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0000-0001-6769-8421
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UNSW Sydney
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Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.SCHRES.2018.02.035
Abstract: To comprehensively assess cardio-metabolic risk factors and their management in a large s le of outpatients treated with clozapine. Observational cross-sectional study of all clozapine users attending specialized clozapine monitoring outpatient clinics in three public hospitals in Sydney, Australia were approached to participate over the one-year period 01/10/2015-30/09/2016. Cardio-metabolic risk factors including metabolic syndrome, risk for future development of diabetes, smoking, physical activity, nutrition, and prescribed medications were assessed at face-to-face interview and through medical record review. Among patients who had cardio-metabolic risk factors, the proportion receiving appropriate management was assessed. Of 451 registered clozapine clinic attenders, 92.2% completed questionnaires and anthropometric measurements. 58.3% met criteria for metabolic syndrome. 79.6% were overweight or obese. 55.9% had blood pressure meeting metabolic syndrome criteria. 46.6% had elevated fasting blood glucose and 55.2% had elevated blood triglycerides. 43.6% were current smokers. Only 10% achieved recommended weekly physical activity levels. Unhealthy food categories were highly consumed. 32.1% were on additional antipsychotics. In the majority of in iduals, cardio-metabolic risk factors were untreated or under-treated. Clozapine use was associated with very high rates of cardiovascular and metabolic risk factors, which were frequently under-treated. Management of both physical and mental health should be prioritized. Polypharmacy should be rationalized. Future research should investigate the effectiveness of smoking cessation and lifestyle interventions in this high-risk population.
Publisher: Wiley
Date: 15-07-2022
DOI: 10.1002/HPJA.633
Abstract: People with severe mental illness have adverse health outcomes compared to the general population. Lifestyle interventions are effective in improving health outcomes in this population. Current cultural processes in mental health services do not generally incorporate physical health care practices. Innovative education is required to improve knowledge and confidence of staff in the delivery of preventative health measures. The Keeping our Staff in Mind (KoSiM) program delivered a brief lifestyle intervention to mental health staff. A qualitative analysis following the Standards for Reporting Qualitative Research was undertaken. Semi‐structured interviews designed to elicit information about the acceptability of the program and the impact of the intervention on participants' personal and professional lives. The interviews were analysed using thematic analysis, with coding independently developed and reviewed by three authors. Of the 103 eligible participants, 75 were interviewed. Responses revealed four main themes: (i) positive changes in clinician's approach to physical health care, (ii) improvements in attitudes to self‐care and family wellbeing, (iii) positive changes in workplace culture associated with physical health care delivery and (iv) high levels of acceptability of the program. The KoSiM model may be useful in other settings as a means of changing the culture of mental health services to better integrate physical health care as a core part of mental health service provision. A novel approach using staff focussed lifestyle interventions model may cut through the resistance that is encountered when implementing proven methods of clinical intervention where cultural barriers exist.
Publisher: Elsevier BV
Date: 05-2020
Publisher: MDPI AG
Date: 27-12-2022
Abstract: Disordered eating behaviors are common in people with a serious mental illness (SMI) such as schizophrenia, bipolar disorder and major depressive disorder. This study employed qualitative exploration to understand the perceived determinants of eating behaviors, in particular those connected to disordered eating patterns, in people with SMI. In total, 28 semi-structured interviews were conducted in a consecutive s le of people with SMI under treatment in local mental health services in Australia (n = 12), Germany (n = 8) and Austria (n = 8) (mean age: 43.3 years, proportion of female participants: 61%, proportion of participants with ICD-10 F2 diagnosis: 57%, proportion of participants with ICD-10 F3 diagnosis: 64%). A thematic analysis approach, the framework method, was applied using MAXQDA 2020. Three main themes of determinants were derived: (i) impacts to daily functioning, (ii) disrupted physical hunger cues and (iii) emotional hunger. For impacts to daily functioning, the following themes emerged: lack of daily structure, time and drive, and difficulty planning ahead. For physical hunger, themes emerged for disrupted hunger and satiety cues, and mindless eating. All motives listed in the Palatable Eating Motives Scale (PEMS), i.e., coping, reward, social and conformity, have been reported by participants to be drivers for their emotional eating behavior. Subsequent reported behaviors were eating too much or too little, binge eating, night eating and food cravings. We conclude that interprofessional approaches should target daily functioning, disrupted physical hunger cues and emotional eating to reduce disordered eating behaviors in people with SMI.
Publisher: Wiley
Date: 30-10-2016
Publisher: © Georg Thieme Verlag KG
Date: 06-2020
Publisher: MDPI AG
Date: 27-10-2021
Abstract: People living with serious mental illness (SMI) experience physical health complications at disproportionate rates to people without an SMI. Unhealthy dietary intake and disordered eating behaviors are key driving factors. There is a lack of valid nutrition-risk screening tools targeted to mental health services, and typically used nutrition-risk screening tools are not suitable for mental health services. This paper details the rationale and study protocol for development and validation of the NutriMental screener, a tool for use in clinical practice to identify service users who are at risk for common nutrition issues experienced by this population group and trigger referral to a specialist clinician. The development process includes five phases. Phase I is the development of nutrition-related domains of interest from screening tools used in mental health services. Phase II involves a literature review and service-user interviews to identify additional domains. Phase III consists of international workshops with relevant clinicians and persons with SMI to gain a consensus on questions to be included in the draft tool. Phase IV involves conducting multinational feasibility and preliminary validation studies. Phase V consists of performing formal validation studies. The development of a nutrition-risk screening tool for mental health services is a necessary step to help rectify the physical-health disparities and life-expectancy gap for people with SMI.
Publisher: Cambridge University Press (CUP)
Date: 04-2020
DOI: 10.1017/S0007114520001191
Abstract: People with severe mental illness (SMI) have numerous risk factors that may predispose them to food insecurity (FI) however, the prevalence of FI and its effects on health are under-researched in this population. The present study aimed to describe the prevalence of FI and its relationship to lifestyle factors in people with SMI. This cross-sectional study recruited people with SMI receiving long-acting injectable (LAI) antipsychotic medication from community services at three sites in Sydney, Australia. Assessments were completed on physical health and lifestyle factors. χ 2 Tests, independent-s les t tests and binary logistic regression analyses were calculated to examine relationships between lifestyle factors and FI. In total, 233 people completed the assessments: 154 were males (66 %), mean age 44·8 ( sd 12·7) years, and the majority (70 %) had a diagnosis of schizophrenia. FI was present in 104 participants (45 %). People with FI were less likely to consume fruits (OR 0·42, 95 % CI 0·24, 0·74, P = 0·003), vegetables (OR 0·39, 95 % CI 0·22, 0·69, P = 0·001) and protein-based foods (OR 0·45, 95 % CI 0·25, 0·83, P = 0·011) at least once daily, engaged in less moderate to vigorous physical activity (min) (OR 0·997, 95 % CI 0·993, 1·000, P = 0·044), and were more likely to smoke (OR 1·89, 95 % CI 1·08, 3·32, P = 0·026). FI is highly prevalent among people with SMI receiving LAI antipsychotic medications. Food-insecure people with SMI engage in less healthy lifestyle behaviours, increasing the risk of future non-communicable disease.
