[Symptom monitoring by patients with a psychiatric disorder in palliative care]. / Symptoommonitoring bij psychiatrische patiënten in de palliatieve fase.

BACKGROUND: Hardly any research has been conducted into systematic symptom monitoring in palliative care for patients with a psychiatric disorder. AIM: To gain insight into the usefulness of the Utrecht Symptom Diary (USD) and the symptom burden of patients with a psychiatric disorder in the palliative phase. METHOD: A pragmatic retrospective study using completed USDs by patients (USD-P) and/or caregivers (USD-Z) at the palliative unit and three clinical departments of geriatric psychiatry of GGz Centraal, from October 2011 to January 2018. Analysis was performed using completed USDs, from 3 months to 14 days before death and ≤ 14 days before death. The first measurement was used in both periods. Primary outcomes: prevalence of symptoms (score > 0) and clinical relevance of symptoms (score > 3). RESULTS: 50 USD’s from 38 patients were included, 9 USD-Ps and 41 USD-Zs were analysed. Self-reporting was usually not possible due to psychotic experiences, forms of denial, difficulty with concentration, weakness or fatique. Fatigue and loss of appetite were the most common in USD-Ps and USD-Zs. Fatigue reached most often clinically relevant intensity in USD-Ps and USD-Zs. CONCLUSION: If the patient cannot fill in the USD-P, the USD-Z can be an alternative to systematically monitor symptoms. Application of the USD-Z requires good observation and awareness of differences in interpretation between healthcare providers and patients in a target group that has difficulty in expressing complaints clearly. Psychical symptoms are reported more often as clinically relevant than psychological symptoms. Fatigue is the most frequently and most unequivocally scored by patients and healthcare providers in terms of presence and clinically relevant intensity.

Effectiveness and implementation of a multidisciplinary lifestyle focused approach in the treatment of inpatients with mental illness (MULTI +): a stepped wedge study protocol.

BACKGROUND: People with mental illness have a reduced life expectancy compared to the general population. Despite the increasing evidence for the efficacy of lifestyle interventions there is little change in routine clinical care. This discrepancy is often referred to as the implementation gap and has caused a need for effectiveness and implementation research in real-world settings. Our study assesses the effectiveness and implementation of a multidisciplinary lifestyle focused approach in the treatment of inpatients with mental illness (MULTI +). METHODS: An open cohort stepped wedge cluster randomized trial in inpatients psychiatric wards of GGz Centraal, the Netherlands. The wards are divided into three clusters based on geographical region. These clusters are randomly allocated to one of the three pre-defined steps to integrate MULTI + . MULTI + can be tailored to fit individual psychiatric wards and includes 10 core components aimed at improving lifestyle factors. The primary outcome is to investigate the difference in the mean QRISK3 score of patients receiving MULTI + compared to patients receiving TAU. Secondary outcomes include somatic and mental health outcomes, lifestyle factors, and implementation factors. Findings will be analysed using mixed model analyses. DISCUSSION: The MULTI + study is the first large-scale study evaluating the long-term effects of a multidisciplinary, multicomponent approach aimed at improving lifestyle factors in routine inpatient mental health care. A limitation of this study is the risk of missing data due to the large-scale, real-world setting of this study. Furthermore, implementation monitoring and external events that may influence outcomes could be difficult to account for. Strengths of this study are the focus on effectiveness as well as implementation and the inclusion of both patient and health care professionals' perspectives. Effectiveness studies in routine clinical care can advance our knowledge on lifestyle interventions in real-world settings. TRIAL REGISTRATION: ClinicalTrials.gov registration. Identifier: NCT04922749 . Retrospectively registered 3th of June 2021.

[Thinking inside the box: improving the lifestyle of inpatients with severe mental illness]. / Thinking inside the box: leefstijl­verbetering bij mensen met een ernstige psychiatrische aandoening in de kliniek.

