Health habits of patients with schizophrenia

Mediterranean and standard American diet consumption in psychosis and non-psychosis affective disorders groups: Symptoms and cognition

Research supports an association between diet and health, and emerging evidence suggests that diet is associated with neuropsychiatric symptoms. However, no human study has examined an anti-inflammatory diet across rigorously defined psychiatric diagnoses and its associations with symptom severity and cognition. As inflammation is implicated in mental illness, we investigated adherence to the Mediterranean diet (MD), an anti-inflammatory diet, and the standard American diet (SAD), and examined cross-sectional relationships with psychiatric symptoms and cognition.

METHOD

Participants included 54 individuals with psychotic disorders, 30 with non-psychosis affective disorders and 40 healthy controls. Participants underwent diagnostic interviews, PANSS symptom ratings, and MATRICS cognitive assessments. The self-report GBAQ was used to assess adherence to the MD versus SAD.

RESULTS

The psychosis group was significantly more likely to consume the SAD than healthy controls (p = 0.007), with MD adherence predicting better working memory (r = 0.461, p < 0.001). In the non-psychosis affective disorders group, MD adherence predicted slower processing speed (r = -0.376, p = 0.049). In the non-psychosis affective disorders group, MD predicted reduced PANSS General Psychopathology scale (r = -0.449, p = 0.013), as well as the Activation (r = -0.362, p = 0.049), and Dysphoric Mood factors (r = -0.403, p = 0.027).

DISCUSSION

This first-of-its kind study identified poor dietary choices in persons with psychosis, showing significantly lower symptoms and better cognition in association with the MD in transdiagnostic analyses. It supports the study of dietary interventions for prevention and treatment of psychiatric conditions.

Unemployment and mental health: a global study of unemployment's influence on diverse mental disorders

Introduction

Globally, one in five individuals faces unemployment, which substantially increases their risk of developing mental disorders. Understanding the relationship between unemployment and specific mental health outcomes is crucial for formulating effective policy interventions.

Methods

This study examines the relationship between unemployment and mental disorders across 201 countries from 1970 to 2020. Using a fixed-effects model, we analyze the impact of unemployment on various mental health outcomes, including anxiety, depression, bipolar disorder, drug use, and eating disorders, with a focus on demographic variations.

Results

The analysis reveals a significant positive association between unemployment and mental disorders, particularly anxiety, depression, and bipolar disorder. Moreover, distinct patterns emerge, linking unemployment to higher rates of drug use and eating disorders in specific demographics.

Discussion

These findings underscore the critical interplay between socio-economic factors and mental health, highlighting the need for proactive strategies to address the dual burden of unemployment and mental health disorders. Targeted interventions, such as employment support programs and accessible mental health services, are essential to improve global mental health outcomes. These initiatives can also alleviate the economic burden of unemployment by boosting workforce participation and productivity. Long-term economic gains may offset the increased healthcare expenditures associated with mental health support.

Consumption of Sugar-Sweetened Beverages in People with Severe Mental Illness: A Community-Based Cohort Study

Objective

Excess mortality in mentally ill is largely due to high rates of physical illnesses that lead to worse health outcomes. This study examines the intake of added sugar from sugar-sweetened beverages (SSBs) and factors associated with poor mental and physical health in people with severe mental illness.

Methods

Data were collected as part of the standard care of consumers attending the Collaborative Centre for Cardiometabolic Health in Psychosis clinics where a diet history is taken by a dietitian. SSBs and tea/coffee with added sugars consumed in the past seven days were collected.

Results

Overall, 1648 occasions of service comprising 1142 consumers (mean age 45.0 ± 12.5 years, 63.5% males) were seen. Of these, 1234 (74.9%) occasions of service were provided by a dietitian. Two-thirds (n = 840) self-reported to have consumed one or more SSBs or tea/coffee with sugar. Over half 697 (56.5%) consumed one or more SSBs and 437 (35.4%) tea/coffee with sugar. The mean daily consumption of added sugar from SSBs and tea/coffee was 86.2 g/day. On multivariable analysis, males, those diagnosed with schizophrenia, being on Olanzapine ± other antipsychotics and lower socio-economic status were statistically associated with consumption of added sugar.

Conclusion

Consumption of added sugars from SSBs in consumers of community mental health services is four times higher than the general population. This is an underestimation of the total intake of added sugars without other contributors from discretionary foods. Measuring consumption of SSBs may be an easy-to-use proxy for assessing dietary risk when dietitians are not available.

Feasibility and effectiveness of a 24-weeks outdoor exercise program on the physical and mental health of persons with schizophrenia

Outdoor exercise can be a novelty and effective therapeutic strategy to achieve positive physical and mental health outcomes in persons with schizophrenia. The aim of this study was to assess the feasibility and effectiveness of a 24-weeks outdoor exercise program in the physical and mental health of persons with schizophrenia. Fifty-two outpatients with schizophrenia were conveniently assigned to a 24-weeks walking/jogging combined with cycling outdoor program (n = 23, male = 14) or control group (n = 29, male = 20). Demographic and clinical measures were collected. Physical health was evaluated using anthropometric measures, 6 min walk test, Eurofit and accelerometer. Mental health was evaluated using self-esteem, motivation for exercise and quality of life questionnaires. Attendance rate to the outdoor program was 92 %. The exercise program significantly decreased participant's body mass index and improved functional exercise capacity and balance. No effects were reported in the self-esteem, motivation for physical activity and quality of life. Significant decreases were found in abdominal strength, hand grip and self-esteem levels of the control group. The outdoor exercise combining walking/jogging and cycling was an effective intervention to decrease body mass index and to improve physical fitness. It can be suggested as a therapeutic approach with an important impact on the management of schizophrenia.

Impact of body mass index elevation, Vitamin D receptor polymorphisms and antipsychotics on the risk of Vitamin D deficiency in schizophrenia patients

Antipsychotics with weight gain as side effect and vitamin D receptor dysfunction associated with single nucleotide polymorphisms (VDR SNPs) may have different effects on vitamin D status. Hence, present study aimed to investigate the relationship between vitamin D with body mass index (BMI), antipsychotics and VDR SNPs (rs2228570, rs1544410, rs7975232 and rs731236) in Malaysian patients with schizophrenia. Serum vitamin D level was measured using competitive enzyme-linked immunosorbent assay kit. VDR SNPs were analyzed using polymerase chain reaction-restriction fragment length polymorphism. We found significantly lower serum vitamin D level in patients with schizophrenia (p < 0.01), especially those taking atypical antipsychotics (p = 0.02) and combined antipsychotics (p = 0.02) and obese (BMI ≥27.5 kg/m2) patients (p = 0.04) after adjustment for covariates. For VDR SNPs, the CT genotype of rs1544410, CA genotype of rs7975232, and AA and AG genotypes of rs731236 may contribute to the significant decreased serum vitamin D level in patients (p < 0.05). Nevertheless, these relationships may differ by populations or medical conditions. The hypotheses of volumetric dilution and sequestration of vitamin D may explain the lower vitamin D level in obese patients. In addition, lifestyle factors such as poor diet and lack of physical activity with less sunlight exposure may cause reduced vitamin D level among patients. As patients in present study were prescribed with various antipsychotics, the effect of each antipsychotic on vitamin D level could not be determined. Thus, future studies should investigate the effect of different types of antipsychotics and obesity on vitamin D level in schizophrenia.

Cardiac healthcare disparities and electrocardiography (ECG) differences in schizophrenia at end of life

Schizophrenia is associated with early mortality of 15 to 20 years, and 80 % of deaths are due to cardiovascular disease with a three-times greater risk of sudden-cardiac-death. While lifestyle, medications, genetics, and healthcare disparities are contributing factors, the etiology of this complex process is not fully understood. The aim of this study is to examine cardiac-related healthcare utilization and electrocardiogram (ECG) outcomes in schizophrenia at the end of life (EOL). A cohort of individuals with schizophrenia (SG) (n = 610, ≥50 years) were identified retrospectively from a unified clinical data platform and measures of cardiovascular healthcare utilization were evaluated within a 12-month period prior to death. Similarly, a control group (n = 610) was randomly identified and matched by gender (53 % females) and age of death (72.8 ± 12.4 years). Statistical methods included Cochran-Mantel-Haenszel and mixed-effects logistic & linear regression tests with adjustments for match strata and marital status, race, age, and gender as covariates. Results indicate that SG was more likely to be unmarried, unemployed, or from minority groups (all p < 0.001), and more likely to have diabetes and/or cardiovascular disease (p < 0.001). SG was less likely to receive an ECG (p = 0.001) or cardiac catheterization procedure (p < 0.001). SG had a greater mean QTc (447.2 ms vs. 434.6 ms; p = 0.001) and were twice as likely to have "prolonged QT" on ECG report (p = 0.006). In conclusion, SG had reduced likelihood of cardiac-related healthcare interventions, and despite greater likelihood of prolonged QTc, a recognized biomarker of cardiac risk, ECG was less likely at EOL. Given greater cardiac comorbidity and risk of sudden cardiac death in schizophrenia, improved practice guidelines are needed.

