There is growing interest in lifestyle interventions as stand-alone and add-on therapies in mental health care due to their potential benefits for both physical and mental health outcomes. We evaluated lifestyle interventions focusing on physical activity, diet, and sleep in adults with severe mental illness (SMI) and the evidence for their effectiveness. To this end, we conducted a meta-review and searched major electronic databases for articles published prior to 09/2022 and updated our search in 03/2024. We identified 89 relevant systematic reviews and assessed their quality using the SIGN checklist. Based on the findings of our meta-review and on clinical expertise of the authors, we formulated seven recommendations. In brief, evidence supports the application of lifestyle interventions that combine behavioural change techniques, dietary modification, and physical activity to reduce weight and improve cardiovascular health parameters in adults with SMI. Furthermore, physical activity should be used as an adjunct treatment to improve mental health in adults with SMI, including psychotic symptoms and cognition in adults with schizophrenia or depressive symptoms in adults with major depression. To ameliorate sleep quality, cognitive behavioural informed interventions can be considered. Additionally, we provide an overview of key gaps in the current literature. Future studies should integrate both mental and physical health outcomes to reflect the multi-faceted benefits of lifestyle interventions. Moreover, our meta-review highlighted a relative dearth of evidence relating to interventions in adults with bipolar disorder and to nutritional and sleep interventions. Future research could help establish lifestyle interventions as a core component of mental health care.
ANTECEDENTES: Muchos países están desarrollando estrategias de prevención del suicidio para las cuales se requiere evidencia actualizada y de alta calidad. MÉTODOS: Se realizaron búsquedas en PubMed y en la Biblioteca Cochrane utilizando múltiples términos relacionados con la prevención del suicidio para los estudios publicados entre el 1 de enero de 2005 y el 31 de diciembre de 2014. Se evaluaron siete intervenciones: La educación pública y médica, las estrategias de los medios de comunicación, el cribado, la restricción del acceso a los medios de suicidio, los tratamientos y el apoyo por internet o por línea telefónica. Se extrajeron datos sobre los resultados primarios de interés, a saber, comportamiento suicida (suicidio, intento o ideación) y resultados intermedios o secundarios (búsqueda de tratamiento, identificación de individuos en riesgo, tasas de prescripción o uso de antidepresivos o referencias). 18 expertos en prevención de suicidios de 13 países europeos revisaron todos los artículos y evaluaron la fuerza de la evidencia utilizando los criterios de Oxford. Debido a que la heterogeneidad de las poblaciones y la metodología no permitieron metanálisis formal, presentamos un análisis narrativo. RESULTADOS: Se identificaron 1797 estudios, incluyendo 23 revisiones sistemáticas, 12 metaanálisis, 40 ensayos controlados aleatorios (ECA), 67 estudios de cohortes y 22 estudios ecológicos o basados en la población. La evidencia de restricción del acceso a medios letales en la prevención del suicidio se ha fortalecido desde 2005, especialmente en lo que se refiere al control de los analgésicos (disminución general del 43% desde 2005) y los puntos calientes de suicidio por salto (reducción del 86% A 91%). Se ha demostrado que los programas de concienciación en la escuela reducen los intentos de suicidio (odds ratio [OR] 0 · 45, IC del 95% 0 · 24-0 85], p = 0, 014) y la ideación suicida (0, 5, -0 · 92; p = 0 · 025). Los efectos anti-suicidas de la clozapina y el litio han sido probados, pero podrían ser menos específicos de lo que se pensaba anteriormente. Los tratamientos farmacológicos y psicológicos eficaces de la depresión son importantes en la prevención. No existen pruebas suficientes para evaluar los posibles beneficios de la prevención del suicidio en la atención primaria, en la educación general del público y en las directrices de los medios de comunicación. Otros enfoques que necesitan más investigación incluyen la formación de guardián, la educación de los médicos, y el apoyo de Internet y ayuda. La escasez de ECA es una limitación importante en la evaluación de las intervenciones preventivas. INTERPRETACIÓN: En la búsqueda de iniciativas eficaces de prevención del suicidio, ninguna estrategia única claramente está por encima de las demás. Las combinaciones de estrategias basadas en la evidencia a nivel individual y el nivel de población deben ser evaluadas con diseños de investigación sólidos. FINANCIACIÓN: Plataforma de Expertos en Salud Mental, Foco en la Depresión, y el Colegio Europeo de Neuropsicofarmacología.
