A systematic review of controlled interventions to reduce overweight and obesity in people with schizophrenia

Effects of Shared Decision Making Model-Based Guided Self-Help Program on Emotional Eating and Uncontrolled Eating Behavior in Individuals with a Severe Mental Disorder: A Randomized Controlled Trial

PURPOSE

The study was aimed at determining the effectiveness of the Shared Decision Making Model-based Guided Self-Help Program (SDM-GSH) on emotional eating behavior and uncontrolled eating behavior in individuals with a severe mental disorder.

METHOD

This randomized controlled experimental study was conducted in the Community Mental Health Center of a university hospital between September 2020 and November 2022. The sample of the study consisted of 64 participants. Of them, 33 were in the Experimental Group and 31 were in the control group. To collect the study data, the Patient Information Form, Emotional Eater Questionnaire, and Three-Factor Eating Questionnaire were administered. The participants in the Experimental Group took part in the SDM-GSH. The study data were collected from the participants in the Experimental and Control Groups before, right after and 6 months after the intervention.

RESULTS

The comparison of the BMI values of the participants with a severe mental disorder who took part in the SDM-GSH demonstrated that their pre-intervention BMI values significantly decreased at the measurements preformed right after and 6 months after the intervention (p < 0.05). The mean emotional eating (λ = 0.189, η2 = 0.811) and uncontrolled eating (λ = 0.218, η2 = 0.782) scores obtained by the participants in the Experimental Group before the intervention significantly decreased at the measurements preformed right after and 6 months after the intervention (p < 0.05).

CONCLUSION

Based on the results of our study, it is concluded that the SDM-GSH positively affected the BMI values, emotional eating behaviors and uncontrolled eating behaviors of the participants with a severe mental disorder.

Outpatients with psychotic disorders need physical health-promoting treatment: A cross-sectional multisite study

Introduction

Impaired quality of life (QoL) and premature death in patients with primary non-affective psychotic disorders is related to lifestyle-induced comorbidities. Current municipal health-promoting treatment and care do not embrace the challenges of living with psychotic disorders.

Aim

This cross-sectional study aimed to identify the proportion of outpatients diagnosed with primary psychotic disorders who need health-promoting treatment and care, and who receive municipal health-promoting interventions.

Methods

Of 206 eligible invited outpatients from three psychiatric services clinics in Southern Denmark, 165 participated. Demographic and health characteristics, and use of alcohol, cannabis, drugs, and cigarettes were identified via a screening tool. Blood test information, body measurements, and medication status were extracted from the outpatients' medical records. The need for health promotion was assessed based on body mass index (BMI), and use of alcohol, cannabis, drugs, and cigarettes.

Results

Seventy-three percent of outpatients needed health promotion, of whom 61 % were not offered municipal health-promoting treatment and care. Thirty-six percent had one or more somatic comorbidities, including diabetes mellitus (15 %) and cardiovascular disease (10 %); 41 % smoked a mean (SD) of 19 (10) cigarettes daily. Mean (SD) BMI was 34 (8) kg/m2 for women and 29 (7) kg/m2 for men.

Conclusion

The majority of outpatients with non-affective psychotic disorders need health-promoting interventions, but only about 40 % of these patients receive such municipal health-promoting treatment and care. Future studies should clarify the impact of these interventions on the health status, QoL, and life expectancy of these patients.

Potential mechanisms of action of resveratrol in prevention and therapy for mental disorders

There is a growing body of evidence about the potential of diet and nutrients to improve the population's mental health and the treatment of psychiatric disorders. Some studies have suggested that resveratrol has therapeutic properties in mental disorders, such as major depressive disorder, bipolar disorder, Alzheimer's disease, and autism. In addition, resveratrol is known to induce several benefits modulated by multiple synergistic pathways, which control oxidative stress, inflammation, and cell death. This review collects the currently available data from animal and human studies and discusses the potential mechanisms of action of resveratrol in prevention and therapy for psychiatric disorders.

Effectiveness of dietary interventions in mental health treatment: A rapid review of reviews

Aim

This rapid review of reviews aimed to determine the extent of research undertaken on the effectiveness of dietary interventions for individuals with a mental disorder.

Methods

Three databases (MEDLINE, Embase, Cochrane Reviews and Cochrane Trials) were searched to February 2021 for systematic reviews including experimental studies assessing the effectiveness of dietary interventions with physical or mental health related outcomes in adults or children with one or more of: severe mental illness, depression or anxiety, eating disorders, or substance use disorder. Results are presented descriptively.

Results

The number of included reviews was 46 (67% in severe mental illness, 20% in depression and anxiety, 7% in eating disorders, and 7% in substance use disorders). Most reviews were published since 2016 (59%), and included studies conducted in adults (63%). Interventions in the eating disorders and severe mental illness reviews were predominantly education and behaviour change, whereas interventions in the substance use disorders, and depression and anxiety reviews were predominantly supplementation (e.g. omega‐3). Twenty‐eight and twelve of the reviews respectively reported mental health and dietary outcomes for one or more included studies. Most reviews in severe mental illness, and depression and anxiety reported conclusions supporting the positive effects of dietary intervention, including positive effects on weight‐related or mental health outcomes, and on mental health outcomes, respectively.

Conclusions

A larger number of systematic reviews were identified which evaluated dietary interventions in individuals with severe mental illness, and depression and anxiety, compared with substance use disorders, and eating disorders. Dietary intervention is an important component of the treatment that should be available to individuals living with mental disorders, to support their physical and mental health.

Quality of life, symptom severity and level of functioning in people with severe mental illness ready for hospital discharge

WHAT IS KNOWN ON THE SUBJECT?: The quality of life (QoL) of people with severe mental illness (SMI) is a growing international concern. Many earlier studies report the determinants and correlates of QoL and functioning in people with SMI in Western countries. The QoL and functioning of Asian inpatients with SMI are largely unknown, particularly at the point where they have been assessed as being ready for hospital discharge. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Physical health, social functioning and community living skills, and negative symptoms are important areas of concern immediately pre-discharge. Social relationship related QoL, overall symptoms, unemployment, education level, living situation, physical illness and treatment duration predict functioning levels. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses should consider interventions beyond the traditional focus on psychopathology to improve functioning outcomes in people with SMI recently discharged from hospital. Inpatient services should utilise the opportunity to monitor and address physical health problems before discharge from inpatient care. Abstract Introduction There is a lack of evidence on quality of life (QoL) and functioning in Asian people with severe mental illness (SMI) immediately prior to hospital discharge. This information could have major implications for treatment. Aim To profile perceived quality of life, symptom severity and level of functioning among people with SMI. Methods A cross-sectional study involving 347 adult inpatients with SMI. QoL (WHO Quality of Life - Brief Form), symptom severity (Positive and Negative Syndrome Scale) and level of functioning (Specific Level of Functioning) were measured immediately pre-discharge. Results Participants reported low social relationship-related QOL. Weak correlations were found between functioning, QoL and symptoms. Regression analysis identified the social relationship QoL domain, employment status, education level, living situation, physical illnesses, overall symptoms and the duration of receiving psychiatric services were statistically significant predictors of functioning levels. Discussion The findings may highlight a need for interventions beyond the traditional emphasis on psychiatric symptoms in order to improve functioning following an inpatient admission. Implications for practice Interventions to improve functioning in recently discharged people with SMI may need to be specifically designed to improve patients' social relationships, support return to employment and minimise the risk of physical illness.