Alcohol drinking in male patients with chronic schizophrenia: prevalence and its relationship to clinical symptoms

Background

It is common practice to associate schizophrenia (SCZ) patients with substance use. The most commonly used substances in China are tobacco and alcohol. However, few studies have focused on alcohol consumption itself in patients with SCZ. Thus the purpose of this study was to detect the prevalence of alcohol use and associated clinical factors in Chinese patients with SCZ.

Methods

A total of 616 male inpatients who met the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for SCZ participated in this study. A detailed questionnaire, including data on alcohol consumption was used to collect demographic and clinical information on all patients. The five-factor model of the positive and negative syndrome scale (PANSS) was adopted to assess psychiatric symptoms.

Results

In this study, 31.49% of SCZ inpatients had a history of alcohol use, and 82.9% of these patients abstained from alcohol use after the onset of SCZ. Compared to nondrinkers, patients who drank were more likely to smoke (p = 0.004), more likely to have suicide attempts (p = 0.002) and suicidal ideation (p = 0.001), more severe positive (p < 0.001) and depressive symptoms (p = 0.034), but less severe negative symptoms (p = 0.04).

Conclusion

These findings suggest that alcohol use is common during the lifetime of SCZ patients and that alcohol use may be associated with clinical symptoms in SCZ patients.

Effects of Dietary Habits on General and Abdominal Obesity in Community-dwelling Patients with Schizophrenia

Objective

To investigate the effects of dietary habits on general and abdominal obesity in community-dwelling patients with schizophrenia spectrum disorder according to sex.

Methods

A total of 270 patients with schizophrenia spectrum disorder registered at mental health welfare centers and rehabilitation facilities were recruited. General obesity was defined as a body mass index ≥ 30 kg/m², and abdominal obesity was defined as a waist circumstance ≥ 90 cm in men and ≥ 85 cm in women. Dietary habits were evaluated using dietary guidelines published by the Korean Ministry of Health and Welfare. Demographic and clinical characteristics along with dietary habits and information related to obesity were collected. Factors related to obesity were evaluated separately by sex.

Results

Dietary habits differed according to sex, in that scores for healthy eating habits were lower in men than in women. In men, the prevalences of general and abdominal obesity were 17.0% and 37.3%, respectively. In women, the prevalences of general and abdominal obesity were 23.1% and 38.5%, respectively. Regression analysis showed that the scores of regular eating habits were negatively associated with general and abdominal obesity in men, and the scores of healthy eating habits were negatively associated with general and abdominal obesity in women.

Conclusion

Among patients with schizophrenia, regular eating habits might reduce the risk of obesity in men, and healthy eating habits might reduce the risk of obesity in women. Nutrition education should be provided to community- dwelling patients with schizophrenia to prevent obesity in this population.

Systematic review of lifestyle interventions to improve weight, physical activity and diet among people with a mental health condition

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.

Alcohol use history increases the likelihood of suicide behavior among male chronic patients with schizophrenia in a Chinese population

AIMS

This study was designed to detect the association between the history of alcohol drinking and suicidality in schizophrenia (SCZ) inpatients in a Chinese population.

METHODS

We recruited 616 male SCZ inpatients and collected demographic and clinical data. Five-factor model of the Positive and Negative Syndrome Scale (PANSS) was used to assess their psychopathological symptoms.

RESULTS

Our results showed that 31.33% of SCZ patients had a history of alcohol drinking. They had higher rates of lifetime suicide attempt and suicidal ideation than those without a history of alcohol drinking. Moreover, patients with a history of drinking were more likely to attempt suicide (14.51% vs. 7.09%; χ²  = 7.70, df = 1, p = 0.006), with an odds ratio (OR) of 2.22 and have suicidal ideation (29.02% vs. 17.49%; χ²  = 9.89, df = 1, p = 0.002), with an OR of 1.93. In addition, patients who used to drink alcohol were more likely to be smokers and had more severe positive and depressive symptoms (all p < 0.05).

CONCLUSIONS

Our study indicates that history of alcohol drinking may increase the prevalence of lifetime suicide attempt and suicidal ideation in male patients with chronic SCZ. Moreover, the history of alcohol drinking may be associated with some demographic data and clinical symptoms.

Olanzapine-associated dose-dependent alterations for weight and metabolic parameters in a prospective cohort

Metabolic abnormalities have been associated with olanzapine treatment. We assessed if olanzapine has dose‐dependent effects on metabolic parameters with changes for weight, blood pressure, lipid and glucose profiles being modelled using linear mixed‐effects models. The risk of metabolic abnormalities including early weight gain (EWG) (≥5% during first month) was assessed using mixed‐effects logistic regression models. In 392 olanzapine‐treated patients (median age 38.0 years, interquartile range [IQR] = 26.0–53.3, median dose 10.0 mg/day, IQR = 5.0–10.0 for a median follow‐up duration of 40.0 days, IQR = 20.7–112.2), weight gain was not associated with olanzapine dose (p = 0.61) although it was larger for doses versus ≤10 mg/day (2.54 ± 5.55 vs. 1.61 ± 4.51% respectively, p = 0.01). Treatment duration and co‐prescription of >2 antipsychotics, antidepressants, benzodiazepines and/or antihypertensive agents were associated with larger weight gain (p < 0.05). Lower doses were associated with increase in total and HDL cholesterol and systolic and diastolic blood pressure (p < 0.05), whereas higher doses were associated with glucose increases (p = 0.01). Patients receiving >10 mg/day were at higher EWG risk (odds risk: 2.15, 1.57–2.97). EWG might be prominent in high‐dose olanzapine‐treated patients with treatment duration and co‐prescription of other medications being weight gain moderators. The lack of major dose‐dependent patterns for weight gain emphasizes that olanzapine‐treated patients are at weight gain risk regardless of the dose.

The Impact of the COVID-19 Pandemic on the Lifestyles and Levels of Anxiety and Depression of Patients with Schizophrenia: A Retrospective Observational Study

The movement restrictions put in place as a result of the COVID-19 pandemic required modification of the population’s usual routines, including those of the most vulnerable groups such as patients with schizophrenia. This was a retrospective observational study. We used an online survey to collect information on patient adherence to the Mediterranean diet (Mediterranean Diet Adherence Screener questionnaire), physical exercise (International Physical Activity Questionnaire Short Form), and tobacco consumption and levels of anxiety and depression (Hospital Anxiety and Depression Scale) before and during the movement restrictions. A total of 102 people with schizophrenia participated in this study. During the COVID-19 pandemic lockdown the participants significantly increased the number of minutes spent sitting per day (z = −6.73; p < 0.001), decreased the time they spent walking (z = −6.32; p < 0.001), and increased their tobacco consumption (X² = 156.90; p < 0.001). These results were also accompanied by a significant increase in their reported levels of anxiety (z = −7.45; p < 0.001) and depression (z = −7.03, p < 0.001). No significant differences in patient diets during the pandemic compared to before the movement restrictions were reported. These results suggest the need to implement specific programs to improve lifestyle and reduce anxiety and depression during possible future pandemic situations.

The evaluation of a physical health promotion intervention for people with severe mental illness receiving community based accommodational support: a mixed-method pilot study

BACKGROUND

Unhealthy lifestyle constitutes a cause of increased morbidity and mortality in people with severe mental illness. The aim of this mixed-method pilot study was to investigate the feasibility and preliminary effectiveness of an intervention to promote a health-conscious lifestyle in comparison to care as usual among people with severe mental illness receiving accommodational support in community settings.

