Lifestyle intervention based on exercise and behavioural counselling and its effect on physical and psychological health in outpatients with schizophrenia spectrum disorders. An exploratory, pragmatic randomized clinical trial

Patients with Schizophrenia Spectrum Disorders (SSD) often lead unhealthy lifestyles. This pragmatic trial evaluated the effectiveness of a lifestyle intervention, consisting of a 12-week aerobic exercise program and behavioural counselling, in SSD outpatients with metabolic syndrome (MetS). It also aimed to assess persistence of potential effects in a 24-month long-term follow-up. Effectiveness was measured in terms of a wide range of outcomes involving physical and psychological health, quality of life, physical activity and changes in motivation to exercise within the context of the self-determination theory. Our primary outcome was waist circumference change. Thirty-three out of 48 participants completed the study. No differences between groups were found in terms of BMI change or other metabolic parameters. However, the active group (AG) showed improvement regarding waist circumference, negative symptomatology and identified motivation to exercise during the study and follow-up. The AG exhibited changes toward a more active pattern of activity after intervention. Moreover, belonging to the AG was a significant predictor for achieving any degree of clinical improvement after 24-month follow-up. Combined interventions of exercise and behavioural counselling in SSD patients with MetS should be considered as an essential part of the integral treatment in the context of mental health services.

Aripirazole-Long Acting Injectable in Pregnant Women with Schizophrenia: A Case Series

Introduction

Long-acting injectable antipsychotics (LAIs) have emerged as a new therapeutic option to treat patients suffering a psychotic disorder. To date, there is a lack of studies regarding safety and clinical use pattern of LAIs in pregnant women.

Objectives

Provide evidence and real world clinical data of pregnant women with schizophrenia who have been treated with long-acting aripiprazole monohydrate (aripiprazole once monthly [AOM] condition) during their pregnancy.

Methods

Descriptive real-world clinical experiences of pregnant women in treatment with AOM. The information was obtained by reviewing electronic medical records and by direct clinical observation management.

Results

The first six case-series describing the pregnancy course of women with schizophrenia treated with AOM. All of them remained psychopathologically stable through pregnancy, and their infants became healthy with normal developmental milestones (Table 1).

Table 1.

Lifestyle intervention on psychotherapy and exercise and their effect on physical and psychological health in outpatients with schizophrenia spectrum disorders. A pragmatic clinical trial

Introduction

Patients with Schizophrenia Spectrum Disorders (SSD) often lead unhealthy lifestyles with higher prevalence of obesity and unfavourable cardiometabolic parameters with less life expectancy and often worse quality of life compared with general population.

Objectives

Evaluate the effectiveness of a combined intervention of exercise and psychoeducation in 48 SSD outpatients with metabolic syndrome (MetS), treated with second-generation antipsychotics and also aimed to explore if the effect persisted in a long-term follow-up of 24 months.

Methods

The intervention included a 12-week aerobic exercise program and a session of lifestyle psychoeducation. Effectiveness was measured in terms a wide range of outcomes involving physical and psychological health, functioning, quality of life, physical activity and changes in motivation to exercise in the context of the self-determination theory.

Results

The active intervention group showed benefits after Bonferroni correction over clinical global impression, identified motivation to exercise and changes of physical activity pattern. Maintenance of effects after 24 months of follow-up was observed for identified regulation to exercise and also for negative symptoms of psychosis (Table). Table. Effects assigned-group/time-over *p≤0.05 **p≤0.01.

Variables	12weeks	24months	Time	Groupxtime	Groupx timex gender
	p	p	p	p	p
HDL (mg/dl)		0.021*
Negative Syndrome Scale	0.044*	0.004**
BREQ-2- Extrinsic regulation	0.008**	0.004**
-External	0.026*
-Introyected		0.038*
-Identified	0.018*	0.015*	0.003**	0.002**
BREQ-2-Intrinsic regulation				0.005**	0.004**
Pedometer (steps/day)			0.001**	0.006**

Conclusions

A combined intervention on SSD outpatients with MetS showed effectiveness over several clinical parameters and functioning. Therefore, should be considered an essential part of the integral treatment in mental health services for SSD patients.

Disclosure

No significant relationships.

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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

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.

Long-acting injectable aripiprazole in pregnant women with schizophrenia: a case-series report

Antipsychotic long-acting formulations (LAI-AP) have emerged as a new therapeutic choice to treat patients presenting a severe mental disorder. Despite that, to date, there is a lack of safety data and studies regarding the use of LAI-AP formulations in pregnant women. Here we present the first six-case series of pregnant women with schizophrenia treated with aripiprazole-LAI reported in the literature. All patients remained psychopathologically stable through pregnancy and the postpartum period, and all of them were in treatment with aripiprazole-LAI. To date, all infants remain healthy with normal developmental milestones, without the presence of congenital malformations or adverse effects. Lack of information on safety data regarding the use of new antipsychotic formulations remains important in treating women with mental illness who desire to become pregnant. Further studies in this clinical population with a larger number of patients included remains necessary.

Subclinical depression in primary care and somatic symptoms

Sir: Studies concerning depression in primary care emphasize the fact that several clinical features of these mood disorders do not satisfy the diagnostic criteria of psychiatric classifications [4]. These primary care patients have been classified as subclinical depression, subthreshold depression, or patients with “depressive symptoms only” [2]. We compared using analysis of variance and Mann–Whitney statistics, a randomized group of 43 patients presenting clinical depressive symptoms (Beck Depression Inventory >16, cut-score validated in Spanish version [1,3]), with another group of 41 “subclinical” patients (BDI scores: 10–16). We considered statistically significative difference P < 0.01.