Randomised, placebo-controlled trial on topiramate add-on therapy for weight reduction and symptomatology in overweight/obese persons with schizophrenia

INTRODUCTION

Higher cardiovascular mortality is seen with schizophrenia due to the disorder itself and antipsychotic use. South Asians are more vulnerable to developing metabolic disorders than others. Resource-limited settings in South Asia have only a few mental health professionals, and individualised case management is mostly unavailable. Therefore, there is less monitoring and personalised support for diet and physical exercise programmes. Topiramate is useful for weight reduction and improvement of psychopathology in schizophrenia. However, there has been only one previous randomised controlled trial (RCT) done in South Asia, which possesses a quarter of the world's population.

METHODS

We conducted a double-blind RCT in an outpatient setting in Sri Lanka. We compared topiramate 100 mg/day with a placebo in overweight/obese adults with schizophrenia who have been on antipsychotics for at least a year. We obtained monthly anthropometric measurements and assessed the symptomatology using the brief psychiatric rating scale (BPRS).

RESULTS

Fifty patients each in the topiramate and placebo arms completed the study. Topiramate add-on therapy led to significant weight/Body Mass Index reduction and improved symptomatology as measured by the BPRS compared to the placebo. The topiramate group had significantly more reporting of loss of appetite.

DISCUSSION

According to available data, this is the RCT with most participants assessing the use of topiramate in schizophrenia and only the second in South Asia. Topiramate was shown to be useful for weight reduction and symptomatic improvement in persons with schizophrenia in a resource-limited setting in South Asia.

Effect of a nurse-led intervention program on the physical health and quality of life of individuals with severe mental illness

PURPOSE

The aim of this study was to investigate the effect of nurse-led intervention programs on patients' physical health, physical activities, healthy lifestyle behaviors, and quality of life.

DESIGN AND METHODS

The research was conducted with a quasi-experimental design. The sample consisted of 33 individuals with severe mental illness. Data were collected with the Healthy Lifestyle Behavior Scale II, the Short Form-36 Quality-of-Life Instrument, and pedometers.

FINDINGS

The individuals in the intervention group showed a statistically significant decrease in waist circumference and increases in the physical activity and nutrition dimensions of healthy lifestyle behaviors and the physical function of quality of life. No statistically significant changes were detected in anthropometric measurements, healthy lifestyle behaviors, or quality-of-life subscales in the control group.

PRACTICE IMPLICATIONS

Mental health nursing and psychiatric nurses should plan and implement interventions to encourage healthy eating and physical activity for patients.

Risk factors for metabolic and cardiovascular disease in inpatients with severe mental illness

Patients with severe mental illness (SMI) have increased burden of somatic illnesses, especially cardiovascular disease. Characterizing the cardiovascular risk profile of patients with SMI is therefore crucial to understanding how to decrease morbidity and mortality in these vulnerable populations. In this observational study, entropy balancing (a form of propensity score matching) was used to compare cardiometabolic health in a sample of the general population from the National Health and Nutrition Examination Survey (NHANES) datasets to inpatients hospitalized in a large, urban, academic psychiatric hospital in Harris County, Texas. Data were analyzed using independent linear regression models for blood pressure, blood glucose, TG:HDL ratio, total cholesterol, and body mass index as outcome variables. Systolic blood pressure (F=34•75, p<0•0001), diastolic blood pressure (F=90•53, p<0•0001), blood glucose (F=12•89, p<0•0001), and the TG:HDL ratio (F=3•16, p<0•0001) were all elevated in the psychiatric inpatient sample vs. the NHANES sample. Contrary to expectations, total cholesterol (F=32•18, p<0•0001) and BMI (F=15•05, p<0•0001) were lower in this sample vs. the NHANES sample. Patients hospitalized with SMI show a cardiometabolic profile which confers greater risk of diabetes- and hypertension-related mortality. Approaches should be developed to target indicators of cardiometabolic health in this population to reduce long-term mortality.

A web-based adapted physical activity program (e-APA) versus health education program (e-HE) in patients with schizophrenia and healthy volunteers: study protocol for a randomized controlled trial (PEPSY V@Si)

Patients with schizophrenia (SZ) have a high level of cardiovascular morbidity and some clinical symptoms of illness remain resistant to pharmacological approaches. A large number of studies support the effectiveness of physical activity (PA) in SZ. The aims of this trial is to assess the effects of a remote, web-based adapted PA program (e-APA) compared to a health education program (e-HE) on brain plasticity in SZ and healthy volunteers (HV) and on psychiatric, neurocognitive, circadian and physical variables. The study is an interventional, multicenter, randomized open-label trial. Forty-two SZ will be randomized to either the active group (e-APA, N = 21) or nonactive group (e-HE, N = 21), and 21 HV will be matched to SZ according to age, gender, and level of PA in both e-APA and e-HE groups. Interventions will consist of 32 sessions (2 × 60 min/week, for 16 weeks) via supervised home-based videoconferencing. Cerebral magnetic resonance imaging, psychiatric symptoms, neurocognitive and circadian rhythms assessments as well as physical tests and biological analyses will be assessed at baseline and 16 weeks after the intervention. To our knowledge, this is the first study aiming to evaluate the efficacy of APA delivered by supervised home-based videoconferencing in SZ. Moreover, using multimodal MRI, this study could clarify the pathophysiological mechanisms underlying the efficacy of APA. Finally, this innovative approach might also increase participation in long-term PA since PA-based programs are known to have low adherence and early dropout. Trial registration: ClinicalTrials.gov identifier: NCT03261817. Registered on 16 August 2017.

Cognitive-behavioural therapy for a variety of conditions: an overview of systematic reviews and panoramic meta-analysis

BACKGROUND

Cognitive-behavioural therapy aims to increase quality of life by changing cognitive and behavioural factors that maintain problematic symptoms. A previous overview of cognitive-behavioural therapy systematic reviews suggested that cognitive-behavioural therapy was effective for many conditions. However, few of the included reviews synthesised randomised controlled trials.

