Integrated Review of Lifestyle Interventions Targeting Diet and Exercise in Early or First-Episode Psychosis

Chris Griffiths,Farah Hina

doi:10.4236/ojpsych.2021.114021

Chris Griffiths, Farah Hina

Open Access

https://doi.org/10.4236/ojpsych.2021.114021

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Abstract

Aims: Life expectancy is reduced by 10 - 20 years in psychotic disorders compared with the general population, largely due to high incidence of physical health disorders: heart attack, stroke, obesity, cardiovascular disease (CVD), and type 2 diabetes. Early or first-episode psychosis patients can be especially vulnerable to physical health, psychological and social consequences of antipsychotic medication weight gain. The aim of this paper is to review diet and exercise lifestyle interventions employed to address these issues. Method: A review of research evidence on lifestyle interventions (diet and exercise) for individuals with early or first-episode psychosis (2000 to 2020) was undertaken. An internet-based literature search employed Medline, PsycINFO, Embase, PubMed and Web of Science. Results: Nine studies meeting the criteria were identified: comprising of three exercise intervention studies, one diet intervention study, and five combined diet and exercise intervention studies. Only one study used a RCT design with prior power analysis to determine participant numbers, two had a RCT design, two had a comparison group and four had no control group. Overall, these studies show that exercise and diet focused interventions may provide beneficial physical and mental health outcomes, but participant engagement and behaviour change may be difficult to achieve in early or first-episode psychosis due to individual factors associated with the experience of psychosis and medication prescribed, and health service related factors. Conclusion: There is a need for evidence-based lifestyle programmes in early or first-episode psychosis that includes individually targeted evidence based exercise and diet interventions. Further appropriately powered RCTs are required to strengthen the evidence base.

Highlights

Psychosis is defined as the experience of false beliefs or false sensory perceptions and lacking insight [1]
One study used a RCT design with prior power analysis to determine participant numbers, two had a RCT design, two had a comparison group and four had no control group. These studies show that exercise and diet focused interventions may provide beneficial physical and mental health outcomes, but participant engagement and behaviour change may be difficult to achieve in early or first-episode psychosis due to individual factors associated with the experience of psychosis and medication prescribed, and health service related factors
In terms of screening criteria, the first phase retained studies with interventions focussed on diet and/or exercise in first-episode or early psychosis

Summary

Introduction

Psychosis is defined as the experience of false beliefs (delusions) or false sensory perceptions (hallucinations) and lacking insight [1]. Compared with the general population, individuals who experience psychosis and go on to receive a diagnosis of schizophrenia have an external cause mortality from that is 12-fold higher; the high mortality rate is mostly explained by unhealthy lifestyles and a high incidence of somatic comorbidities [4] [5]. People with mental health disorders (including psychotic disorders) have a 10 - 20 years reduced life expectancy compared with the general population [6]. This reduced life expectancy is mostly due to elevated incidence of physical health disorders such as heart attack, stroke, obesity, cardiovascular disease (CVD), and type 2 diabetes (T2D) [7] [8]

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