Physiotherapy for functional motor disorders: a consensus recommendation.

BACKGROUND: Patients with functional motor disorder (FMD) including weakness and paralysis are commonly referred to physiotherapists. There is growing evidence that physiotherapy is an effective treatment, but the existing literature has limited explanations of what physiotherapy should consist of and there are insufficient data to produce evidence-based guidelines. We aim to address this issue by presenting recommendations for physiotherapy treatment. METHODS: A meeting was held between physiotherapists, neurologists and neuropsychiatrists, all with extensive experience in treating FMD. A set of consensus recommendations were produced based on existing evidence and experience. RESULTS: We recommend that physiotherapy treatment is based on a biopsychosocial aetiological framework. Treatment should address illness beliefs, self-directed attention and abnormal habitual movement patterns through a process of education, movement retraining and self-management strategies within a positive and non-judgemental context. We provide specific examples of these strategies for different symptoms. CONCLUSIONS: Physiotherapy has a key role in the multidisciplinary management of patients with FMD. There appear to be specific physiotherapy techniques which are useful in FMD and which are amenable to and require prospective evaluation. The processes involved in referral, treatment and discharge from physiotherapy should be considered carefully as a part of a treatment package.

Sedentary behaviour is associated with elevated C-reactive protein levels in people with psychosis.

Psychosis is associated with elevated inflammatory markers including C-reactive protein (CRP), a marker of cardiovascular disease (CVD) risk. Using a cross sectional design, 250 participants with established psychosis (48.2years (SD 10.2), 39.2% female) were classified as having normal (<5.0mg/µl, N=159) or high CRP levels (>5.0mg/µl, N=91). Regression analysis demonstrated that higher sedentary behaviour was associated with elevated CRP levels (ß=.155, p=.01) after adjustment for confounding variables. Female gender (ß=.229, p=.001), waist circumference (ß=.205, p=.003) and non-white ethnicity (ß=.181, p=.005) were also associated with elevated CRP. Sedentary behaviour is modifiable and increasing physical activity may reduce CRP levels.

Schizophrenia and the risk of fractures: a systematic review and comparative meta-analysis.

BACKGROUND: People with schizophrenia experience increased rates of osteoporosis and may be at heightened risk of fractures. We conducted a systematic review and meta-analysis to investigate fractures among people with schizophrenia compared to people without mental illness. METHOD: We systematically searched major electronic databases from inception until October 2014. Articles were included that reported the number of fractures in people with schizophrenia and a control group. Two independent authors conducted searches, completed methodological assessment and extracted data. Data were narratively synthesized, and a random-effects incidence rate ratio (IRR) meta-analysis was performed. RESULTS: Eight studies were included encompassing 48,384 people with schizophrenia (49.9-75.2 years, 41%-100% female) and 3,945,783 controls. The pooled adjusted rate of fractures per 1000 person-years was 5.54 [95% confidence interval (CI)=4.92-5.57] in people with schizophrenia and 3.48 (95% CI=3.39-3.64) in control participants. The comparative meta-analysis showed that people with schizophrenia experience an increased rate of fractures compared to control participants (IRR 1.72, 95% CI=1.24-2.39, I2=49%; n=168,914). There were insufficient data to conduct moderation analysis, but the narrative review consistently highlighted that antipsychotic medication was an important risk factor for fractures. CONCLUSION: People with schizophrenia are at significantly increased risk of fractures. Future research is required to understand the mechanisms and should seek to validate fracture prediction algorithms used in the general population. Importantly, there is a need to develop preventative strategies to improve bone health and reduce fracture risk involving the wider multidisciplinary team and incorporating falls-prevention strategies.

Pain is independently associated with reduced health related quality of life in people with psychosis.

The objective was to investigate the relationship between pain and health related quality of life (HRQOL) in people with psychosis. The study utilised a cross-sectional design including individuals with established psychosis from five Mental Health Trusts across England. Participants were classified as having pain or not and HRQOL was determined with the EQ-5D-3L. Covariates considered include the Positive and Negative Syndrome Scale (PANSS), the Montgomery Asberg Depression Rating Scale (MADRS) and Global Assessment of Functioning (GAF). Hierarchical multiple linear regression analyses were conducted. The final sample included 438 individuals with psychosis (47.5 years, SD 10.1, 193 females (42.9%)). 160 participants reported pain (36.5%) and compared to the non-pain group (N=278) they had significantly higher depressive symptoms (MADRS 14.91 vs 8.68), total (51.8 vs 47.9) and general PANSS scores (26.8 vs. 23.5) and lower overall HRQOL (54.7 vs 68.3). The final regression analysis (n=387) demonstrated that lower levels of pain were a predictor of better HRQOL (ß=.173) after adjusting for the PANSS, MADRS and GAF. Depressive symptoms were the largest predictor of HRQOL (ß=-.486). Only 1-2% of the sample were in receipt of analgesic medication suggesting pain is greatly overlooked despite its wider deleterious impact on HRQOL.