METHODS

This was a prospective, quasi-experimental, controlled study over four six-month assessment points (t0, + 6 months, + 12 months, + 18 months) with 70 persons with severe mental illness receiving community based accommodational support. Mental health staff members of the housing facilities were trained in Motivational Interviewing and conducted a six-week health course with the intervention group participants in addition to care as usual. Next to the primary outcome - self-rated physical well-being (FEW 16) - anthropometric parameters and unhealthy behaviours (diet, physical activity, alcohol and tobacco consumption, and oral hygiene) were examined. Effectiveness analysis was conducted using mixed-effects regression models with propensity score adjustment to control for selection bias. One year after the end of the intervention, semi-standardized expert interviews were conducted with 12 of these employees and evaluated by content analysis.

RESULTS

The qualitative interviews with mental health staff underline the intervention's feasibility in people with severe mental illness in sheltered housing, and the acceptability of and satisfaction with the intervention among mental health workers. But in this pilot study no superiority of the HELPS intervention compared to routine care could be demonstrated in terms of the investigated outcomes.

CONCLUSIONS

The findings of this pilot study underscore the feasibility and acceptability of health promotion programmes based on Motivational Interviewing and highlight the need to further develop multi-modal programs according to the needs of the target group. Long-term and sustainable support for healthy lifestyles of people with severe mental illness receiving community mental health care requires multi-modal concepts and organisational change.

TRIAL REGISTRATION

DRKS00011659 , date of registration was 2017/02/15; retrospectively registered as date of first enrolment was 2017/01/24.

Dietary Habits and Obesity in Patients with Psychotic Disorders in Rural Areas in Northwestern Greece

People suffering from psychotic disorders display high rates of physical morbidity and mortality in comparison to the general population. The present study explores the relation between the dietary habits, the prevalence of obesity and the occurrence of physical morbidity in patients who suffer from psychotic disorders in rural regions of northwest Greece. Two scales were applied to evaluate the quality of life (Quality of Life Questionnaire II, Moorehead–Ardelt) and the dietary habits (Dietary Instrument for Nutrition Education (DINE) Questionnaire) of these patients. The study sample used in this study consisted of 55 patients who suffered from a psychotic disorder. Most (75%) were male, with a mean age of 51.5 years and an average duration of disease of 25.1 years. Of these, 38.2% (21 patients) were obese with a BMI < 30 Kg/m2, 32.7% (16 patients) were overweight and 29.1% had a normal body weight. The majority of the sample, 80%, was treated with second-generation medications. With regards to their dietary habits, 94.5% (52/55) of the sample showed a low intake of fiber content, 67.3% (37/55) showed a high intake of saturated fats and 100% (55/55) a low intake of unsaturated fats. The rates of physical morbidity in the present sample were 21.8% with at least one disease and 14.5% with two diseases, whereas 5.5% met the criteria for metabolic syndrome (MS). The average BMI of the women was statistically significantly higher compared to the men. The majority of the sample (69.1%) exhibited acceptable levels of quality of life. No co-relations of quality of life with BMI were found. In addition, no co-relations of BMI with dietary habits were revealed.

Examining service participation and outcomes from a population-level telephone-coaching service supporting changes to healthy eating, physical activity and weight: A comparison of participants with and without a mental health condition

Population-level telephone coaching services provide accessible behaviour change support for modifiable health risk behaviours. The NSW Get Healthy Information and Coaching Service® (GHS) is a free telephone-based coaching service in Australia, supporting improvements in healthy eating, physical activity and achieving or maintaining a healthy weight. This study compared measures of participation (such as program completion) and outcomes achieved immediate post-program (including changes in fruit and vegetable consumption, physical activity and weight) for GHS participants with and without a self-identified mental health condition (MHC). Secondary data analysis was conducted on service data collected at program intake and completion for individuals who enrolled in a coaching program between January 2018 and October 2019 (n = 5,629); 33% identified as having had an MHC. While those with and without an MHC had similar rates of completion, those with an MHC were less likely to complete a coaching program (31% vs 36%, p = .003). Participants with an MHC made significant positive changes to their fruit and vegetable consumption, physical activity (walking and moderate), weight and BMI, but not to waist circumference or vigorous physical activity. When comparing the magnitude of change for those with and without an MHC, individuals without made greater improvements to their weight (adjusted mean difference -0.623 kg, p = .034) and daily vegetable intake (adjusted mean difference -0.199 serves; p = .01). There were no differences for other variables. The GHS is an effective means of supporting behaviour change for people with an MHC who complete a coaching program. Further research should consider means of improving retention rates.

Prevalence of schizophrenia and its association with socio-demographic correlates in an agricultural region of China

Little is known about the epidemiology of schizophrenia in the agricultural regions of China. This study examined the 1-month and lifetime prevalence of schizophrenia and their association with socio-demographic factors in Hebei province which is an important agricultural region of China. A multi-stage, stratified, cluster random sampling method was adopted. The diagnosis of schizophrenia was ascertained with the validated Structured Clinical Interview for DSM-IV Axis I Disorders-Patient Edition (SCID-I/P/C). Altogether, 23,675 subjects were screened, of whom, 20,884 were included for analyses. The weighted 1-month and lifetime prevalence of schizophrenia were 0.5 % [95 % confidence interval (CI): 0.4-0.5 %] and 0.6 % (95 %CI: 0.5-0.7 %), respectively. Multiple logistic regression analyses found that unmarried marital status [P < 0.001, Odd Ratio(OR)=2.670, 95 %CI:1.767-4.036], lower education level (primary school or below: P = 0.042, OR=2.447, 95 % CI: 1.034-5.933; secondary school: P = 0.002, OR = 4.261, 95 % CI:1.692-10.730), unemployment (P = 0.006, OR=1.870, 95 % CI:1.198-2.920), lower income (P < 0.001, OR=4.017, 95 % CI:2.207-7.310) and family history of psychiatric disorders (P < 0.001, OR=16.278, 95 % CI:10.435-25.393) were independently associated with a higher risk of schizophrenia, while age above 60 years (P = 0.004, OR=0.440, 95 % CI:0.253-0.765) was associated with a lower risk of schizophrenia. The prevalence of schizophrenia appeared to be lower in Hebei province compared to other regions of China or other countries. Socioeconomic factors should be further examined to inform the public health surveillance and policies relevant to schizophrenia in the agricultural regions of China.

Metabolic Syndrome and Dietary Habits in Hospitalized Patients with Schizophrenia: A Cross-Sectional Study

Background and Objectives: The true prevalence of metabolic syndrome (MetS) and the reason for it being higher in patients with schizophrenia when compared to general population have not yet been fully determined. Although being considered as one of the major causes, currently there are limited findings regarding differences in dietary patterns of schizophrenic patients with and without MetS. The present study aimed to determine the prevalence of MetS among hospitalized patients with schizophrenia, to investigate the differences in socio-demographic, clinical, and lifestyle characteristics between participants with and without MetS, with the special emphasis being put on their dietary habits, and to ascertain the correlation between dietary habits and MetS components. Materials and Methods: A cross-sectional study included 259 hospitalized patients with schizophrenia aged ≥ 18 years. All participants underwent basic anthropometric measurements, blood sampling and blood pressure assessment, and provided relevant socio-demographic and lifestyle information. The presence of MetS was determined according to the Joint Interim Statement definition and dietary habits were assessed using a non-quantitative food frequency questionnaire. Results: The overall prevalence of MetS was 47.9%. No socio-demographic or lifestyle differences were found between participants with and without MetS. A large number of participants (42.9%) reported consuming carbonated soft drinks on a daily basis. Daily frequency of fruit (11.6%) and vegetables intake (29.3%) was far below recommended. Dietary habits of participants with and without MetS did not significantly differ, while consumption frequencies of some of the studied food and beverage items and groups significantly correlated with certain MetS components (such as statistically significant positive correlation between cured meat products consumption frequency and waist circumference, as well as between red meat consumption frequency and systolic blood pressure). Conclusions: The concept of the present study did not allow us to distinguish to what extent the participants’ dietary habits were influenced by independent procurement of food products, nor has it allowed us to quantify the portion sizes of consumed food and beverage items and groups. Nevertheless, the findings indicate the need for early identification of individuals with high MetS risk and for the incorporation of nutritional support programs into hospital treatment of patients with schizophrenia.

