How do we help patients with severe mental disorders live longer and healthier?

Many patients with severe mental disorders have behavioural risk factors for chronic disease, including reduced physical activity, poor diet, and high smoking rates1. Lifestyle interventions, such as physical exercise and psychosocial support, may play important roles in reducing these risk factors, as discussed in this EPA2020 symposium.

Behavioural risk factors for chronic disease lead to poorer outcomes

There are still significant unmet needs in severe mental disorders

There are still significant unmet needs in severe mental disorders. Recovery rates are only 15-45%2, with cognitive dysfunction and negative symptoms responding less well to treatment. Life expectancy is reduced compared to the general population by an average of 12 years3 and mortality rate is doubled4. Behavioural risk factors may be accentuated by metabolic side effects of medication, and many of these factors do not have easy solutions.

Need for lifestyle behaviour interventions

Prevention and treatment of chronic diseases is important to improve life expectancy and mortality rates                                                                                    

Prevention and treatment of chronic diseases is important to improve life expectancy and mortality rates. The Lancet Psychiatry Commission’s ‘A Blueprint for Protecting Physical Health in People with Mental Illness’1 and the World Health Organization’s ‘Helping people with severe mental disorders live longer and healthier lives’5 stress the importance of lifestyle behaviour interventions and collaboration between health professionals, caregivers and the patient.

Positive effects of physical exercise

Peter Falkai (University of Munich, Germany) explained how physical exercise has both mental and physical benefits. The STRIDE trial6 demonstrated that a lifestyle intervention for patients taking antipsychotics, involving diet and physical activity, led to weight loss and improved fasting glucose levels.

Endurance training plus cognitive remediation led to significant improvements in cognition and functioning and reduction in negative symptoms

In patients with schizophrenia, aerobic exercise has been shown to improve cognitive performance7. When endurance training (cycling) was augmented with cognitive remediation there were significant improvements in cognition and functioning and reduction in negative symptoms8. Exercise has effects on brain structure and function, acting via synaptic and neurogenic pathways to increase functional plasticity9.

Demonstrating benefit of exercise interventions in large-scale studies is more challenging, suggesting the nature of exercise intervention is important. The CHANGE trial, in patients with schizophrenia and obesity, showed that lifestyle coaching plus care coordination led to significant improvement in cognition, non-significant improvement in psychotic and negative symptoms, but no reduction in cardiovascular risk factors10.

Role of psychosocial interventions in adopting healthy lifestyle behaviour

Ensuring any psychosocial intervention is feasible and effective over the long-term in real-world studies

Psychosocial interventions may support patients in adopting healthy lifestyle behaviours11. Martina Rojnic-Kuzman (University Hospital Center Zagreb, Croatia) examined if an extensive multimodal psychosocial program in patients with first episode psychosis could influence weight gain and metabolic abnormalities, compared to supportive psychotherapy12. After 18-month follow-up, both groups had less psychopathology and higher functioning scores, but body mass index, lipids and cholesterol had increased.

Gaia Sampogna (University of Campania, Italy) stressed the importance of ensuring any psychosocial intervention was feasible and effective over the long-term in real-world studies11. Her group is trialing a lifestyle intervention including informative, motivational and problem-solving components.

Our correspondent’s highlights from the EPA 2020 symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

AU-NOTPR-0221 . October 2020

References
  1. Firth J, et al. Lancet Psychiatry 2019;6:675-712
  2. Watt DC, et al. Psychological Med 1983;13:663-70
  3. Chang C-K, et al. PLoS One 2011;6:e19590
  4. Walker ER, et al. JAMA Psychiatry 2015;72:334-41
  5. https://www.who.int/mental_health/evidence/policy_brief_on_severe_mental_disorders/en/
  6. Green CA, et al. Am J Psychiatry 2015;172:71-81
  7. Firth J et al. Schizophr Bull 2017;43:546:56
  8. Malchow B, et al. Schizophr Bull 2015;41:847-58
  9. Papiol S, et al. Transl Psychiatry 2017;7:e1159
  10. Speyer H, et al. World Psychiatry 2016; 15: 55–165
  11. De Rosa C, et al. Expert Rev Neurother 2017;17:667-81
  12. Kuzman MR, et al. Psychiatr Danub 2019;31:162-71
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