OBJECTIVES

This project was undertaken to map the quality and gaps in the cognitive-behavioural therapy systematic review of randomised controlled trial evidence base. Panoramic meta-analyses were also conducted to identify any across-condition general effects of cognitive-behavioural therapy.

DATA SOURCES

The overview was designed with cognitive-behavioural therapy patients, clinicians and researchers. The Cochrane Library, MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Child Development & Adolescent Studies, Database of Abstracts of Reviews of Effects and OpenGrey databases were searched from 1992 to January 2019.

REVIEW METHODS

Study inclusion criteria were as follows: (1) fulfil the Centre for Reviews and Dissemination criteria; (2) intervention reported as cognitive-behavioural therapy or including one cognitive and one behavioural element; (3) include a synthesis of cognitive-behavioural therapy trials; (4) include either health-related quality of life, depression, anxiety or pain outcome; and (5) available in English. Review quality was assessed with A MeaSurement Tool to Assess systematic Reviews (AMSTAR)-2. Reviews were quality assessed and data were extracted in duplicate by two independent researchers, and then mapped according to condition, population, context and quality. The effects from high-quality reviews were pooled within condition groups, using a random-effect panoramic meta-analysis. If the across-condition heterogeneity was I2 < 75%, we pooled across conditions. Subgroup analyses were conducted for age, delivery format, comparator type and length of follow-up, and a sensitivity analysis was performed for quality.

RESULTS

A total of 494 reviews were mapped, representing 68% (27/40) of the categories of the International Classification of Diseases, Eleventh Revision, Mortality and Morbidity Statistics. Most reviews (71%, 351/494) were of lower quality. Research on older adults, using cognitive-behavioural therapy preventatively, ethnic minorities and people living outside Europe, North America or Australasia was limited. Out of 494 reviews, 71 were included in the primary panoramic meta-analyses. A modest effect was found in favour of cognitive-behavioural therapy for health-related quality of life (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.05 to 0.50, I2 = 32%), anxiety (standardised mean difference 0.30, 95% confidence interval 0.18 to 0.43, prediction interval -0.28 to 0.88, I2 = 62%) and pain (standardised mean difference 0.23, 95% confidence interval 0.05 to 0.41, prediction interval -0.28 to 0.74, I2 = 64%) outcomes. All condition, subgroup and sensitivity effect estimates remained consistent with the general effect. A statistically significant interaction effect was evident between the active and non-active comparator groups for the health-related quality-of-life outcome. A general effect for depression outcomes was not produced as a result of considerable heterogeneity across reviews and conditions.

LIMITATIONS

Data extraction and analysis were conducted at the review level, rather than returning to the individual trial data. This meant that the risk of bias of the individual trials could not be accounted for, but only the quality of the systematic reviews that synthesised them.

CONCLUSION

Owing to the consistency and homogeneity of the highest-quality evidence, it is proposed that cognitive-behavioural therapy can produce a modest general, across-condition benefit in health-related quality-of-life, anxiety and pain outcomes.

FUTURE WORK

Future research should focus on how the modest effect sizes seen with cognitive-behavioural therapy can be increased, for example identifying alternative delivery formats to increase adherence and reduce dropout, and pursuing novel methods to assess intervention fidelity and quality.

STUDY REGISTRATION

This study is registered as PROSPERO CRD42017078690.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 9. See the NIHR Journals Library website for further project information.

An appraisal of methodology reporting in lifestyle interventions among people with psychosis: A systematic review

ISSUE ADDRESSED

Lifestyle interventions use nutrition and physical activity behaviour modification techniques to decrease obesity and cardio-metabolic risk in people with psychosis. Evidence on the specific behaviour modification strategies applied to decrease obesity is weakened by inadequate methodology reporting of lifestyle interventions. A systematic review that we conducted earlier highlighted a possible deficiency in reporting; hence we aim to critically appraise lifestyle intervention studies that target weight outcomes for people with psychosis against the methods component of the CONSORT statement for randomised trials of nonpharmacologic treatments.

METHODS COMPONENT

We considered randomised controlled studies which delivered lifestyle interventions to community-dwelling adults with psychotic disorders, and included those with the following outcomes of interest: weight, body mass index, waist circumference and waist-to-hip ratio. The Cochrane Library, MEDLINE/PREMEDLINE, EMBASE, CINAHL, Scopus and PsycINFO were searched for English publications between 1985 and 2018. Methodology and reporting of studies were evaluated using the CONSORT statement for randomised trials of nonpharmacologic treatments.

RESULTS

Thirty-two studies met the inclusion criteria. Critical appraisals revealed that reporting of lifestyle intervention studies was generally incomplete. Fewer than 50% provided the recommended information on trial design, participant characteristics, detail of interventions, outcomes, sample size, randomisation, blinding and statistical methods.

CONCLUSIONS

Application of guidelines, like the CONSORT statement, in future publications of lifestyle interventions for people with psychosis will improve accuracy of reporting. SO WHAT?: Enhanced reporting in lifestyle intervention studies for people with psychosis will promote guideline creation and translation of research, which is likely to positively impact physical health outcomes.

Nonpharmacological Interventions for the Treatment of Cardiometabolic Risk Factors in People With Schizophrenia-A Systematic Review

Background: People suffering from schizophrenia are notably vulnerable to cardiometabolic risk factors (CMRF), such as obesity, high blood pressure, hyperglycemia and insulin resistance, high serum triglycerides, and low serum high-density lipoprotein (HDL), which are related to increased mortality and decreased quality of life. The increased risk of "metabolic syndrome" (MS) is related to low physical activity, an unhealthy diet, and side effects of antipsychotic drugs. Nonpharmacological interventions seem to be important in the prevention and therapy of MS. Aim: This paper provides an overview of published studies and a critical analysis of pilot programs involving nonpharmacological measures aimed at prevention and treatment of CMRF in patients with schizophrenia. Material and Method: We searched the PubMed, PsycARTICLES, and Cochrane Library databases to identify clinical trials. We included full-text studies that met the following criteria: age > 18 years, a diagnosis of schizophrenia or schizoaffective disorder, and monitored parameters associated with MS. Results: All 1,555 references were evaluated for inclusion in the review, and 20 met the inclusion criteria. Nonpharmacological interventions led to improvement in physical health and showed a promising potential for implementation in treatment programs dedicated to this particular group of patients. However, a critical analysis revealed limitations, which have implications for the direction of future research. Conclusions: Patients suffering from schizophrenia can benefit from nonpharmacological interventions aimed at counteracting CMRF, improving either metabolic parameters, cardiovascular fitness, or their health perception. Notwithstanding, to achieve long-term effects, future studies should comprise appropriate follow-up procedures.

