1
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Korman N, Stanton R, Vecchio A, Chapman J, Parker S, Martland R, Siskind D, Firth J. The effect of exercise on global, social, daily living and occupational functioning in people living with schizophrenia: A systematic review and meta-analysis. Schizophr Res 2023; 256:98-111. [PMID: 37209456 DOI: 10.1016/j.schres.2023.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 03/28/2023] [Accepted: 04/19/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Schizophrenia is associated with high rates of global, social and occupational functional impairments. While prior meta-analyses have extensively examined the impact of exercise on physical and mental health, the impact on functioning in schizophrenia have yet to be fully established. This review aimed to update the evidence base regarding the impact of exercise on functioning in schizophrenia, and explore moderators of effect. METHODS A systematic search was conducted to identify randomized controlled trials (RCTs) of exercise evaluating global functioning versus any comparator in people with schizophrenia; between group meta-analyses of global functioning (and secondary - social, living skills, occupational, adverse events) were computed using a random effects model. Subgroup analyses based on diagnosis and aspects of the intervention were conducted. RESULTS 18 full text articles were included, involving 734 participants. A moderate impact of exercise on global functioning was found (g = 0.40, 95 % C·I. = 0.12 to 0.69, p = 0.006), with a moderate impact of exercise on social (N = 5, g = 0.54 95 % C.I = 0.16 to 0.9 p = 0.005), and daily living functioning (N = 3, g = 0.65, 95 % C.I. = 0.07 to 1.22, p = 0.005). CONCLUSIONS There is good evidence that exercise can improve the global functioning of people with schizophrenia, with preliminary evidence for social and daily living skills; exercise should be considered an important adjunct to usual care. Higher impacts on global functioning were seen in aerobic interventions and of at least moderate to vigorous intensity. More research is required into resistance training, in early psychosis cohorts and to evaluate the comparison of exercise with other established psychosocial therapies.
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Affiliation(s)
- Nicole Korman
- Addiction and Mental Health Services, Metro South Health Services, Australia; School of Medicine, University of Queensland, Brisbane, Australia.
| | - Robert Stanton
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Australia
| | - Anna Vecchio
- Addiction and Mental Health Services, Metro South Health Services, Australia
| | - Justin Chapman
- Addiction and Mental Health Services, Metro South Health Services, Australia; Queensland Institute of Medical Research, Brisbane, Australia
| | - Stephen Parker
- Addiction and Mental Health Services, Metro South Health Services, Australia; School of Medicine, University of Queensland, Brisbane, Australia; The Prince Charles Hospital, Metro North Mental Health Services, Australia
| | - Rebecca Martland
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Dan Siskind
- Addiction and Mental Health Services, Metro South Health Services, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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2
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Méndez-Aguado C, Cangas AJ, Aguilar-Parra JM, Lirola MJ. Benefits, Facilitators and Barrier Reductions in Physical Activity Programmes for People with Severe Mental Disorder: A Systematic Review. Healthcare (Basel) 2023; 11:healthcare11091215. [PMID: 37174757 PMCID: PMC10178509 DOI: 10.3390/healthcare11091215] [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: 02/22/2023] [Revised: 03/16/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023] Open
Abstract
The current high prevalence of people with Severe Mental Disorder and the high impact the latter has on their quality of life is one of the main problems in terms of health, as it affects both physical and mental health. One of the lines of action to intervene in these factors is the practice of physical activity, as this usually has a low level of participation due to different barriers. However, there are several facilitators that improve adherence to these practices. The main objectives of this work were (1) to conduct a systematic review of the scientific literature on the possible benefits obtained by people with SMD from their participation in physical activity programmes; (2) to identify the characteristics of physical activity programmes and determine the barriers to their implementation that have been considered and (3) the facilitators incorporated. To meet these objectives, the SCOPUS, Web of Science, PubMed, Dialnet and Elsevier online databases were consulted and, following the PRISMA statement, 17 articles were finally selected. Their analysis has revealed various physical, psychological and social benefits, as well as the barriers that appear in the intervention programmes, mostly related to personal factors and the programme itself, and those factors that facilitate their adherence or development, the most common being the carrying out of the activities outdoors, the inclusion of social components and the possibility of adapting the activities. In this way, the results obtained have made it possible to highlight the characteristics that should be taken into account when planning this type of intervention.
