Ward Martha C, White DeJuan T, Druss Benjamin G
Department of Psychiatry and Behavioral Sciences, Department of General Medicine, Emory University, 49 Jesse Hill Jr. Dr SE, Ste 231, Atlanta, GA 30303
J Clin Psychiatry. 2015 Apr;76(4):e477-86. doi: 10.4088/JCP.13r08657.
Individuals with serious mental illness die years younger than members of the general population, with cardiovascular disease and related risk factors accounting for the majority of deaths. Lifestyle interventions targeting these risk factors have begun to be developed for those with serious mental illness, but they have largely been created de novo rather than with information from work already done in the general population. This review aims to synthesize for a mental health audience the common factors for success in nonpharmacologic lifestyle interventions and identify specific considerations in adapting these models for those with serious mental illness.
We searched the PubMed and Cochrane databases for English-language reviews from 2003 to 2013. The search employed combinations of the following terms: diabetes, diabetes mellitus, hypertension, hyperlipidemia, dyslipidemia, obesity, mental illness, schizophrenia, psychosis, bipolar disorder, lifestyle intervention, non-pharmacologic intervention, lifestyle modification, and weight gain.
We identified 8,147 review articles from the PubMed and Cochrane databases. 123 articles were selected. The selected articles were reviews of dietary, behavioral, or exercise interventions that focused on obesity and related cardiometabolic risk factors.
We undertook a qualitative "review of reviews" focusing on nonpharmacologic interventions for obesity and related cardiometabolic risk factors.
Effects of interventions in the general population were meaningful but generally modest. Specific elements of diet, exercise, and behavioral therapy produced larger effects. Additionally, successful programs employed multiple components, personalization, longer duration, more frequent contact, and trained treatment providers. Interventions addressing these risk factors in people with serious mental illness typically incorporated some, but not all, of the elements demonstrated to be effective in general medical populations.
Studies from the general medical literature demonstrate considerable promise in addressing lifestyle risk factors. Existing programs will require tailoring to address the needs of those with serious mental illness and may be harder to implement given the challenges faced by this population. However, successful lifestyle interventions for those with serious mental illness can make a significant impact on the health and well-being of this vulnerable population and may inform future strategies for other underserved groups.
患有严重精神疾病的个体比普通人群早数年死亡，心血管疾病及相关风险因素占死亡原因的大部分。针对这些风险因素的生活方式干预措施已开始为患有严重精神疾病的人群制定，但这些措施大多是从头开始创建的，而非借鉴普通人群已有的研究成果。本综述旨在为心理健康领域的受众总结非药物生活方式干预取得成功的共同因素，并确定将这些模式应用于患有严重精神疾病的人群时的具体注意事项。
我们在PubMed和Cochrane数据库中检索了2003年至2013年的英文综述。检索使用了以下术语的组合：糖尿病、糖尿病 mellitus、高血压、高脂血症、血脂异常、肥胖症、精神疾病、精神分裂症、精神病、双相情感障碍、生活方式干预、非药物干预、生活方式改变和体重增加。
我们从PubMed和Cochrane数据库中识别出8147篇综述文章。选取了123篇文章。所选文章是关于饮食、行为或运动干预的综述，重点关注肥胖症及相关的心脏代谢风险因素。
我们进行了一项定性的“综述之综述”，重点关注针对肥胖症及相关心脏代谢风险因素的非药物干预。
普通人群中干预措施的效果是显著的，但通常较为适度。饮食、运动和行为疗法的具体要素产生了更大的效果。此外，成功的项目采用了多个组成部分、个性化、更长的持续时间、更频繁的接触以及经过培训的治疗提供者。针对患有严重精神疾病的人群中这些风险因素的干预措施通常纳入了一些（但并非全部）在普通医疗人群中已证明有效的要素。
普通医学文献中的研究表明，在解决生活方式风险因素方面有很大的前景。现有的项目需要进行调整以满足患有严重精神疾病的人群的需求，并且鉴于该人群面临的挑战，可能更难实施。然而，针对患有严重精神疾病的人群成功的生活方式干预可以对这一弱势群体的健康和福祉产生重大影响，并可能为其他服务不足群体的未来策略提供参考。
