Social versus biological psychiatry: It's time for integration!

Combination of Two Long-Acting Antipsychotics in Schizophrenia Spectrum Disorders: A Systematic Review

BACKGROUND

Up to 34% of patients with schizophrenia are resistant to several treatment trials. Lack of continuous and adequate treatment is associated with relapse, rehospitalization, a lower effect of antipsychotic therapy, and higher risk of side effects. Long-acting injectables antipsychotics (LAI APs) enhance compliance and improve clinical outcomes and quality of life in patients with schizophrenia, and thus it may be advisable to administer two LAI APs at the same time in cases of treatment-resistant schizophrenia. The purpose of this review is to summarize the available literature regarding the combined use of two LAI APs in patients with schizophrenia or other psychotic spectrum disorders.

METHODS

An extensive literature search for relevant articles regarding any combination of two long-acting injectable antipsychotics has been performed from inception up to 9 February 2024, on PubMed, Scopus and APA PsycInfo, according to the PRISMA statement. Only studies reporting combination of two LAI APs and its clinical outcome in patients with schizophrenia and related disorders were selected.

RESULTS

After the selection process, nine case reports, four case series and two observational retrospective studies were included in the final analysis. All patients treated with dual LAI APs reported a good response, and no new or unexpected adverse effects due to the combination of two LAIs were reported. Different drug combinations were used, and the most frequent association resulted in aripiprazole monohydrate + paliperidone palmitate once monthly (32 times).

CONCLUSIONS

Our review highlights that the treatment regimen with two concurrent LAI APs is already widely used in clinical practice and is recognized as providing a promising, effective, and relatively safe therapeutic strategy for treating the schizophrenia spectrum disorders.

Using sport-based interventions for people with severe mental disorders: results from the European EASMH study

People with severe mental disorders report significantly poorer physical health and a higher mortality rate compared with the general population. Several interventions have been proposed in order to challenge this mortality gap, the promotion of physical activities represents one of the most important strategies. In fact, in people with severe mental disorders, physical activity can improve body composition, quality of life, personal functioning, self-esteem, cognition, and cardiorespiratory fitness, as well as reducing affective, psychotic and anxiety symptoms, cardiometabolic burden and increase the global recovery. While sport-based programs are consistently being proposed as an integral part of effective personalized treatment approaches for people with severe mental disorders, their routine implementation is hampered by poor working task integration among different professionals and the lack of training programmes for sport professionals focused on people with severe mental disorders. In this paper, we will: (a) review the efficacy of exercise/sport-based interventions for people with severe mental disorders; (b) describe the main difficulties in engaging patients with severe mental disorders in these interventions; and (c) report the results of the first study on the best practices available in Europe in the field of sport and mental health carried out in the context of the European Alliance for Sport and Mental Health (EASMH) project. According to the EASMH survey, sport-based psychosocial interventions are not frequently available in mental health services, with significant differences at the European level. In the near future, it would be advisable to promote the integration and collaboration between mental health professionals and sport professionals, in order to improve the dissemination and availability of sport-based interventions in routine clinical practice. The EASMH project aims to fill this gap by creating a network of collaborators, researchers and stakeholders with different backgrounds in order to improve the dissemination of sport-based rehabilitation interventions and by developing an innovative training programme for sport coaches in order to improve their skills in interacting and building an effective relationship with people with severe mental disorders.

The Complex Interplay Between Physical Activity and Recovery Styles in Patients With Severe Mental Disorders in a Real-World Multicentric Study

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.

Mortality gap and physical comorbidity of people with severe mental disorders: the public health scandal

BACKGROUND

Patients suffering from severe mental disorders, including schizophrenia, major depression and bipolar disorders, have a reduced life expectancy compared to the general population of up to 10-25 years. This mortality gap requires urgent actions from a public health perspective in order to be reduced.

MAIN TEXT

Factors associated with the high mortality rates in patients with severe mental disorders can be grouped into four groups: those related to the patients, to psychiatrists, to other non-psychiatrist medical doctors and to the healthcare system. Each of these factors should become the target of specific and dedicated interventions, in order to reduce the morbidity and mortality rate in patients with severe mental disorders. All these elements contribute to the neglect of physical comorbidity in patients with severe mental. In particular, the long-standing separation of psychiatry from other branches of medicine and the lack of specific training on this issue further contribute to the poor attention dedicated to management of physical comorbidities. Recently, several professional associations have invited national bodies regulating education of healthcare professionals to include the management of physical health of people with severe mental disorders in undergraduate and postgraduate educational programs.

CONCLUSIONS

The premature mortality in patients with severe mental disorders is a complex phenomenon resulting by the interaction of several protective and risk factors. Therefore, a multilevel approach is needed, in which the different stakeholders involved in health care provision establish workforces for the long-term management of physical and mental health conditions.