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Affiliation(s)
- Cristina Méndez-Aguado
- Hum-760 Research Team, Department of Psychology, Health Research Centre, University of Almeria, 04120 Almeria, Spain
| | - Adolfo J Cangas
- Hum-760 Research Team, Department of Psychology, Health Research Centre, University of Almeria, 04120 Almeria, Spain
| | - José M Aguilar-Parra
- Hum-878 Research Team, Department of Psychology, Health Research Centre, University of Almeria, 04120 Almeria, Spain
| | - María J Lirola
- Hum-760 Research Team, Department of Psychology, Health Research Centre, University of Almeria, 04120 Almeria, Spain
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3
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Eklund M, Lund K, Argentzell E. The impact of the BEL intervention on levels of motivation, engagement and recovery in people who attend community mental health services. Scand J Occup Ther 2023. [PMID: 36867590 DOI: 10.1080/11038128.2023.2184717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Community-based day centres (DC) in Sweden provide support to people with severe mental health problems. The role of DC motivation for outcomes in terms of occupational engagement and personal recovery is yet unknown. AIMS To compare two groups who received DC services, one of which also received the 16-week Balancing Everyday Life (BEL) intervention. The focus was motivation for DC services at baseline and after 16 weeks of services, while also investigating the importance of DC motivation for the selected outcomes and service satisfaction. MATERIAL AND METHODS Sixty-five DC attendees were randomised to BEL (n = 27) or standard support (n = 38) and responded to questionnaires about motivation, the selected outcomes and satisfaction with DC services. RESULTS The groups did not differ on any measured aspects of motivation; nor were changes seen over time. The BEL group, but not those receiving standard support, improved from baseline to 16 weeks on occupational engagement and recovery. Motivation for attending the DC was related to service satisfaction. CONCLUSION The BEL program could be a viable enrichment tool in the DC context and boost occupational engagement and personal recovery among the attendees. SIGNIFICANCE The study provided knowledge of importance when developing community-based services while enhancing motivation.
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Affiliation(s)
- Mona Eklund
- Department of Health Sciences, the Mental Health, Activity and Participation (MAP) Group, Lund University, Lund, Sweden
| | - Kristine Lund
- Department of Health Sciences, the Mental Health, Activity and Participation (MAP) Group, Lund University, Lund, Sweden
| | - Elisabeth Argentzell
- Department of Health Sciences, the Mental Health, Activity and Participation (MAP) Group, Lund University, Lund, Sweden
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4
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Arnautovska U, Kesby JP, Korman N, Rebar AL, Chapman J, Warren N, Rossell SL, Dark FL, Siskind D. Biopsychology of Physical Activity in People with Schizophrenia: An Integrative Perspective on Barriers and Intervention Strategies. Neuropsychiatr Dis Treat 2022; 18:2917-2926. [PMID: 36544549 PMCID: PMC9763049 DOI: 10.2147/ndt.s393775] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
People with severe mental illness such as schizophrenia experience high physical comorbidity, leading to a 15-20-year mortality gap compared with the general population. Lifestyle behaviours such as physical activity (PA) play important roles in the quest to bridge this gap. Interventions to increase PA engagement in this population have potential to be efficacious; however, their effectiveness can be hindered by low participant engagement, including low adherence and high drop-out, and by implementation of interventions that are not designed to compensate for the cognitive and motivational impairments characteristic for this group. Moreover, and importantly, the negative symptoms of schizophrenia are associated with neurobiological changes in the brain, which-based on principles of biopsychology-can contribute to poor motivation and impaired decision-making processes and behavioural maintenance. To increase PA levels in people with schizophrenia, better understanding of these neurological changes that impact PA engagement is needed. This has the potential to inform the design of interventions that, through enhancement of motivation, could effectively increase PA levels in this specific population. Incorporating strategies that address the dopamine dysregulation associated with schizophrenia, such as boosting the role of reward and self-determined motivation, may improve long-term PA maintenance, leading to habitual PA. Consideration of motivation and behavioural maintenance is also needed to impart health benefits such as prevention of chronic disease, which is associated with currently low PA levels in this high metabolic risk population. Taking a biopsychological perspective, we outline the neural pathways involved in motivation that are impacted by schizophrenia and propose strategies for promoting motivation for and PA engagement from adoption to habit formation.
