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

Behavioral 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. Behavioral risk factors may be accentuated by metabolic side effects of medication, and many of these factors do not have easy solutions.

Need for lifestyle behavior 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 behavior 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 behavior

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 behaviors¹¹. 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.