Cornelis Van Heeringen

Effectiveness and cost-effectiveness of lifestyle interventions on physical activity and eating habits in persons with severe mental disorders: a systematic review.

BackgroundThere is a high prevalence of overweight and obesity in persons with severe mental disorders and this has serious implications on the short and long term health outcomes of these patients. The aim of this review was to evaluate the effectiveness of lifestyle interventions targeting physical activity and eating habits in persons with severe mental disorders. Special attention was given if any of the included studies in the review also examined the cost-effectiveness of these health promotion interventions.MethodsA systematic search through the electronic databases Medline, Web of Science, CINAHL and Cohrane Library was conducted, and by hand-searching the reference lists of the retrieved articles from the electronic databases. Studies were included if they examined effectiveness and/or cost-effectiveness of lifestyle interventions targeting physical activity and eating habits in persons with severe mental disorders, with primary outcome changes in Body Mass Index and body weight.ResultsFourteen studies met the inclusion criteria. Weight loss and Body Mass Index decrease were observed in intervention groups in 11 studies. The difference in weight change between intervention and control groups was statistically significant in nine studies. Differences in mean Body Mass Index between intervention and control groups were statistically significant in eight studies. Five studies reported improvements in quality of life and general health. In none of the studies cost-effectiveness of lifestyle interventions was examined.ConclusionFurther research on both effectiveness and cost-effectiveness of lifestyle interventions targeting physical activity and eating habits in persons with severe mental disorders is required to assist in the development of new health promotion interventions in this population.

Do restrictive and bingeing/purging subtypes of anorexia nervosa differ on central coherence and set shifting?

OBJECTIVEnAnorexia nervosa (AN) has been associated with weak central coherence (CC) and weak set shifting (SS). The main aim of this study was to examine possible differences between restrictive AN (AN-R) and bingeing/purging AN (AN-BP) on these features.nnnMETHODSnA total of 31 patients with AN-R, 20 patients with AN-BP and 26 healthy controls (HC) completed five neuropsychological tests (Block Design, Object Assembly, an adapted task-switching paradigm, Wisconsin Card Sorting Test and Trail Making Test).nnnRESULTSnUsing Block Design and Object Assembly, indicative for CC, AN-R patients performed significantly worse than AN-BP patients and HC, without any difference between AN-BP and HC. On SS measures, no group differences were observed.nnnDISCUSSIONnThe results suggest that cognitive profiles of AN-R and AN-BP patients differ significantly on CC and not on SS. Our current findings support the idea that the two subtypes of AN have a distinctive underlying nature and might need a different approach in cognitive remediation.

Health promotion in mental health care: perceptions from patients and mental health nurses

AIMS AND OBJECTIVESnTo gain insight into the factors influencing the integration of physical activity and healthy eating into the daily care of individuals with mental disorders (MD) living in sheltered housing and to increase the understanding of the relationships between and complexities of these factors.nnnBACKGROUNDnGrowing attention is given to the implementation of health promotion activities in mental health care. By improving the understanding of perceptions of patients and mental health nurses, health promotion programmes targeting physical activity and healthy eating can be developed that better meet the patients needs.nnnDESIGNnA descriptive qualitative study.nnnMETHODSnBased on a purposive sampling strategy, three focus groups including 17 mental health nurses and individual interviews with 15 patients were conducted.nnnRESULTSnAlthough physical and mental health benefits of physical activity and healthy eating were identified, several barriers to integrate healthy lifestyles into the daily life of patients were reported. Important barriers identified by the patients consisted of lack of energy and motivation as a result of the MD, side effects of psychotropic drug use, and hospitalisation. Lack of time and personal views and attitudes towards health promotion were reported by the mental health nurses as important elements influencing the way in which they integrate health promotion in the care provided. Support from the mental health nurse was considered important by the patients in changing their unhealthy lifestyle behaviour.nnnCONCLUSIONSnThe results of the study provide insight into important factors influencing the integration of health promotion activities targeting physical activity and healthy eating in individuals with MD living in sheltered housing.nnnRELEVANCE TO CLINICAL PRACTICEnThe information derived from this study is useful and relevant in the design and implementation of health promotion interventions targeting physical activity and healthy eating in people with MD living in sheltered housing.

