We searched Medline, Scopus, PsycINFO, and CINAHL using the terms “psychosis”, “schizophrenia”, “severe mental illness”, “serious mental illness” with “physical health”, “weight”, “diet”, “exercise”, “smoking”, “tobacco”, “nicotine”, and “intervention”, “trial”, “therapy”, and “treatment”. We included results from trials in human beings published in English language journals. Relevant references for weight loss or attenuation of weight gain and smoking cessation cited in recent meta-analyses
ReviewMental health starts with physical health: current status and future directions of non-pharmacological interventions to improve physical health in first-episode psychosis
Introduction
Much evidence supports that living with and receiving treatment for a psychotic disorder are associated with substantial physical health deterioration.1, 2, 3, 4 People with schizophrenia have two to three times the risk of premature death compared with the general population, and this risk has increased over the past three decades.5 The risk equates to 10–25 years of life lost for people diagnosed with schizophrenia.6 Although treatment with antipsychotic medications and inequalities of access and quality of management in health-care treatment worldwide are implicated in this increased risk,2, 7 it can also be attributed to modifiable risk factors for cardiovascular disease, such as smoking, substance use, poor diet, insufficient physical activity, and overweight and obesity.8 Interest in non-pharmacological interventions to reduce the risk of early death for people with psychosis has increased in recent years.
Several systematic reviews and meta-analyses have already assessed non-pharmacological interventions for smoking cessation or reduction,9 exercise, diet, and weight loss in individuals with severe mental illness.10, 11, 12, 13, 14, 15 However, very little research in this topic has been undertaken in patients with a first episode of psychosis. This is surprising, because significant weight gain usually occurs in the first few months after initial treatment.16 Early intervention for smoking is particularly pertinent, because smoking cessation before the age of 30 years reduces long-term health risks to levels similar to those in non-smokers.17
Our narrative Review synthesises findings on physical health interventions in populations with severe mental illness based on the limited research reported in patients with first-episode psychosis, which have largely focused on weight gain or smoking cessation. We briefly summarise the present evidence for physical health interventions, pointing to limitations that might be addressed through a proposed framework to guide development of interventions. Because development of interventions has rarely been driven by theory, with little attention paid to mechanisms of action for behaviour change, our proposed framework for early interventions to achieve many changes in behaviour around physical health is based on an empirically tested theory of motivation and behaviour change.
Section snippets
Current status of non-pharmacological interventions
The increased risk of cardiovascular disease due to overweight or obesity means that studies of interventions to improve physical health have focused primarily on how exercise and diet interventions can lead to weight loss or attenuate weight gain. Five studies12, 13, 14, 15, 18 in our Review included patients with chronic and first episodes of psychosis, and these suggest that weight loss is achievable but that the magnitude of actual loss is small, roughly 2–4% of initial bodyweight.12, 13
Diet, exercise, and smoking
To date, evidence from two randomised trials34, 21 and one controlled trial26 in patients with first-episode psychosis suggests that prevention of weight gain is an achievable outcome, but the effects are not maintained.40 Alvarez-Jimenez and colleagues21 and Curtis and colleagues26 showed that a multicomponent intervention that addressed diet and exercise resulted in less weight gain for participants who received the intervention than controls. Lovell and colleagues34 reported the results of a
A framework for development of interventions
Previous studies of interventions to improve physical health outcomes have faced challenges, including non-clinically significant weight loss, limited evidence for maintenance of weight loss, and insufficient evidence for smoking-cessation interventions. Although early intervention for physical health problems in patients with a first episode of psychosis is likely to result in improved physical and mental health outcomes, further research into long-term outcomes is needed. To address the
Conclusion
Interventions for weight loss and smoking cessation have primarily been investigated in individuals experiencing chronic forms of psychosis. It is promising to see physical health interventions being used for individuals with a first episode of psychosis, but significant research in this topic is lacking. To date, findings from intervention studies with individuals experiencing continuing psychotic illness show that weight loss is achievable—but minimal—and not sufficient to reduce
Search strategy and selection criteria
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2022, Journal of Affective DisordersCitation Excerpt :Therefore, interventions focusing on reducing risky alcohol consumption, and increasing physical activity can be effective in reducing depressive symptoms. Such efforts to improve these factors in those presenting with depressive symptoms are also primordial to increase the quality of life and protect physical health (Ashdown-Franks et al., 2020; Firth et al., 2019; Gates et al., 2015; Gilbody et al., 2019; Rüther et al., 2014). Our results should be interpreted in light of some limitations.
In- and outpatient lifestyle interventions on diet and exercise and their effect on physical and psychological health: a systematic review and meta-analysis of randomised controlled trials in patients with schizophrenia spectrum disorders and first episode of psychosis
2021, Neuroscience and Biobehavioral ReviewsCitation Excerpt :Concerning to the duration of exercise, emerging data suggest that symptomatic or functional benefit in this population is observed with 150 minutes of moderate-vigorous physical activity per week (Ashdown-Franks et al., 2020; Ohi et al., 2019) or 30 minutes of AE at a minimum of 50% peak O2 consumption (VO2 max) for each session (Sabe et al., 2020), while group approaches may enhance treatment adherence (Vogel et al., 2019). Moreover, it is possible that the effectivity of these programs may be higher in patients with first episode of psychosis (FEP) or relatively newly diagnosed SSD, as these patients have still relatively preserved cognitive and psychological functioning and may be more suitable for lifestyle intervention (Gates et al., 2015). To date, many authors have been devoted to the study of the efficacy of non-pharmacological interventions in psychiatric population through review of previous RCTs.
Cognitive ability and metabolic physical health in first-episode psychosis
2021, Schizophrenia Research: CognitionThe Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness
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