OBJECTIVE: To summarize the evidence on the health benefits of tai chi.Sources Of Information: A literature review was conducted on the benefits of tai chi for 25 specific conditions, as well as for general health and fitness, to update a 2014 review of systematic reviews. Systematic reviews and recent clinical trials were assessed and organized into 5 different groups: evidence of benefit as excellent, good, fair, or preliminary, or evidence of no direct benefit.Main Message: During the past 45 years more than 500 trials and 120 systematic reviews have been published on the health benefits of tai chi. Systematic reviews of tai chi for specific conditions indicate excellent evidence of benefit for preventing falls, osteoarthritis, Parkinson disease, rehabilitation for chronic obstructive pulmonary disease, and improving cognitive capacity in older adults. There is good evidence of benefit for depression, cardiac and stroke rehabilitation, and dementia. There is fair evidence of benefit for improving quality of life for cancer patients, fibromyalgia, hypertension, and osteoporosis. Current evidence indicates no direct benefit for diabetes, rheumatoid arthritis, or chronic heart failure. Systematic reviews of general health and fitness benefits show excellent evidence of benefit for improving balance and aerobic capacity in those with poor fitness. There is good evidence for increased strength in the lower limbs. There is fair evidence for increased well-being and improved sleep. There were no studies that found tai chi worsened a condition. A recent systematic review on the safety of tai chi found adverse events were typically minor and primarily musculoskeletal; no intervention-related serious adverse events have been reported.CONCLUSION: There is abundant evidence on the health and fitness effects of tai chi. Based on this, physicians can now offer evidence-based recommendations to their patients, noting that tai chi is still an area of active research, and patients should continue to receive medical follow-up for any clinical conditions.
BACKGROUND: This evidence map describes the volume and focus of Tai Chi research reporting health outcomes. Originally developed as a martial art, Tai Chi is typically taught as a series of slow, low-impact movements that integrate the breath, mind, and physical activity to achieve greater awareness and a sense of well-being.
METHODS: The evidence map is based on a systematic review of systematic reviews. We searched 11 electronic databases from inception to February 2014, screened reviews of reviews, and consulted with topic experts. We used a bubble plot to graphically display clinical topics, literature size, number of reviews, and a broad estimate of effectiveness.
RESULTS: The map is based on 107 systematic reviews. Two thirds of the reviews were published in the last five years. The topics with the largest number of published randomized controlled trials (RCTs) were general health benefits (51 RCTs), psychological well-being (37 RCTs), interventions for older adults (31 RCTs), balance (27 RCTs), hypertension (18 RCTs), fall prevention (15 RCTs), and cognitive performance (11 RCTs). The map identified a number of areas with evidence of a potentially positive treatment effect on patient outcomes, including Tai Chi for hypertension, fall prevention outside of institutions, cognitive performance, osteoarthritis, depression, chronic obstructive pulmonary disease, pain, balance confidence, and muscle strength. However, identified reviews cautioned that firm conclusions cannot be drawn due to methodological limitations in the original studies and/or an insufficient number of existing research studies.
CONCLUSIONS: Tai Chi has been applied in diverse clinical areas, and for a number of these, systematic reviews have indicated promising results. The evidence map provides a visual overview of Tai Chi research volume and content.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42014009907.
Este mapa evidencia proporciona una visión general de la investigación de Tai Chi y describe su volumen y concentración. Combina una revisión sistemática de las revisiones sistemáticas con una revisión de alcance para la VA áreas prioritarias dolor, el trastorno de estrés postraumático y de prevención de caídas. El mapa de las pruebas se resumen los resultados de pacientes reportados en las revisiones de los estudios en pacientes que practican Tai Chi para indicaciones relacionadas con la salud. Se realizaron búsquedas en PubMed, DARE, la Biblioteca Cochrane de Revisiones Sistemáticas, la base de datos de Colaboración Campbell, AMED, CINAHL, PsycINFO, Scopus, Web of Science, y PROSPERO; opiniones de un control de revisión; y consultó con expertos en el tema. Se utilizó el gráfico de burbujas para mostrar gráficamente el campo de la investigación y se resumieron los resultados narrativamente en un resumen ejecutivo. Tai Chi ha sido investigado como un tratamiento para una serie de indicaciones clínicas. La revisión sistemática identificó 107 revisiones sistemáticas. Comentarios abordan los efectos generales de la salud, el bienestar psicológico, o intervenciones en los adultos mayores incluyen entre 31 y 51 ensayos controlados aleatorios (ECA). El balance de las áreas temáticas, la hipertensión, las caídas, la calidad de vida, rendimiento cognitivo y vestibulopatía también han sido el foco de la investigación; revisiones incluidas identificaron 10 o más pertinentes ECA por tema. Estadísticamente se informaron efectos significativos entre los estudios existentes para la hipertensión, cae fuera de las instituciones, el rendimiento cognitivo, la osteoartritis, enfermedad pulmonar obstructiva crónica, el dolor, equilibrar la confianza, la depresión y la fuerza muscular. Sin embargo, los revisores advirtieron que conclusiones firmes no pueden establecerse debido a las limitaciones metodológicas de los estudios originales y / o un número insuficiente de estudios de investigación.
