Mental health starts with physical health: current status and future directions of non-pharmacological interventions to improve physical health in first-episode psychosis

Gates, Jesse; Killackey, Eóin; Phillips, Lisa; Álvarez-Jiménez, Mario

doi:10.1016/s2215-0366(15)00213-8

Cited by 73Schizophrenia research and treatmentPhysical Activity and HealthHealth and Lifestyle Studies

Mental health starts with physical health: current status and future directions of non-pharmacological interventions to improve physical health in first-episode psychosis

Gates, Jesse, Killackey, Eóin, Phillips, Lisa, Álvarez-Jiménez, Mario·2015·The Lancet Psychiatry

DOI 10.1016/s2215-0366(15)00213-8

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Abstract

People with psychotic disorders have reduced life expectancy compared with the general population. This difference is primarily due to increased prevalence of cardiovascular disease associated with antipsychotic drugs and with modifiable risk factors, including weight gain, low exercise, poor diet, and high prevalence of cigarette smoking. We review non-pharmacological interventions for physical health behaviour in patients with chronic and first-episode psychosis. Our findings suggest that weight loss and attenuation of weight gain are achievable but limited and might not persist beyond the end of an intervention. Evidence for smoking cessation interventions is scarce. The case for early intervention to prevent deterioration of physical health is strong. We propose a framework for development of interventions, which addresses three main factors largely absent in previous research: (1) examination of aetiological factors related to poor physical health, (2) theory-driven interventions that target aetiological factors, and (3) assessment of feasibility.

