PHYSICO-DSM-VR Physical health promotion in patients with functional psychoses of the 4 Community Psychiatric Services of ULSS 20, Verona: a multicentre Randomised Controlled Study

Introduzione. La letteratura sulla comorbilit\ue0 fisica nei pazienti psicotici mostra che i pazienti con disturbi mentali gravi (come la schizofrenia e il disturbo bipolare) hanno una salute fisica peggiore e una minore aspettativa di vita rispetto alla popolazione generale. Tali risultati sono stati spiegati con un modello multi-causale. Tra i fattori di rischio sono inclusi sia fattori non modificabili (sesso, et\ue0, anamnesi famigliare) che fattori modificabili attraverso cambiamenti comportamentali e miglioramento delle cure (fumo, obesit\ue0, diabete, ipertensione e dislipidemia). Negli ultimi anni, in particolare, sono stati sviluppati programmi di intervento specifici o adattati per modificare stili di vita non salutari attraverso cambiamenti nella dieta e/o nell'attivit\ue0 fisica. Quando si trattano pazienti psicotici con farmaci antipsicotici, si dovrebbero prendere in considerazione interventi sullo stile di vita preventivi e/o individualizzati, che includano la dieta e l'attivit\ue0 fisica. Obiettivi. L'obiettivo generale dello studio \ue8 di implementare strategie di promozione della salute riguardo le abitudini alimentari e l'attivit\ue0 fisica e di studiare la loro efficacia tramite un trial controllato randomizzato in pazienti con psicosi in carico ai 4 servizi psichiatrici dell'ULSS 20 (Verona). L'ipotesi principale \ue8 che il pacchetto d'intervento porti al miglioramento nei comportamenti relativi alla dieta e all'attivit\ue0 fisica nei pazienti con psicosi, rispetto ai pazienti che riceveranno il trattamento standard. Metodi. Il programma di intervento (6 mesi) consiste in sessioni educative per i pazienti su attivit\ue0 fisica e alimentazione; camminate di gruppo sotto la guida di un allenatore esperto; sessioni educative per gli operatori dei Centri di Salute Mentale coinvolti; colloquio motivazionale per promuovere l'aderenza. I soggetti sono stati testati al baseline, a intervalli mensili e alla fine dell'intervento rispetto a stato di salute fisica, abitudini alimentari e attivit\ue0 fisica, numero di passi durante le camminate, qualit\ue0 della vita legata alla salute e soddisfazione rispetto al servizio psichiatrico. La misura di esito primaria \ue8 basata sulle raccomandazioni dell'Organizzazione Mondiale della Sanit\ue0 sulla dieta e l'esercizio fisico (almeno 5 porzioni di frutta e/o verdura al giorno; attivit\ue0 fisica moderata per almeno 30 minuti al giorno per 5 giorni a settimana). Il miglioramento di almeno un criterio OMS alla valutazione finale rispetto al baseline viene considerato un successo. Risultati. Nel gruppo sperimentale, il 40.57% (71/175) dei soggetti soddisfa un criterio in pi\uf9 al follow-up rispetto al baseline, mentre il 32.35% (55/170) nel gruppo di controllo lo fa. La differenza tra i due guppi non \ue8 statisticamente significativa (\u3c72(1) = 2.51, p = 0.11). Analizzando separatamente dieta e attivit\ue0 fisica tenendo in considerazione la partecipazione all'intervento (>60% delle sessioni), i soggetti "partecipanti" mostrano un incremento statisticamente significativo del numero di porzioni di frutta/verdura al giorno (+ 0.3) e del numero di minuti di attivit\ue0 fisica moderata a settimana (+ 80). Conclusioni. I risultati di questo trial e della fase osservazionale dello studio corrispondono con la situazione allarmante riportata dalla letteratura sull'aumentata presenza di fattori di rischio, comorbilit\ue0 fisica e mortalit\ue0 dei pazienti psichiatrici. I risultati su aspetti specifici dell'intervento mostrano una significativa differenza nelle abitudini alimentari e motorie dei soggetti che hanno partecipato ad un numero sufficiente di sessioni. La difficolt\ue0 principale sembra essere portare effettivamente questo tipo di pazienti a partecipare ad un intervento di promozione della salute. Una volta coinvolti, essi possono trarne beneficio, anche se per far raggiungere un cambiamento significativo un intervento di questo tipo necessita di ulteriori miglioramenti e metodi perfezionati.Background Literature on physical comorbidity in psychosis shows that, in comparison to the general population, patients with severe mental illness (such as schizophrenia and bipolar disorder) have worse physical health and a far shorter life expectancy. These findings have been explained with a multi-causal model including a higher prevalence of risk factors like high blood pressure, high plasma cholesterol and obesity, smoking, diabetes, tendency to self neglect, unhealthy lifestyles, medication side-effects and low socio-economical status, hence including risk factors that are inherently non-modifiable (gender, age, family history) and risk factors that are modifiable through behavioural changes and improved care (smoking, obesity, diabetes, hypertension and dyslipidaemia). In the last years, in particular, specific or adapted intervention programmes to change unhealthy lifestyles through diet and/or physical activity modifications are being developed. Preventive and individual lifestyle interventions that include diet and physical activity should be taken into account when treating schizophrenic patients with antipsychotics. Objectives The general objective of the trial is to implement health promotion strategies on dietary habits and physical exercise and to study their efficacy with a randomised controlled trial in patients with functional psychoses referred to the 4 Community Psychiatric Services (CPSs) of ULSS 20 (Verona). The main hypothesis is that the intervention package will result in the improvement of physical activity and diet-related behaviours in people with functional psychoses, compared to those receiving treatment as usual. Secondary hypotheses are the improvement of examined physical health parameters, health-related quality of life and patients satisfaction with the psychiatric services. Methods The intervention package (6 months) consists in: health education sessions for patients on physical activity and nutrition; group walking under the guide of an expert trainer; educational sessions for the mental health workers involved; motivational interviewing to promote adherence. Subjects have been tested at baseline and after the end of treatment on: physical health status, physical activity and diet habits, number of steps during walking groups, health-related quality of life, patients satisfaction with CPS. The primary outcome is based on WHO recommendations on diet and exercise (at least five servings of fruit and/or vegetables a day; moderate physical activity for at least 30 minutes on at least 5 days a week). The improvement of at least one WHO criterion at the final assessment compared to the initial one will be considered a successful change. Results In the experimental group, 40.57% (71/175) of subjects fulfil one criterion more at follow-up than at baseline, while 32.35% (55/170) of subjects of the control group do. The difference between groups is not significant (\u3c72(1) = 2.51, p = 0.11). When diet and physical activity are analysed separately according to subjects participation to the intervention (>60% of sessions attended), participants show a significant increase in the number of fruit/vegetables portions per day (+ 0.3) and in the number of minutes of moderate physical activity (+ 80) per week. Conclusions Results of this trial and the observational phase of the study correspond with the alarming situation reported by literature on the increased risk factors, physical morbidity and mortality of psychiatric patients. Results on specific aspects of the intervention revealed a significant difference in diet and physical activity habits in subjects who participated to a sufficient number of sessions. The principal issue is actually engaging this kind of population in a lifestyle intervention. Once engaged they can benefit from it, although to reach a significant change an intervention of this kind needs further improvement and refined methods