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
To establish the clinical effectiveness and cost-effectiveness of electroconvulsive therapy (ECT) for depressive illness, schizophrenia, catatonia and mania. Electronic bibliographic databases. The reference lists of relevant articles and health services research-related resources were consulted via the Internet. Identified studies were examined to ascertain whether they met the inclusion criteria for the review. The study quality of relevant articles was assessed using standard checklists and data were abstracted using standardised forms into a database. Where relevant, results from studies were pooled for meta-analysis. Two economic models were developed primarily based on evidence from the clinical effectiveness analysis and limited quality of life studies. Two good-quality systematic reviews of randomised evidence of the efficacy and safety of ECT in people with depression, schizophrenia, catatonia and mania were identified. Four systematic reviews on non-randomised evidence were also identified, although only one of these could be described as good quality. There was no randomised evidence of the effectiveness of ECT in specific subgroups including older people, children and adolescents, people with catatonia and women with postpartum exacerbations of depression or schizophrenia. The economic modelling results for depression did not demonstrate that any of the scenarios had a clear economic benefit over the others, mainly because of the uncertainty surrounding the clinical effectiveness of the different treatments and the quality of life utility gains. Sensitivity analysis surrounding the cost of ECT and the quality of life utility values had little effect on the overall results. The results of the model for schizophrenia adapted to include ECT suggest that clozapine is a cost-effective treatment compared with ECT. For patients who fail to respond to clozapine, ECT treatment may be preferred to the comparative treatment of haloperidol/chlorpromazine. Real ECT is probably more effective than sham ECT, but as stimulus parameters have an important influence on efficacy, low-dose unilateral ECT is no more effective than sham ECT. ECT is probably more effective than pharmacotherapy in the short term and limited evidence suggests that ECT is more effective than repetitive transcranial magnetic stimulation. Tricyclic antidepressants (TCAs) may improve the antidepressant effect of ECT during the course of treatment. Continuation pharmacotherapy with TCAs combined with lithium in people who have responded to ECT reduces the rate of relapses. Overall, gains in the efficacy of the intervention depending on the stimulus parameters of ECT are achieved only at the expense of an increased risk of cognitive side-effects. Limited evidence suggests these effects do not last beyond 6 months, but there is no evidence examining the longer term cognitive effects of ECT. There is little evidence of the long-term efficacy of ECT. ECT either combined with antipsychotic medication or as a monotherapy is not more effective than antipsychotic medication in people with schizophrenia. More research is needed to examine the long-term efficacy of ECT and the effectiveness of post-ECT pharmacotherapy, the short-term and longer term cognitive side-effects of ECT, and the impact of ECT on suicide and all-cause mortality. Further work is needed to examine the information needs of people deciding whether to accept ECT and how their decision-making can be facilitated. More research is also needed on the mechanism of action of ECT. Finally, the quality of reporting of trials in this area would be vastly improved by strict adherence to the Consolidated Standards of Reporting Trials recommendations. Economic analysis may identify areas in which research would be best targeted by identifying parameters where reducing the level of uncertainty would have the most effect in helping to make the decision on whether ECT is a cost-effective treatment.
Clinical and cost-effectiveness of electroconvulsive therapy for depressive illness, schizophrenia, catatonia and mania: Systematic reviews and economic modeling studies (PDF Download Available). Available from: https://www.researchgate.net/publication/7961151_Clinical_and_cost-effectiveness_of_electroconvulsive_therapy_for_depressive_illness_schizophrenia_catatonia_and_mania_Systematic_reviews_and_economic_modeling_studies [accessed Dec 09 2017].
There is growing interest in lifestyle interventions as stand-alone and add-on therapies in mental health care due to their potential benefits for both physical and mental health outcomes. We evaluated lifestyle interventions focusing on physical activity, diet, and sleep in adults with severe mental illness (SMI) and the evidence for their effectiveness. To this end, we conducted a meta-review and searched major electronic databases for articles published prior to 09/2022 and updated our search in 03/2024. We identified 89 relevant systematic reviews and assessed their quality using the SIGN checklist. Based on the findings of our meta-review and on clinical expertise of the authors, we formulated seven recommendations. In brief, evidence supports the application of lifestyle interventions that combine behavioural change techniques, dietary modification, and physical activity to reduce weight and improve cardiovascular health parameters in adults with SMI. Furthermore, physical activity should be used as an adjunct treatment to improve mental health in adults with SMI, including psychotic symptoms and cognition in adults with schizophrenia or depressive symptoms in adults with major depression. To ameliorate sleep quality, cognitive behavioural informed interventions can be considered. Additionally, we provide an overview of key gaps in the current literature. Future studies should integrate both mental and physical health outcomes to reflect the multi-faceted benefits of lifestyle interventions. Moreover, our meta-review highlighted a relative dearth of evidence relating to interventions in adults with bipolar disorder and to nutritional and sleep interventions. Future research could help establish lifestyle interventions as a core component of mental health care.
Síntesis amplia»Revisión panorámica de revisiones sistemáticas