Efficacy of lifestyle interventions in physical health management of patients with severe mental illness

It is well known that patients with severe mental illnesses (SMIs) such as schizophrenia, depression, or bipolar disorder have worse physical health and reduced life expectancy compared to the general population [1-4]. There are data suggesting that patients with SMIs die on average between 13.5 and 32.2 years earlier than the general population. A recent study, using years of potential life lost (YPLL) as a measure of premature mortality showed that the mean YPLL in patients with SMIs was 14.5 compared with 10.3 for the general population [5]. Factors affecting patients with SMIs which contribute to these outcomes include more frequent physical comorbidities as compared to the general population [6], genetic predisposition to certain pathologies [7-9], eating habits and sedentary lifestyles [10,11], high levels of cigarette smoking and drug abuse [12-14], limited access to regular health care services [15,16], and potential adverse events arising during pharmacological treatment [17].Weight gain and metabolism disturbances are among the well documented potential adverse events related to antipsychotic medication. A recently published meta-analysis shows that some second-generation antipsychotics (SGAs), such as olanzapine, lead to substantially more metabolic side effects than other SGAs [18]. The majority of studies used to perform the head-to-head comparisons with olanzapine were less than 1 year in length. Other studies have shown no statistical differences between olanzapine and other antipsychotics (typical and atypical) in weight gain and metabolic disturbances after 1 year of treatment [19-21], although significantly greater weight gain was found in olanzapine compared with risperidone and haloperidol after 3 months of treatment [22]. Regardless, a different pattern of weight gain in olanzapine compared with other antipsychotics is proposed [21].In recent years the importance of physical health in patients with SMI has become increasingly recognized by the m