An examination of autism spectrum traits in adolescents with anorexia nervosa and their parents

There may be a link between anorexia nervosa and autism spectrum disorders. The aims of this study were to examine whether adolescents with anorexia nervosa have autism spectrum and/or obsessive-compulsive traits, how many would meet diagnostic criteria for autism spectrum disorder, and whether these traits are shared by parents

HELPS: Rete Europea per la Promozione della Salute nelle Persone che vivono in Istituzioni Psichiatriche e Sociali

HELPS: Rete Europea per la Promozione della Salute nelle Persone che vivono in Istituzioni Psichiatriche e Social

Chapter 8: Meeting the challenge of physical comorbidity and unhealthy lifestyles

Excess rates of mortality and physical comorbidity are highly prevalent among people with severe mental illness (SMI) and pose new challenges and obligations to health professionals. A number of factors, such as self-neglect, side effects of medication and limited concern with personal health and well-being, tend to be associated with poor lifestyles. These factors are shared both by people with mental illness and by disadvantaged people as a whole, and are associated with unhealthy diet, lack of exercise, smoking and excessive consumption of alcohol and drugs. In geographical terms, such groups of people are more likely to live in deteriorated neighbourhoods with crime and safety problems, further hindering an active life. This chapter discusses the global context of these problems in countries with different levels of income. An exploratory study encouraged the authors to design a comprehensive evaluation, and this is described

Physical comorbidity in psychiatric patients: the opinion of patients and mental health professionals of the Community Psychiatric Service (CPS) of Verona- Sud

OBJECTIVEIn the context of HELPS (European Network for Promoting the Health of Residents in Psychiatric and Social Care Facilities; Contract No.: 2006334, 2008\u20132010) we carried out focus groups to gather information on how staff members and psychiatric institutions users perceive physical health risk factors, illnesses and symptoms, and prevention possibilities. METHODSWe carried out 4 focus groups with patients and mental health professionals of the Verona-Sud CPS using the following Research Questions: 1: What kind of physical illnesses/somatic symptoms have you experienced/have your patients experienced?2: In your view, what causes or conditions lead to such physical illnesses/somatic symptoms?3: What can be done to improve your/your patients physical health?Transcripts of the findings were analyzed with MaxQDA software.RESULTSHealth problems most often experienced by patients are neurological, musculoskeletal, cardiovascular, metabolic, and overweight problems. Psychopathology, personal beliefs, lack of medical care and prevention, diet and medication side effects are among the most common causes. Prevention measures suggested are further medical advice and lifestyle interventions.CONCLUSIONSFocus groups identified behavioural, environmental and iatrogenic risks. Efforts must be directed towards health promotion interventions based on the heterogeneity of mental disorders and physical problems and on beliefs and life conditions of psychiatric facilities users

La comorbilit\ue0 fisica nei pazienti psichiatrici: l\u2019opinione di pazienti e operatori del Servizio Psichiatrico di Verona-Sud

La comorbilit\ue0 fisica nei pazienti psichiatrici: l\u2019opinione di pazienti e operatori del Servizio Psichiatrico di Verona-Su

La comorbilit\ue0 fisica nei pazienti psichiatrici: l\u2019opinione di pazienti e operatori del Servizio Psichiatrico di Verona-Sud

La comorbilit\ue0 fisica nei pazienti psichiatrici: l\u2019opinione di pazienti e operatori del Servizio Psichiatrico di Verona-Su