Equine-Assisted Therapeutic Interventions Among Individuals Diagnosed With Schizophrenia. A Systematic Review

Persons diagnosed with schizophrenia are not sufficiently offered health promotion interventions, notwithstanding their increased risk of bodily ill health. Physical activity is found to improve health and decrease psychiatric symptoms although, there is a challenge to motivate and increase physical activity in people with schizophrenia and innovative evidence-based treatment interventions are needed. The aim was to systematically review studies concerning equine assisted interventions among individuals diagnosed with schizophrenia. The findings of the six included articles indicate that therapeutic equine assisted interventions could be beneficial for individuals with severe mental illness such as schizophrenia or schizophrenia like disorders.

[Physical activity in patients with schizophrenia: From neurobiology to clinical benefits]

Schizophrenia is a severe chronic mental disorder that mainly manifests by positive symptoms, negative symptoms, disorganized behavior and thought and cognitive impairments. Taken together, these symptoms have substantial impact on quality of life, well-being and functional outcome. Patients with schizophrenia have dramatically higher levels of cardiovascular and metabolic morbidity than the general population due to poor physical fitness and to sedentary lifestyle. They have a reduced life expectancy, and an excess mortality being two or three times more than that in the general population. Moreover, despite major therapeutic advances in the overall management of these patients, some symptomatic dimensions, and more specifically the negative and cognitive ones, remain to be resistant to the usual pharmacological approaches. Moreover, antipsychotics can also reinforce the global cardiovascular risk due to side effects and low neurometabolic tolerance. The benefits of physical activity on health are now well described in the general population and in many medical diseases. More recently, physical activity has also found its place as an adjuvant therapy in severe mental illnesses, particularly in schizophrenia. In the literature physical activity programs, in addition to pharmacological treatments, appear to be feasible in patients and improve both physical and mental health as well as functional outcome. Clinical benefits of physical activity would be underpinned by biological and cerebral mechanisms, which remain unclear. In this review, we propose to present a state of the art and to present an update of the interests of physical activity in the management of patients with schizophrenia. We emphasize the clinical benefits of physical activity regarding the different symptomatic dimensions and its impact specifically on cognitive deficits. Finally, we describe the various underlying pathophysiological mechanisms in particular in the neurobiological, cerebral and physiological fields. We then discuss the barriers, facilitators and motivating factors towards physical activity to enhance health promotion initiatives, to optimize resource allocation when delivering physical activity programs in clinical practice, and to maximize physical activity participation. Physical activity appears to be an original and novel adjunctive therapeutic approach in the management of patients with schizophrenia and would both reduce schizophrenic symptoms and act like pro-cognitive therapy, improve quality of life and long-term functioning in daily life and reduce cardiovascular comorbidities. However, efforts are still needed to increase the motivating factors and adherence towards physical activity participation for people with schizophrenia.

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.

The opinions of Turkish mental health nurses on physical health care for individuals with mental illness: A qualitative study

WHAT IS KNOWN ON THE SUBJECT

Individuals with mental illness have significantly higher mortality and morbidity than the general population due to physical illnesses. Mental health nurses play a key role in providing care for common physical problems and protecting and promoting healthy lifestyles. Little is known from previous studies in the international literature about the attitudes, behaviours and thoughts of mental health nurses on providing physical health care.

WHAT THIS PAPER ADDS TO THE EXISTING KNOWLEDGE

Mental health nurses mostly focus on the existing physical health problems of individuals with mental illness. However, mental health nurses do not include practices of disease prevention and physical health promotion for individuals with mental illness. The desire to see positive changes in individuals with mental illness, receiving positive feedback, feeling useful and happy, and feeling satisfied with their profession motivate mental health nurses in terms of providing physical health care.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

The knowledge and skill required of mental health nurses to provide physical health care need to be increased. Institutions should employ expert nurses who are able to guide mental health nurses to provide physical health care. It is important to provide adequate physical infrastructure and human resources to provide better physical health care in mental health services.

ABSTRACT

Background Mental health nurses play an important role in improving the physical health of individuals with mental illnesses. However, there are limited studies of their attitudes and practices about physical health. Therefore, there is a need for qualitative studies to clarify the issue.

AIM

The aim of this study was to determine mental health nurses' opinions about physical health care for individuals with mental illness.

METHODS

This study was carried out in Turkey. A qualitative descriptive approach was taken in the study. The sample consisted of twelve mental health nurses selected by purposeful sampling. In-depth interviews were conducted using a semi-structured interview format. A thematic analysis was used to evaluate the interviews.

RESULTS

Four main themes were determined. (1) The barriers to physical healthcare theme included barriers related to patients, illness and treatment, barriers related to patients' caregivers, barriers related to health professionals and barriers related to the healthcare system. (2) The physical healthcare practices theme included common physical health problems and current nursing practices. (3) Motivators theme included the desire to see positive changes in a patient, receiving positive feedback, feeling useful and happy, having a sense of conscience and feeling satisfied with their profession. (4) The needs for better physical healthcare theme included the nurses' recommendations for better physical health care.

CONCLUSION

Mental health nurses believe that the physical health care provided to individuals with mental illness is not adequate. Many barriers to providing care for physical health, such as having psychiatric symptoms that are not seen as a priority by patients and health personnel, were determined.

IMPLICATIONS FOR PRACTICE

Mental health nurses should integrate physical healthcare practices into their routine care. In addition, mental health nurses' knowledge and skills about physical health care should be improved.

Reducing the Risk of Type 2 Diabetes in Nonselected Outpatients With Schizophrenia: A 30-Month Program

BACKGROUND

Type 2 diabetes is 2- to 3-fold more common in patients with schizophrenia than in the general population. A lifestyle with a focus on diet, exercise, and medication is required to prevent complications from type 2 diabetes, but patients with schizophrenia frequently have trouble maintaining such a lifestyle because of factors related to their illness, such as cognitive disturbances, negative and positive symptoms, and side effects of psychotropic medications.

OBJECTIVE

To measure and reduce risk factors for type 2 diabetes in patients with schizophrenia and examine characteristics associated with positive outcomes.

METHODS

This study, which was conducted in clinics treating both newly diagnosed and long-term (LT) patients with schizophrenia, evaluated the effects of a 30-month naturalistic intervention on improvement in the physical health of patients treated for schizophrenia and reduction in their risk factors for type 2 diabetes. The clinical intervention incorporated individual guidance, group sessions, and treatment as usual.