The Psychology of Food Cravings in Patients With First-Episode Psychosis

Objectives: Food cravings may cause weight gain in patients with schizophrenia. This study investigated psychological characteristics associated with food cravings in patients with first-episode psychosis. Methods: This study analyzed data from a clinical cohort of first-episode psychosis patients taking antipsychotics for 3 months or less. The strength of food cravings was measured using the General Food Cravings Questionnaire-Trait (G-FCQ-T). Psychological characteristics and psychiatric symptoms were investigated with the Positive and Negative Symptom Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS), Social and Occupational Functioning Assessment Scale, Rosenberg Self-Esteem Scale (RSES), and Perceived Stress Scale (PSS). Clinical characteristics were compared according to significant weight gain (≥10% increase in body weight compared to baseline) over 3 months. Associations between the G-FCQ-T and other psychiatric scales were investigated. We conducted sex-stratified analyses. Results: In total, 182 patients (78 males and 104 females) with first-episode psychosis were enrolled in this study. In females, the G-FCQ-T total score at baseline was associated with baseline body weight and significant weight gain over 3 months. The PSS scales were significantly associated the G-FCQ-T total and all subscale scores in female participants. Scores on the RSES and CDSS were significantly associated with the G-FCQ-T total score and with the preoccupation and loss of control subscale scores. The PANSS negative and general subscales were significantly associated with the positive outcome expectancy and loss of control subscales of the G-FCQ-T, respectively. In males, the only significant association was between the loss of control subscale and RSES scores. Linear regression analysis showed significant associations of PSS scores with the total and all subscale scores of the G-FCQ-T despite the loss of significance for other variables. Conclusion: These results indicate that the food cravings in patients with first-episode psychosis, which were associated with weight gain, were influenced by perceived stress in females. To reduce food cravings in female patients with schizophrenia, interventions aimed at perceived stress should be considered.

Worldwide prevalence of smoking cessation in schizophrenia patients: A meta-analysis of comparative and observational studies

Although the rate of cigarette smoking is high in schizophrenia patients, the prevalence of smoking cessation in this group is reportedly low. This meta-analysis aimed to examine the prevalence of cessation among schizophrenia patients worldwide. A systematic literature search in PubMed, PsycINFO, Medline, EMBASE, Cochrane Library and Web of Science was performed from their inception date until 15 November 2018. Studies that reported prevalence of smoking cessation were synthesized using a random-effects model. Fourteen studies were included. The pooled prevalence of smoking cessation among schizophrenia patients was 14.0 % (95 % CI: 9.2-18.8 %; I² = 97.3 %). Compared with schizophrenia patients, both healthy controls (OR = 0.45, 95 % CI:0.38-0.54, p < 0.001) and controls with other psychiatric disorders (OR = 0.79, 95 % CI:0.63-0.99, p = 0.004) had significantly higher prevalence of cessation. Subgroup and meta-regression analyses found that year of survey (after 2005), duration of smoking cessation (<6 months), outpatient setting and poor study quality were significantly associated with higher prevalence of smoking cessation. This meta-analysis found that the prevalence of smoking cessation was significantly lower among schizophrenia patients compared to healthy control and those with other psychiatric disorders. Better understanding of the barriers to smoking cessation and more effective measures for quitting smoking should be developed for patients with schizophrenia.

Dietary Behaviors and Metabolic Syndrome in Schizophrenia Patients

The metabolic syndrome (MS) is highly prevalent in schizophrenia patients, resulting from both pharmacotherapy and their lifestyle. To avoid its development, the analysis of patients' eating behaviors followed by the necessary nutritional changes should become a routine element of treatment. The aim of this study is to investigate the effect of dietary habits on the course of schizophrenia and MS, cognitive performance, symptom severity, and subjective assessment of eating behaviors in schizophrenia patients. Total of 87 participants (63.2% women) aged 19 to 67 years (M = 41.67; SD = 12.87), of whom 60 met the IDF criteria for MS, completed the PANSS, the verbal fluency test, the Stroop Color-Word Test, and the digit span task, followed by a thorough nutritional interview. There were no significant differences in the dietary behaviors between investigated schizophrenia patients with and without comorbid MS. Interestingly, their eating habits compared quite favorably to those described in the literature. No associations were found between positive eating habits and other tested variables in patients with MS. They were, however, linked to lower PANSS scores in the entire sample. In addition, positive eating habits correlated with better cognitive performance and a more adequate subjective assessment of dietary habits. It would be amiss to assume that schizophrenia patients lack the ability to control their eating behaviors. Nutrition education may foster desirable dietary changes and improve the sense of agency, thus helping to reduce symptom severity and enhancing cognitive performance in this patient population.

A health promotion intervention to improve lifestyle choices and health outcomes in people with psychosis: a research programme including the IMPaCT RCT

Background

People with psychotic disorders have reduced life expectancy largely because of physical health problems, especially cardiovascular disease, that are complicated by the use of tobacco and cannabis.

Objectives

We set out to (1) chart lifestyle and substance use choices and the emergence of cardiometabolic risk from the earliest presentation with psychosis, (2) develop a pragmatic health promotion intervention integrated within the clinical teams to improve the lifestyle choices and health outcomes of people with psychosis and (3) evaluate the clinical effectiveness and cost-effectiveness of that health promotion intervention.

Design

We performed a longitudinal cohort study of people presenting with their first episode of psychosis in three mental health trusts and followed up participants for 1 year [work package 1, physical health and substance use measures in first episode of psychosis (PUMP)]. We used an iterative Delphi methodology to develop and refine a modular health promotion intervention, improving physical health and reducing substance use in psychosis (IMPaCT) therapy, which was to be delivered by the patient’s usual care co-ordinator and used motivational interviewing techniques and cognitive–behavioural therapy to improve health choices of people with psychosis (work package 2). We then conducted a multicentre, two-arm, parallel-cluster, randomised controlled trial to determine the clinical effectiveness and cost-effectiveness of using the intervention with people with established psychosis (work package 3: IMPaCT randomised controlled trial) in five UK mental health trusts. The work took place between 2008 and 2014.

Participants

All people aged between 16 and 65 years within 6 months of their first presentation with a non-organic psychosis and who were proficient in English were eligible for inclusion in the PUMP study. Participants in the work package 2 training development were staff selected from a range of settings, working with psychosis. Participants in the phase 3 Delphi consensus and manual development comprised three expert groups of (1) therapists/researchers recruited from the local and national community, (2) clinicians and (3) service users, each of whom took part in two iterative review and feedback sessions. For work package 3, IMPaCT randomised controlled trial, care co-ordinators in participating community mental health teams who were permanently employed and had a minimum of four eligible patients (i.e. aged between 18 and 65 years with a diagnosis of a psychotic disorder) on their caseload were eligible to participate. In studies 1 and 3, patient participants were ineligible if they were pregnant or had a major illness that would have had an impact on their metabolic status or if they had a significant learning disability. All participants were included in the study only after giving written confirmed consent.

Main outcome measures

Cardiometabolic risk markers, including rates of obesity and central obesity, and levels of glycated haemoglobin (HbA1c) and lipids, were the main outcomes in work package 1 (PUMP), with descriptive data presented on substance use. Our primary outcome measure for the IMPaCT randomised controlled trial was the physical or mental health component Short Form questionnaire-36 items quality-of-life scores at 12 months.

Results

Obesity rates rose from 18% at first presentation with psychosis to 24% by 1 year, but cardiometabolic risk was not associated with baseline lifestyle and substance use choices. Patterns of increase in the levels of HbA1c over the year following first presentation showed variation by ethnic group. We recruited 104 care co-ordinators, of whom 52 (with 213 patients) were randomised to deliver IMPaCT therapy and 52 (with 193 patients) were randomised to deliver treatment as usual, in keeping with our power calculations. Of these 406 participants with established psychosis, 318 (78%) and 301 (74%) participants, respectively, attended the 12- and 15-month follow-ups. We found no significant effect of IMPaCT therapy compared with treatment as usual on the physical or mental health component Short Form questionnaire-36 items scores at either time point in an intention-to-treat analysis [physical health score (‘d’) –0.17 at 12 months and –0.09 at 15 months; mental health score (‘d’) 0.03 at 12 months and –0.05 at 15 months] or on costs. Nor did we find an effect on other cardiovascular risk indicators, including diabetes, except in the case of high-density lipoprotein cholesterol, which showed a trend for greater benefit with IMPaCT therapy than with treatment as usual (treatment effect 0.085, 95% confidence interval 0.007 to 0.16; p = 0.034).