Publisher: Wiley
Date: 09-09-2019
DOI: 10.1002/WPS.20672
Publisher: Wiley
Date: 07-09-2018
DOI: 10.1002/WPS.20571
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-04-2020
Publisher: Oxford University Press (OUP)
Date: 13-08-2021
DOI: 10.1111/BJD.20567
Abstract: Frontal fibrosing alopecia (FFA) has become one of the most common causes of cicatricial alopecia worldwide. However, there is a lack of clear aetiology and robust clinical trial evidence for the efficacy and safety of agents currently used for treatment. To enable data to be collected worldwide on FFA using common criteria and assessment methods. A multicentre, international group of experts in hair loss was convened by email to create consensus recommendations for clinical trials. Consensus was defined at > 90% agreement on each recommended part of these guidelines. Standardized diagnostic criteria, severity rating, staging, and investigator and patient assessment of scalp hair loss and other clinical features of FFA were created. These guidelines should allow the collection of reliable aggregate data on FFA and advance efforts in both clinical and basic research to close knowledge gaps in this condition.
Publisher: Elsevier BV
Date: 02-2022
Publisher: Emerald
Date: 20-08-2021
DOI: 10.1108/JMHTEP-12-2020-0086
Abstract: This paper aims to examine student exercise physiologists (EPs) and student dietitians’ confidence regarding working with people with severe mental illness (SMI) pre- and post-practicum in a mental health service. This single-arm, quality improvement project included students completing practicum within a lifestyle programme embedded in mental health services. Student EPs completed 100 h of practicum across 15 weeks as part requirement for their Bachelor of Exercise Physiology degree and student dietitians completed six weeks full-time (40 h/week) for the part requirement of their Master of Nutrition and Dietetics. Students completed the Dietetic Confidence Scale (terminology was adapted for student EPs) pre- and post-practicum. In total, 27 student EPs and 13 student dietitians completed placement and returned pre- and post-practicum questionnaires. Pre-practicum confidence scores were 90.8 ± 17.1 and 86.9 ± 18.9 out of a possible 140 points for student EPs and student dietitians, respectively. Confidence scores increased substantially post-practicum for both student EPs [mean difference (MD) = 29.3 ± 18.8, p 0.001, d = 1.56] and dietitian students (MD = 26.1 ± 15.9, p = 0.002, d = 1.64). There were significant improvements in confidence across all domains of the confidence questionnaire for both EPs and dietitian students. There is a research gap in understanding the confidence levels of student EPs’ and student dietitians’ when working with people with mental illness and the impact that undertaking a practicum in a mental health setting may play. To the best of the authors’ knowledge, this is the first study to explore student EP and student dietitian confidence in working with people with SMI pre- and post-practicum in a mental health setting.
Publisher: Springer Science and Business Media LLC
Date: 25-08-2018
Publisher: Informa UK Limited
Date: 16-11-2021
Publisher: MDPI AG
Date: 24-06-2022
DOI: 10.3390/NU14132616
Abstract: The impact of poor diet quality and nutritional inadequacies on mental health and mental illness has recently gained considerable attention in science. As the opinions and experiences of people living with serious mental illness on dietary issues are unknown, we aimed to understand the role of nutrition in a biopsychosocial approach. In total, 28 semi-structured interviews were conducted with people living with serious mental illness (SMI) in Australia, Germany and Austria, and a generic thematic analysis approach was applied. Four positive (positive effects on the body and mind, therapeutic effects in treating somatic illnesses, pleasure and opportunity for self-efficacy) and three negative (impairment related to mental illness and its treatment, perceived stigma and negative effects on the body and mind) implications of diet were identified. A key issue for most of the participants was the mental burden arising from their body weight. This might indicate that negative implications, such as guilt and stigma, were of primary importance for people with SMI when talking about their dietary behavior. In conclusion, diet-related support is urgently needed for people with SMI. However, especially participants from Germany and Austria reported that this is not yet widely available in mental health settings, leading to hopelessness and resignation.
Publisher: Frontiers Media SA
Date: 24-12-2018
Publisher: Georg Thieme Verlag KG
Date: 06-2021
Publisher: Elsevier BV
Date: 04-2014
Publisher: Wiley
Date: 28-01-2020
DOI: 10.1002/HPJA.320
Abstract: People living with mental illness die on average 15 years earlier than the general population, primarily due to preventable and premature cardiovascular disease. Lifestyle interventions can be effective in reducing cardiovascular risk, yet mental health services do not routinely provide targeted lifestyle interventions. Exposing mental health staff to lifestyle interventions prior to targeting patients may be critical to changing culture and improving patient outcomes. This study aimed to improve the physical health of mental health staff through a targeted lifestyle intervention. A pragmatic single-arm intervention study was conducted in a public mental health service, including inpatient and community settings, in Sydney, Australia. Participants in this study were n = 212 clinical and non-clinical staff. A five-session in idualised lifestyle intervention (delivered over 5 weeks) incorporating physical activity and nutritional counselling was delivered by multidisciplinary teams. Participants were assessed at baseline, following the intervention, and at follow-up (mean = 16.7 weeks). The primary outcome was the barriers, attitudes, knowledge and confidence regarding screening, promoting and intervening to improve physical health outcomes of patients (M-BACK questionnaire). Secondary outcomes included anthropometric measures, cardiorespiratory fitness, sedentary time and nutritional intake. Repeated measures ANCOVAs were performed. A total of 212 staff (79% female) participated in this study. M-BACK total score significantly increased from baseline to follow-up (P < .001). Waist circumference, sedentary time and total energy intake all significantly decreased (all P's < .001) and cardiorespiratory fitness significantly increased (P < .001). A brief lifestyle intervention for staff of a public mental health service may increase the capability of the participants to improve their own physical health. SO WHAT?: Improving staff health may be an important strategy in improving the uptake and/or the effectiveness of lifestyle interventions targeting mental health service users.
Publisher: Elsevier BV
Date: 08-2019
Publisher: Springer Science and Business Media LLC
Date: 19-12-2015
DOI: 10.1007/S10597-014-9787-7
Abstract: In idual dietetic consultations were trialled in a community-based first-episode psychosis program. Participants received eight in idualised dietetic consultations, plus weekly shopping tours and cooking groups. The outcome measure was waist circumference (WC). In total, 30 patients commenced the program. An intention-to-treat analysis revealed, a statistically significant reduction in WC (mean=2.1±5.4 cm, t=2.1, df=29, p=0.04). Similar results were found for the 14 participants who attended all eight sessions (mean WC reduction=2.9±4.7 cm, t=2.3, df=13, p=0.04). Dietetic consultations were feasible and effective in reducing WC, and could enhance programs to reduce cardiometabolic risk in youth with psychosis using lifestyle interventions.