RESULTS

Patients newly diagnosed with schizophrenia were found to have high consumption of soft drinks and low physical activity at their index evaluation. At follow-up, the physical profile of these patients had worsened, with increased weight, waist circumferences, visceral adiposity index (P=0.030), and glycosylated hemoglobin (HbA1c; P=0.010). Average HbA1c values increased in newly diagnosed male patients by 0.24 mmol/l (P=0.007). At follow-up, LT patients improved with regard to their consumption of soft drinks (P=0.001) and fast food (P=0.009). The LT patients also reduced their weight and waist circumferences and became more physically active. No changes in HbA1c values were found in the LT patients during the intervention period.

CONCLUSION

The study found that positive outcomes were associated with female sex and a longer duration of illness. Negative outcomes with worsening of risk factors were associated with being newly diagnosed with schizophrenia and male sex. It was possible to produce improvements in some risk factors through individual health-oriented lifestyle interventions, especially in LT patients.

Reducing the Risk of Cardiovascular Diseases in Non-selected Outpatients With Schizophrenia: A 30-Month Program Conducted in a Real-life Setting

BACKGROUND

The most common cause of premature death in people with schizophrenia is cardiovascular disease, partially explained by an unhealthy lifestyle, smoking, poor diet and sedentary behavior. We aimed to reduce cardiovascular risk factors.

METHOD

Naturalistic follow-up study with 54 long-term-treated non-selected outpatients with schizophrenia. The 30-month program consisted of individual guidance, group sessions and normal treatment and care offered in our clinic.

RESULTS

On average, the participating women reduced their waist circumference by 11.4cm (P=0.037), whereas the participating men increased their waist circumference by 3.3cm (P=0.590). Patients' consumption of fast food was reduced from 1.2 to 0.8 times/week (P=0.016), just as their consumption of soft drinks was reduced from 0.7 to 0.1l/day (P=0.006). Their consumption of coffee increased from 1.6 to 2.5 cups/day (P=0.086). The time women spent on light physical activity increased from 134 to 469min/week (P=0.055). The number of daily cigarettes smoked was reduced by 25.7% for all smokers.

CONCLUSIONS

Our program showed that it is possible for women but not for men to reduce their risk factors for developing cardiovascular disease. The program is manageable in most outpatient clinics and can be performed by nursing staff interested in physical health with support from and in cooperation with medical doctors, psychiatrist and leaders/managers.

Comparative efficacy of lifestyle intervention strategies on weight outcomes in people with psychosis: a systematic review and network meta-analysis protocol

REVIEW QUESTION/OBJECTIVE:: (i) To systematically review and rank the efficacy of different types of lifestyle intervention strategies on weight outcomes (weight, body mass index [BMI], waist circumference and waist-to-hip ratio) in people with psychosis. (The efficacy of different types of lifestyle intervention strategies will be ranked by comparing the effect size on weight outcomes in people with psychotic disorders.) (ii) To stratify lifestyle interventions that target weight outcomes (weight, BMI, waist circumference and waist-to-hip ratio) in people with psychosis, according to their inclusion of dietary information that adheres with Australian Dietary Guidelines (National Health and Medical Research Council. Eat for Health, Australian Dietary Guidelines Canberra National Health and Medical Research Council; 2013).Specifically, the review question is: What lifestyle intervention strategies targeting weight outcomes (weight, BMI, waist circumference and waist-to-hip ratio) in people with psychosis compared to no treatment or various control conditions have the best efficacy?

Improving quality of life and physical health in patients with schizophrenia: A 30-month program carried out in a real-life setting

BACKGROUND

Patients with schizophrenia experience low quality of life (QoL) and poor physical health, which is explained, in part, by unhealthy lifestyle, tobacco smoking, poor diet and sedentary behavior.

AIM

To measure QoL and physical health in patients with schizophrenia and to quantify associations between QoL and physical health.

METHODS

This was a naturalistic longitudinal 30-month follow-up study including individual guidance, group sessions and treatment as usual.

RESULTS

We included 190 patients. QoL was low among newly diagnosed patients. Higher body mass index was significantly associated with lower QoL. Newly diagnosed male patients showed lower QoL compared with females. Newly diagnosed patients experienced worsened health during the study period. In contrast, long-term schizophrenic patients started with worse physical health but improved with regard to weight, waist circumferences, intake of fast food and soft drinks, and light physical activity level. Newly diagnosed patients improved their QoL ( p = .056), and the psychological domain improved by 8.0 points ( p = .003). The number of interventions was positively associated with QoL.

CONCLUSION

Patients with schizophrenia presented with low QoL and elevated risk factors for poor physical health. The intervention added onto 'treatment as usual' improved some risk factors for poor physical health among long-term patients. The number of interventions had an elevating effect on QoL in patients.

Exploration of food addiction in people living with schizophrenia

The term food addiction (FA) denotes a concept among researchers and lay consumers as a behavioural phenotype related to excessive food consumption. In this study we examined the prevalence of FA using the validated Yale Food Addiction Scale (YFAS) as well as the dimensional symptom count. In addition, we explored associations between participant characteristics and FA diagnosis. Outpatients attending a clozapine clinic and possessing a diagnosis of schizophrenia were invited to complete an anonymous survey using the YFAS. Ninety three surveys were used to calculate the diagnostic YFAS criteria for FA. The prevalence of FA found in this sample was 26.9%. Among individuals who did not meet "diagnostic" criteria FA, 77.4% endorsed 3 or more symptoms but did not report distress or impairment. The most common food addiction symptom was a persistent desire or repeated unsuccessful attempts to cut down consumption (97.9%). The significant finding in association between individual's characteristics and diagnosis of FA was employment. Several factors related to reported results are postulated and discussed. The current study has found the prevalence of FA amongst people living with schizophrenia to be higher than the general populations but not as high as populations with disordered eating.

Interventions to improve lifestyle and quality-of-life in patients with concurrent mental illness and substance use

BACKGROUND

Patients with co-existence of psychiatric disorders and substance use have an increased risk of premature death. This is attributable to a higher prevalence of physical comorbidities and a lifestyle related to substance use. Furthermore, they experience low quality-of-life (QoL). Studies addressing lifestyle interventions for these patients are warranted.

AIMS

To investigate the physical health and QoL in patients with co-existence of psychiatric disorders and substance use, and to analyse for changes in their (a) health, (b) substance use, and (c) QoL after a 24-month health-promotion programme. Further aims were to investigate associations between (a) QoL and number of interventions, (b) QoL and patient characteristics, and (c) QoL and length of participation in the intervention.

METHODS

In this naturalistic cohort study, 64 non-selected patients were engaged in health-promoting interventions added to contemporary treatments. QoL and clinical variables were measured at the beginning of and continuously during the programme by means of the WHOQoL-Bref questionnaire.