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Affiliation(s)
- Urska Arnautovska
- Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addictions and Mental Health Service, Woolloongabba, QLD, Australia
| | - James P Kesby
- Centre for Mental Health, Griffith University, Nathan, QLD, Australia
- Queensland Centre for Mental Health Research, Wacol, QLD, 4076, Australia
| | - Nicole Korman
- Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addictions and Mental Health Service, Woolloongabba, QLD, Australia
| | - Amanda L Rebar
- Motivation of Health Behaviours Lab, Appleton Institute, School of Health, Medical, and Applied Sciences; Central Queensland University, Rockhampton, QLD, Australia
| | - Justin Chapman
- Metro South Addictions and Mental Health Service, Woolloongabba, QLD, Australia
- Centre for Mental Health, Griffith University, Nathan, QLD, Australia
| | - Nicola Warren
- Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addictions and Mental Health Service, Woolloongabba, QLD, Australia
| | - Susan L Rossell
- Centre for Mental Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
- Psychiatry, St Vincent’s Hospital Melbourne, Fitzroy, VIC, Australia
| | - Frances L Dark
- Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addictions and Mental Health Service, Woolloongabba, QLD, Australia
| | - Dan Siskind
- Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
- Metro South Addictions and Mental Health Service, Woolloongabba, QLD, Australia
- Queensland Centre for Mental Health Research, Wacol, QLD, 4076, Australia
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5
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Seymour J, Pratt G, Patterson S, Korman N, Rebar A, Tillston S, Chapman J. Changes in self-determined motivation for exercise in people with mental illness participating in a community-based exercise service in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e1611-e1624. [PMID: 34614232 DOI: 10.1111/hsc.13588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 07/11/2021] [Accepted: 09/20/2021] [Indexed: 06/13/2023]
Abstract
Exercise has diverse benefits for physical and mental health in people with mental illness; however, it is unclear how to effectively promote exercise motivation in this group. The aim of this study is to evaluate the effectiveness of interventions utilising exercise instruction or behavioural counselling with people with mental illness to improve self-determined motivation for exercise, and physical and mental health. Participants were adults (aged 18+ years) receiving mental health services. Participants could choose from two 8-week programs comprising weekly group-based sessions delivered by an exercise physiologist: (a) exercise instruction in a gym (GYM) or (b) behavioural counselling (MOT). Self-determined motivation was measured using the Behaviour Regulations for Exercise Questionnaire (BREQ3). Physical health indicators included waist circumference, blood pressure, leg strength (sit-to-stand test), physical capacity (six-minute walk test) and self-reported exercise. Mental health was assessed using the Kessler-6 scale of psychological distress. Most of the 95 participants chose exercise instruction (GYM = 60; MOT = 35). At baseline, participants who chose MOT had higher external motivation, body mass index, waist circumference and psychological distress, and a higher proportion had multiple physical comorbidities than those who chose GYM. More self-determined motivation was associated with meeting physical activity guidelines. Post-intervention, GYM participants had significant improvements in self-determined motivation, psychological distress and sit-to-stand test; MOT participants had significant improvements in integrated regulation, self-reported exercise and physical functioning. In conclusion, exercise instruction can improve self-determined motivation; however, more intensive behavioural counselling support may be needed to improve self-determined motivation. Counselling programs can increase exercise behaviour and may appeal more to people with poorer health and more external motivation. Findings have high ecological validity and applicability to real-world implementation of exercise interventions. To accommodate people with diverse conditions and motivations, motivational counselling should be combined with practical exercise support, and participants afforded the autonomy to decide their level of involvement.