Publisher: Oxford University Press (OUP)
Date: 30-11-2018
Publisher: Wiley
Date: 02-10-2022
DOI: 10.5694/MJA2.51680
Abstract: To review recent published trials of nutrition and dietary interventions for people with serious mental illness to assess their effectiveness in improving metabolic syndrome risk factors. Systematic review and meta-analysis of randomised and non-randomised controlled trials of interventions with a nutrition/diet-related component delivered to people with serious mental illness, published 1 January 2010 - 6 September 2021. Primary outcomes were weight, body mass index (BMI), and waist circumference. Secondary outcomes were total serum cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, triglyceride, and blood glucose levels. MEDLINE, EMBASE, PsycINFO, CINAHL, and CENTRAL databases. In addition, reference lists of relevant publications were examined for further additional studies. Twenty-five studies encompassing 26 intervention arms were included in our analysis. Eight studies were at low or some risk of bias, seventeen were deemed to be at high risk. Eight of seventeen intervention arms found statistically significant intervention effects on weight, ten of 24 on BMI, and seven of seventeen on waist circumference. The pooled effects of nutrition interventions on metabolic syndrome risk factors were statistically non-significant. However, we identified small size effects on weight for interventions delivered by dietitians (five studies 262 intervention, 258 control participants standardised mean difference [SMD], -0.28 95% CI, -0.51 to -0.04) and interventions consisting of in idual sessions only (three studies 141 intervention, 134 control participants SMD, -0.30 95% CI, -0.54 to -0.06). We found only limited evidence for nutrition interventions improving metabolic syndrome risk factors in people with serious mental illness. However, they may be more effective when delivered on an in idual basis or by dietitians. CRD42021235979 (prospective).
Publisher: MDPI AG
Date: 20-08-2021
DOI: 10.3390/NU13082862
Abstract: People with serious mental illness (SMI) experience challenges that may make typical dietary assessment methods less feasible and accurate. This study aims to determine the feasibility, acceptability and preliminary validity of a 3-day photographic food record (PR), a 1-day food diary (FD) and a 1-day weighed food protocol (WR) in people with SMI. Participants completed measures at two timepoints, with a 4-week interval. Feasibility and acceptability for each method were measured through four outcomes: percent of completers, quality assessment, number of participants requiring technical devices and satisfaction questionnaire. Relative validity was measured by agreement in estimated energy intake between methods, using Bland–Altman analysis and WR as the benchmark, and prevalence of misreporting, using the Goldberg cut-off method, updated by Black. In total, 63 participants were recruited, with a dropout rate of 19.0% prior to timepoint 1 and additional 6.4% prior to timepoint 2. Quality deficits were identified for all methods. The FD was most acceptable to participants, followed by the PR. The difference in estimated energy intake between assessment methods was not statistically significant, though there was considerable in idual variability. Underreporting was considerable across all methods but appeared highest in the PR. A FD and PR present as feasible and acceptable methods for assessing dietary intake in people with SMI. Further validity testing is required. In addition, clear guidance for completion and removal of potential barriers is required for participants.
Publisher: Wiley
Date: 19-09-2021
DOI: 10.1002/HPJA.538
Abstract: The COVID‐19 pandemic and associated social distancing regulations have disproportionally impacted the health of older adults. Lifestyle interventions targeting physical activity, diet and fostering social connection may help to alleviate the potential negative health consequences. This study aimed to determine the feasibility and preliminary effectiveness of delivering an online group lifestyle intervention for older adults during the COVID‐19 pandemic. Adults aged 60+, living in Australia were recruited to a single‐arm feasibility study of a 6‐week program delivered via a private Facebook group between June‐August 2020. Facilitators provided motivation and education on weekly topics including goal setting and reducing sedentary behaviour in the form of Facebook posts and group video calls. Primary outcomes included feasibility and acceptability and secondary outcomes included psychological distress, quality of life (AQoL‐6D), functioning, loneliness and physical activity (PA) with assessments conducted at baseline, post‐intervention and 4‐week follow‐up. N = 11 participants were recruited and n = 10 (91%) completed the post‐assessment questionnaires. High acceptability was observed and exploratory analysis from pre‐post intervention found evidence of an effect on secondary outcomes. A mental health informed lifestyle program delivered online via Facebook appears feasible and well‐accepted among older adults and may help to prevent some of the consequences of inactivity and social isolation associated with the pandemic. Online lifestyle interventions appear safe and may provide a scalable, cost‐effective strategy for protecting the physical and mental health of older adults during the COVID‐19 pandemic.
Publisher: JMIR Publications Inc.
Date: 07-12-2021
Abstract: mergency service workers are at an increased risk of experiencing poor mental health due to prolonged, repeated exposure to potentially traumatic events. Promoting healthy lifestyle behaviours including physical activity and diet may help to mitigate some the consequences of emergency service work. his study aimed to evaluate the impact of an online physical activity and diet intervention on levels of psychological distress among emergency service workers and their nominated support partner e.g., spouse, family member close friend. e delivered a 10-week physical activity program via a private Facebook group. The Facebook group was co-facilitated by exercise physiologists, a dietitian and peer-facilitators. Weekly modules on overcoming barriers to exercise, self-monitoring of activity and nutrition were delivered. Participants could also join weekly group telehealth calls and were provided with a physical activity tracking device. A stepped-wedge design was applied to compare levels of psychological distress (Kessler-6) during baseline, to intervention by comparing slopes of change. Visual inspection of the data was used to identify the location for a knot point. Then separate slopes were modelled for a) baseline b) intervention slope 1 c) intervention slope 2 d) change in level of knot points. Secondary outcomes included a pre-post assessment of mental health symptoms, physical activity levels, quality of life, social support to exercise, sleep quality and suicidal ideation. n total, N=90 participants (n=47 emergency service workers and n=43 support partners) were recruited in 4 separate cohorts (mean age 42.3(SD=11.5) years, 51% male). Levels of psychological distress did not change significantly during the baseline (control) slope, while during the first 6 weeks of intervention (intervention slope 1) levels reduced significantly. The interaction between baseline and intervention slopes were significant, b=-0.351, p = 0.003, (i.e., the trajectories of change were significantly different) and improvements plateaued until the 4-week follow up (intervention slope 2). Participation was associated with improvements in mental health symptoms, weekly minutes of physical activity, sedentary time and quality of life. Retention in the intervention was high (92%). 10-week physical activity intervention delivered via social media is feasible and effective in improving psychological distress among emergency service workers and their support partners. Future research should consider investigating the factors mediating changes in health behaviours and outcomes. ustralian New Zealand Clinical Trials Registry (ACTRN): 12619000877189. R2-10.1136/bmjopen-2019-030668
Publisher: MDPI AG
Date: 02-03-2021
DOI: 10.3390/NU13030822
Abstract: Nutritional interventions have beneficial effects on certain psychiatric disorder symptomatology and common physical health comorbidities. However, studies evaluating nutritional literacy in mental health professionals (MHP) are scarce. This study aimed to assess the across 52 countries. Surveys were distributed via colleagues and professional societies. Data were collected regarding self-reported general nutrition knowledge, nutrition education, learning opportunities, and the tendency to recommend food supplements or prescribe specific diets in clinical practice. In total, 1056 subjects participated in the study: 354 psychiatrists, 511 psychologists, 44 psychotherapists, and 147 MHPs in-training. All participants believed the diet quality of in iduals with mental disorders was poorer compared to the general population (p 0.001). The majority of the psychiatrists (74.2%) and psychologists (66.3%) reported having no training in nutrition. Nevertheless, many of them used nutrition approaches, with 58.6% recommending supplements and 43.8% recommending specific diet strategies to their patients. Only 0.8% of participants rated their education regarding nutrition as ‘very good.’ Almost all (92.9%) stated they would like to expand their knowledge regarding ‘Nutritional Psychiatry.’ There is an urgent need to integrate nutrition education into MHP training, ideally in collaboration with nutrition experts to achieve best practice care.
