PsychiatryCharité UniversitätsmedizinBerlinGermany
| | - Linmarie Sikich
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNCUSA
| | - Gloria Reeves
- Division of Child and Adolescent Psychiatry, School of MedicineUniversity of MarylandBaltimoreMDUSA
| | | | - Courtney Keeton
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral SciencesJohns Hopkins UniversityBaltimoreMDUSA
| | - Marina Spanos
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNCUSA
| | - Sandeep Kapoor
- Division of Psychiatric ResearchZucker Hillside HospitalNYUSA,Department of Psychiatry and Molecular MedicineDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNYUSA,Department of Child and Adolescent PsychiatryCharité UniversitätsmedizinBerlinGermany
| | - Kristin Bussell
- Division of Child and Adolescent Psychiatry, School of MedicineUniversity of MarylandBaltimoreMDUSA
| | - Leslie Miller
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral SciencesJohns Hopkins UniversityBaltimoreMDUSA
| | - Tara Chandrasekhar
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNCUSA
| | - Eva M. Sheridan
- Department of Science EducationDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNYUSA
| | - Sara Pirmohamed
- Division of Child and Adolescent Psychiatry, School of MedicineUniversity of MarylandBaltimoreMDUSA
| | - Shauna P. Reinblatt
- Division of Child and Adolescent Psychiatry, School of MedicineUniversity of MarylandBaltimoreMDUSA,Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral SciencesJohns Hopkins UniversityBaltimoreMDUSA
| | | | - Abigail Scheer
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNCUSA
| | - Irmgard Borner
- Division of Psychiatric ResearchZucker Hillside HospitalNYUSA
| | - Terrence C. Bethea
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNCUSA,Hughes CenterDanvilleVAUSA
| | - Sarah Edwards
- Division of Child and Adolescent Psychiatry, School of MedicineUniversity of MarylandBaltimoreMDUSA
| | - Robert M. Hamer
- Department of PsychiatryUniversity of North CarolinaChapel HillNCUSA
| | - Mark A. Riddle
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral SciencesJohns Hopkins UniversityBaltimoreMDUSA
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