Health promotion in individuals with mental disorders: a cluster preference randomized controlled trial

BackgroundThe existing literature on weight management interventions targeting physical activity and healthy eating in mental health care appears to provide only limited evidence. The aim of the study was to examine the effectiveness of a 10-week health promotion intervention, followed by a 6-month follow-up period in individuals with mental disorders living in sheltered housing in the Flanders region (Belgium).MethodsThe study had a cluster preference randomized controlled design. Twenty-five sheltered housing organisations agreed to participate (16 in the intervention group, nine in the control group). In the intervention group, 225 individuals agreed to participate, while in the control group 99 individuals entered into the study. The main outcomes were changes in body weight, Body Mass Index, waist circumference and fat mass. Secondary outcomes consisted of changes in physical activity levels, eating habits, health-related quality of life and psychiatric symptom severity.ResultsA significant difference was found between the intervention group and the control group regarding body weight (−0.35 vs. +0.22 kg; p=0.04), Body Mass Index (−0.12 vs. +0.08 kg/m2; p=0.04), waist circumference (−0.29 vs. + 0.55 cm; p<0.01), and fat mass (−0.99 vs. −0.12%; p<0.01). The decrease in these outcomes in the intervention group disappeared during the follow up period, except for fat mass. Within the intervention group, a larger decrease in the primary outcomes was found in the participants who completed the intervention. No significant differences between the two groups in changes in the secondary outcomes were found, except for the pedometer-determined steps/day. In the intervention group, the mean number of daily steps increased, while it decreased in the control group.ConclusionsThe study demonstrated that small significant improvements in the primary outcomes are possible in individuals with mental disorders. Integration of health promotion activities targeting physical activity and healthy eating into daily care are, however, necessary to maintain the promising results.Trial registrationThis study is registered at ClinicalTrials.gov NCT01336946

The Vulnerability to Suicidal Behavior is Associated with Reduced Connectivity Strength

Suicidal behavior constitutes a major public health problem. Based on the stress–diathesis model, biological correlates of a diathesis might help to predict risk after stressor-exposure. Structural changes in cortical and subcortical areas and their connections have increasingly been linked with the diathesis. The current study identified structural network changes associated with a diathesis using a whole-brain approach by examining the structural connectivity between regions in euthymic suicide attempters (SA). In addition, the association between connectivity measures, clinical and genetic characteristics was investigated. We hypothesized that SA showed lower connectivity strength, associated with an increased severity of general clinical characteristics and an elevated expression of short alleles in serotonin polymorphisms. Thirteen euthymic SA were compared with fifteen euthymic non-attempters and seventeen healthy controls (HC). Clinical characteristics and three serotonin-related genetic polymorphisms were assessed. Diffusion MRI together with anatomical scans were administered. Preprocessing was performed using Explore DTI. Whole brain tractography of the diffusion-weighted images was followed by a number of streamlines-weighted network analysis using NBS. The network analysis revealed decreased connectivity strength in SA in the connections between the left olfactory cortex and left anterior cingulate gyrus. Furthermore, SA had increased suicidal ideation, hopelessness and self-reported depression, but did not show any differences for the genetic polymorphisms. Finally, lower connectivity strength between the right calcarine fissure and the left middle occipital gyrus was associated with increased trait anxiety severity (rs = −0.78, p < 0.01) and hopelessness (rs = −0.76, p < 0.01). SA showed differences in white matter network connectivity strength associated with clinical characteristics. Together, these variables could play an important role in predicting suicidal behavior.

