Mental health in elite athletes: International Olympic Committee consensus statement (2019).

Mental health symptoms and disorders are common among elite athletes, may have sport related manifestations within this population and impair performance. Mental health cannot be separated from physical health, as evidenced by mental health symptoms and disorders increasing the risk of physical injury and delaying subsequent recovery. There are no evidence or consensus based guidelines for diagnosis and management of mental health symptoms and disorders in elite athletes. Diagnosis must differentiate character traits particular to elite athletes from psychosocial maladaptations.Management strategies should address all contributors to mental health symptoms and consider biopsychosocial factors relevant to athletes to maximise benefit and minimise harm. Management must involve both treatment of affected individual athletes and optimising environments in which all elite athletes train and compete. To advance a more standardised, evidence based approach to mental health symptoms and disorders in elite athletes, an International Olympic Committee Consensus Work Group critically evaluated the current state of science and provided recommendations.

The evolution of sport psychiatry, circa 2009.

Over the past three decades, the world of both amateur and professional sports has expanded greatly and become more complex. In part related to these changes - and relatively unknown to sports medicine practitioners - the field of sport psychiatry has steadily evolved and grown. This paper focuses on what these changes have been. A sport psychiatrist is a physician-psychiatrist who diagnoses and treats problems, symptoms and/or disorders associated with an athlete, with their family/significant others, with their team, or with their sport, including spectators/fans. The primary aims of the specialty are to (i) optimize health, (ii) improve athletic performance, and (iii) manage psychiatric symptoms or disorders. The training includes medical training to provide knowledge and skills unique to physicians; psychiatric training to provide knowledge and skills inherent in that field, and training and/or experience in sport psychiatry to provide knowledge and skills about psychiatric aspects of sports. The sport psychiatrist first makes an individual, family-systems and phenomenological diagnosis of the clinical situation. Based on this evaluation, he sets goals for not only the athlete, but also for significant others involved. He delivers treatment based on the psychiatric disorder or problem using a combination of medication, psychotherapy or self-help group interventions plus strategies targeted to specific sport performance issues. Evolution of the International Society of Sport Psychiatry as well as the field, including incorporation into school and professional team sports, is described along with a 'typical day' for a sport psychiatrist. Case examples, a training curriculum and core literature are included.

Psychiatric conditions in sports: diagnosis, treatment, and quality of life.

The social stigma surrounding psychiatric illness may prevent athletes from seeking counseling, psychotherapy, medication, or other treatment when needed. Few controlled studies on athletes exist to guide the team physician, clinician, or psychiatrist who must deal with diagnostic issues. Management involves setting realistic goals, educating as well as inducing the patient into treatment, soliciting support from family or significant others, and delivering appropriate treatment (the most difficult task). The objective is to improve performance and quality of life. Confidentiality issues are paramount during diagnosis and treatment. Physicians who understand sports and team dynamics may have more success in helping patients follow through with treatment.

A trial evaluating gradual- or immediate-switch strategies from risperidone, olanzapine, or aripiprazole to iloperidone in patients with schizophrenia.

In a 12-week randomized open-label trial, adults diagnosed with schizophrenia experiencing inadequate efficacy and/or poor tolerability on risperidone, olanzapine, or aripiprazole were randomized to switch to iloperidone either gradually (ie, down-titration of current therapy over the first 2weeks [to 50% on Day 1, 25% by Week 1, 0% by Week 2]) or immediately. All patients were titrated on iloperidone to 6mg BID by Day 4, then flexibly dosing between 6 and 12mg BID, as needed. The primary variable was the Integrated Clinical Global Impression of Change (I-CGI-C) and the primary analysis time point was Week 12. A total of 500 patients were randomized and received iloperidone (gradual switch, 240; immediate switch, 260), with 175, 155, and 170 patients switched from risperidone, olanzapine, and aripiprazole, respectively. I-CGI-C Results confirmed improved outcomes at Week 12, with scores that were similar between the gradual- and immediate-switch groups, respectively, for risperidone, 2.82 and 2.67 (95% CI: -0.229, 0.511); olanzapine, 2.87 and 3.03 (95% CI: -0.548, 0.235); and aripiprazole, 2.79 and 2.81 (95% CI: -0.405, 0.368). Incidence of adverse events (AEs) was similar in both switch groups, with the most frequently reported (≥10%) being dizziness, dry mouth, somnolence, and weight increase. In conclusion, switching to iloperidone by either a gradual or an immediate method did not reveal any clinically significant differences in ratings of overall efficacy and safety/tolerability outcomes, based on the I-CGI-C at 12weeks. Similar overall safety/AE profiles were observed regardless of the specific agent from which patients were switched.

Diagnosis and psychiatric treatment of athletes.

Although enormous amounts of time and money have been invested in enhancing performance for college and professional athletes, their psychiatric needs have been minimally addressed. Given the virtual absence of controlled scientific literature, in this article the authors detail the diagnostic issues and delineate treatment principles, including: (1) making an accurate diagnosis; (2) setting realistic goals; (3) delivering psycho-education; (4) inducing the patient to undergo treatment, including involving the family and significant others; and (5) delivering appropriate treatment (the most difficult task). The objective is to improve performance and quality of life by treating the problem or psychiatric illness. A special concern is minimizing countertransference feelings and avoiding undertreatment, because by definition the athlete needs to perform.