Mindgardens Neuroscience Network

AIM: This rapid review of reviews aimed to determine the extent of research undertaken on the effectiveness of dietary interventions for individuals with a mental disorder. METHODS: Three databases (MEDLINE, Embase, Cochrane Reviews and Cochrane Trials) were searched to February 2021 for systematic reviews including experimental studies assessing the effectiveness of dietary interventions with physical or mental health related outcomes in adults or children with one or more of: severe mental illness, depression or anxiety, eating disorders, or substance use disorder. Results are presented descriptively. RESULTS: The number of included reviews was 46 (67% in severe mental illness, 20% in depression and anxiety, 7% in eating disorders, and 7% in substance use disorders). Most reviews were published since 2016 (59%), and included studies conducted in adults (63%). Interventions in the eating disorders and severe mental illness reviews were predominantly education and behaviour change, whereas interventions in the substance use disorders, and depression and anxiety reviews were predominantly supplementation (e.g. omega-3). Twenty-eight and twelve of the reviews respectively reported mental health and dietary outcomes for one or more included studies. Most reviews in severe mental illness, and depression and anxiety reported conclusions supporting the positive effects of dietary intervention, including positive effects on weight-related or mental health outcomes, and on mental health outcomes, respectively. CONCLUSIONS: A larger number of systematic reviews were identified which evaluated dietary interventions in individuals with severe mental illness, and depression and anxiety, compared with substance use disorders, and eating disorders. Dietary intervention is an important component of the treatment that should be available to individuals living with mental disorders, to support their physical and mental health.

Our aim was to conduct an umbrella review of evidence from meta-analyses of observational studies investigating the link between sugar-sweetened beverage consumption and human health outcomes. Using predefined evidence classification criteria, we evaluated evidence from 47 meta-analyses encompassing 22,055,269 individuals. Overall, 79% of these analyses indicated direct associations between greater sugar-sweetened beverage consumption and higher risks of adverse health outcomes. Convincing evidence (class I) supported direct associations between sugar-sweetened beverage consumption and risks of depression, cardiovascular disease, nephrolithiasis, type 2 diabetes mellitus, and higher uric acid concentrations. Highly suggestive evidence (class II) supported associations with risks of nonalcoholic fatty liver disease and dental caries. Out of the remaining 40 meta-analyses, 29 were graded as suggestive or weak in the strength of evidence (classes III and IV), and 11 showed no evidence (class V). These findings inform and provide support for population-based and public health strategies aimed at reducing sugary drink consumption for improved health.

BACKGROUND: Noncommunicable diseases (NCDs) are the leading cause of death globally. Promoting physical activity and healthy eating is essential to help manage the NCD burden and reduce mortality. Social media may be a potential platform for delivering and scaling health promotion initiatives. In this systematic review, we aimed to examine i) the feasibility and acceptability of social media interventions targeting physical activity and/or diet for people with NCDs, ii) the effectiveness of improving exercise and diet behaviours, iii) specific design components used to promote user engagement and iv) the effectiveness on other health outcomes. METHODS: We searched MEDLINE, Google Scholar, CINAHL, EMBASE, and SPORTDiscus from inception until June 2021. Social media interventions targeting physical activity and/or diet were included. Participants were any age, with a diagnosis of one of the following categories of NCDs; cardiovascular disease, cancer, chronic respiratory disease, diabetes or mental illness. Interventions using social media alone or as part of an intervention with other modes of delivery were included. Eligible study designs were randomised controlled trials (RCTs), non-randomised controlled trials, feasibility or pilot studies, or quasi-experimental studies. RESULTS: A total of 2358 publications were identified. After removal of duplicates, 2233 publication titles and abstracts were screened, and 10 publications were eligible, describing 8 individual studies. The study designs included five RCTs and three pilot or feasibility studies, all published between 2016 and 2020. Sample sizes ranged from n = 11 to n = 312. Half of the studies were conducted in the United States of America. Clinical populations included severe mental illness (2 studies), cardiovascular disease (2 studies), chronic obstructive pulmonary disease (2 studies), cancer (1 study) and Type 2 diabetes (1 study). Facebook (three studies) and WeChat (three studies) were the most used social media platforms. The majority utilised social media to deliver health education and facilitate social support and all studies reported >70% retention. Four of the five included RCTS reported significant improvements in exercise behaviours (e.g., step count, exercise capacity) while diet was only assessed in two studies and results were non-significant. CONCLUSIONS: Social media interventions appear to be feasible and acceptable among specific NCD populations and preliminary evidence suggests interventions they may be effective for improving exercise behaviours. The evidence for diet behaviours remains unclear. While overall there is an emerging evidence base, more rigorous evaluation including replication studies are needed to determine the efficacy of social media interventions.