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Affiliation(s)
- Jessica Seymour
- Queensland Police-Citizens Youth Welfare Association, Brisbane, Queensland, Australia
| | - Greg Pratt
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Sue Patterson
- Metro North Hospital and Health Service, Mental Health, Brisbane, Queensland, Australia
- School of Applied Psychology, Griffith University, Mt Gravatt, Queensland, Australia
| | - Nicole Korman
- Addiction and Mental Health, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Amanda Rebar
- Motivation of Health Behaviours Lab, College of Psychology, Rockhampton, Queensland, Australia
| | - Stephen Tillston
- Queensland Police-Citizens Youth Welfare Association, Brisbane, Queensland, Australia
| | - Justin Chapman
- Queensland Police-Citizens Youth Welfare Association, Brisbane, Queensland, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
- Addiction and Mental Health, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
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6
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Broughan J, McCombe G, Lim J, O'Keeffe D, Brown K, Clarke M, Corcoran C, Hanlon D, Kelly N, Lyne J, McGorry P, O' Brien S, O' Connor K, O' Mahony K, Scott S, Wycherley E, Cullen W. Keyworker mediated enhancement of physical health in patients with first episode psychosis: A feasibility/acceptability study. Early Interv Psychiatry 2022; 16:883-890. [PMID: 34716662 DOI: 10.1111/eip.13234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 07/08/2021] [Accepted: 10/19/2021] [Indexed: 11/26/2022]
Abstract
AIM Early intervention for people experiencing first episode psychosis is a priority, and keyworkers are vital to such services. However, keyworkers' roles in addressing first episode psychosis patients' physical health are under researched. This study addresses this knowledge gap by evaluating a keyworker-mediated intervention promoting physical health among first episode psychosis patients. METHODS The study was informed by the Medical Research Council's Framework for Complex Interventions to Improve Health. First episode psychosis participants were recruited from three Irish mental health services. The intervention was evaluated in terms of its feasibility/acceptability. RESULTS Feasibility outcomes were mixed (recruitment rate = 24/68 [35.3%]; retention rate = 18/24 [75%]). The baseline sample was predominantly male (M:F ratio = 13:6; Med age = 25 y; IQR = 23-42 y). Common health issues among participants included overweightness/obesity (n = 11) and substance use (smoking/alcohol consumption [n = 19]). Participants' initial health priorities included exercising more (n = 10), improving diet (n = 6), weight loss (n = 7) and using various health/healthcare services. The intervention's acceptability was evidenced by the appreciation participants had for physical health keyworkers' support, as well as the healthy lifestyle, which the intervention promoted. Acceptability was somewhat compromised by a low-recruitment rate, variable linkages between keyworkers and general practitioners (GPs) and COVID-19 restrictions. CONCLUSIONS Physical health-oriented keyworker interventions for first episode psychosis patients show promise and further evaluation of such initiatives is warranted. Future interventions should be mindful of participant recruitment challenges, strategies to enhance relationships between keyworkers and GPs, and if necessary, they should mitigate COVID-19 restrictions' impacts on care.
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Affiliation(s)
- John Broughan
- School of Medicine, University College Dublin, Dublin, Leinster, Ireland
| | - Geoff McCombe
- School of Medicine, University College Dublin, Dublin, Leinster, Ireland
| | - Jayleigh Lim
- School of Medicine, University College Dublin, Dublin, Leinster, Ireland
| | - Donal O'Keeffe
- DETECT Early Intervention in Psychosis Service, Dublin, Leinster, Ireland
| | | | - Mary Clarke
- School of Medicine, University College Dublin, Dublin, Leinster, Ireland.,DETECT Early Intervention in Psychosis Service, Dublin, Leinster, Ireland
| | - Ciarán Corcoran
- Longford Westmeath Mental Health Service, Health Service Executive, Dublin, Leinster, Ireland
| | - David Hanlon
- Health Service Executive, Dublin, Leinster, Ireland
| | - Ned Kelly
- Health Service Executive, Dublin, Leinster, Ireland
| | - John Lyne
- Royal College of Surgeons in Ireland, Dublin, Leinster, Ireland.,Wicklow Mental Health Services, Wicklow, Leinster, Ireland
| | - Patrick McGorry