How to improve the quality of World Psychiatric Association educational activities? Results from an online survey with World Psychiatric Association zonal representatives

INTRODUCTION

The World Psychiatric Association (WPA), a global association representing 145 psychiatric societies in 121 countries, has a specific focus on education and learning, promoting educational programs on a regular basis. Education in mental health is a continuously evolving phenomenon, although it happens quite often that it is still based on a knowledge formed in the last century and with the latest scientific updates mainly available in English. The WPA is constantly committed in improving and updating the type of educational materials available and ready to be disseminated worldwide.

METHODS

An online survey has been developed and sent to the 18 WPA zonal representatives in order: to evaluate the educational needs for mental health, to translate materials into native languages or inclusivity, and to prioritize educational activities to be developed by the WPA in the next years.

RESULTS

Fifteen out of the 18 zonal representatives participated in the study. According to the public mental health perspective, collaboration with general practitioners (GPs) (80%), communities/stakeholders (66.7%) and programs for promoting mental health in schools (53.3%) are the most prioritized activities carried out. Programs for suicide prevention (86.7%) and promotion of mental health and well-being in the general population (66.7%) are considered as the most relevant to be implemented. From the healthcare perspective, new knowledge on pharmacological and non-pharmacological interventions (73%) was requested. The educational packages are mostly available in the English language, although respondents prioritize the translation of WPA educational material into, at least, Spanish and French. The most preferred formats for educational activities are webinar live (80%) and key opinion lectures (66.7%).

CONCLUSIONS

These findings represent the first step in the continuing promotion of education carried out by the WPA. We aim to run these kinds of initiatives from time to time in order to adapt themes and topics of these materials to the real educational needs of all mental healthcare professionals worldwide.

Electroconvulsive Therapy in Italy-Current Dissemination of Treatment and Determining Factors of the Past

OBJECTIVES

The history of electroconvulsive therapy (ECT) spans eight decades, over which period this method of treatment has been modernized. At the same time, however, the conflict between acceptance and rejection of ECT therapy remains unresolved today. This ambivalence is particularly noticeable in Italy, where the number of uses of ECT has been declining for several years. The aim of the present study is to examine the distribution and use of ECT in Italy today in comparison to 2009 and to analyze the factors that have influenced this downward development.

METHODS

A cross-sectional study using a standardized Italian-language questionnaire was conducted in 2017 to investigate the dissemination and practice of ECT in Italy. The study was addressed to all public and private hospitals providing ECT as a treatment.

RESULTS

Of the 145 mental health facilities in Italy, only 9 offered ECT. A total of 293 patients were treated with ECT within 1 year (mainly for depression). Rates for 3-year treatments in the centers yielded an uneven picture: 4 centers showed an increase in cases and just as many a decline. A north-south divide existed in terms of geographical distribution: centers were mainly located in the north in 2017.

CONCLUSIONS

The study shows that the dissemination and use of ECT have reached a historical low in Italy. It further documents the extent to which the use of ECT declined after 2009. Three factors that have accompanied this development are discussed. If this downward trend is to be reversed, it will be necessary to develop a new approach so as to engender a perception of ECT as a viable treatment option.

Dental Whitening Gels: Strengths and Weaknesses of an Increasingly Used Method

Many people nowadays undergo treatments to improve their aesthetics, often neglecting the general state of health. Aesthetics and appearance have become of prime importance, perhaps correlating with of the advent of social networks and digital photographs. One of the most requested aesthetic treatments for dentists is dental bleaching through the use of whitening gels. Dental bleaching is a treatment which involves an improvement in the chrome of the teeth in a short time, and this treatment appears not invasive for the patients. In-office and at-home bleaching treatments can be found. The purpose of this scientific study is to evaluate all of the advantages and disadvantages of this medical treatment. In this study, were report information and items related to bleaching side effects. Dentists often find themselves in disagreement on this topic. The PICO (Population/Intervention/Comparison/Outcome) question investigated was: Are dental patients who have dental bleaching an increased risk of teeth damage? All of the data in the literature has been collected, and all of the side effects of this treatment were evaluated. 263 studies emerged from initial research; only 14 were screened after screening, as they contained sufficient data to evaluate the side effects of treatment. One certain thing emerged; among the contraindications to the treatment of dental bleaching dentinal hypersensitivity could be cited. In fact, one of the most reported undesirable effects regards this problem. Other studies have evaluated pain, color improvement and duration, or patient satisfaction. Dental bleaching is a treatment that aims to improve the aesthetics of our patients; this is also reflected from a psychological point of view and therefore has effects on general health. However, the whitening treatment is not suitable for everyone and must be carefully evaluated by a specialist. This treatment also entails maintenance by the patient and therefore better compliance to normal oral hygiene procedures.