Cost-effectiveness of health promotion targeting physical activity and healthy eating in mental health care

BackgroundThere is a higher prevalence of obesity in individuals with mental disorders compared to the general population. The results of several studies suggested that weight reduction in this population is possible following psycho-educational and/or behavioural weight management interventions. Evidence of the effectiveness alone is however inadequate for policy making. The aim of the current study was to evaluate the cost-effectiveness of a health promotion intervention targeting physical activity and healthy eating in individuals with mental disorders.MethodsA Markov decision-analytic model using a public payer perspective was applied, projecting the one-year results of a 10-week intervention over a time horizon of 20xa0years, assuming a repeated yearly implementation of the programme. Scenario analysis was applied evaluating the effects on the results of alternative modelling assumptions. One-way sensitivity analysis was performed to assess the effects on the results of varying key input parameters.ResultsAn incremental cost-effectiveness ratio of 27,096€/quality-adjusted life years (QALY) in men, and 40,139€/QALY in women was found in the base case. Scenario analysis assuming an increase in health-related quality of life as a result of the body mass index decrease resulted in much better cost-effectiveness in both men (3,357€/QALY) and women (3,766€/QALY). The uncertainty associated with the intervention effect had the greatest impact on the model.ConclusionsAs far as is known to the authors, this is the first health economic evaluation of a health promotion intervention targeting physical activity and healthy eating in individuals with mental disorders. Such research is important as it provides payers and governments with better insights how to spend the available resources in the most efficient way. Further research examining the cost-effectiveness of health promotion targeting physical activity and healthy eating in individuals with mental disorders is required.

Health promotion intervention in mental health care: design and baseline findings of a cluster preference randomized controlled trial

BackgroundGrowing attention is given to the effects of health promotion programs targeting physical activity and healthy eating in individuals with mental disorders. The design of evaluation studies of public health interventions poses several problems and the current literature appears to provide only limited evidence on the effectiveness of such programs. The aim of the study is to examine the effectiveness and cost-effectiveness of a health promotion intervention targeting physical activity and healthy eating in individuals with mental disorders living in sheltered housing. In this paper, the design of the study and baseline findings are described.Methods/designThe design consists of a cluster preference randomized controlled trial. All sheltered housing organisations in the Flanders region (Belgium) were asked if they were interested to participate in the study and if they were having a preference to serve as intervention or control group. Those without a preference were randomly assigned to the intervention or control group. Individuals in the intervention group receive a 10-week health promotion intervention above their treatment as usual. Outcome assessments occur at baseline, at 10 and at 36 weeks. The primary outcomes include body weight, Body Mass Index, waist circumference, and fat mass. Secondary outcomes consist of physical activity levels, eating habits, health-related quality of life and psychiatric symptom severity. Cost-effectiveness of the intervention will be examined by calculating the Cost-Effectiveness ratio and through economic modeling.Twenty-five sheltered housing organisations agreed to participate. On the individual level 324 patients were willing to participate, including 225 individuals in the intervention group and 99 individuals in the control group. At baseline, no statistical significant differences between the two groups were found for the primary outcome variables.DiscussionThis is the first trial evaluating both the effectiveness and cost-effectiveness of a health promotion intervention targeting physical activity and healthy eating in mental health care using a cluster preference randomized controlled design. The baseline characteristics already demonstrate the unhealthy condition of the study population.Trial registrationThis study is registered at clinicaltrials.gov – NCT 01336946

Functional Brain Imaging of Suicidal Behavior

Suicidal behaviour poses a major challenge to clinicians and health policy makers due to its difficult prediction and prevention, and its substantial impact at individual and societal levels. Although current research focuses particularly on the biological causes of suicidal behaviour, surprisingly little use has been made of structural and functional neuroimaging in order to increase our understanding of the suicidal brain. This chapter reviews the few available studies that have utilized functional neuroimaging, including brain perfusion and receptor ligand studies. The results of these studies have contributed to the development of the suicidal brain concept. The suicidal brain is thought to be composed of the frontotemporal cortex (in connection with the hippocampus) and the prefrontal cortex (in conjunction with the amygdala). These structures appear to be involved in the social cognitive and behavioural expressive components of the suicidal brain. Evidence is increasingly showing, among others using functional neuroimaging techniques, that these two components are involved in the neurobiologically mediated basic neuropsychological dysfunctions associated with suicidal behaviour.