- Center for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen Youth Health, Parkville, VIC, Australia
| | | | - Karen O' Connor
- Cork University Hospital, Health Services Executive, Cork, Munster, Ireland
| | - Karen O' Mahony
- Cork Kerry Mental Health Services, Health Service Executive South, Munster, Ireland
| | - Seamus Scott
- Longford Westmeath Mental Health Service, Health Service Executive, Dublin, Leinster, Ireland
| | - Elizabeth Wycherley
- Cork Kerry Mental Health Services, Health Service Executive South, Munster, Ireland
| | - Walter Cullen
- School of Medicine, University College Dublin, Dublin, Leinster, Ireland
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7
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Abstract
PURPOSE OF REVIEW The aim of this study was to provide psychiatrists with the knowledge, tools and guidance to support physical activity promotion in clinical practice. The review also aims to provide an up-to-date summary of the evidence regarding physical activity in the prevention and treatment of mental disorders in adults. RECENT FINDINGS There is emerging evidence demonstrating that physical activity can protect against incident anxiety and depression. There is robust evidence showing that physical activity is an effective adjunct treatment strategy for depressive disorders and anxiety and stress-related disorders, with emerging evidence for schizophrenia and bipolar disorders. Translation of this evidence into practice is in general ad hoc, and large physical health disparities for people with mental disorders persist. The reasons for this are multifactorial, and include the intersection of social, economic and personal barriers to physical activity. Evidence-based approaches include regular screening of physical activity levels, staff culture change within mental health services and established referral pathways. SUMMARY Translation of evidence regarding physical activity for mental health into routine programmes is critical. Efforts to move beyond solely targeting individual-level barriers to physical activity and address systemic barriers include lack of access to appropriate exercise services. This requires consideration of training needs, service structure and culture change.
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8
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Falkai P, Schmitt A, Rosenbeiger CP, Maurus I, Hattenkofer L, Hasan A, Malchow B, Heim-Ohmayer P, Halle M, Heitkamp M. Aerobic exercise in severe mental illness: requirements from the perspective of sports medicine. Eur Arch Psychiatry Clin Neurosci 2022; 272:643-677. [PMID: 34873635 PMCID: PMC9095557 DOI: 10.1007/s00406-021-01360-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/24/2021] [Indexed: 12/21/2022]
Abstract
Major depression, bipolar disorder, and schizophrenia are severe mental illnesses. Despite receiving psychopharmacological and psychosocial treatments, about half of patients develop a chronic course with residual cognitive and negative symptoms and have a high risk for cardiovascular disease and reduced life expectancy. Therefore, add-on innovative treatment approaches are needed to improve outcome. Aerobic exercise interventions have been shown to improve global functioning, cognition, and negative and depressive symptoms in these patients. The basic mechanism of these exercise-related changes has been reported to be improved brain plasticity, e.g., increased volume of disease-related brain regions such as the hippocampus. The optimal type, duration, and frequency of exercise have not yet been determined and need to be addressed in supervised physical exercise studies. Because of the low physical activity levels, lack of drive related to negative and depressive symptoms, and high prevalence of cardiovascular comorbidities in patients with severe mental illness, besides aiming to improve symptoms of mental illness, exercise interventions should also aim to increase cardiorespiratory fitness, which they should comprehensively assess by direct measurements of maximal oxygen uptake. Based on the recommendations for developing cardiorespiratory fitness by the American College of Sports Medicine, 150 min moderate-intensity training per week or vigorous-intensity exercise training for 75 min per week are appropriate. Most studies have had relatively short intervention periods, so future studies should focus on long-term adherence to exercise by implementing motivational strategies supported by telemedicine and by identifying and targeting typical barriers to exercise in this patient population.