Publisher: Wiley
Date: 04-10-2021
Abstract: The present study aimed to measure the prevalence and severity of food insecurity in people with a severe mental illness, defined as schizophrenia and related psychoses, and bipolar disorder and explore relationships between food insecurity status, and sociodemographic and clinical characteristics. This cross‐sectional study recruited community‐dwelling people with severe mental illness receiving clozapine and/or a long‐acting injectable antipsychotic medication within three mental health services in Sydney, Australia. Participants completed the 18‐item Household Food Insecurity Access Scale. Sociodemographic and medical information was obtained from participants' medical records. Independent s les t ‐test and chi‐square analyses were used to test for between group differences based on food insecurity status. Binary logistic regression analyses adjusting for age and gender were used to determine the odds ratio. One‐hundred and eighty‐eight people completed the assessment: 63% were male, mean age was 49.2 ± 12.4 years, and the majority (85%) had a diagnosis of schizophrenia. Food insecurity was detected in 31% of participants. Of those who were food insecure, 12% were classified as severe, 13% as moderate and 7% as mild. Tobacco smoking was higher in food insecure people compared to food secure people (odds ratio = 3.1, 95% CI 1.3 to 7.1, p = 0.01). Food insecurity status was not associated with demographic, diagnostic or other clinical data. Food insecurity is highly prevalent among community‐dwelling people with severe mental illness receiving clozapine and/or long‐acting injectable antipsychotic medication. Food security screening should be considered as routine care for this population group.
Publisher: SAGE Publications
Date: 03-06-2015
Publisher: Wiley
Date: 12-09-2021
Abstract: This scoping review aimed to explore the extent of the evidence of experimental studies evaluating the cost effectiveness of dietary interventions in in iduals with mental disorders. Five databases (CINAHL, EMBASE, MEDLINE, PsycINFO and Scopus) were searched to October 2020 for cost‐analysis studies of interventions aiming to improve dietary intake in people with mental disorders. No restriction was placed on participant age, mental disorder type or intervention design. Results are presented narratively. Of 2753 articles identified, 13 articles reporting on eight studies were included. Studies were RCTs ( n = 5), cluster RCT ( n = 1), cluster preference RCT ( n = 1), and pre‐post test ( n = 1). Seven studies were in community settings (eg, outpatient clinics), and one study in the community housing setting. All studies were in adults, seven included male and female participants, and one included only females. Defined mental disorder diagnoses included serious/severe mental disorders ( n = 3), major depression ( n = 2), schizophrenia, schizoaffective disorder or first‐episode psychosis ( n = 1), any mental disorder ( n = 1), and bulimia nervosa ( n = 1). Five interventions were multi‐behaviour, two were diet only and one was eating disorder treatment. Cost analyses included cost‐utility ( n = 3), cost‐effectiveness ( n = 1), cost‐utility and cost‐effectiveness ( n = 3), and a costing study ( n = 1). Two studies (25%) reported positive results in favour of cost effectiveness, and four studies reported a mix of positive and neutral results. There is limited evidence evaluating the cost effectiveness of dietary interventions in in iduals with mental disorders. Additional studies in various settings are needed to confirm cost effectiveness of different interventions.
Publisher: MDPI AG
Date: 11-2022
DOI: 10.3390/PATHOGENS11111279
Abstract: The microbiome has been implicated in the development of metabolic conditions which occur at high rates in people with schizophrenia and related psychoses. This exploratory proof-of-concept study aimed to: (i) characterize the gut microbiota in antipsychotic naïve or quasi-naïve people with first-episode psychosis, and people with established schizophrenia receiving clozapine therapy (ii) test for microbiome changes following a lifestyle intervention which included diet and exercise education and physical activity. Participants were recruited from the Eastern Suburbs Mental Health Service, Sydney, Australia. Anthropometric, lifestyle and gut microbiota data were collected at baseline and following a 12-week lifestyle intervention. Stool s les underwent 16S rRNA sequencing to analyse microbiota ersity and composition. Seventeen people with established schizophrenia and five people with first-episode psychosis were recruited and matched with 22 age-sex, BMI and ethnicity matched controls from a concurrent study for baseline comparisons. There was no difference in α- ersity between groups at baseline, but microbial composition differed by 21 taxa between the established schizophrenia group and controls. In people with established illness pre-post comparison of α- ersity showed significant increases after the 12-week lifestyle intervention. This pilot study adds to the current literature that detail compositional differences in the gut microbiota of people with schizophrenia compared to those without mental illness and suggests that lifestyle interventions may increase gut microbial ersity in patients with established illness. These results show that microbiome studies are feasible in patients with established schizophrenia and larger studies are warranted to validate microbial signatures and understand the relevance of lifestyle change in the development of metabolic conditions in this population.
Publisher: Cambridge University Press (CUP)
Date: 04-04-2016
DOI: 10.1017/S0007114516001033
Abstract: Severe mental illness is characterised by a 20-year mortality gap due to cardiometabolic disease. Poor diet in those with severe mental illness is an important and modifiable risk factor. The present study aimed to (i) examine baseline nutritional intake in youth with first-episode psychosis (FEP), (ii) evaluate the feasibility and acceptability of nutritional intervention early in FEP and (iii) to evaluate the effectiveness of early dietary intervention on key nutritional end points. Participants were recruited over a 12-month period from a community-based programme specifically targeting young people aged 15–25 years with newly diagnosed FEP. In idual dietetic consultations and practical group sessions were offered as part of a broader lifestyle programme. Dietary assessments were conducted before and at the end of the 12-week intervention. Participants exceeded recommended energy and Na intakes at baseline. Retention within the nutrition intervention was 67 %, consistent with other interventions offered to FEP clients. There was a 47 % reduction in discretionary food intake (−94 g/d, P ·001) and reductions in daily energy (−24 %, P ·001) and Na (−26 %, P ·001) intakes. Diet quality significantly improved, and the mean change was 3·6 (95 % CI 0·2, 6·9, P ·05), although this finding was not significant after Bonferroni’s correction. Increased vegetable intake was the main factor contributing to improved diet quality. Nutrition intervention delivered shortly after initiation of antipsychotic medication is feasible, acceptable and effective in youth with FEP. Strategies to prevent weight gain and metabolic decline will contribute to prevent premature cardiometabolic disease in this vulnerable population.