Limitations

Follow-up in work package 1 was challenging, with 127 out of 293 participants attending; however, there was no difference in cardiometabolic measures or demographic factors at baseline between those who attended for follow-up and those who did not. In work package 3, the IMPaCT randomised controlled trial, care co-ordinators struggled to provide additional time to their patients that was devoted to the health promotion intervention on top of their usual clinical care contact with them.

Conclusions

Cardiometabolic risk is prominent even soon after first presentation with psychosis and increases over time. Lifestyle choices and substance use habits at first presentation do not predict those who will be most cardiometabolically compromised 1 year later. Training and supervising care co-ordinators to deliver a health promotion intervention to their own patients on top of routine care is not effective in the NHS for improving quality of life or reducing cardiometabolic risk.

Future work

Further work is needed to develop and evaluate effective, cost-effective and affordable ways of preventing the emergence of and reversing existing cardiometabolic risk indicators in people with psychosis.

Trial registration

Current Controlled Trials ISRCTN58667926.

Funding

This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 8, No. 1. See the NIHR Journals Library website for further project information.

Dietary Intake, Adherence to Mediterranean Diet and Lifestyle-Related Factors in People with Schizophrenia

The purpose of this study was to examine the dietary intake of both inpatients and outpatients with schizophrenia in the Portuguese population as a potential key contributing factor to the poor physical health profiles, and understand the relationship of diet quality to other lifestyle factors. Participants of this cross-sectional study completed a semi quantitative food frequency questionnaire. Diet quality was determined by adherence to the Mediterranean Diet. In addition participants completed the International Physical Activity Questionnaire-Short-Form and Pittsburgh Sleep Quality Index. Tobacco smoking was assessed through a series of general questions. A total of 100 patients (50% inpatients and 28% female) with schizophrenia were included in the final analysis. Patients reported a high consumption of caffeine, while deficits were evident for fibre and folate intakes, when compared to the European Food Safety Authority recommendations. Both inpatients and outpatients reported poor to moderate diet quality. Smokers reported poorer diet quality when compared to non-smokers (p < 0.001). Dietary intake, and its relationship to other lifestyle components, should be considered for intervention, in order to improve physical health of people living with schizophrenia.

Dietary intake of people with severe mental illness: systematic review and meta-analysis

BACKGROUND

Severe mental illness (SMI) is thought to be associated with lower diet quality and adverse eating behaviours contributing towards physical health disparities. A rigorous review of the studies looking at dietary intake in psychotic disorders and bipolar disorder is lacking.AimsTo conduct a systematic, comprehensive evaluation of the published research on dietary intake in psychotic disorders and bipolar disorder.

METHOD

Six electronic databases were searched for studies reporting on dietary intakes in psychotic disorders and bipolar disorder. Dietary-assessment methods, and dietary intakes, were systematically reviewed. Where possible, data was pooled for meta-analysis and compared with healthy controls.

RESULTS

In total, 58 eligible studies were identified. People with SMI were found to have significantly higher dietary energy (mean difference 1332 kJ, 95% CI 487-2178 kJ/day, P = 0.002, g = 0.463) and sodium (mean difference 322 mg, 95% CI 174-490 mg, P &lt; 0.001, g = 0.414) intake compared with controls. Qualitative synthesis suggested that higher energy and sodium intakes were associated with poorer diet quality and eating patterns.

CONCLUSIONS

These dietary components should be key targets for preventative interventions to improve weight and other physical health outcomes in people with SMI.Declaration of interestS.B.T. and E.T. have clinical dietitian appointments within the South Eastern Sydney Local Health District and do not receive any further funding.

The phenolic interactome and gut microbiota: opportunities and challenges in developing applications for schizophrenia and autism

Schizophrenia and autism spectrum disorder have long been associated with elevated levels of various small phenolic molecules (SPMs). In turn, the gut microbiota (GMB) has been implicated in the kinetics of many of these analytes. Unfortunately, research into the possible relevance of GMB-mediated SPMs to neuropsychiatry continues to be limited by heterogeneous study design, numerous sources of variance and technical challenges. Some SPMs have multiple structural isomers and most have conjugates. Without specialized approaches, SPMs can be incorrectly assigned or inaccurately quantified. In addition, SPM levels can be affected by dietary polyphenol or protein consumption and by various medications and diseases. Nonetheless, heterotypical excretion of various SPMs in association with schizophrenia or autism continues to be reported in independent samples. Recent studies in human cerebrospinal fluid demonstrate the presence of many SPMs A large number of these are bioactive in experimental models. Whether such mechanisms are relevant to the human brain in health or disease is not known. Systematic metabolomic and microbiome studies of well-characterized populations, an appreciation of multiple confounds, and implementation of standardized approaches across platforms and sites are needed to delineate the potential utility of the phenolic interactome in neuropsychiatry.

Perceived barriers and facilitators for healthy behaviours among parents of adolescents receiving mental health care in a public hospital in Cape Town, South Africa: A qualitative study

Objective: To explore the perceived barriers and facilitators for healthy behaviours among parents and caregivers of adolescents receiving mental health care in Cape Town, South Africa. Method: Thirty-five qualitative in-depth interviews were conducted with parents and caregivers of adolescents receiving mental health treatment by six facilitators matched for language. The data was analysed using thematic analysis. Results: The participants were predominantly female (n = 28, 80%) and parents (n = 29, 83%) of the adolescents. Personal barriers to good health included unhealthy eating, substance use and physical inactivity. Environmental barriers were inherited medical conditions, the easy availability of unhealthy foods and the absence of recreational facilities in communities. Perceived facilitators to good health were parental role modelling, planning and preparing healthy meals, exercise opportunities providing by walking long distances to work, and doing physically demanding jobs and household chores. Conclusion: Parents and caregivers are essential to adolescents' healthy development as they may influence adolescent health behaviours. It is likely that the promotion of positive health behaviours may be achieved though family-based interventions.

Community participation factors and poor neurocognitive functioning among persons with schizophrenia

Poor neurocognitive functioning among individuals with schizophrenia is typically conceptualized as resulting from a disease process. The objective of this article is to further expand understanding of poor neurocognition beyond pathogenesis toward a perspective that also incorporates community participation factors. This article focuses on three such factors-sedentary behavior, loneliness, and poverty-that have been demonstrated to be related to neurocognition and are highly prevalent among individuals with schizophrenia. This article provides an overview of the research on each factor and discusses its possible connection to neurocognitive challenges for individuals with schizophrenia. Implications for research, policy, and practice efforts are then proposed to broaden approaches to understanding and addressing neurocognitive challenges in this population. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Low Physical Activity and Cardiorespiratory Fitness in People With Schizophrenia: A Comparison With Matched Healthy Controls and Associations With Mental and Physical Health

Introduction: The aim of this study was to objectively assess time spent in physical activity (PA) and sedentary behavior (SB) in patients with schizophrenia compared to healthy controls matched for age, gender and socioeconomic status. Associations between both PA and cardiorespiratory fitness (CRF) and mental and physical health parameters in patients with schizophrenia were examined. Materials and Methods: Moderate and vigorous PA (MVPA), moderate PA, vigorous PA, total and active energy expenditure (TEE and AEE), number of steps, lying down and sleeping time was assessed with SenseWear Pro-2 body monitoring system for three 24-h bouts in patients with schizophrenia (n = 63) and matched healthy controls (n = 55). Severity of symptoms (Positive and Negative Syndrome Scale and Montgomery and Åsberg Depression Rating Scale), CRF (peak oxygen uptake, VO_2peak), body mass index (BMI), and metabolic syndrome were assessed. Results: Patients with schizophrenia performed less MVPA and moderate activity had lower TEE and AEE, spent more time per day lying down and sleeping, and had poorer CRF compared to healthy controls. The amount of MVPA, but especially CRF was associated with severity of negative symptoms in patients with schizophrenia. Only CRF was associated with BMI. Discussion: The current data offer further evidence for interventions aiming to increase physical activity and decrease sedentary behavior. Given strong associations of CRF with both negative symptoms and BMI, treatment aimed at CRF-improvement may prove to be effective.

The views and habits of the individuals with mental illness about physical activity and nutrition

PURPOSE

The aim of this study is to determine the views and habits of the individuals with mental illness on physical activities and nutrition behaviors.

DESIGN AND METHODS

This study was carried out descriptive qualitative method. The sample of the study consisted of 15 individuals with mental illness. The data were collected with Socio-Demographic Information Form and Semi-Structured Interview Form and analyzed by content analysis.

