Reducing The Mortality Gap In People With Severe Mental Disorders The Role Of Lifestyle Psychosocial Interventions

Patients with severe mental disorders (SMD), including major depression, bipolar disorder, schizophrenia and related spectrum disorders, have a reduced life expectancy of 10-25 year compared with the general population. This life expectancy gap is mainly due to the co-occurrence of many physical diseases, such as hypertension, coronary heart disease, stroke, chronic obstructive pulmonary disease, tuberculosis, hepatitis and HIV. Factors contributing to the reduced life expectancy can be grouped into three main categories: a) factors related to the patient; b) factors related to clinicians; and c) factors related to the health system. As regards the first group, patients with SMD often adopt unhealthy lifestyle behaviors, including heavy smoking, reduced physical activity, sedentary behaviors, poor diet and alcohol or drug abuse, and are reluctant to seek for physical care with GPs and other medical specialists. Increasing the levels of physical activity, improving the dietary patterns, and reducing the smoking habits of people with severe mental disorders represent a global health challenge and a public health priority. Until now, attempts made to reduce this mortality gap have acted at three different levels: health system level, physician level, and patient level. The third-level interventions include electronic alerts through smartphones and web-based platforms, intensive case management, promotion of healthy habits, complex psychosocial interventions. Several population-based studies have showed that lifestyle behaviors are amenable to change through the adoption of specific psychosocial interventions. However, most clinical guidelines, although emphasizing the importance of health monitoring and regular check-ups for patients with severe mental illnesses, do not make specific recommendations on the provision of lifestyle interventions. These lifestyle-oriented interventions, consisting of behavioral, educational, and psychological components, have been conducted mainly in research settings, and have shown a good impact on patients’ physical health. Despite this, their feasibility in routine settings has not been tested yet. It seems to be clinically and ethically relevant to develop, validate and carry out interventions to improve the lifestyle’s behaviors of patients with severe mental disorders, to reduce the presence of comorbidities and to improve their life expectancy. In this Research Topic we will summarize the available knowledge of the efficacy and effectiveness of psychosocial interventions aimed at improving healthy lifestyle behaviors and promoting the physical health of patients with severe mental disorders. Total number of articles: 19

Introduction: Patients with severe mental disorders (SMD) die on average 20 years earlier than the general population. This mortality gap is mainly due to the higher prevalence of physical diseases and unhealthy lifestyle behaviors, such as smoking, sedentary behavior and unhealthy lifestyle pattern. Therefore, there is the need to develop psychoeducational intervention for improving lifestyle behaviours.Objectives: to evaluate the efficacy of a new psychosocial, manualised group intervention compared to a brief psychoeducational group intervention in a community sample of obese or overweight patients with SMD.Methods: This trial is a multicentric, randomized, controlled and blind trial carried out in six Italian Universities and funded by the Italian Ministry of Health. All patients are assessed six times: at baseline; 2 months post-randomization; 4 months post-randomization; 6 months post-randomization; 12 months post-randomization; and 24 months post-randomization. The primary outcome is the change of BMI.Results: The hypothesis is that the LIFESTYLE intervention will be more effective than the psychoeducational group intervention in reducing the BMI. We expect a mean difference between the two groups of at least one point at BMI. Secondary outcomes are: improvements in eating, smoking and sleeping habits; increased physical activity; improvement of personal and social functioning; reduced severity of physical comorbidities; better adherence to medications. The expected sample size consists of 420 patients, which will be allocated with a 1:1 ratio randomization between the two groups.Conclusions: We expect that LIFESTYLE intervention will help to provide a new instrument for improving healthy behaviours in patients with SMD.

In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

The first resource of its kind, Palliative and Serious Illness Patient Management for Physician Assistants provides a fundamental framework for physician assistants and physician associates to incorporate palliative care medicine, including end-of-life care, into their practice. The book focuses on pharmacologic and integrative medical therapeutic modalities, as well as the evaluation and treatment of special populations, which reflects the reality of a physician assistant's day-to-day job. It uses a patient-centered approach to address the comprehensive management of serious illness patients, as well as their designated families, significant others, caregivers, and health care providers. Chapters are organized into six sections that cover the essential aspects of care, symptom management, and transitioning care at the end-of-life. This book is ideal for physician assistant trainers (didactic or clinical), students, and practicing clinicians who seek to enhance their communication and medical skills in the treatment of all seriously illness patient populations in any specialty, and in the management of their symptoms at any stage of their disease or condition.

Mental Health, Diabetes and Endocrinology examines key areas of clinical overlap between endocrinology and mental health. Written for clinicians, it draws together developments from literature and clinical practice, with a focus on clinical conundrums and treatment challenges which arise across endocrinology, psychiatry, psychology and primary care.

Mental health and substance use disorders affect approximately 20 percent of Americans and are associated with significant morbidity and mortality. Although a wide range of evidence-based psychosocial interventions are currently in use, most consumers of mental health care find it difficult to know whether they are receiving high-quality care. Although the current evidence base for the effects of psychosocial interventions is sizable, subsequent steps in the process of bringing a psychosocial intervention into routine clinical care are less well defined. Psychosocial Interventions for Mental and Substance Use Disorders details the reasons for the gap between what is known to be effective and current practice and offers recommendations for how best to address this gap by applying a framework that can be used to establish standards for psychosocial interventions. The framework described in Psychosocial Interventions for Mental and Substance Use Disorders can be used to chart a path toward the ultimate goal of improving the outcomes. The framework highlights the need to (1) support research to strengthen the evidence base on the efficacy and effectiveness of psychosocial interventions; (2) based on this evidence, identify the key elements that drive an intervention's effect; (3) conduct systematic reviews to inform clinical guidelines that incorporate these key elements; (4) using the findings of these systematic reviews, develop quality measures - measures of the structure, process, and outcomes of interventions; and (5) establish methods for successfully implementing and sustaining these interventions in regular practice including the training of providers of these interventions. The recommendations offered in this report are intended to assist policy makers, health care organizations, and payers that are organizing and overseeing the provision of care for mental health and substance use disorders while navigating a new health care landscape. The recommendations also target providers, professional societies, funding agencies, consumers, and researchers, all of whom have a stake in ensuring that evidence-based, high-quality care is provided to individuals receiving mental health and substance use services.

This book focuses on hot issues faced by clinicians in everyday clinical practice, and provides in-depth analyses of both met and unmet needs in the management of psychiatric disorders. It has been repeatedly shown that the needs of patients, relatives, the community at large and those of the governmental bodies only partially overlap. For instance, patients in their families are more concerned about quality of life, treatment, autonomy, and independent living; whereas governmental stakeholders are typically more concerned about relapse prevention and reduction of hospitalizations. As such, a volume bridging the gap between theoretical notions and practical understanding of patients’ untreated aspects of their psychiatric disorders is much needed. Instead of focusing on traditional descriptions of psychopathology and diagnostic criteria, the volume guides readers to core problems for each topic, taking into account new approaches in the classification of mental disorders as proposed by DSM-5. It elaborates on much-debated controversial problems such as the assessment and treatment of psychomotor agitation, and non-adherence to treatment that impacts on the psychiatric context. With its unique approach, this volume appeals to anyone with an interest in the field, including researchers, clinicians, and trainees.