Physical health interventions on adolescent mental health inpatient units : a systematic review and call to action

Aim: Physical health inequalities experienced by people with mental health conditions are labelled an international scandal; due to the 15 to 30‐year gap in life expectancy, driven mostly by physical health conditions. Lifestyle interventions are recommended to prevent the onset of poor physical health in people with mental illness. Yet, there is less high‐quality evidence for adolescents, particularly those in inpatient settings. We aimed to assess existing literature reporting physical health or lifestyle interventions conducted on adolescent mental health inpatient units. Method: An electronic search of MEDLINE, PsycINFO, Embase, the Cochrane Central Register of Controlled Trials and AMED was conducted on 13th June 2019. Eligible studies included peer‐reviewed English language research articles of physical health interventions delivered within child and adolescent mental health inpatient services. A narrative synthesis was conducted on the data. Results: Only three studies were identified implementing health interventions for adolescent inpatients. The interventions consisted of two physical health interventions aiming to increase activity levels within routine care (one gym‐based, one sports led) and a yoga intervention. Outcome measurements varied and benefits were observed in relation to overall health (HONOSCA), physical health (waist, hip and chest circumference) and behaviour. Conclusions: Although preliminary results suggest lifestyle interventions may be feasible and beneficial for this group, more work is needed to fully understand the best way to implement these interventions within adolescent clinical settings. Adolescent inpatients are an important target for such interventions, affording the opportunity to prevent the onset of physical comorbidities

Physical exercise and the brain

The concept of physical exercise being inexplicably linked to the healthy mind predates modern medicine itself. The great philosopher Socrates (470–399 B.C.) often spoke of the overarching benefits of physical activity, saying, “Surely a person of sense would submit to anything, like exercise, so as to obtain a well-functioning mind and a pleasant, happy life” (www.hiddendominion.com/socrates-quotes-on-physical-fitness). The Buddha (563–483 B.C.) also saw the cognitive importance of physical fitness, famously saying, “To keep the body in good health is a duty; otherwise we shall not be able to keep our mind strong and clear” (Lu and Ahmed 2010, p. 378). Contemporary great thinkers have further speculated on this mind-body connection, with perhaps the most specific quote coming from President John F. Kennedy: “Physical fitness is not only the key to a healthy body; it is also the basis of dynamic and creative intellectual activity” (Kotecki 2011, p. 210)

Issues with inclusion and interpretation : a cause for concern in mHealth reviews?

We read with interest the systematic review by Wang et al. (2018) on “the effectiveness of mobile apps for monitoring and management of mental health symptoms or disorders”; which sought to identify all studies of mobile apps for ‘mental health in all ages’, across a broad range of outcomes (including mood disorders, psychotic disorders, along with sleep, substance use and suicidal behaviours), including both single-arm studies and randomized controlled trials (RCTs). Given this very broad scope, we were surprised to see the authors included just 16 apps, only 5 from RCTs - particularly given that recent metaanalyses of smartphone interventions focused on single mental health outcomes, such as anxiety (Firth et al., 2017a) and depression (Firth et al., 2017b) identified 9 and 18 RCTs, respectively, for these outcomes alone

Modern-day malnutrition : examining the links between mineral deficits and mental health status

Modern-day malnutrition-the result of poor dietary habits marked by high intakes of excess sugar and processed foods-is depleting our bodies of essential micronutrients. Among these micronutrients, zinc and magnesium support key functions in the brain, such as neurotransmitter synthesis and preservation, and are thought to play a significant role in an individual's mental health status. What can we learn from the data on zinc and magnesium supplementation

Bipolar disorder

Mood fluctuations are common during normal daily life as a result of either stressful or pleasant events. However, severe and persistent mood swings that result in psychological distress and behavioural impairment may be symptomatic of an underlying affective disorder. Affective disorders are classified along a spectrum from unipolar depressive disorders to bipolar disorder types II and I.1

Mobile phone ownership and endorsement of "mHealth" among people with psychosis : a meta-analysis of cross-sectional studies

There is currently growing interest in using mobile phones to support the treatment of psychotic disorders, such as schizophrenia. However, the widespread implementation of these interventions will ultimately depend upon patients' access to mobile devices and their willingness to engage with mobile health ("mHealth"). Thus, we conducted a systematic review and meta- Analysis to assess mobile phone ownership and interest in mHealth among patients with psychosis. An electronic search of Ovid MEDLINE, Embase, PsycINFO, CENTRAL, AMED, Health Technology Assessment Database, and Health Management Information Consortium Database was conducted, using search terms synonymous with mobile phones and psychotic disorders. The initial literature search yielded 2572 results. Fifteen studies matched eligibility criteria, reporting data from 12 independent samples of psychiatric patients (n = 3227). Data pertaining to mobile phone ownership, usage, and opinions on mHealth among patients with psychotic disorders were extracted from these studies, and meta- Analytic techniques were applied. The overall mobile phone ownership rate was 66.4% (95% CI = 54.1%- 77.6%). However, we found strong statistical evidence that mobile phone ownership has been significantly increasing since 2007, and the rate among patients surveyed in the last 2 years was 81.4% (n = 454). Furthermore, in surveys of mHealth acceptability, the majority of patients responded in favor of using mobile phones to enhance contact with services and support self-management. Considering the increasing availability of mobile phones and the broad acceptability of mHealth among patients, there is now a need to develop and evaluate mHealth interventions to enhance healthcare services for people with psychosis