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Going Beyond: An Adventure- and Recreation-Based Group Intervention Promotes Well-Being and Weight Loss in Schizophrenia
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Effects of contingency management and bupropion on cigarette smoking in smokers with schizophrenia
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Financial Motivation Undermines Maintenance in an Intensive Diet and Activity Intervention
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Using Self-Determination Theory to Understand Motivation Deficits in Schizophrenia: The ‘Why’ of Motivated Behavior
Gard, D. E., Sanchez, A. H., Starr, J., Cooper, S., Fisher, M., Rowlands, A., & Vinogradov, S. (2014) · Schizophrenia Research · doi:10.1016/j.schres.2014.04.027 · Cited by 60 · see citing works
Policy recommendations for smoking cessation and treatment of tobacco dependence
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Health promotion in mental health care: perceptions from patients and mental health nurses
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A systematic review of controlled interventions to reduce overweight and obesity in people with schizophrenia
Hjorth, P., Davidsen, A. S., Kilian, R., & Skrubbeltrang, C. (2014) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12245 · Cited by 57 · see citing works
Behavioral Treatment of Obesity in Patients Taking Antipsychotic Medications
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An Exploratory Randomized Controlled Study of a Healthy Living Intervention in Early Intervention Services for Psychosis
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Self-Efficacy and Self-Care: Missing Ingredients in Health and Healthcare among Adults with Serious Mental Illnesses
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Extended use of nicotine replacement therapy to maintain smoking cessation in persons with schizophrenia
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Rethinking the association between smoking and schizophrenia
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Review of smoking cessation treatments for people with mental illness
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Long‐term weight loss and weight‐loss maintenance strategies
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Employment Status and Self Rated Health
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Weight change in treatment with olanzapine and a psychoeducational approach
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Self-Determination and First-Episode Psychosis: Associations with Symptomatology, Social and Vocational Functioning, and Quality of Life
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Predictors of long-term outcome of first-episode schizophrenia: A ten-year follow-up study
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Promoting Physical Health In Youth Mental Health Services: Ensuring Routine Monitoring of Weight and Metabolic Indices in a First Episode Psychosis Clinic
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Impact of physical activity on functioning of patients with first-episode psychosis — A 6 months prospective longitudinal study
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An Open Trial of Relapse Prevention Therapy for Smokers With Schizophrenia
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Spaces for smoking in a psychiatric hospital: Social capital, resistance to control, and significance for ‘therapeutic landscapes’
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Nonmedication Smoking Reduction Program for Inpatients With Chronic Schizophrenia
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Counseling and Exercise Intervention for Smoking Reduction in Patients With Schizophrenia: A Feasibility Study
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Cigarette Smoking And Psychosis: Naturalistic Follow up 4 Years After an Intervention Trial
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A 12-Week Weight Reduction Intervention for Overweight Individuals Taking Antipsychotic Medications
Green, C., Janoff, S., Yarborough, B. J. H., & Yarborough, M. T. (2014) · Community mental health journal · doi:10.1007/s10597-014-9716-9 · Cited by 27 · see citing works
Behavioral Interventions for Antipsychotic Induced Appetite Changes
Werneke, U., Taylor, D. M., & Sanders, T. A. B. (2013) · Current Psychiatry Reports · doi:10.1007/s11920-012-0347-y · Cited by 26 · see citing works
Preliminary effects of bupropion and the promoter region (HTTLPR) serotonin transporter (SLC6A4) polymorphism on smoking behavior in schizophrenia
Bloch, B., Reshef, A., Cohen, T. R., Tafla, A., Gathas, S., Israel, S., Gritsenko, I., Kremer, I., & Ebstein, R. P. (2009) · Psychiatry Research · doi:10.1016/j.psychres.2008.12.015 · Cited by 26 · see citing works
Motivational intervention increases exercise in schizophrenia and co-occurring substance use disorders
Beebe, L. H., Smith, K., Burk, R., McIntyre, K., Dessieux, O. L., Tavakoli, A. S., & Velligan, D. I. (2012) · Schizophrenia Research · doi:10.1016/j.schres.2011.12.008 · Cited by 25 · see citing works
Effects of nicotine on social cognition, social competence and self-reported stress in schizophrenia patients and healthy controls
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Managing Weight in Persons Living with Severe Mental Illness in Community Settings: A Review of Strategies Used in Community Interventions
Galletly, C. L., & Murray, L. (2009) · Issues in Mental Health Nursing · doi:10.1080/01612840903131784 · Cited by 24 · see citing works
Preventing the Development of Metabolic Syndrome in People with Psychotic Disorders—Difficult, but Possible: Experiences of Staff Working in Psychosis Outpatient Care in Sweden
Bergqvist, A., Karlsson, M., Foldemo, A., Wärdig, R. E., & Hultsjö, S. (2013) · Issues in Mental Health Nursing · doi:10.3109/01612840.2013.771234 · Cited by 21 · see citing works
Improving Metabolic and Cardiovascular Health at an Early Psychosis Intervention Program in Vancouver, Canada