FINDINGS

Four main themes emerged as the result of the analysis of the data. These themes are the barriers, facilitators, habits, and the needs.

PRACTICE IMPLICATIONS

Mental health nurses should be aware of the barriers of individuals with mental illness. It is recommended that mental health nurses make interventions to encourage patients to have physical activity and healthy eating.

Lifestyles of Patients with Functional Psychosis Compared to Those of a Sample of the Regional General Population: Findings from a Study in a Community Mental Health Service of the Veneto Region, Italy

Unhealthy lifestyles contribute, with other risk factors, to the high prevalence of mortality and physical comorbidity among mental patients compared to the general population. We collected data on the lifestyles of 193 subjects with psychosis in contact with a Community Mental Health Service in north-eastern Italy and compared them with a representative sample (total: 3219 subjects) of the general population of the same region. Diet, exercise, smoking and alcohol consumption were worse in mental patients. A higher percentage of patients was overweight or obese. The associations between socio-demographic and lifestyles variables showed that older patients exercise less, female patients tend to smoke and use alcohol less, while more educated patients tend to have higher alcohol consumption levels. Mental patients have unhealthier lifestyles and they appear to be more refractory to recommendations than the general population, indicating the necessity of specific health promotion programmes in this population.

No differences in olanzapine- and risperidone-related weight gain between women and men: a meta-analysis of short- and middle-term treatment

OBJECTIVE

A plethora of data deriving from single studies as well as meta-analyses demonstrates that weight gain is associated with the exposure to the majority of antipsychotics (AP). However, potential sex differences have widely evaded the attention of AP treatment trials. It is hypothesised that female patients gain more weight compared with male patients due to their enhanced susceptibility to adverse drug reactions.

METHOD

A meta-analysis was conducted using clinical trials of AP that reported weight change separately for female and male patients. Duration of AP use was stratified in four categories: <6 weeks, 6-16 weeks, 16-38 weeks and >38 weeks. Forest plots were generated for men and women separately, stratified by AP as well as by duration of use. Sex differences were tested by performing meta-regression.

RESULTS

Data of 26 studies were used in the present analysis because sufficient data were available only for olanzapine, risperidone and the no-medication group. Both female and male patients showed considerable weight gain after switch or initiate of olanzapine or risperidone, but meta-regression analyses did not show significant sex differences.

CONCLUSION

The present meta-analysis revealed that sex differences in AP-related weight gain have been under investigated hampering the detection of sex-specific patterns. In chronic patients switching to olanzapine or risperidone receiving short-or middle-term treatment, AP were associated with weight gain in both sex subgroups and no significant differences were reported.

Determination of physical health status and healthy lifestyle behaviors of individuals with mental illness

PURPOSE

The aim of this study is to determine the physical health status and healthy lifestyle behaviors of individuals with mental illness.

DESIGN AND METHODS

A descriptive research design was used. The sample of the study consisted of 115 individuals with mental illness. The Health Lifestyle Behaviors Scale II was used to assess the healthy lifestyle behaviors of the participants.

FINDINGS

Of the individuals, 49.6% were found to have metabolic syndrome. Individuals with mental illness obtained the lowest score from the physical activity dimension of the scale.

PRACTICE IMPLICATIONS

Individuals with mental illness need to receive education and support, especially in terms of nutrition and exercise.

Cardiometabolic comorbidities and life expectancy in people on medication for schizophrenia in Australia

OBJECTIVE

This study aimed to assess the risks of people on medication for schizophrenia developing different components of the metabolic syndrome and their life expectancy, through reference to a representative population of Australians without schizophrenia.

METHOD

Pharmacy payment-claim records from the Pharmaceutical Benefits Scheme were analyzed based on a representative 10% sample of Medicare numbers supplied by the Department of Human Services. Records were analyzed based on the date of supply of the prescription and the dataset included year of death information. Two major analyses were conducted for 9,533 people on medication for schizophrenia and a 1:1 sex/age matched control, followed for up to 7 years. Patient life expectancy was estimated by performing a Kaplan Meier survival analysis.

RESULTS

People on medication for schizophrenia compared to controls were 1.91-times (95% CI = 1.66-2.21) and 1.28-times (95% CI = 1.15-1.43) more likely to start treatment for diabetes and hyperlipidemia, respectively, but were no more likely to start treatment for hypertension (hazard ratio = 0.87; 95% CI = 0.78-0.97). Overall, people on medication for schizophrenia were 1.32-times more likely to start treatment for one of these three comorbidities. Median life expectancy was assessed as 80 years for people on medication for schizophrenia, and 91 years for controls.

CONCLUSIONS

The results for this study confirm in a large representative Australian sample of people on medication for schizophrenia, an excess risk of components of the metabolic syndrome and early death.

Eating behavior of schizophrenic patients

ABSTRACT Objective To assess the eating behavior, food practices, nutritional and metabolic profiles of patients with schizophrenia undergoing treatment. Methods Cross-sectional exploratory descriptive qualitative study used a semi-structured questionnaire on the eating behavior, food practices, and perception of changes after the initiation of drug therapy and a quantitative method using anthropometric and body composition measurements, metabolic parameters, and 5-day dietary records to analyze nutrient ingestion of patients with schizophrenia in an outpatient clinic at a tertiary hospital (n=33). The qualitative data were analyzed and coded by three researchers and quantitative data were analyzed using descriptive exploratory statistics. Results The results of this study showed that schizophrenic patients presented high prevalence of excess weight (71.0%), metabolic syndrome (42.0%), dyslipidemia (62.0%), changes in appetite (76.0%), and increase in energy intake (74.2%), associated with important irregularities in eating behavior and food practices (such as irregularity of meals, emotional intake, high carbohydrate and fat intake, and low energy expenditure) and lifestyle (changes in social and work routines). Conclusion This eating profile may interact synergistically with psychotropic drugs to contribute to weight gain and metabolic changes in schizophrenia. Nutrition education may prevent and monitor the risk of metabolic and nutrition problems, irrespective of the medications used.

Assessment of the relationship between food addiction and nutritional status in schizophrenic patients

OBJECTIVE

Obesity is one of today's most important public health problems. It is suggested that overeating and substance addiction show similarities, and addiction to food may be an important factor in the obesity epidemic. This study aimed to determine the prevalence of food addiction among schizophrenic patients and to examine the relationship between food addiction and anthropometric measurements and dietary nutrient intake.

METHODS

Study participants included a total of 104 schizophrenic outpatients, 62 females and 42 males. Food addiction was assessed by using the Yale Food Addiction Scale, and the anthropometric measurements of participants and their three-day food consumption were recorded.

RESULTS

This study found that more than half of the schizophrenic patients (60.6%) had food addiction, and that female schizophrenic patients had a higher prevalence (62.9%) of food addiction than male patients (57.1%). More than one-third of the schizophrenic patients with food addiction (41.3%) were found to be obese and their BMI, body weight, waist circumference, and body-fat ratio were higher than those of schizophrenic patients who did not have food addiction (P > 0.05). Moreover, the schizophrenic patients with food addiction were found to take significantly more energy, carbohydrate, and fat in their diet (P < 0.05).

CONCLUSION

It was observed that the development of food addiction in schizophrenic patients increased the risk of obesity and cardiovascular diseases, which were found to be at higher levels in these patients. Educational programs should be planned for these patients to acquire health dietary habits and to increase their physical activity levels, and an additional psychosocial support should be provided for patients with food addiction.

Temporal trends in cardiovascular disease risk factor profiles in a population-based schizophrenia sample: a repeat cross-sectional study

Background

People with schizophrenia have an increased burden of cardiovascular diseases (CVD); however, little is known about the cardiovascular risk factor profiles of non-institutionalised individuals with schizophrenia. This study estimated the prevalence of CVD risk factors in a population-based sample of Canadians with and without schizophrenia.

Methods

Ontario respondents of the Canadian Community Health Survey were linked to administrative health databases; using a validated algorithm, we identified 1103 non-institutionalised individuals with schizophrenia and 156 376 without schizophrenia. We examined the prevalence of eight CVD risk factors: smoking, diabetes, hypertension, obesity, physical inactivity, fruit/vegetables consumption, psychosocial stress and binge drinking. To examine temporal trends, we compared prevalence estimates from 2001–2005 to 2007–2010.