OBJECTIVES: To analyze Australian national data to examine the impact of the coronavirus disease 2019 (COVID-19) pandemic on mental health-related hospital presentations among children and adolescents during the pandemic period with restrictions, and the period after the restrictions eased. METHODS: We analyzed the monthly mental health-related inpatient admissions and emergency department (ED) attendances data from 6 large pediatric hospitals across Australia, using the Bayesian structural time series models. The COVID-19 restriction period was from March 2020 to December 2021 and the COVID-19 restriction-eased period from January to June 2022. RESULTS: A total of 130 801 mental health-related hospital admissions (54 907) and ED attendances (75 894) were analyzed. During the COVID-19 restriction period, there was a significant increase in inpatient admissions related to deliberate self-harm behaviors (82%, 95% credible interval [CrI], 7%-160%) and ED attendances related to overall mental health disorders (15%, 95% CrI, 1.1%-30%) and eating disorders (76%, 95% CrI, 36%-115%). The increase was higher among females and those living in the least socioeconomically disadvantaged areas, suggesting a widening gap between mental health-related presentations by sex and socioeconomic status. After the restrictions eased, there were slight declines in mental health-related hospital presentations; however, the numbers remained higher than the pre-COVID-19 levels. CONCLUSIONS: The increase in mental health-related hospital presentations during the COVID-19 period calls for additional support for pediatric mental health care, particularly for eating disorders and deliberate self-harm among female adolescents. It is important to monitor pediatric mental health service use as we enter "COVID-19 normal" period.

In this viewpoint we describe the architecture of, and design rationale for, a new software platform designed to support the conduct of digital phenotyping research studies. These studies seek to collect passive and active sensor signals from participants' smartphones for the purposes of modelling and predicting health outcomes, with a specific focus on mental health. We also highlight features of the current research landscape that recommend the coordinated development of such platforms, including the significant technical and resource costs of development, and we identify specific considerations relevant to the design of platforms for digital phenotyping. In addition, we describe trade-offs relating to data quality and completeness versus the experience for patients and public users who consent to their devices being used to collect data. We summarize distinctive features of the resulting platform, InSTIL (Intelligent Sensing to Inform and Learn), which includes universal (ie, cross-platform) support for both iOS and Android devices and privacy-preserving mechanisms which, by default, collect only anonymized participant data. We conclude with a discussion of recommendations for future work arising from learning during the development of the platform. The development of the InSTIL platform is a key step towards our research vision of a population-scale, international, digital phenotyping bank. With suitable adoption, the platform will aggregate signals from large numbers of participants and large numbers of research studies to support modelling and machine learning analyses focused on the prediction of mental illness onset and disease trajectories.

The impact of poor diet quality and nutritional inadequacies on mental health and mental illness has recently gained considerable attention in science. As the opinions and experiences of people living with serious mental illness on dietary issues are unknown, we aimed to understand the role of nutrition in a biopsychosocial approach. In total, 28 semi-structured interviews were conducted with people living with serious mental illness (SMI) in Australia, Germany and Austria, and a generic thematic analysis approach was applied. Four positive (positive effects on the body and mind, therapeutic effects in treating somatic illnesses, pleasure and opportunity for self-efficacy) and three negative (impairment related to mental illness and its treatment, perceived stigma and negative effects on the body and mind) implications of diet were identified. A key issue for most of the participants was the mental burden arising from their body weight. This might indicate that negative implications, such as guilt and stigma, were of primary importance for people with SMI when talking about their dietary behavior. In conclusion, diet-related support is urgently needed for people with SMI. However, especially participants from Germany and Austria reported that this is not yet widely available in mental health settings, leading to hopelessness and resignation.