RESULTS

At enrolment, the patients' intake of cannabis and alcohol was high. During follow-up, patients consumed significantly fewer caffeinated beverages (p = .038) and fast-food meals (p = .018), and slept significantly less (p = .032). The average dose of antipsychotic medication increased significantly (p = .015). QoL was low at enrolment, but improved significantly overall (p = .009) and in the psychological (p = .020) and environmental domains (p = .012) at follow-up. The difference in total QoL was positively associated with the number of interventions attended.

CONCLUSION

This programme shows promise in addressing health promotion for these patients and can easily be integrated into contemporary treatments.

Reducing cardiovascular risk factors in non-selected outpatients with schizophrenia

OBJECTIVES

Cardiovascular diseases are the most common causes of premature death in patients with schizophrenia. We aimed at reducing cardiovascular risk factors in non-selected outpatients with schizophrenia using methods proven effective in short-term trials. Furthermore, we examined whether any baseline characteristics were associated with positive outcomes.

METHODS

All outpatients treated for schizophrenia at two Danish hospitals were included in this 1-year follow-up study. The patients were offered health interventions both individually and in groups. Weight, waist circumference, blood glucose and lipids and information on smoking and alcohol were obtained.

RESULTS

On average, small significant increases in body mass index (BMI) and waist circumferences were observed while small non-significant improvements in other cardiovascular risk factors were seen. Patients with high baseline BMI and patients with duration of treated illness beyond 2 years had significantly better intervention outcomes.

CONCLUSION

Our results show that it was difficult to improve physical health in a group of non-selected patients with schizophrenia as part of routine care. The patients were not easily motivated to participate in the interventions, and it was difficult to monitor the recommended metabolic risk measures in the patient group. Future research should focus on simple strategies in health promotion that can be integrated into routine care.

Reducing cardiovascular risk factors in non-selected outpatients with schizophrenia

OBJECTIVES

Cardiovascular diseases are the most common causes of premature death in patients with schizophrenia. We aimed at reducing cardiovascular risk factors in non-selected outpatients with schizophrenia using methods proven effective in short-term trials. Furthermore, we examined whether any baseline characteristics were associated with positive outcomes.

METHODS

All outpatients treated for schizophrenia at two Danish hospitals were included in this 1-year follow-up study. The patients were offered health interventions both individually and in groups. Weight, waist circumference, blood glucose, serum lipids, and information on smoking and alcohol were obtained.

RESULTS

On average, small significant increases in body mass index (BMI) and waist circumferences were observed while small non-significant improvements in other cardiovascular risk factors were seen. Patients with high baseline BMI and patients with duration of treated illness beyond 2 years had significantly better intervention outcomes.

CONCLUSIONS

Our results show that it was difficult to improve physical health in a group of non-selected patients with schizophrenia as part of routine care. The patients were not easily motivated to participate in the interventions, and it was difficult to monitor the recommended metabolic risk measures in the patient group. Future research should focus on simple strategies in health promotion that can be integrated into routine care.

Recommendations for the optimal care of patients with recent-onset psychosis in the Asia-Pacific region

Providing optimal care to patients with recent-onset psychosis can improve outcomes and reduce relapse. However, there is a lack of consistency of the implementation of guidelines for such patients across the Asia-Pacific region. We determined a pragmatic set of recommendations for use on a day-to-day basis to help provide optimal care at this crucial stage of illness. The recommendations were developed over a series of meetings by an international faculty of 15 experts from the Asia-Pacific region, Europe, and South Africa. A structured search of the PubMed database was conducted. This was further developed based on the faculty's clinical experience and knowledge of the literature into 10 key aspects of optimal care for patients during the first five years of a diagnosis of a psychotic disorder, with particular relevance to the Asia-Pacific region. Several common principles emerged: adherence to antipsychotic medications is crucial; substance abuse, psychiatric and medical comorbidities should be addressed; psychosocial interventions play a pivotal role; and family members can play a vital role in overall patient care. By following these recommendations, clinicians may improve outcomes for patients with recent-onset psychosis.

Cancer screening, prevention, and treatment in people with mental illness

People with mental illness die decades earlier in the United States compared with the general population. Most of this disparity is related to preventable and treatable chronic conditions, with many studies finding cancer as the second leading cause of death. Individual lifestyle factors, such as smoking or limited adherence to treatment, are often cited as highly significant issues in shaping risk among persons with mental illness. However, many contextual or systems-level factors exacerbate these individual factors and may fundamentally drive health disparities among people with mental illness. The authors conducted an integrative review to summarize the empirical literature on cancer prevention, screening, and treatment for people with mental illness. Although multiple interventions are being developed and tested to address tobacco dependence and obesity in these populations, the evidence for effectiveness is quite limited, and essentially all prevention interventions focus at the individual level. This review identified only one published article describing evidence-based interventions to promote cancer screening and improve cancer treatment in people with mental illness. On the basis of a literature review and the experience and expertise of the authors, each section in this article concludes with suggestions at the individual, interpersonal, organizational, community, and policy levels that may improve cancer prevention, screening, and treatment in people with mental illness.

Improving lifestyle interventions for people with serious mental illnesses: Qualitative results from the STRIDE study

OBJECTIVE

Individuals with serious mental illnesses are disproportionately affected by overweight and obesity. Understanding the factors that facilitate or hinder lifestyle change in this population could lead to better interventions and improved health outcomes.

METHODS

A subset of intervention and usual-care participants (n = 84) in the STRIDE randomized trial were interviewed at 3, 9, and 18 months, yielding 101 interviews (some were interviewed more than once). Participants had a mean age of 48.1 (SD = 10.1); 64% were female. Participants had diagnoses of schizophrenia or schizoaffective disorder (41%), bipolar disorder (20%), affective psychoses (37%), or PTSD (2%). Interviews were transcribed verbatim, coded using Atlas.ti, and analyzed for common themes.

RESULTS

Barriers to behavior change were similar to those described for the general population, including lack of support from significant others, the lure of unhealthy foods, and poor weather impeding exercise. Additional challenges included the effects of psychiatric symptoms, or consequences of symptoms (i.e., social isolation), on ability to make and sustain lifestyle changes. We found a strong preference for ongoing, group-based support to foster a sense of accountability which motivated and helped to sustain behavior changes.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Individuals with serious mental illnesses encounter many of the same barriers to weight loss seen in the general population, but they may be more vulnerable to additional obstacles. Lifestyle change interventions for this population should help participants develop the ability to iteratively cope with fluctuating mood and subsequent changes in motivation to eat healthfully and exercise regularly.

Quality of life and clinical characteristics in a nonselected sample of patients with schizophrenia

BACKGROUND

Patients with schizophrenia experience low quality of life (QOL).