Publisher: Royal College of Psychiatrists
Date: 20-02-2019
DOI: 10.1192/BJP.2019.20
Abstract: 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. To conduct a systematic, comprehensive evaluation of the published research on dietary intake in psychotic disorders and bipolar disorder. 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. 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 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. These dietary components should be key targets for preventative interventions to improve weight and other physical health outcomes in people with SMI. S.B.T. and E.T. have clinical dietitian appointments within the South Eastern Sydney Local Health District and do not receive any further funding.
Publisher: Wiley
Date: 15-08-2021
DOI: 10.1002/HPJA.377
Abstract: 1) Describe the dietary intake of mental health staff within South Eastern Sydney Local Health District and 2) Evaluate the impact of an in idualised staff lifestyle program on the following nutrition parameters (i) energy, (ii) core food groups and (iii) discretionary foods. This was a pragmatic single‐arm intervention study, conducted for all staff working in a public mental health service, in Sydney, Australia. A five‐session in idualised lifestyle intervention delivered over 5 weeks incorporated nutritional counselling delivered by a dietitian. Participants were assessed at baseline, following the intervention, and at follow‐up using diet history to assess dietary intake. Eighty‐eight staff completed the dietary intervention and follow‐up. An intake of core food groups significantly below national recommendations was reported for total vegetables (−1.75 ± 0.14 serves, P .001), fruit (−0.29 ± 0.11 serves, P = .01), grains (−1.25 ± 0.20 serves, P .001) and dairy servings (−1.00 ± 1.08 serves, P .001), and protein‐based foods were significantly above national recommendations (0.2 ± 0.09 serves, P = .03). At completion of the program, energy from discretionary foods was reduced by 460 kJ (95% CI −635 to −285, P .001), and the serves of total vegetables (0.91 serves, 95% CI 0.59‐1.22, P .001) and dairy (0.31 serves, 95% CI 0.11‐0.50, P .001) were increased significantly. A workplace‐based well‐being program for staff working in the mental health setting coincided with dietary improvements. Mental health staff can act as positive role models for clients to promote developing positive physical health behaviours.
Publisher: Elsevier BV
Date: 09-2021
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.PSYCHRES.2019.112606
Abstract: People living with severe mental illness (SMI) experience significant physical health co-morbidity. Few studies have focused on physical health outcomes for those prescribed long-acting injectable (LAI) antipsychotics. This observational cross-sectional study aimed to assess the prevalence of metabolic syndrome (MetS) and other cardio-metabolic risk factors in a large cohort prescribed LAI and managed by community mental health services. For participants with elevated cardio-metabolic risk factors, the proportion receiving appropriate management was assessed. Of the 301 eligible participants, many met the full criteria for MetS (44%) and its components. Cardio-metabolic risk factors were largely under- or un-treated. Smoking rates were very high (62%) along with reported high rates of physical inactivity and poor dietary intake. The vast majority (89%) reported seeing their general practitioner in the preceding twelve months. In iduals prescribed LAI have a very high prevalence of MetS and potentially modifiable risk factors for cardiovascular disease. Routine monitoring accompanied by evidence-based treatment of cardiometabolic abnormalities which contribute to significant morbidity, disability and premature death should be prioritised. Better collaboration between mental health services and primary care providers should be pursued to optimise the delivery of effective physical health care to in iduals living with SMI.
Publisher: Wiley
Date: 27-06-2020
Abstract: The aim of this study was to comprehensively assess dietary intake, nutrition knowledge and food addiction in young people with mental illness. This was a three-arm cross-sectional study of 16-25-year-olds attending community mental health services who met criteria for: (i) first-episode psychosis (FEP), (ii) ultra-high risk for psychosis (UHR) or (iii) depression/anxiety. Participants self-completed three validated questionnaires: (i) Australian Eating Survey, (ii) General Nutrition Knowledge Questionnaire-Revised and (iii) Yale Food Addiction Score Questionnaire. Thirty participants (mean age 19.7 ± 2.5 years) completed the study (10 per study arm) 43% of the energy intake was obtained from energy-dense, non-nutritious foods, higher than the recommended upper limit (<15%) and the levels reported in the general population (35%). Mean diet quality score was 33.5 ± 11.8 of 73. Mean food addiction symptom score was 3.3 ± 3.7. Prevalence of food addiction was 37%. Nutrition knowledge was lower in the FEP and UHR participants than the depression/anxiety group (48.2 ± 13.8 and 49.5 ± 8.2 of 88 respectively) however, this difference was not statistically significant. Unhealthy dietary intake was observed in the early stages of mental illness, likely seeding future poor physical health. Further research is needed on the role of food addiction in this population, including effective intervention techniques.
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.ORCP.2019.02.003
Abstract: Severe mental illness is characterised by a 15-year mortality gap driven by cardiometabolic disease. Antipsychotic treatment leads to increased appetite and rapid weight gain. The 12-week lifestyle pilot intervention improved dietary intake and prevented antipsychotic-induced weight gain. Here we report two-year outcomes. Participants were exposed to an extended program. Weight and waist circumference were measured, and food frequency questionnaire completed. Diet quality was higher, and discretionary food intake was 40% lower, at two-years compared to baseline. Weight and waist-circumference did not increase. This pilot study demonstrated sustained effectiveness of a dietetic intervention in youth with first-episode psychosis with improvements in diet quality and no increase in weight secondary to antipsychotic medication initiation.
Publisher: Cambridge University Press (CUP)
Date: 17-07-2018
Publisher: Wiley
Date: 15-12-2020
DOI: 10.1111/INM.12683
Abstract: The life expectancy gap experienced by people living with severe mental illness is primarily a result of cardiometabolic disease that is often exacerbated by side effects of antipsychotic medication. Commencement of atypical antipsychotic medication is commonly associated with weight gain. The Keeping the Body in Mind programme has demonstrated that early intervention with lifestyle activities can attenuate this weight gain and potentially improve long-term health outcomes. The aim of this study was to explore the experiences of young people who participated in the Keeping the Body in Mind programme, a targeted lifestyle intervention programme. A qualitative approach was used employing a semi-structured interview format. The interview schedule included questions related to four topics: aspects of the programmes that were useful, attributes of staff members that influenced the programme, changes in attitudes towards their own physical health, and suggestions for programme improvements. Interviews were recorded with duration ranging from 40 to 65 min. Thematic analysis was used to detect and assemble codes. These were then synthesized and classified into themes. Eleven participants were interviewed (seven males), aged between 18 and 25 years. Thematic analysis revealed four main themes: the role of physical health in mental health recovery the importance of staff interactions the value of peer interaction and graduation to a sustainable healthy lifestyle. Study participants reported that they valued the programme for both their physical health and mental health recovery.