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Affiliation(s)
- Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Andrea Schmitt
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany ,Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Christian P. Rosenbeiger
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Isabel Maurus
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336, Munich, Germany.
| | - Lisa Hattenkofer
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 7, 80336 Munich, Germany
| | - Alkomiet Hasan
- Department of Psychiatry and Psychosomatics of the University Augsburg, Medical Faculty, Bezirkskrankenhaus Augsburg, University of Augsburg, Augsburg, Germany
| | - Berend Malchow
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Von-Siebold-Str. 5, 37075 Göttingen, Germany
| | - Pascale Heim-Ohmayer
- Department of Prevention and Sports Medicine, Medical Faculty, Technical University of Munich, University Hospital ‘Klinikum Rechts der Isar’, Munich, Germany
| | - Martin Halle
- Department of Prevention and Sports Medicine, Medical Faculty, Technical University of Munich, University Hospital ‘Klinikum Rechts der Isar’, Munich, Germany ,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Melanie Heitkamp
- Department of Prevention and Sports Medicine, Medical Faculty, Technical University of Munich, University Hospital ‘Klinikum Rechts der Isar’, Munich, Germany
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9
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Dubreucq J, Gabayet F, Godin O, Andre M, Aouizerate B, Capdevielle D, Chereau I, Clauss-Kobayashi J, Coulon N, D’Amato T, Dorey JM, Dubertret C, Faraldo M, Laouamri H, Leigner S, Lancon C, Leboyer M, Llorca PM, Mallet J, Misdrahi D, Passerieux C, Rey R, Pignon B, Schorr B, Urbach M, Schürhoff F, Szoke A, Fond G, Berna F. Overlap and Mutual Distinctions Between Clinical Recovery and Personal Recovery in People With Schizophrenia in a One-Year Study. Schizophr Bull 2021; 48:382-394. [PMID: 34718808 PMCID: PMC8886587 DOI: 10.1093/schbul/sbab114] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Recovery is a multidimensional construct that can be defined either from a clinical perspective or from a consumer-focused one, as a self-broadening process aimed at living a meaningful life beyond mental illness. We aimed to longitudinally examine the overlap and mutual distinctions between clinical and personal recovery. Of 1239 people with schizophrenia consecutively recruited from the FondaMental Advanced Centers of Expertise for SZ network, the 507 present at one-year did not differ from those lost to follow-up. Clinical recovery was defined as the combination of clinical remission and functional remission. Personal recovery was defined as being in the rebuilding or in the growth stage of the Stages of Recovery Instrument (STORI). Full recovery was defined as the combination of clinical recovery and personal recovery. First, we examined the factors at baseline associated with each aspect of recovery. Then, we conducted multivariable models on the correlates of stable clinical recovery, stable personal recovery, and stable full recovery after one year. At baseline, clinical recovery and personal recovery were characterized by distinct patterns of outcome (i.e. better objective outcomes but no difference in subjective outcomes for clinical recovery, the opposite pattern for personal recovery, and better overall outcomes for full recovery). We found that clinical recovery and personal recovery predicted each other over time (baseline personal recovery for stable clinical recovery at one year; P = .026, OR = 4.94 [1.30-23.0]; baseline clinical recovery for stable personal recovery at one year; P = .016, OR = 3.64 [1.31-11.2]). In short, given the interaction but also the degree of difference between clinical recovery and personal recovery, psychosocial treatment should target, beyond clinical recovery, subjective aspects such as personal recovery and depression to reach full recovery.