Fredrikson, D. H., Boyda, H. N., Tse, L., Whitney, Z., Pattison, M. A., Ott, F. J., Hansen, L., & Barr, A. M. (2014) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2014.00105 · Cited by 19 · see citing works
Developing a healthy living intervention for people with early psychosis using the Medical Research Council's guidelines on complex interventions: Phase 1 of the HELPER – InterACT programme
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Community Rehabilitation and Psychosocial Interventions for Psychotic Disorders in Youth
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Self-Determination Theory and First-Episode Psychosis: A Replication
Breitborde, N. J. K., Woolverton, C. B., Frost, R. B., & Kiewel, N. A. (2014) · Advances in Psychiatry · doi:10.1155/2014/240125 · Cited by 7 · see citing works
The short term effect of nicotine abstinence on visuospatial working memory in smoking patients with schizophrenia
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Prevention of antipsychotic-induced weight gain in young people with psychosis: a multi-modal psychological intervention
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The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness
Firth, J., Siddiqi, N., Koyanagi, A., Siskind, D., Rosenbaum, S., Galletly, C., Allan, S., Caneo, C., Carney, R., Carvalho, A. F., et al. (2019) · The Lancet Psychiatry · doi:10.1016/s2215-0366(19)30132-4 · Cited by 1,531 · see citing works
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Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders
Galletly, C., Castle, D., Dark, F., Humberstone, V., Jablensky, A., Killackey, E., Kulkarni, J., McGorry, P., Nielssen, O., & Tran, N. (2016) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867416641195 · Cited by 877 · see citing works
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Resurrection of endogenous retroviruses during aging reinforces senescence
Liu, X., Liu, Z., Wu, Z., Ren, J., Fan, Y., Sun, L., Cao, G., Niu, Y., Zhang, B., Ji, Q., et al. (2023) · Cell · doi:10.1016/j.cell.2022.12.017 · Cited by 390 · see citing works
The clinical characterization of the patient with primary psychosis aimed at personalization of management
Maj, M., van Os, J., De Hert, M., Gaebel, W., Galderisi, S., Green, M. F., Guloksuz, S., Harvey, P. D., Jones, P. B., Malaspina, D., et al. (2021) · World Psychiatry · doi:10.1002/wps.20809 · Cited by 285 · see citing works
Lifestyle interventions for weight loss among overweight and obese adults with serious mental illness: A systematic review and meta-analysis
Naslund, J. A., Whiteman, K. L., McHugo, G. J., Aschbrenner, K. A., Marsch, L. A., & Bartels, S. J. (2017) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2017.04.003 · Cited by 176 · see citing works
In- and outpatient lifestyle interventions on diet and exercise and their effect on physical and psychological health: a systematic review and meta-analysis of randomised controlled trials in patients with schizophrenia spectrum disorders and first episode of psychosis
Fernández-Abascal, B., Suárez‐Pinilla, P., Cobo-Corrales, C., Crespo‐Facorro, B., & Suárez‐Pinilla, M. (2021) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2021.01.005 · Cited by 93 · see citing works
Implementation of a Lifestyle Intervention for People With Serious Mental Illness in State-Funded Mental Health Centers
Bartels, S. J., Aschbrenner, K. A., Pratt, S. I., Naslund, J. A., Scherer, E. A., Zubkoff, L., Cohen, M. J., Williams, G. E., Wolfe, R. S., Jue, K., et al. (2018) · Psychiatric Services · doi:10.1176/appi.ps.201700368 · Cited by 68 · see citing works
Metabolic-inflammatory status as predictor of clinical outcome at 1-year follow-up in patients with first episode psychosis
Nettis, M. A., Pergola, G., Kolliakou, A., O’Connor, J. A., Bonaccorso, S., David, A. S., Gaughran, F., Forti, M. D., Murray, R. M., Marques, T. R., et al. (2018) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2018.09.005 · Cited by 56 · see citing works
Long‐term maintenance and effects of exercise in early psychosis
Firth, J., Carney, R., French, P., Elliott, R., Cotter, J., & Yung, A. R. (2016) · Early Intervention in Psychiatry · doi:10.1111/eip.12365 · Cited by 49 · see citing works
Cuando la asistencia no sigue a la evidencia: el caso de la falta de programas de intervención temprana en psicosis en España
Arango, C., Bernardo, M., Bonet, P., Cabrera, A., Crespo‐Facorro, B., Cuesta, M. J., González, N., Parrabera, S., Sanjuán, J., Serrano, A., et al. (2017) · Revista de Psiquiatría y Salud Mental · doi:10.1016/j.rpsm.2017.01.001 · Cited by 40 · see citing works
The social inclusion of young people with serious mental illness: A narrative review of the literature and suggested future directions
Gardner, A., Filia, K., Killackey, E. J., & Cotton, S. (2018) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867418804065 · Cited by 41 · see citing works
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Is autonomous motivation the key to maintaining an active lifestyle in first‐episode psychosis?
Vancampfort, D., Binder, M. D., Broderick, J. M., Lederman, O., Firth, J., Rosenbaum, S., & Probst, M. (2016) · Early Intervention in Psychiatry · doi:10.1111/eip.12373 · Cited by 38 · see citing works
Bridging the gap: What have we done and what more can we do to reduce the burden of avoidable death in people with psychotic illness?
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Prospective associations between multiple lifestyle behaviors and depressive symptoms
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Mortality, Revascularization, and Cardioprotective Pharmacotherapy After Acute Coronary Syndrome in Patients With Severe Mental Illness: A Systematic Review and Meta-analysis
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Brain, lifestyle and environmental pathways linking physical and mental health
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Current Data on and Clinical Insights into the Treatment of First Episode Nonaffective Psychosis: A Comprehensive Review
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Premature death in schizophrenia: bridging the gap
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Schizophrenia and “unmet needs”: From diagnosis to care in Italy