BACKGROUND: An unhealthy lifestyle plays an important role in the substantially reduced life-expectancy of inpatients with severe mental illness (SMI). However, there is a lack of evidence on the long-term effectiveness and implementation of lifestyle improvements in inpatient mental healthcare.
AIM: Increasing knowledge and understanding of (the implementation of) lifestyle changes in inpatients with SMI in longer-term clinical care.
METHOD: Cross-sectional research followed by an observational study to evaluate a multidisciplinary lifestyle enhancing treatment (MULTI) for both changes in health-related outcomes after 18 months compared to treatment as usual (TAU), and the implementation barriers and facilitators.
RESULTS: Patients were very sedentary and less physically active compared to people without SMI. After 18 months, MULTI showed significant improvements in total physical activity, cardiometabolic risk factors, psychosocial functioning and mediation use, compared to TAU. Physical health did not improve in TAU. The implementation of MULTI was hampered by organisational factors and facilitated by positive attitudes of healthcare professionals and patients towards MULTI and their own role in it.
CONCLUSION: Using a multidisciplinary integrated approach, it is possible to improve the lifestyle, and thus the health status, of SMI inpatients, within the current context of routine mental healthcare.

[The efficacy of physical activity on psychiatric symptoms and physical health in people with psychiatric disorders: a systematic review of recent meta-analyses]. / Effect van bewegen op psychiatrische symptomen en lichamelijke gezondheid bij mensen met psychiatrische aan-doeningen; systematische review van recente meta-analyses.

BACKGROUND: Physical activity (PA) has been introduced in the sixties as standard care in the mental health care systems of The Netherlands and Belgium.
AIM: To summarize the recent meta-analytic evidence of PA in the prevention and treatment of depressive disorders, anxiety disorders, psychotic disorders, bipolar disorders, substance use disorders, adhd, autism, and eating disorders.
METHOD: medline/PubMed, Psycarticles and Embase were searched from January 1st, 2015 until January 31st, 2020 for meta-analyses of randomized controlled trials and cohort studies.
RESULTS: There is strong evidence for the beneficial effects of PA in the treatment of mild and moderate depression in children / adolescents and adults, severe depression, anxiety disorders and psychotic disorders in adults and reductions in adhd-symptoms in children. PA reduces the risk for depression, anxiety and to a lesser extent also psychosis. PA also improves cardiorespiratory fitness and quality of sleep in people with a psychiatric disorder.
CONCLUSION: There is trans-diagnostic scientific evidence for the beneficial effects of PA on psychiatric symptoms and physical health in people with a psychiatric disorder.

[The art of endurance: implementation of lifestyle interventions in mental healthcare]. / De kunst van de lange adem: implemen-tatie van leefstijlinterventies in de ggz.

BACKGROUND: An increasing number of studies in people with mental illness have demonstrated the efficacy of lifestyle interventions for both mental and physical health. However, implementing and sustaining such interventions in routine mental healthcare is challenging.
AIM: To describe implementation barriers and facilitators of various lifestyle interventions in routine mental healthcare.
METHOD: In this paper we summarise the results of three recent doctoral theses and provide recommendations for routine mental healthcare.
RESULTS: Enabling factors and barriers for successful implementation appeared to be universal across various settings and patient populations. Mental healthcare professionals and patients appreciated and supported the lifestyle interventions. A lack of priority, recognition and support on the organisational level were reported as barriers in all the studies. Addressing various lifestyle behaviours simultaneously (e.g. physical activity and diet), personalised to the patients' abilities and preferences, and setting measurable and attainable goals, were important for success. Moreover, involving qualified professionals (e.g. exercise professionals and dietitians with expertise in mental healthcare) and ensuring cooperation between patients and healthcare professionals and disciplines within and outside mental healthcare appeared crucial.
CONCLUSION: Successful implementation of lifestyle interventions in mental healthcare requires changes in culture and behaviour, a long-term strategy and endurance.