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Affiliation(s)
- Julien Dubreucq
- Fondation FondaMental, Créteil, France,Centre Référent de Réhabilitation psychosociale et de Remédiation cognitive (C3R), CH Alpes Isère, Saint Egrève, France,To whom correspondence should be addressed to: Centre Référent de Réhabilitation psychosociale et de Remédiation Cognitive (C3R), CH Alpes Isère, 8 place du Conseil National de la Résistance, 38400 Saint Martin d’Hères, France; tel: (33 4) 56 58 88 00, e-mail:
| | - Franck Gabayet
- Fondation FondaMental, Créteil, France,Centre Référent de Réhabilitation psychosociale et de Remédiation cognitive (C3R), CH Alpes Isère, Saint Egrève, France
| | - Ophélia Godin
- Fondation FondaMental, Créteil, France,Univ Paris Est Créteil, INSERM U955, IMRB, Translational Neuro-Psychiatry, Créteil, France
| | - Myrtille Andre
- Fondation FondaMental, Créteil, France,IGF, University of Montpellier, CNRS, INSERM, Montpellier, France,Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHU Montpellier, France
| | - Bruno Aouizerate
- Fondation FondaMental, Créteil, France,Centre Hospitalier Charles Perrens, Université de Bordeaux, Bordeaux, France,INRA, NutriNeuro, University of Bordeaux, Bordeaux, France
| | - Delphine Capdevielle
- Fondation FondaMental, Créteil, France,IGF, University of Montpellier, CNRS, INSERM, Montpellier, France,Service Universitaire de Psychiatrie Adulte, Hôpital la Colombière, CHU Montpellier, France
| | - Isabelle Chereau
- Fondation FondaMental, Créteil, France,Université Clermont Auvergne, CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
| | - Julie Clauss-Kobayashi
- Fondation FondaMental, Créteil, France,Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Nathalie Coulon
- Fondation FondaMental, Créteil, France,Centre Référent de Réhabilitation psychosociale et de Remédiation cognitive (C3R), CH Alpes Isère, Saint Egrève, France
| | - Thierry D’Amato
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, PSYR2 team, Lyon, France,Centre Hospitalier le Vinatier, Centre Expert Dépression Résistante, Lyon, France
| | - Jean-Michel Dorey
- INSERM U1028, CNRS, UMR 5292, Lyon Neuroscience Research Center, EDUWELL Team, Lyon 2 University, Lyon, France,Centre Hospitalier le Vinatier, Pôle PsyPA, Lyon, France
| | - Caroline Dubertret
- Fondation FondaMental, Créteil, France,AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, Service de Psychiatrie et Addictologie. Hôpital Louis Mourier, Colombes, France,Université de Paris INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Mégane Faraldo
- Fondation FondaMental, Créteil, France,Centre Référent de Réhabilitation psychosociale et de Remédiation cognitive (C3R), CH Alpes Isère, Saint Egrève, France
| | | | - Sylvain Leigner
- Fondation FondaMental, Créteil, France,Centre Référent de Réhabilitation psychosociale et de Remédiation cognitive (C3R), CH Alpes Isère, Saint Egrève, France
| | - Christophe Lancon
- Fondation FondaMental, Créteil, France,AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, Service de Psychiatrie et Addictologie. Hôpital Louis Mourier, Colombes, France,Université de Paris INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - Marion Leboyer
- Fondation FondaMental, Créteil, France,Univ Paris Est Créteil, INSERM U955, IMRB, Translational Neuro-Psychiatry, Créteil, France,AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d’Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Paris, France
| | - Pierre-Michel Llorca
- Fondation FondaMental, Créteil, France,Université Clermont Auvergne, CMP-B CHU, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand, France
| | - Jasmina Mallet
- Fondation FondaMental, Créteil, France,AP-HP, Groupe Hospitalo-Universitaire AP-HP Nord, Service de Psychiatrie et Addictologie. Hôpital Louis Mourier, Colombes, France,Université de Paris INSERM UMR1266, Institute of Psychiatry and Neuroscience of Paris, Paris, France
| | - David Misdrahi
- Fondation FondaMental, Créteil, France,Pôle de psychiatrie Générale et Universitaire, Centre Hospitalier Charles Perrens, Université de Bordeaux, CNRS UMR 5287-INCIA, Bordeaux, France
| | - Christine Passerieux
- Fondation FondaMental, Créteil, France,Service Universitaire de Psychiatrie d’Adultes et d’Addictologie, Centre Hospitalier de Versailles, Le Chesnay, France,DisAP-DevPsy-CESP, INSERM UMR1018, Université Paris-Saclay, Université Versailles Saint-Quentin-En-Yvelines, Villejuif, France
| | - Romain Rey
- INSERM, U1028, CNRS, UMR5292, Lyon Neuroscience Research Center, PSYR2 team, Lyon, France,Centre Hospitalier le Vinatier, Centre Expert Dépression Résistante, Lyon, France
| | - Baptiste Pignon
- Fondation FondaMental, Créteil, France,Univ Paris Est Créteil, INSERM U955, IMRB, Translational Neuro-Psychiatry, Créteil, France,AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d’Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Paris, France