AIMS

To examine QOL in these patients and the relation between QOL and illness duration, adjusted daily doses (ADDs) of antipsychotics, body mass index (BMI), waist circumference and smoking.

METHODS

In this naturalistic, cross-sectional study, 82 patients were interviewed about smoking habits. Patients completed a QOL questionnaire (World Health Organization Quality of Life-Bref) consisting of physical, psychological, social and environmental domains and had height, weight and waist circumference measured. The characteristics and QOL were correlated using multiple regression analysis.

RESULTS

QOL was significantly lower in the patients than in the general population (p < .01). In first-ever diagnosed patients, QOL was associated with BMI (regression coefficient (RC): physical -0.73, psychological -1.44 and environmental -0.55; all p < .05), ADD (RC: physical 3.71, psychological 4.37 and environmental 2.94; all p < .10) and smoking (RC: physical -0.69; p < .01). In the long-term ill patients, QOL was associated with BMI (RC: physical -1.19 and psychological -1.28; all p < .05) and illness duration (RC: physical 1.38; p < .05).

CONCLUSION

Patients experienced low QOL. Lower QOL was associated with high BMI, low ADD and smoking in first-ever diagnosed patients and with high BMI and short illness duration in long-term ill patients.

Resveratrol Supplementation in Schizophrenia Patients: A Randomized Clinical Trial Evaluating Serum Glucose and Cardiovascular Risk Factors

BACKGROUND

Patients with schizophrenia (SZ) are generally overweight or obese and have several metabolic disorders. Additionally, such patients have a lower life expectancy and the main cause of their increased mortality is cardiovascular disease (CVD). The objective of this study was to determine the efficacy of resveratrol supplementation on serum glucose and CVD risk factors in individuals with SZ.

METHODS AND RESULTS

This is a four-week randomized, double-blind controlled trial (registration No.: NCT 02062190) in which 19 men with a diagnosis of SZ, aged 18 to 65, were assigned to either a resveratrol supplement group (200 mg/day) or a placebo group (200 mg/day). In short, we did not observe significant changes after resveratrol supplementation. In the placebo group, we found a significant increase in total cholesterol levels (p = 0.024) and in LDL-cholesterol (p = 0.002), as well as a decrease in body fat percentage (p = 0.038). The placebo group also showed an increase in triglycerides (9.19%) and a reduction in HDL-cholesterol (4.88%). In the resveratrol group, triglycerides decreased (7.64%).

CONCLUSION

In summary, oral resveratrol in reasonably low dosages (200 mg daily) brought no differences to body weight, waist circumference, glucose, and total cholesterol. It was possible to note that the lipid profile in the placebo group worsened and, although no significant differences were found, we can assume that resveratrol might prevent lipid profile damage and that the intervention affected the lipoprotein metabolism at various levels.

Intervention to promote physical health in staff within mental health facilities and the impact on patients' physical health

BACKGROUND

Patients with severe mental illnesses have an increased physical morbidity and premature mortality on account of somatic diseases. Patients with mental illness are nursed and cared for by the staff, who may acts as role models for the patients.

AIMS

The study tested the efficacy of an intervention programme for improving physical health in staff working in long-term psychiatric treatment facilities. Furthermore, the paper measured the association between staff's changes in physical health and the patients' changes in physical health.

METHODS

The study was a cluster randomized controlled 12-month intervention study, and the intervention was active awareness on physical health.

RESULTS

In the intervention group the staff reduced their waist circumference by 2.3 cm (95% CI: 0.3-4.4) when controlling for gender, age and cigarette consumption. In the control group, the staff changed their waist circumference by - 2.1 cm (95% CI: - 5.6-1.5). The staff in the intervention group experienced a significant reduction in diastolic blood pressure of - 5.9 mmHg (95% CI: - 9.5 to - 2.3, p = 0.009). The study indicated an association between the staff average change in each facility and the individual patient's changes in health parameters (body mass index, total body fat and quality of life).

CONCLUSION

The staff in the intervention group showed a significant reduction of waist circumference, while staff in the control group showed a non-significant increase. Furthermore, a significant reduction in the diastolic blood pressure was seen. Indications that staff acted as positive role models for the patients' physical health were seen.

Promoting physical health in severe mental illness: patient and staff perspective

OBJECTIVE

To explore physical health problems and their causes in patients with severe mental illness, as well as possibilities for prevention and treatment from the patients' and staff's perspectives.

METHOD

We conducted six focus groups with patients and staff separately, from three out-patient clinics treating patients with schizophrenia or substance-use disorder comorbid to another psychiatric disorder. Focus groups were audio-recorded, transcribed verbatim and analysed using a template approach.

RESULTS

Paramount physical health problems are weight issues, cardiovascular diseases and poor physical shape. Main causes are lifestyle, the mental disorder and organisational issues. Patients and staff expressed similar opinions regarding physical health problems and their causes. Possibilities for prevention and treatment includes a case manager and binding communities with like-minded, as well as management support and implementation of physical health into daily psychiatric practice. Although patients and staff suggested different possibilities for prevention and treatment, they support one strategy: less fragmentation of the treatment system and cooperation between psychiatric and somatic healthcare.

CONCLUSION

To prevent and treat physical health problems in patients with severe mental illness, support in daily structure and lifestyle changes is needed. Management support is needed to change daily practice and implement routines regarding physical health.

Early insulin resistance predicts weight gain and waist circumference increase in first-episode psychosis--A one year follow-up study

First-episode psychosis (FEP) is associated with weight gain during the first year of treatment, and risk of abdominal obesity is particularly increased. To identify early risk markers of weight gain and abdominal obesity, we investigated baseline metabolic differences in 60 FEP patients and 27 controls, and longitudinal changes during the first year of treatment in patients. Compared to controls at baseline, patients had higher low-density lipoprotein, triglyceride and apolipoprotein B levels, and lower levels of high-density lipoprotein and apolipoprotein A-I but no difference in body mass index or waist circumference. At 12-month follow-up, 60.6% of patients were overweight or obese and 58.8% had abdominal obesity. No significant increase during follow-up was seen in markers of glucose and lipid metabolism or blood pressure, but increase in C-reactive protein between baseline and 12-month follow-up was statistically significant. Weight increase was predicted by baseline insulin resistance and olanzapine use, while increase in waist circumference was predicted by baseline insulin resistance only. In conclusion, insulin resistance may be an early marker of increased vulnerability to weight gain and abdominal obesity in young adults with FEP. Olanzapine should be avoided as a first-line treatment in FEP due to the substantial weight increase it causes. In addition, the increase in the prevalence of overweight and abdominal obesity was accompanied by the emergence of low-grade systemic inflammation.

