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

Fernández-Abascal, Blanca; Suárez-Pinilla, Paula; Cobo-Corrales, Carlos; Crespo‐Facorro, Benedicto; Suárez-Pinilla, Marta

doi:10.1016/j.neubiorev.2021.01.005

Cited by 57 publications

(42 citation statements)

References 130 publications

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“…Patients and clinicians might prefer to tolerate a slightly higher threshold of risk when the proposed intervention could be deemed more burdensome or might increase the risk of other adverse effects. Regarding interventions that might be deemed more burdensome, prescribed lifestyle interventions have shown promise in lowering cardiometabolic risk in young people with psychosis, 17 but regular appointments may be difficult to maintain around work or other commitments. Regarding interventions that might increase the risk of other adverse effects, our results show that switching from metabolically active antipsychotics, or not prescribing them in the first place, is an effective means to reduce cardiometabolic risk.…”

Section: Discussionmentioning

confidence: 99%

“…We developed PsyMetRiC using pooled retrospective data from patients aged [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] In a sensitivity analysis, we examined the performance of PsyMetRiC in young adults who had or were at risk of See Online for appendix…”

Section: Data Sourcesmentioning

confidence: 99%

“…PsyMetRiC=Psychosis Metabolic Risk Calculator. *A raised triglyceride:HDL ratio is indicative of insulin resistance 17.…”

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confidence: 99%

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Development and external validation of the Psychosis Metabolic Risk Calculator (PsyMetRiC): a cardiometabolic risk prediction algorithm for young people with psychosis

Perry

Osimo

Upthegrove

et al. 2021

The Lancet Psychiatry

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Summary Background Young people with psychosis are at high risk of developing cardiometabolic disorders; however, there is no suitable cardiometabolic risk prediction algorithm for this group. We aimed to develop and externally validate a cardiometabolic risk prediction algorithm for young people with psychosis. Methods We developed the Psychosis Metabolic Risk Calculator (PsyMetRiC) to predict up to 6-year risk of incident metabolic syndrome in young people (aged 16–35 years) with psychosis from commonly recorded information at baseline. We developed two PsyMetRiC versions using the forced entry method: a full model (including age, sex, ethnicity, body-mass index, smoking status, prescription of a metabolically active antipsychotic medication, HDL concentration, and triglyceride concentration) and a partial model excluding biochemical results. PsyMetRiC was developed using data from two UK psychosis early intervention services (Jan 1, 2013, to Nov 4, 2020) and externally validated in another UK early intervention service (Jan 1, 2012, to June 3, 2020). A sensitivity analysis was done in UK birth cohort participants (aged 18 years) who were at risk of developing psychosis. Algorithm performance was assessed primarily via discrimination (C statistic) and calibration (calibration plots). We did a decision curve analysis and produced an online data-visualisation app. Findings 651 patients were included in the development samples, 510 in the validation sample, and 505 in the sensitivity analysis sample. PsyMetRiC performed well at internal (full model: C 0·80, 95% CI 0·74–0·86; partial model: 0·79, 0·73–0·84) and external validation (full model: 0·75, 0·69–0·80; and partial model: 0·74, 0·67–0·79). Calibration of the full model was good, but there was evidence of slight miscalibration of the partial model. At a cutoff score of 0·18, in the full model PsyMetRiC improved net benefit by 7·95% (sensitivity 75%, 95% CI 66–82; specificity 74%, 71–78), equivalent to detecting an additional 47% of metabolic syndrome cases. Interpretation We have developed an age-appropriate algorithm to predict the risk of incident metabolic syndrome, a precursor of cardiometabolic morbidity and mortality, in young people with psychosis. PsyMetRiC has the potential to become a valuable resource for early intervention service clinicians and could enable personalised, informed health-care decisions regarding choice of antipsychotic medication and lifestyle interventions. Funding National Institute for Health Research and Wellcome Trust.

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Section: Discussionmentioning

confidence: 99%

Section: Data Sourcesmentioning

confidence: 99%

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Development and external validation of the Psychosis Metabolic Risk Calculator (PsyMetRiC): a cardiometabolic risk prediction algorithm for young people with psychosis

Perry

Osimo

Upthegrove

et al. 2021

The Lancet Psychiatry

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“…Also, improvements in psychotic-symptoms ratings (PANSS and BPRS) may reflect benefits of the medication provided and perhaps added benefits associated with the psychoeducational intervention aimed to increase patients' insight ( 25 ). Improvements in BMI, carbohydrates, hemoglobin glycosylation, serum lipids and prolactin concentration may in part reflect changes in life-style, diet and physical exercise, all as encouraged by the psychoeducation intervention ( 26 ). In addition, participants' attitudes toward medications and their adherence to scheduled injections improved as reflected in ratings with the DAI-30.…”