| | - Benoit Schorr
- Fondation FondaMental, Créteil, France,Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
| | - Mathieu Urbach
- Fondation FondaMental, Créteil, France,Service Universitaire de Psychiatrie d’Adultes et d’Addictologie, Centre Hospitalier de Versailles, Le Chesnay, France,DisAP-DevPsy-CESP, INSERM UMR1018, Université Paris-Saclay, Université Versailles Saint-Quentin-En-Yvelines, Villejuif, France
| | - Franck Schürhoff
- Fondation FondaMental, Créteil, France,Univ Paris Est Créteil, INSERM U955, IMRB, Translational Neuro-Psychiatry, Créteil, France,AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d’Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Paris, France
| | - Andrei Szoke
- Fondation FondaMental, Créteil, France,Univ Paris Est Créteil, INSERM U955, IMRB, Translational Neuro-Psychiatry, Créteil, France,AP-HP, Hôpitaux Universitaires Henri Mondor, Département Médico-Universitaire de Psychiatrie et d’Addictologie (DMU IMPACT), Fédération Hospitalo-Universitaire de Médecine de Précision en Psychiatrie (FHU ADAPT), Paris, France
| | | | - Guillaume Fond
- Fondation FondaMental, Créteil, France,AP-HM, Aix-Marseille Univ, School of medicine—La Timone Medical Campus, EA 3279: CEReSS—Health Service Research and Quality of Life Center, Marseille, France
| | - Fabrice Berna
- Fondation FondaMental, Créteil, France,Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg, France
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Rocamora-Montenegro M, Compañ-Gabucio LM, Garcia de la Hera M. Occupational therapy interventions for adults with severe mental illness: a scoping review. BMJ Open 2021; 11:e047467. [PMID: 34716157 PMCID: PMC8559113 DOI: 10.1136/bmjopen-2020-047467] [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] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To identify the occupational therapy (OT) interventions in adults with severe mental illness (SMI) most investigated in intervention studies and to describe their characteristics. DESIGN Scoping review. DATA SOURCES On 17 January 2020, we searched the following electronic databases: MEDLINE, Scopus, Web of Science and EMBASE. We also performed a manual search of TESEO doctoral thesis database and of the journals indexed in the first quartile of OT according to the SCImago Journal Rank. We updated our search on 10 March 2021, performing a complementary search on ProQuest database and repeating the search in all sources. The terms included in the search strategy were: schizophrenia, schizotypal personality, delusional, schizoaffective, psychotic, bipolar, major depression, obsessive-compulsive, severe mental, OT and intervention. STUDY SELECTION The study screening was peer-reviewed. Inclusion criteria were: (1) OT intervention studies in SMI: experimental, randomised, non-randomised and pilot/exploratory studies; (2) adult population with SMI: schizophrenia, schizotypal personality disorder, delusional disorder, obsessive-compulsive disorder, schizoaffective disorder, psychotic disorder, bipolar disorder, major depressive disorder; (3) OT identified as a discipline involved in the intervention; (4) English or Spanish language and (5) studies with full text available. RESULTS Thirty-five studies met the inclusion criteria. OT interventions were classified in psychosocial, psychoeducational, cognitive and exercise interventions. The most used OT intervention was psychosocial intervention. CONCLUSION Psychosocial intervention was the most investigated OT intervention in SMI, followed by psychoeducational, cognitive and exercise interventions. These interventions are usually group interventions in patients with schizophrenia, performed by a multidisciplinary team (in which an occupational therapist collaborates), with 2-3 weekly 60 min sessions and a duration of 3-6 months.
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Affiliation(s)
- María Rocamora-Montenegro
- Department of Public Health History of Science and Gynaecology, Universidad Miguel Hernandez de Elche, Sant Joan d'Alacant, Alicante, Spain
| | - Laura-María Compañ-Gabucio
- Department of Public Health History of Science and Gynaecology, Universidad Miguel Hernandez de Elche, Sant Joan d'Alacant, Alicante, Spain
- ISABIAL, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Comunidad Valenciana, Spain
| | - Manuela Garcia de la Hera
- Department of Public Health History of Science and Gynaecology, Universidad Miguel Hernandez de Elche, Sant Joan d'Alacant, Alicante, Spain
- ISABIAL, Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Comunidad Valenciana, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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