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When the healthcare does not follow the evidence: The case of the lack of early intervention programs for psychosis in Spain
Arango, C., Bernardo, M., Bonet, P., Cabrera, A., Crespo‐Facorro, B., Cuesta, M. J., González, N., Parrabera, S., Sanjuán, J., Serrano, A., et al. (2017) · Revista de Psiquiatría y Salud Mental (English Edition) · doi:10.1016/j.rpsmen.2017.02.001 · Cited by 19 · see citing works
Sensory‐based approaches in psychiatric care: A systematic mixed‐methods review
Ma, D., Jianping, S., Wang, H., Zhao, Y., Li, H., Li, Y., Zhang, X., Qi, Y., & Sun, J. (2021) · Journal of Advanced Nursing · doi:10.1111/jan.14884 · Cited by 15 · see citing works
Health Promotion for Young Adults With Serious Mental Illness
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Systems for physical health care for mental health patients in the community: different approaches to improve patient care and safety in an Early Intervention in Psychosis Service
Mouko, J., & Sullivan, R. (2017) · BMJ Quality Improvement Reports · doi:10.1136/bmjquality.u209141.w3798 · Cited by 12 · see citing works
Outcome of a psychosocial health promotion intervention aimed at improving physical health and reducing alcohol use in patients with schizophrenia and psychotic disorders (MINT)
Westman, J., Eberhard, J., Gaughran, F., Lundin, L., Stenmark, R., Edman, G., Eriksson, S. V., Jedenius, E., Rydell, P., Overgaard, K., et al. (2019) · Schizophrenia Research · doi:10.1016/j.schres.2019.03.026 · Cited by 12 · see citing works
A Longitudinal Treatment Effect Analysis of Antipsychotics on Behavior of Residents in Long-Term Care
Leme, D. E. D. C., Mathias, K., Mofina, A., Liperoti, R., Betini, G. S., & Hirdes, J. P. (2024) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2024.105255 · Cited by 10 · see citing works
Dose-dependent association between physical activity and mental health, and mitigation effects on risk behaviors
Zhou, H., Jiang, F., Liu, H., Wu, Y., & Tang, Y. (2025) · iScience · doi:10.1016/j.isci.2025.111866 · Cited by 10 · see citing works
Cognitive ability and metabolic physical health in first-episode psychosis
Whitson, S., O'Donoghue, B. N., Hester, R., Baldwin, L., Harrigan, S., Francey, S. M., Graham, J. R., Nelson, B., Ratheesh, A., Álvarez‐Jiménez, M., et al. (2021) · Schizophrenia Research Cognition · doi:10.1016/j.scog.2021.100194 · Cited by 10 · see citing works
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Mortality rates in people with first diagnosis of schizophrenia-spectrum disorders: A 5-year population-based cohort study
Yung, N. C. L., Wong, C. S. M., Chan, J. K. N., & Chang, W. C. (2022) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674221121575 · Cited by 10 · see citing works
Counting up the risks: How common are risk factors for morbidity and mortality in young people with psychosis?
Hahn, L. A., Mackinnon, A. J., Foley, D. L., Morgan, V. A., Waterreus, A. J., Watts, G. F., Castle, D. J., Liu, D., & Galletly, C. A. (2016) · Early Intervention in Psychiatry · doi:10.1111/eip.12406 · Cited by 9 · see citing works
Crystallizing the relationship between adolescents, music, and emotions
McFerran, K. S. (2019) · doi:10.1093/oso/9780198808992.003.0001 · Cited by 9 · see citing works
30-year cardiovascular disease risk for young adults with serious mental illness
Miley, K. M., Hooker, S. A., Crain, A. L., O’Connor, P. J., Haapala, J. L., Bond, D. J., & Rossom, R. C. (2023) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2023.10.015 · Cited by 8 · see citing works
Premature Mortality and Schizophrenia—The Need to Heal Right From the Start
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Notes
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“I’m Sick From Head to Toe”
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Personal Note
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“They Do Not Get the Care That They Need”
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Copyright Page
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Flattening the Mortality Curve
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Smoking
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Engaging in Healthy Lifestyles
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“It Cures You in One Way and It Damages You in Another”
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Preface
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Authors: Gates, J., Killackey, E., Phillips, L., & Álvarez-Jiménez, M.
Affiliations: The University of Melbourne (AU)
ORCID: Gates, Jesse
Phillips, Lisa
Venue: The Lancet Psychiatry
Publisher: Elsevier BV
Published: 2015-08
Volume: 2
Issue: 8
Pages: 726-742
ISSN: 2215-0366 (ISSN-L)
DOI: 10.1016/s2215-0366(15)00213-8
OpenAlex: W1951834807
Cited by: 72
References: 127
Citations by year: 2026: 2 · 2025: 3 · 2024: 5 · 2023: 20 · 2022: 6 · 2021: 5 · 2020: 7 · 2019: 6 · 2018: 4 · 2017: 6 · 2016: 8
FWCI: 0.82
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: The Lancet Psychiatry (publishedVersion)
PubMed (publishedVersion)
Funders: National Health and Medical Research Council
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Health Sciences › Medicine › Physiology › Physical Activity and Health
Health Sciences › Health Professions › General Health Professions › Health and Lifestyle Studies
Keywords: first-episode psychosis, non-pharmacological treatment, physical health, cardiovascular disease, antipsychotic-induced weight gain, weight loss, smoking cessation, physical activity, diet, life expectancy, early intervention, theory-based intervention, intervention feasibility
MeSH terms: Cardiovascular Diseases, Health Promotion, Health Status, Humans, Mental Health, Psychotic Disorders, Smoking, Antipsychotic Agents, Weight Gain, Exercise, Smoking Cessation, Weight Reduction Programs

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Mental health starts with physical health: current status and future directions of non-pharmacological interventions to improve physical health in first-episode psychosis

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