Schizophrenia

Schizophrenia is a chronic psychiatric disorder with a heterogeneous genetic and neurobiological background that influences early brain development, and is expressed as a combination of psychotic symptoms - such as hallucinations, delusions and disorganization - and motivational and cognitive dysfunctions. The mean lifetime prevalence of the disorder is just below 1%, but large regional differences in prevalence rates are evident owing to disparities in urbanicity and patterns of immigration. Although gross brain pathology is not a characteristic of schizophrenia, the disorder involves subtle pathological changes in specific neural cell populations and in cell-cell communication. Schizophrenia, as a cognitive and behavioural disorder, is ultimately about how the brain processes information. Indeed, neuroimaging studies have shown that information processing is functionally abnormal in patients with first-episode and chronic schizophrenia. Although pharmacological treatments for schizophrenia can relieve psychotic symptoms, such drugs generally do not lead to substantial improvements in social, cognitive and occupational functioning. Psychosocial interventions such as cognitive-behavioural therapy, cognitive remediation and supported education and employment have added treatment value, but are inconsistently applied. Given that schizophrenia starts many years before a diagnosis is typically made, the identification of individuals at risk and those in the early phases of the disorder, and the exploration of preventive approaches are crucial.

Mental health starts with physical health: current status and future directions of non-pharmacological interventions to improve physical health in first-episode psychosis

People with psychotic disorders have reduced life expectancy compared with the general population. This difference is primarily due to increased prevalence of cardiovascular disease associated with antipsychotic drugs and with modifiable risk factors, including weight gain, low exercise, poor diet, and high prevalence of cigarette smoking. We review non-pharmacological interventions for physical health behaviour in patients with chronic and first-episode psychosis. Our findings suggest that weight loss and attenuation of weight gain are achievable but limited and might not persist beyond the end of an intervention. Evidence for smoking cessation interventions is scarce. The case for early intervention to prevent deterioration of physical health is strong. We propose a framework for development of interventions, which addresses three main factors largely absent in previous research: (1) examination of aetiological factors related to poor physical health, (2) theory-driven interventions that target aetiological factors, and (3) assessment of feasibility.

The prevention of diabetes and cardiovascular disease in people with schizophrenia

OBJECTIVE

Primary prevention of diabetes and cardiovascular disease is an important priority for people with schizophrenia. This review aims to identify lifestyle and pharmacological interventions that reduce diabetes and cardiovascular disease in people with schizophrenia.

METHOD

PubMed and other electronic databases were searched to identify relevant articles.

RESULTS

Lifestyle interventions that focus on diet and physical activity reduce the incidence of diabetes. Similar programmes in people with schizophrenia have led to significant weight loss and may reasonably be expected to reduce diabetes in the long-term. Metformin may be considered when lifestyle change is not feasible or effective. Lifestyle interventions, particularly smoking cessation, are likely to be effective in reducing cardiovascular disease in people with schizophrenia. Although cardiovascular prevention trials with statins have not been performed in people with schizophrenia, similar reductions in cholesterol has been seen as in the general population and statins should be considered for those at high risk. Traditional cardiovascular risk prediction models perform well in identifying those at high cardiovascular risk, but bespoke prediction models using data from people with schizophrenia perform better.

CONCLUSION

Reducing diabetes and cardiovascular disease requires a coordinated and concerted effort from mental and physical health teams working across primary and secondary care.

Exercise prevents downregulation of hippocampal presynaptic proteins following olanzapine-elicited metabolic dysregulation in rats: Distinct roles of inhibitory and excitatory terminals

Schizophrenia patients treated with olanzapine, or other second-generation antipsychotics, frequently develop metabolic side-effects, such as glucose intolerance and increased adiposity. We previously observed that modeling these adverse effects in rodents also resulted in hippocampal shrinkage. Here, we investigated the impact of olanzapine treatment, and the beneficial influence of routine exercise, on the neurosecretion machinery of the hippocampus. Immunodensities and interactions of three soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) proteins (syntaxin-1, synaptosome-associated protein of 25kDa (SNAP-25) and vesicle-associated membrane protein (VAMP)), synaptotagmin and complexins-1/2 were quantified in the hippocampus of sedentary and exercising rats exposed over 9weeks to vehicle (n=28) or olanzapine (10mg/kg/day, n=28). In addition, brain sections from subgroups of sedentary animals (n=8) were co-immunolabeled with antibodies against vesicular GABA (VGAT) and glutamate (VGLUT1) transporters, along with syntaxin-1, and examined by confocal microscopy to detect selective olanzapine effects within inhibitory or excitatory terminals. Following olanzapine treatment, sedentary, but not exercising rats showed downregulated (33-50%) hippocampal densities of SNARE proteins and synaptotagmin, without altering complexin levels. Strikingly, these effects had no consequences on the amount of SNARE protein-protein interactions. Lower immunodensity of presynaptic proteins was associated with reduced CA1 volume and glucose intolerance. Syntaxin-1 depletion appeared more prominent in VGAT-positive terminals within the dentate gyrus, and in non-VGAT/VGLUT1-overlapping areas of CA3. The present findings suggest that chronic exposure to olanzapine may alter hippocampal connectivity, especially in inhibitory terminals within the dentate gyrus, and along the mossy fibers of CA3. Together with previous studies, we propose that exercise-based therapies might be beneficial for patients being treated with olanzapine.

Physical performance and disability in schizophrenia

Despite 50 years of pharmacological and psychosocial interventions, schizophrenia remains one of the leading causes of disability. Schizophrenia is also a life-shortening illness, caused mainly by poor physical health and its complications. The end result is a considerably reduced lifespan that is marred by reduced levels of independence, with few novel treatment options available.

Disability is a multidimensional construct that results from different, and often interacting, factors associated with specific types and levels of impairment. In schizophrenia, the most poignant and well characterized determinants of disability are symptoms, cognitive and related skills deficits, but there is limited understanding of other relevant factors that contribute to disability. Here we conceptualize how reduced physical performance interacts with aging, neurobiological, treatment-emergent, and cognitive and skills deficits to exacerbate ADL disability and worsen physical health. We argue that clearly defined physical performance components represent underappreciated variables that, as in mentally healthy people, offer accessible targets for exercise interventions to improve ADLs in schizophrenia, alone or in combination with improvements in cognition and health. And, finally, due to the accelerated aging pattern inherent in this disease – lifespans are reduced by 25 years on average – we present a training model based on proven training interventions successfully used in older persons. This model is designed to target the physical and psychological declines associated with decreased independence, coupled with the cardiovascular risk factors and components of the metabolic syndrome seen in schizophrenia due to their excess prevalence of obesity and low fitness levels.