Results

The prevalence of most CVD risk factors was significantly higher among those with schizophrenia than the general population. Obesity and diabetes prevalence increased by 39% and 71%, respectively, in the schizophrenia group vs 11% and 24%, respectively, in the non-schizophrenia group between the two time periods. Unlike the general population, smoking rates among those with schizophrenia did not decline. Almost 90% of individuals with schizophrenia had at least one CVD risk factor and almost 40% had ≥3 co-occurring risk factors.

Conclusion

Individuals with schizophrenia had a greater prevalence of individual and multiple CVD risk factors compared with those without schizophrenia, which persisted over time. Our findings suggest that public health efforts to reduce the burden of CVD risk factors have not been as effective in the schizophrenia population, thus highlighting the need for more targeted interventions and prevention strategies.

Physical activity in outpatients with mental disorders: status, measurement and social cognitive determinants of health behavior change

INTRODUCTION

Physical activity (PA) can play an important role in improving the mental and physical health in patients with mental disorders but is not well studied in this population. The aim of this study was to assess the status of PA in outpatients with mental disorders, compare the convergence of self-rating and accelerometer measurement and examine the influence of social cognitive variables from the Motivation-Volition (MoVo) model and clinical measures on PA.

METHODS

Eighty-four patients were recruited from three psychiatric outpatient clinics and local psychiatrists (Distribution of ICD-10-Diagnoses: F3.x = 59.5%, F4.x = 20.2%, F2.x = 17.9%, F1.x = 2.4%). PA, Self-efficacy, Outcome-expectancies, Intention, Self-concordance, Action- and Coping-planning, Health-related Quality of Life (SF-12) and Psychiatric Symptoms (SCL-27) were assessed through questionnaires. PA was assessed objectively by accelerometers.

RESULTS

Most of the participants did not reach PA recommendations. Subjective and objective measurement of PA showed good accordance for total PA on group level but lower accordance on individual level. Motivational and volitional determinants of health behavior change showed a similar pattern of correlations with PA as in populations without mental disorders.

CONCLUSION

Outpatients with mental disorders have the ability and are willing to perform PA but a large proportion of our sample did not meet PA recommendations. To assess group levels of PA, subjective and objective measurement seem equally apt, for individual diagnostics, a combination of both should be considered. Social cognitive determinants of health behavior change seem to be as helpful for the design of PA interventions for patients with mental disorders as they are in other populations.

Prevalence of smoking in patients with bipolar disorder, major depressive disorder and schizophrenia and their relationships with quality of life

Few studies have compared the prevalence of smoking between patients with bipolar disorder, major depressive disorder (MDD) and schizophrenia. This study examined the prevalence of smoking and its relationships with demographic and clinical characteristics, and quality of life (QOL) in patients with these psychiatric disorders. A total of 1,102 inpatients were consecutively screened. Psychopathology and QOL were measured with standardized instruments. The prevalence of current smoking in the whole sample was 16.7%; 17.5% in bipolar disorder, 10.6% in MDD and 18.5% in schizophrenia. The rates of smoking in bipolar disorder (p = 0.004, OR = 2.5, 95%CI: 1.3–4.7) and schizophrenia (p = 0.03, OR = 2.0, 95%CI: 1.06–3.8) were significantly higher than in MDD, while no difference was found between bipolar disorder and schizophrenia. Smokers had a higher mental QOL than non-smokers (p = 0.007) in MDD, but no difference was found in the other two groups. Male gender, living alone, higher personal income, older age of onset, health insurance coverage, and first episode was significantly associated with smoking in one or more diagnostic groups. Smoking appears more common in bipolar disorder and schizophrenia than in MDD in China. The figures in all disorders were lower than that reported in most of other countries.

[Schizophrenia and oral health]

Mental health is an essential component of general health. Schizophrenia is a severe and chronic mental illness that affects higher brain functions. It is characterized by the presence of a mental dissociation, dampened or inappropriate affects, hallucinations and delirium. Schizophrenia has also a negative impact on oral health. As schizophrenia affects 1% of the population, every practitioner concerned with oral sphere will be confronted one day or another with a patient suffering from this disease. It is therefore important to acquire essential notions. The aim of our work was to make an update about factors that may affect oral health in patients with schizophrenia.

Effects of childhood and adolescence physical activity patterns on psychosis risk-a general population cohort study

Schizophrenia spectrum disorders are associated with high morbidity and mortality in somatic diseases. The risk factors of this excess mortality include, e.g., obesity, dietary factors, and physical inactivity, especially after the onset of psychosis, but there are limited early developmental data on these factors in individuals who later develop psychosis. A population-based cohort study "Cardiovascular Risk of Young Finns" started in 1980 with 3596 children and adolescents from six different age groups (3, 6, 9, 12, 15, and 18 years). Cardiovascular health parameters, including questionnaire of physical activity before first hospitalization (≤18 years), were studied in 1980, 1983, and 1986. All psychiatric diagnoses of the participants were derived from the Finnish Hospital Discharge Register up to the year 2012. We identified diagnostic groups of non-affective psychosis (n = 68, including a schizophrenia subgroup, n = 41), personality disorders (n = 43), affective disorders (n = 111), and substance-related disorders (n = 49), based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Groups were compared with controls with no psychiatric diagnoses (n = 3325). Sex, age, body mass index, birth weight, non-preterm birth, and mother's mental disorders were included in the statistical model. Low physical activity in childhood and adolescence (9-18 years) independently predicted later development of non-affective psychosis. Lower physical activity index (relative risk 1.26 [1.1-1.5]), lower level of common activity during leisure time (relative risk 1.71 [1.2-2.5]), and non-participation in sports competitions (relative risk 2.58 [1.3-5.3]) were associated with a higher risk for later non-affective psychosis (expressed as increase in relative risk per physical activity unit). The findings were even stronger for schizophrenia, but no such link was observed for other diagnoses. The cause of low physical activity in premorbid/prodromal phase is likely to be multifactorial, including deviant motor and cognitive development. The results provide a rationale for including exercise and physical activity interventions as a part of psychosis prevention programs.

Functioning in patients with schizophrenia: a systematic review of the literature using the International Classification of Functioning, Disability and Health (ICF) as a reference

PURPOSE

To identify and quantify the main concepts included in published studies focusing on individuals with schizophrenia using the International Classification of Functioning, Disability and Health (ICF).

METHODS

Searches (limited to those published from 2008 to 2012) were performed in MEDLINE, PsycINFO and CINAHL. Included studies described participants with schizophrenia, were original articles and included only subjects who were at least 18 years of age at study entry. All concepts underlying the measures and the text of the articles were extracted, and they were linked to ICF categories using standardized rules.

RESULTS

From the 3584 abstracts retrieved, 348 were randomly selected, and of these, 206 studies met the inclusion criteria. A total of 17,141 concepts were extracted, 84.8% of which could be linked to 491 ICF categories: 222 (45.21%) of the categories referred to Body Functions, 29 (5.91%) to Body Structures, 186 (37.88%) to Activities and Participation and 54 (11%) to Environmental Factors. Seventy second-level categories were reported in at least 5% of all studies: 30 of these categories referred to Body Functions, 2 to Body Structures, 34 to Activities and Participation and 4 to Environmental Factors.

CONCLUSION

The study has allowed us to identify and quantify the main concepts included in studies focusing on people with schizophrenia using the ICF. The majority of the concepts refer to Body Functions and Activities and Participation, rather than to Body Structures and Environmental Factors.

Prevalence and Predictors of Metabolic Syndrome in People With Schizophrenia in Inpatient Rehabilitation Wards

BACKGROUND

Atypical antipsychotic medications increase the risk of developing metabolic syndrome (MetS) and cardiovascular diseases in people with schizophrenia.

AIM

To explore the prevalence of MetS and the predictors associated with the number of MetS components in people with chronic schizophrenia.

METHODS

We recruited 357 participants from 10 rehabilitation wards in northern Taiwan. The Beck Anxiety Inventory, Beck Depression Inventory-II, Health-Promoting Lifestyle Profile (HPLP), and modified Baecke physical activity questionnaire were used to evaluate the participants. MetS prevalence was calculated using the modified Adult Treatment Panel III criteria for Asians.