Publisher: Wiley
Date: 18-09-2020
DOI: 10.1111/EIP.12871
Abstract: Youth with at-risk mental states (ARMS) have low levels of physical activity (PA), reduced fitness levels and experience poor sleep quality. These lifestyle factors exacerbate mental health symptoms and increase cardiometabolic disease risk. PA interventions can help prevent this decline in physical health whilst reducing mental health symptom severity. Whether PA interventions are feasible and acceptable amongst youth with ARMS is unclear. This study evaluated the feasibility and acceptability of headspace Active, a pragmatic PA program offered to 14 to 25 year olds with ARMS. The 12-week exercise physiologist-led intervention was conducted in adjunct to usual care. Feasibility was determined by number of referrals, attendance, engagement in exercise sessions and dropout from the intervention. Acceptability was assessed by a 10-item questionnaire. Secondary outcomes included anthropometry, cardiorespiratory fitness and strength. Subjective PA levels, symptoms of depression and anxiety, sleep, motivation and quality of life were also assessed. Within 12 months, 77% of referrals completed the 12-week intervention (n = 20), with six dropouts. Of the 20 "completers", 95% attended at least five sessions over the 12-week intervention. Participants found the program highly acceptable (mean = 41.2/50 on the 10-item acceptability questionnaire) and experienced significant improvements in PA, strength, motivation, depressive symptoms and sleep quality post-intervention. No changes in anthropometry were observed. Results suggest headspace Active was feasible and acceptable and was associated with improvements in physical and mental health outcomes among ARMS youth. Given the potential scalability of this real-world PA program to other youth mental health settings, these data have implications for best practice implementation of PA interventions for in iduals with emerging mental illness.
Publisher: Springer Science and Business Media LLC
Date: 27-06-2013
DOI: 10.1038/SREP02045
Publisher: Wiley
Date: 26-02-2016
DOI: 10.1111/EIP.12230
Abstract: Initiating antipsychotic medication frequently induces rapid, clinically significant weight gain. We aimed to evaluate the effectiveness of a lifestyle and life skills intervention, delivered within 4 weeks of antipsychotic medication initiation, in attenuating weight gain in youth aged 14-25 years with first-episode psychosis (FEP). We undertook a prospective, controlled study in two early psychosis community services. Intervention participants (n = 16) received a 12-week in idualized intervention delivered by specialist clinical staff (nurse, dietician and exercise physiologist) and youth peer wellness coaches, in addition to standard care. A comparison group was recruited from a similar service and received standard care (n = 12). The intervention group experienced significantly less weight gain at 12 weeks compared to standard care (1.8 kg, 95% CI -0.4 to 2.8 vs. 7.8 kg, 4.8-10.7, P < 0.001). Thirteen per cent (2/16) of the intervention group experienced clinically significant weight gain (greater than 7% of baseline weight), while 75% (9/12) of the standard care group experienced this level of weight gain. Similar positive effects of the intervention were observed for waist circumference. A lifestyle and life skills intervention delivered as part of standard care attenuated antipsychotic-induced weight gain in young people with FEP. The intervention was acceptable to the young people referred to the service. Such interventions may prevent the seeding of future disease risk and in the long-term help reduce the life expectancy gap for people living with serious mental illness.
Publisher: Oxford University Press (OUP)
Date: 04-2018
Publisher: Oxford University Press (OUP)
Date: 06-06-2020
DOI: 10.1093/TBM/IBZ067
Abstract: The scandal of premature mortality in people with serious mental illness is well established. Despite an increase in studies evaluating the efficacy of lifestyle interventions, translating this evidence into routine clinical care and policies is challenging, in part due to limited effectiveness or implementation research. We highlight the challenge of implementation that is increasingly recognized in clinical practice, advocate for adopting implementation science to study the implementation and systematic update of effective interventions in practice and policy, and provide directions for future research.
Publisher: Royal College of Psychiatrists
Date: 02-2017
DOI: 10.1192/BJP.BP.115.177139
Abstract: Nutrition interventions would appear fundamental for weight management and cardiometabolic risk reduction in people experiencing severe mental illness (SMI). Comprehensive evaluation of nutrition interventions is lacking. To subject randomised controlled trials of nutrition interventions in people with SMI to systematic review and meta-analysis, and to measure anthropometric and biochemical parameters and nutritional intake. An electronic database search identified trials with nutrition intervention components. Trials were pooled for meta-analysis. Meta-regression analyses were performed on anthropometric moderators. Interventions led to significant weight loss (19 studies), reduced body mass index (17 studies), decreased waist circumference (10 studies) and lower blood glucose levels (5 studies). Dietitian-led interventions (6 studies) and studies delivered at antipsychotic initiation (4 studies) had larger effect sizes. Evidence supports nutrition interventions as standard care in preventing and treating weight gain among people experiencing SMI.
Publisher: Elsevier BV
Date: 04-2015
Publisher: JMIR Publications Inc.
Date: 14-10-2021
Abstract: ackground: Noncommunicable diseases (NCDs) are the leading cause of death globally. Promoting physical activity and healthy eating is essential to help manage the NCD burden and reduce mortality. Social media may be a potential platform for delivering and scaling health promotion initiatives. bjective: In this systematic review, we aimed to examine i) the feasibility and acceptability of social media interventions targeting physical activity and/or diet for people with NCDs, ii) the effectiveness of these interventions on exercise and diet behaviours, iii) specific design components used to promote user engagement and iv) the effectiveness on other health outcomes. ethods: We searched MEDLINE, Google Scholar, CINAHL, EMBASE, and SPORTDiscus from inception until June 2021. Social media interventions targeting physical activity and/or diet were included. Participants were any age, with a diagnosis of one of the following categories of NCDs cardiovascular disease, cancer, chronic respiratory disease, diabetes or mental illness. Interventions using social media alone or as part of an intervention with other modes of delivery were included. Eligible study designs were randomised controlled trials (RCTs), non-randomised controlled trials, feasibility or pilot studies, or quasi-experimental studies. esults: A total of 2,358 publications were identified. After removal of duplicates, 2,233 publication titles and abstracts were screened, and 10 publications were eligible, describing 8 in idual studies. The study designs included n=5 RCTs and n=3 pilot or feasibility studies, all published between 2016 and 2020. S le sizes ranged from n=11 to n=312. Half of the studies were conducted in the United States of America. Clinical populations included severe mental illness (n=2), cardiovascular disease (n=2), chronic obstructive pulmonary disease (n=2), cancer (n=1) and Type 2 diabetes (n=1). Facebook (n=3) and WeChat (n=3) were the most used social media platforms. The majority utilised social media to deliver health education and facilitate social support and all studies reported % retention. Four of the five included RCTS reported significant improvements in exercise behaviours (e.g., step count, exercise capacity) while diet was only assessed in two studies and results were non-significant. Of the 6 included RCTs (including 1 pilot RCT), study quality ranged from fair to good according to the PEDRo quality checklist. onclusions: Social media interventions appear to be feasible and acceptable among specific ND populations and preliminary evidence suggests interventions delivered solely via social media or in addition to other modalities may be effective for improving exercise behaviours. The evidence for diet behaviours remains unclear. While overall there is an emerging evidence base, more rigorous evaluation including replication studies are needed to determine the efficacy of social media interventions. RD42021251838
Publisher: Elsevier BV
Date: 11-2017
Publisher: Wiley
Date: 21-03-2018
DOI: 10.1111/EIP.12544
Publisher: Cambridge University Press (CUP)
Date: 23-08-2021
DOI: 10.1017/S0033291721003147
Abstract: People with psychosis experience cardiometabolic comorbidities, including metabolic syndrome, coronary heart disease and diabetes. These physical comorbidities have been linked to diet, inactivity and the effects of the illness itself, including disorganisation, impairments in global function and amotivation associated with negative symptoms of schizophrenia or co-morbid depression. We aimed to describe the dietary intake, physical activity (PA) and sedentary behaviour patterns of a s le of patients with established psychosis participating in the Improving Physical Health and Reducing Substance Use in Severe Mental Illness (IMPaCT) randomised controlled trial, and to explore the relationship between these lifestyle factors and mental health symptomatology. A majority of participants had poor dietary quality, low in fruit and vegetables and high in discretionary foods. Only 29.3% completed ⩾150 min of moderate and/or vigorous activity per week and 72.2% spent ⩾6 h per day sitting. Cross-sectional associations between negative symptoms, global function, and PA and sedentary behaviour were observed. Additionally, those with more negative symptoms receiving IMPaCT therapy had fewer positive changes in PA from baseline to 12-month follow-up than those with fewer negative symptoms at baseline. These results highlight the need for the development of multidisciplinary lifestyle and exercise interventions to target eating habits, PA and sedentary behaviour, and the need for further research on how to adapt lifestyle interventions to baseline mental status. Negative symptoms in particular may reduce patient's responses to lifestyle interventions.