Section: Discussionmentioning

confidence: 99%

Use of Psychoeducation for Psychotic Disorder Patients Treated With Modern, Long-Acting, Injected Antipsychotics

et al. 2021

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Introduction: There is an increased risk of adverse metabolic effects of some modern antipsychotic drugs, and concern that long-acting, injected preparations of them may increase such risk. We now report on clinical and metabolic outcomes in patient-subjects diagnosed with affective and non-affective psychotic disorders following exposure to psychoeducation on metabolic risks of modern antipsychotics followed by treatment with long-acting atypical injected antipsychotics over 6-months.Materials and Methods: 85 psychotic disorder outpatients (42 affective [AP]; 43 non-affective [NAP]) at the University of Foggia were treated with long-acting, injected, second-generation antipsychotics in association with a set of psychoeducational sessions concerning general health and potential effects of antipsychotic drug treatments. They were evaluated at baseline and six months.Results: Initially, NAP subjects reported higher ratings of positive and negative symptoms than AP subjects, were more likely to receive risperidone or paliperidone, with higher CPZ-eq doses of antipsychotics (294.0 ± 77.8 vs. 229.3 ± 95.8 mg/day), and shorter QTc electrocardiographic recovery intervals. During the 6-month follow-up, ratings of treatment-adherence improved through overall (+8.75%), and symptom-ratings decreased (−7.57%) as did Body-Mass Index (−2.40%; all p ≤ 0.001). Moreover, serum levels of fasting glucose, hemoglobin glycosylation, cholesterol and prolactin concentrations all decreased, with little difference between subjects with AP vs. NAP.Discussion and Conclusions: A psychoeducational program was associated with consistent improvement in psychotic symptoms and several metabolic and physiological measures, as well as with treatment-adherence during six months of treatment with long-acting, injected, second-generation antipsychotics, in association with both affective and non-affective psychotic disorders.

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“…1a). Beispielsweise werden auch während sportlicher Aktivität die Stressachsen kurzzeitig aktiviert, was jedoch einen günstigen Gesamteffekt erzielt [28,29]. Die kurzeitige Aktivierung der beschriebenen Systeme kann kompensiert werden und das Immunsystem fällt nach beenden des Stressors normalerweise wieder in seinen Ausgangszustand zurück [18,30,31] [40][41][42][43][44].…”

Section: Ist Stress Gut Oder Schlecht Für Das Immunsystem?unclassified

Das gestresste Immunsystem und Autoimmunität

Pongratz

2021

Aktuelle Rheumatologie

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ZusammenfassungÜber einen möglichen Zusammenhang zwischen psychologischem Stress, Immunsystem und Autoimmunität wird schon lange debattiert. Erkenntnisse aus der Grundlagen- und epidemiologischen Forschung, die das Verständnis für diesen komplexen Zusammenhang erhöhen werden in dieser kurzen Übersicht zusammengestellt. Zunächst werden bekannte anatomisch-physiologische Grundlagen für einen Zusammenhang zwischen psychologischem Stress und Immunsystem dargestellt. Es wird beschrieben, dass die Interaktion zwischen Gehirn über autonomes Nervensystem und Hormonsystem bis zur Immunzelle mit entsprechenden Rezeptoren für Neurotransmitter und Hormone mittlerweile bis auf die molekulare Ebene gut beschrieben ist. Im Rahmen der akuten Stressreaktion treten charakteristische Veränderungen im Immunsystem auf, die ebenfalls gut dokumentiert sind. In einem zweiten Teil wird dann beschrieben welche Veränderungen im Rahmen einer chronischen Stressbelastung am Immunsystem auftreten können und zuletzt wird diskutiert inwiefern diese Veränderungen auch für pathophysiologische Zustände des Immunsystems, z. B. im Rahmen von Autoimmunerkrankungen, relevant sein könnten. Zusammenfassend führt akuter Stress, im Sinne der optimalen Vorbereitung einer fight&flight Situation, zu einer Steigerung der Immunfunktion v. a. der humoralen Immunität, wohingegen die Auswirkungen von chronischem Stress weniger klar definiert sind und es eher zu einer Immundysregulation mit verminderter basaler Immunfunktion, v. a. der zytotoxischen Funktion aber einer gesteigerten Reaktion nach Aktivierung, v. a. im angeborenen Immunschenkel kommt. Epidemiologische Daten belegen gut, dass chronischer Stress zu einer erhöhten Suzeptibilität für Autoimmunerkrankungen führt. Erste klinische Anwendungen, wie beispielsweise die gezielte neuronale Stimulation des N. vagus sind in Erprobung, für einen breiteren klinischen Einsatz sollten aber die biologischen Netzwerkstrukturen noch besser verstanden werden, um die besten Angriffspunkte zu finden.

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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

Cited by 57 publications

References 130 publications

Development and external validation of the Psychosis Metabolic Risk Calculator (PsyMetRiC): a cardiometabolic risk prediction algorithm for young people with psychosis

Development and external validation of the Psychosis Metabolic Risk Calculator (PsyMetRiC): a cardiometabolic risk prediction algorithm for young people with psychosis

Use of Psychoeducation for Psychotic Disorder Patients Treated With Modern, Long-Acting, Injected Antipsychotics

Das gestresste Immunsystem und Autoimmunität

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