The mental health and physical health face interface

Thementalhealth-physicalhealthinterface:ACENTRALroleforphysicaltherapists

BrendonStubbsMCSP,PhDHeadofPhysiotherapy– SouthLondonandMaudsley NHS

FoundationTrustPostDoctoralResearchPhysiotherapist– IoPPN,KCL

@BrendonStubbs

Talkoutline

• PoorerphysicalhealthinpeoplewithSMI• HowWEcanmakeadifference

ConflictofinterestNoneAcknowledgments:SouthLondonCLAHRC

Scandalofprematuremortality

3Nielsen et al. Increasing mortality gap for patients diagnosed with schizophrenia over the last three decades--a Danish nationwide study from 1980 to 2010. Schiz Res 2013; 146(1-3):22-7

CausesofprematuremortalityMales:Averagelifeexpectancy79.1yearsWAgeneralpopulation

Schizophrenia- 62.7years(61.1to64.3)years(difference16.4(14.7to18.0))AffectivePsychosis- 64.9years(62.9to67.0)years(difference14.1(12.1to16.2))OtherPsychosis56.3(54.2to58.5)years(difference22.7(20.5to24.9))

Females:Averagelifeexpectancy83.8years

Schizophrenia- 71.3years(69.3to73.3)(difference20.7(17.7to23.7))Affectivepsychosis- 73.9yeas(72.5to75.3)(difference12.5(10.5to14.5))Otherpsychosis61.2years(57.6to64.8)(difference22.6(19.0to26.2))

Maincausesdeath:over70%duetopreventablephysicalhealthcomorbiditiesCardiovasculardiseaseSchizophrenia(31.8%ofmalesand46.3%offemales),Otherpsychosis(32.5%ofmalesand40.6%offemales)

Lawrenceetal2013BMJ

De Hert M, et al. Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, and recommendations at the system and individual levels. World Psychiatry. 2011;10(2):138-151.

Currentfocusoftreatmentinschizophrenia

• Psychotropicmedication– antipsychoticmedication.Moderateeffectsizesonpsychoticsymptoms(Leucht etal2013).

• Psychologicaltherapy(e.g.CBT),smallES(e.gJauhar etal2013).

• Lifestyleinterventionse.g.physicalactivitygrowingimportancebutstillseenasluxury/secondary

StubbsetalSchiz Res2016;Stubbs,WilliamsetalSchiz Res2016

-3.4 mins/day -14.2 mins/day NS ? +2.8 hours/day

g = -0.39 g = -0.45 NS ? g = 1.13

0

2

4

6

8

10

12

14

Depression Bipolar Schizophrenia

Sedentarytime(hoursperday)

StubbsetalSchiz Res2016;Stubbs,WilliamsetalSchiz Res2016;Vancampfort etal2016JAD;Schuch etal(underreview)

Sedentarybehaviour inSMI

BenefitsofphysicalactivityinpeoplewithSchizophrenia

SymptomsofSchizophreniaSMD=1.0(95%CI,0.37–1.64)

QualityoflifeSMD=0.64;(95%CI,0.35to0.92;I2=0%).

AnthropometricmeasuresSMD=0.24;(95%CI,0.06–0.41;I2=0%)

DepressivesymptomsSMD=0.80(95%CI,0.47–1.13,I2=84%;

Fitnessversusfatness

Vancampfort etal2016SportsMed1;Vancampfort etal2015Acta PsychScan2;Vancampfort etal2015Schiz Res3;Stubbsetal2015JAD4

Among SMI population1:• Negative symptoms, BMI & female = ↓CRF• First episode and inpatient status = ↑CRF

3.052.8

0

0.5

1

1.5

2

2.5

3

3.5

Depression Schizophrenia

VolumeOxygenmL/kg/m

in(V

O2)

Improvementsinfitnessfollowingaverage12-weekexerciseinterventions2.3

ExerciseworksbuthowcanWEmaximiseeffectiveness

Exerciseismosteffectivewhendeliveredbyrecognisedexerciseprofessionalse.g.physiotherapistsfor:• Cognition(Firthetal2016)• Cardiorespiratoryfitness(Vancampfort etal2016)

• Reducingdropout(Stubbsetal2016)

Summary

• Peoplewithmentalillnesshavemanyphysicalhealthcomplaintsthatwecanhelp.

• PeoplewithSMIarelikelytodieearlierduetophysicalhealthconditions– CVD.

• WehaveakeyroleinmaintainingthehealthofpeoplewithSMI

Acknowledgments

• SimonRosenbaum&PhilipWard,UNSWPsychiatry

• DavyVancampfort,KULeuven,Belgium• FelipeSchuch,Universidade FederaldoRioGrandedoSul,Brazil

• JosephFirth,UniversityofManchester• FionaGaughran,KCL

Questions?

Brendon.stubbs@kcl.ac.uk