Publisher: Informa UK Limited
Date: 24-07-2019
DOI: 10.1080/01612840.2019.1642426
Abstract: 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 (
Publisher: SAGE Publications
Date: 23-01-2018
Publisher: Cambridge University Press (CUP)
Date: 03-2016
DOI: 10.1016/J.EURPSY.2016.01.108
Abstract: We recently demonstrated that weight gain could be prevented in young people experiencing a first-episode of psychosis commencing treatment with antipsychotics. A 12-week, intensive lifestyle and life skills intervention – the Keeping the Body in Mind program, – was delivered by dedicated nursing, dietetic and exercise physiology clinicians, for new referrals with one month of antipsychotic exposure. (Curtis et al., Early intervention in psychiatry, in press). At the conclusion of the intervention the 16 young people participating in the program experienced a mean weight gain of 1.8 kilograms, and a mean increase in waist circumference of 0.1 centimeters. The participants were followed up for two years after initial referral. During the two-year follow-up, participants had continuing access to an in house gym and weekly cooking groups, but without the same intensity of follow-up. Two year follow-up data were obtained from 11 participants form the original cohort. Mean weight gain at two-year follow-up was 0.90 (SD 8.7) kilograms, and this difference was not statistically significant [ t (10) = 0.3, NS]. Waist circumference decreased by 0.7 (SD 7.7) centimeters, which was not t statistically significant [ t (10) = 0.3, NS]. Nine of the participants (82%) did not experience clinically significant weight gain two years after initiation of antipsychotic medication. This two-year follow-up data demonstrated that it is feasible to prevent weight gain in youth with first-episode psychosis over the first two years of treatment. The authors have not supplied their declaration of competing interest.
Publisher: Informa UK Limited
Date: 11-03-2021
DOI: 10.1080/10408398.2021.1882382
Abstract: Dietary guidelines for many Western countries base their edible oil and fat recommendations solely on saturated fatty acid content. This study aims to demonstrate which nutritional and bioactive components make up commonly consumed edible oils and fats and explore the health effects and strength of evidence for key nutritional and bioactive components of edible oils. An umbrella review was conducted in several stages. Food composition databases of Australia and the United States of America, and studies were examined to profile nutrient and bioactive content of edible oils and fats. PUBMED and Cochrane databases were searched for umbrella reviews, systematic literature reviews of randomized controlled trials or cohort studies, in idual randomized controlled trials, and in idual cohort studies to examine the effect of the nutrient or bioactive on high-burden chronic diseases (cardiovascular disease, type 2 diabetes mellitus, obesity, cancer, mental illness, cognitive impairment). Substantial systematic literature review evidence was identified for fatty acid categories, tocopherols, biophenols, and phytosterols. Insufficient evidence was identified for squalene. The evidence supports high mono- and polyunsaturated fatty acid compositions, total biophenol content, phytosterols, and possibly high α-tocopherol content as having beneficial effects on high-burden health comes. Future dietary guidelines should use a more sophisticated approach to judge edible oils beyond saturated fatty acid content.
Publisher: Cambridge University Press (CUP)
Date: 16-02-2017
DOI: 10.1017/S0033291717000022
Abstract: When used as an adjunctive with antipsychotics, certain vitamins and minerals may be effective for improving symptomatic outcomes of schizophrenia, by restoring nutritional deficits, reducing oxidative stress, or modulating neurological pathways. We conducted a systematic review of all randomized controlled trials (RCTs) reporting effects of vitamin and/or mineral supplements on psychiatric symptoms in people with schizophrenia. Random-effects meta-analyses were used to calculate the standardized mean difference between nutrient and placebo treatments. An electronic database search in July 2016 identified 18 eligible RCTs, with outcome data for 832 patients. Pooled effects showed that vitamin B supplementation (including B6, B8 and B12) reduced psychiatric symptoms significantly more than control conditions [ g = 0.508, 95% confidence interval (CI) 0.01–1.01, p = 0.047, I 2 = 72.3%]. Similar effects were observed among vitamin B RCTs which used intention-to-treat analyses ( g = 0.734, 95% CI 0.00–1.49, p = 0.051). However, no effects of B vitamins were observed in in idual domains of positive and negative symptoms (both p 0.1). Meta-regression analyses showed that shorter illness duration was associated with greater vitamin B effectiveness ( p = 0.001). There were no overall effects from antioxidant vitamins, inositol or dietary minerals on psychiatric symptoms. There is preliminary evidence that certain vitamin and mineral supplements may reduce psychiatric symptoms in some people with schizophrenia. Further research is needed to examine how the benefits of supplementation relate to nutrient deficits and the impact upon underlying neurobiological pathways, in order to establish optimal nutrient formulations for improving clinical outcomes in this population. Future studies should also explore the effects of combining beneficial nutrients within multi-nutrient formulas.