RESULTS

The prevalence of MetS in this sample was 37.8%. Multinomial logistic regression revealed that the HPLP-exercise score (odds ratio [OR] = 0.411, p = .002) and depressive symptoms (OR = 0.949, p = .040) were protective factors for ≥4 MetS components. The leisure physical activity level (OR = .536, p = .024) was a protective factor for three MetS components. Body mass index ≥24 kg/m(2) was the strongest risk factor for two MetS components (OR = 8.057, p < .001), three MetS components (OR = 11.287, p < .001), and ≥four MetS components (OR = 15.621, p < .001). Additionally, participants' age >40 (OR = 3.638, p = .012) was a risk factor for ≥four MetS components.

CONCLUSION

In this study, the prevalence of MetS was higher than that reported for patients utilizing community-based services in Taiwan. The important risk factors for MetS were being overweight and older than 40. The protective factors for MetS were a high HPLP-exercise score and leisure-based physical activities.

Smoking in male patients with schizophrenia in China: A meta-analysis

BACKGROUND

The aim of this study was to examine the prevalence of current smoking in male patients with schizophrenia in China.

METHOD

A systematic literature search was conducted from database inception until June 20, 2015 without language restrictions in PubMed, EMBASE, China National Knowledge Infrastructure (CNKI) and WanFang Database. Studies fulfilling the following criteria were included: (a) data available in male schizophrenia patients and (b) data available on current smoking status. Statistical analyses were performed with the Comprehensive Meta-Analysis program.

RESULTS

A total of 23 studies met eligibility criteria for the meta-analysis. The pooled prevalence of current smoking was 59.1% (95% Confidence interval [CI]: 53.3-64.7%). Current smoking was significantly more frequent in inpatients than in outpatients (61.3% vs. 48.2%, Q=7.5, P=0.006), and higher in chronic compared to first-episode patients (74.5% vs. 45.1%, Q=32.3, P=0.0001). Furthermore, using a median split, patients aged 38.2 years or older smoked more often than those aged below 38.2 years (65.8% vs. 52.3%, Q=6.4, P=0.01). There were no significant associations between prevalence of current smoking and definitions of smoking, study publication year, sample size and illness duration.

CONCLUSIONS

The pooled prevalence of current smoking of male patients with schizophrenia in China is lower compared to Western and other Asian countries. Possible relationships between lower prevalence of current smoking and psychopathology in patients with schizophrenia require further investigation.

Relationship between antipsychotic medication, serum prolactin levels and osteoporosis/osteoporotic fractures in patients with schizophrenia: a critical literature review

INTRODUCTION

Using an antipsychotic medication can increase prolactin (PRL) levels, causing hyperprolactinemia (HPRL). Although the occurrence of osteoporosis within the population of patients with schizophrenia has been recognized, the precise nature of the association between antipsychotic treatment, PRL, osteoporosis, and the disease itself seems to be elusive.

AREAS COVERED

The aim of this review is to critically review the literature regarding the association between osteoporosis and PRL and to summarize the available evidence with respect to the impact of PRL-elevating antipsychotics on bone mineral density (BMD) and fractures in non-elderly patients with schizophrenia.

EXPERT OPINION

Although long-standing HPRL can have an impact on the rate of bone metabolism and, when associated with hypogonadism, may lead to decreased bone density in both female and male subjects, the relative contribution of antipsychotic-induced HPRL in bone mineral loss in patients with schizophrenia remains unclear. Methodological shortcomings of existing studies, including the lack of prospective data and the focus on measurements of BMD instead of bone turnover markers, preclude definitive conclusions regarding the relationship between PRL-raising antipsychotics and BMD loss in patients with schizophrenia. Therefore, more well conducted prospective trials of these biomarkers are necessary to establish the precise relationship between antipsychotics, PRL levels and osteoporosis/osteoporotic risk.

Prevalence and predictors of treatment dropout from physical activity interventions in schizophrenia: a meta-analysis

OBJECTIVE

Physical activity interventions have been shown to improve the health of people with schizophrenia, yet treatment dropout poses an important challenge in this population, and rates vary substantially across studies. We conducted a meta-analysis to investigate the prevalence and predictors of treatment dropout in physical activity interventions in people with schizophrenia.

METHOD

We systematically searched major electronic databases from inception until August 2015. Randomized controlled trials of physical activity interventions in people with schizophrenia reporting dropout rates were included. Two independent authors conducted searches and extracted data. Random-effects meta-analysis and meta-regression analyses were conducted.

RESULTS

In 19 studies, 594 patients with schizophrenia assigned to exercise interventions were investigated (age=37.2 years, 67.5% male, range=37.5%-100%). Trim and fill adjusted treatment dropout rate was 26.7% [95% confidence interval (CI)=19.7%-35.0%], which is more than double than in nonactive control interventions (odds ratio=2.15, 95% CI=1.29-3.58, P=.003). In the multivariate regression, qualification of the professional delivering the intervention (β=-1.06, 95% CI=-1.77 to -0.35, P=.003) moderated treatment dropout rates, while continuous supervision of physical activity approached statistical significance (P=.05).

CONCLUSIONS

Qualified professionals (e.g., physical therapists/exercise physiologists) should prescribe supervised physical activity for people with schizophrenia to enhance adherence, improve psychiatric symptoms and reduce the onset and burden of cardiovascular disease.

Cardiovascular diseases among patients with schizophrenia

The presence of comorbid physical illnesses especially, cardiovascular diseases (CVD) in schizophrenia is a growing area of concern in recent years. In order to reduce disease burden, to improve quality of life and to provide holistic care, it is important to know about the relationship between schizophrenia and CVD. The objective of this review is to explore the extent of CVD problems, relevant risk factors and potential measures for early diagnosis and prevention of CVD among patients with schizophrenia. Worldwide studies show that patients with schizophrenia have a higher mortality and lower life expectancy than the general population. CVD is the leading cause of increased mortality in schizophrenia. Common CVD risk factors in schizophrenia include metabolic syndrome, sedentary behaviour, tobacco smoking, effects of antipsychotics, long chain omega-3 fatty acid deficiency and shared genetics between CVD and schizophrenia. The potential methods for early detection and prevention of CVD in schizophrenia are also discussed. Though the patients with schizophrenia form a high risk group for CVD, consensus guidelines for early detection and prevention of CVD in schizophrenia are lacking. Comorbidity of CVD in schizophrenia needs more serious attention by clinicians and researchers.

Current cigarette smoking in Chinese female patients with schizophrenia: A meta-analysis

The study objective was to perform a meta-analysis of the prevalence of current smoking in Chinese female patients with schizophrenia. A systematic literature search was conducted and studies fulfilling the following criteria were included: female schizophrenia patients; reporting current smoking rate computed from samples. Eight studies were included. The pooled current smoking prevalence was 4.3% (95% Confidence interval [CI]: 3.2-5.6%). The finding showed that smoking rate of female patients with schizophrenia in China was lower compared to their Western and other Asian counterparts.

Relationship between prolactin, breast cancer risk, and antipsychotics in patients with schizophrenia: a critical review

OBJECTIVE

A recent meta-analysis showed that breast cancer probably is more common in female patients with schizophrenia than in the general population (effect size = 1.25, P < 0.05). Increasing experimental and epidemiological data have alerted researchers to the influence of prolactin (PRL) in mammary carcinogenesis. We therefore investigated the possible relationship between antipsychotic-induced hyperprolactinemia (HPRL) and breast cancer risk in female patients with schizophrenia.

METHOD

A literature search (1950 until January 2015), using the MEDLINE database, was conducted for English-language published clinical trials to identify and synthesize data of the current state of knowledge concerning breast cancer risk (factors) in women with schizophrenia and its (their) relationship between HPRL and antipsychotic medication.

RESULTS

Although an increasing body of evidence supports the involvement of PRL in breast carcinogenesis, results of human prospective studies are limited, equivocal, and correlative (with risk ratios ranging from 0.70 to 1.9 for premenopausal women and from 0.76 to 2.03 for postmenopausal women). Moreover, these studies equally do not take into account the local production of PRL in breast epithelium, although amplification or overexpression of the local autocrine/paracrine PRL loop may be a more important mechanism in tumorigenesis. Until now, there is also no conclusive evidence that antipsychotic medication can increase the risk of breast malignancy and mortality.

CONCLUSION

Other breast risk factors than PRL, such as nulliparity, obesity, diabetes mellitus, and unhealthy lifestyle behaviours (alcohol dependence, smoking, low physical activity), probably are of greater relevance in individual breast cancer cases within the population of female patients with schizophrenia.