Are community-based health worker interventions an effective approach for early diagnosis of cancer? : a systematic review and meta-analysis

Objective: This systematic review aimed to assess the effectiveness of community-based health worker (CBHW) interventions for early detection of cancer. Secondary aims were to consider the extent that interventions were based on theory, and potential moderators including behaviour change techniques (BCTs). Methods: Six databases were searched for randomized controlled trials. Random-effects meta-analyses were applied to 30 eligible studies with a cancer screening outcome. Results: Participation in CBHW interventions was associated with increased receipt of screening (OR =1.901, 95% CI: 1.60-2.26, p<0.001) for breast, cervical and bowel cancer. Larger effect sizes were observed in participants previously non-adherent with recommended schedules of cancer screening. 25/30 studies were conducted with ethnic minority groups. Only 15 (45%) studies explicitly reported a theoretical foundation for intervention. The number of BCTs used by CBHWs had a trend level association with observed effect size (p=0.08). Study quality was generally poor and common limitations were inadequate blinding and reliance on self-reported outcomes. Conclusions: CBHW interventions are an effective resource for increasing uptake of all three types of cancer screening in ethnic minority groups. Those previously non-adherent with recommended schedules of cancer screening benefitted the most from the CBHW approach. However, better quality studies based on more explicit evidence-based theory are needed to optimise the effectiveness of CBHW interventions on screening uptake. Further research is needed to ascertain whether CBHWs can help promote symptom recognition and help-seeking behaviour to facilitate early diagnosis of cancer

Lifestyle factors may be linked to symptoms of metabolic syndrome in people at risk for psychosis

A recent article by Cordes and colleagues reported the prevalence of metabolic syndrome (MetS) in individuals at clinical-high risk of psychosis (CHR) (Cordes et al. 2017). The authors add to the growing evidence that physical health abnormalities may occur even prior to the onset of psychosis. In their study, the CHR group had higher rates of individual MetS criteria than a general population sample; specifically higher blood pressure, waist circumference, fasting blood glucose and reduced HDL concentration. This carries important clinical implications, and strengthens our recommendation that physical health should be monitored in this group (Carney et al. 2015)

Cardiometabolic risk factors in young people at ultra-high risk for psychosis : a systematic review and meta-analysis

Background: The physical health of people with schizophrenia is poor, and associated with increased morbidity and mortality. Unhealthy lifestyles and side-effects of antipsychotic medication contribute to cardiometabolic dysfunction. Yet it is unclear when this unhealthy profile starts. We aimed to see if people at ultra-high risk for psychosis (UHR) have increased rates of cardiometabolic risk factors. Method: An electronic search of MEDLINE, PsycINFO, Embase and the Cochrane Central Register of Controlled Trials was conducted on 1st May 2015 using terms associated with the ultra-high risk state and health. Eligible studies were peer-reviewed English language research articles with populations that met at-risk diagnostic criteria and reported cardiometabolic risk factors. A meta-analysis was conducted on smoking data, the cardiometabolic risk factor that yielded the most studies. Results: Forty-seven eligible studies were identified. UHR samples had low levels of physical activity, and high rates of smoking and alcohol abuse compared with controls. No differences were found for body mass index. An overall pooled rate of smoking for UHR participants was 33% (95% CI = 0.24-0.42) and significantly more UHR individuals smoked compared with controls with a pooled odds ratio of 2.3 (P < 0.05; 95% CI = -1.48-3.48). Conclusions: UHR samples display cardiometabolic risk factors which are largely modifiable. The UHR phase is an important opportunity for early intervention services to improve physical health

Methodology and reporting of mobile health and smartphone application studies for schizophrenia

The increasing prevalence of mobile devices among patients of all demographic groups has the potential to transform the ways we diagnose, monitor, treat, and study mental illness. As new tools and technologies emerge, clinicians and researchers are confronted with an increasing array of options both for clinical assessment, through digital capture of the essential behavioral elements of a condition, and for intervention, through formalized treatments, coaching, and other technology-assisted means of patient communication. And yet, as with any new set of tools for the assessment or treatment of a medical condition, establishing and adhering to reporting guidelines—that is, what works and under what conditions—is an essential component of the translational research process. Here, using the recently published World Health Organization mHealth Evaluation, Reporting and Assessment guidelines for evaluating mobile health applications, we review the methodological strengths and weaknesses of existing studies on smartphones and wearables for schizophrenia. While growing evidence supports the feasibility of using mobile tools in severe mental illness, most studies to date failed to adequately report accessibility, interoperability, costs, scalability, replicability, data security, usability testing, or compliance with national guidelines or regulatory statutes. Future research efforts addressing these specific gaps in the literature will help to advance our understanding and to realize the clinical potential of these new tools of psychiatry