Publisher: Informa UK Limited
Date: 04-2019
Publisher: Springer International Publishing
Date: 2021
Publisher: Elsevier BV
Date: 09-2018
Publisher: Wiley
Date: 17-04-2017
DOI: 10.1111/JHN.12473
Abstract: People experiencing a severe mental illness (SMI), such as schizophrenia, schizoaffective disorder, bipolar affective disorder or depression with psychotic features, have a 20-year mortality gap compared to the general population. This 'scandal of premature mortality' is primarily driven by preventable cardiometabolic disease, and recent research suggests that the mortality gap is widening. Multidisciplinary mental health teams often include psychiatrists, clinical psychologists, specialist mental health nurses, social workers and occupational therapists, offering a range of pharmacological and nonpharmacological treatments to enhance the recovery of clients who have experienced, or are experiencing a SMI. Until recently, lifestyle and life skills interventions targeting the poor physical health experienced by people living with SMI have not been offered in most routine clinical settings. Furthermore, there are calls to include dietary intervention as mainstream in psychiatry to enhance mental health recovery. With the integration of dietitians being a relatively new approach, it is important to review and assess the literature to inform practice. This review assesses the dietary challenges experienced by people with a SMI and discusses potential strategies for improving mental and physical health.
Publisher: SAGE Publications
Date: 04-09-2018
Abstract: This article aims to draw mental health clinicians’ attention to the connections between nutrition and mental health, and the roles that Accredited Practising Dietitians play in improving mental and physical health through dietary change. Selective narrative review. Unhealthy dietary practices are common in high prevalence and severe mental illness. Epidemiological evidence demonstrates that nutrients and dietary patterns impact on mental health. In addition, poor physical health is well documented in people with mental illness and the greatest contributor to the mortality gap. Dietary intervention studies demonstrate improved mental and physical health outcomes. Accredited Practising Dietitians translate nutrition science into practical advice to improve the nutritional status of patients with mental illness, and prevent and manage comorbidities in a variety of care settings. Medical Nutrition Therapy offers opportunities to improve the physical and mental health of people living with mental illness.
Publisher: Elsevier BV
Date: 05-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2019
DOI: 10.1097/PSY.0000000000000673
Abstract: Poor diet can be detrimental to mental health. However, the overall evidence for the effects of dietary interventions on mood and mental well-being has yet to be assessed. We conducted a systematic review and meta-analysis examining effects of dietary interventions on symptoms of depression and anxiety. Major electronic databases were searched through March 2018 for all randomized controlled trials of dietary interventions reporting changes in symptoms of depression and/or anxiety in clinical and nonclinical populations. Random-effects meta-analyses were conducted to determine effect sizes (Hedges' g with 95% confidence intervals [CI]) for dietary interventions compared with control conditions. Potential sources of heterogeneity were explored using subgroups and meta-regression analyses. Sixteen eligible randomized controlled trials (published in English) with outcome data for 45,826 participants were included the majority of which examined s les with nonclinical depression ( n = 15 studies). Nonetheless, dietary interventions significantly reduced depressive symptoms ( g = 0.275, 95% CI = 0.10 to 0.45, p = .002). Similar effects were observed among high-quality trials ( g = 0.321, 95% CI = 0.12 to 0.53, p = .002) and when compared with both inactive ( g = 0.308, 95% CI = 0.02 to 0.60, p = .038) and active controls ( g = 0.174, 95% CI = 0.01 to 0.34, p = .035). No effect of dietary interventions was observed for anxiety ( k = 11, n = 2270, g = 0.100, 95% CI = −0.04 to 0.24, p = .148). Studies with female s les observed significantly greater benefits from dietary interventions, for symptoms of both depression and anxiety. Dietary interventions hold promise as a novel intervention for reducing symptoms of depression across the population. Future research is required to determine the specific components of dietary interventions that improve mental health, explore underlying mechanisms, and establish effective schemes for delivering these interventions in clinical and public health settings. PROSPERO Online Protocol: CRD42018091256.
Publisher: Wiley
Date: 24-08-2023
DOI: 10.1111/JPM.12969
Abstract: Food insecurity in adults living with Severe Mental Illness (SMI) is an underresearched area worldwide. This systematic review and meta‐analysis aimed to identify and collate evidence on food insecurity in adults with SMI, in high‐ and upper‐middle income countries. A comprehensive electronic search was completed up to August 2022. Random effects meta‐analysis was undertaken to determine the prevalence and the odds ratio for food insecurity in adults with SMI. Narrative synthesis explored the data further. Sixteen publications were included (13 in the meta‐analysis). The prevalence estimate of food insecurity in adults with SMI was 41% (95% CI: 29% to 53%, I 2 = 99.9%, n = 13). Adults with SMI were 3.31 (95% CI: 2.03 to 5.41) times more likely to experience food insecurity than comparators without SMI ( z = 6.29, p .001, I 2 = 98.9%, n = 6). Food insecurity appears to be a risk factor for developing SMI. This review suggests adults with SMI living in high‐ or upper‐middle income countries are more likely to experience food insecurity than the general population and that this relationship may be inverse. Mental health practitioners should be aware of food insecurity and support in iduals with SMI to access sufficient food.
Publisher: Elsevier BV
Date: 08-2019
Publisher: Wiley
Date: 05-03-2020
DOI: 10.1111/JHN.12716
Publisher: Wiley
Date: 19-11-2017
DOI: 10.1111/ACPS.12670
Publisher: Wiley
Date: 10-10-2015
DOI: 10.1111/ACPS.12350
Publisher: Cambridge University Press (CUP)
Date: 03-2016
DOI: 10.1016/J.EURPSY.2016.01.2320
Abstract: Nutrition interventions are critical for weight management and cardiometabolic risk reduction in people experiencing severe mental illness (SMI). As mental health teams evolve to incorporate nutrition interventions, evidence needs to guide clinical practice. A systematic review and meta-analysis was performed to assess whether nutrition interventions improve: – anthropometric and biochemical measures, – nutritional intake of people experiencing SMI. To evaluate the effectiveness of a dietician-led nutrition intervention, as part of a broader lifestyle intervention, in the early stages of antipsychotic prescription. An electronic database search was conducted to identify all trials with nutritional components. Included trials were pooled for meta-analysis. Meta-regression analyses were run on potential anthropometric moderators. Weekly in idualised dietetic consultations plus group cooking classes were then offered to clients attending a Community Early Psychosis Programme, who had recently commenced antipsychotics for a 12-week period. From pooled trials, nutrition interventions resulted in significant weight loss (19 studies, g = –0.39, P 0.001), reduced BMI (17 studies, g = –0.40, P 0.001), decreased waist circumference (10 studies, g = –0.27, P 0.001) and lower blood glucose levels (5 studies, g = –0.37, P = 0.02). Dietician-led interventions ( g = –0.90) and trials focussing on preventing weight gain ( g = –0.61) were the most effective. The 12-week nutrition intervention resulted in a 47% reduction in discretionary (junk) food intake ( P 0.001) and reductions in daily energy (–24%, P 0.001) and sodium intakes (–26%, P 0.001), while improving diet quality ( P 0.05). Evidence supports the inclusion of nutrition interventions as part of standard care for preventing weight gain and metabolic deterioration among people with SMI. The authors have not supplied their declaration of competing interest.
No related grants have been discovered for Scott Teasdale.