This paper draws together critical learnings from diverse qualitative health research projects in Australia that sought to shift power and focus on the strengths and expertise of people with lived experience who are involved as co-researchers. These projects have included exploring and challenging identities, understanding experiences in treatment programs, critiquing and designing/re-designing services, and sharing experiences with the wider community in novel and innovative ways. Lived experiences included alcohol and other drug dependency, mental health, domestic, family or sexual violence, and living with HIV. This paper provides important learnings and actions about partnering with co-researchers with lived experience. In this paper we draw on a process of reflective discussions that occurred over six months with fortnightly online meetings between co-researchers, including co-authors with lived experience external to academia and university-based researchers, some of whom also have lived-experience that intersects with their research. From this, we distilled key learnings across seven themes: (1) the ethics of ethics, which highlights a need for constant reflection on the ethical issues in co-research; (2) recruiting co-researchers, which focuses on ensuring and integrating a diversity of voices; (3) creating safety for all, which must be a priority of engagement and support self-determination; (4) supporting different ways of partnering, which emphasises the need for diverse roles and ways to contribute on research teams; (5) capacity building and training, which requires ongoing evaluation of needs and tailored responses; (6) positioning, which highlights the need to transition from the idea of vulnerability to a strengths-based perspective of lived experience; and (7) power plays, reflecting the need to disrupt the dynamics and established hierarchies of privileging certain forms of knowledge and expertise. The paper includes recommendations for action against these seven themes.

OBJECTIVE: To review recent published trials of nutrition and dietary interventions for people with serious mental illness; to assess their effectiveness in improving metabolic syndrome risk factors. STUDY DESIGN: Systematic review and meta-analysis of randomised and non-randomised controlled trials of interventions with a nutrition/diet-related component delivered to people with serious mental illness, published 1 January 2010 - 6 September 2021. Primary outcomes were weight, body mass index (BMI), and waist circumference. Secondary outcomes were total serum cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, triglyceride, and blood glucose levels. DATA SOURCES: MEDLINE, EMBASE, PsycINFO, CINAHL, and CENTRAL databases. In addition, reference lists of relevant publications were examined for further additional studies. DATA SYNTHESIS: Twenty-five studies encompassing 26 intervention arms were included in our analysis. Eight studies were at low or some risk of bias, seventeen were deemed to be at high risk. Eight of seventeen intervention arms found statistically significant intervention effects on weight, ten of 24 on BMI, and seven of seventeen on waist circumference. The pooled effects of nutrition interventions on metabolic syndrome risk factors were statistically non-significant. However, we identified small size effects on weight for interventions delivered by dietitians (five studies; 262 intervention, 258 control participants; standardised mean difference [SMD], -0.28; 95% CI, -0.51 to -0.04) and interventions consisting of individual sessions only (three studies; 141 intervention, 134 control participants; SMD, -0.30; 95% CI, -0.54 to -0.06). CONCLUSIONS: We found only limited evidence for nutrition interventions improving metabolic syndrome risk factors in people with serious mental illness. However, they may be more effective when delivered on an individual basis or by dietitians. PROSPERO REGISTRATION: CRD42021235979 (prospective).

Abstract Introduction Food insecurity in adults living with Severe Mental Illness (SMI) is an underresearched area worldwide. Aim This systematic review and meta‐analysis aimed to identify and collate evidence on food insecurity in adults with SMI, in high‐ and upper‐middle income countries. Method A comprehensive electronic search was completed up to August 2022. Random effects meta‐analysis was undertaken to determine the prevalence and the odds ratio for food insecurity in adults with SMI. Narrative synthesis explored the data further. Results Sixteen publications were included (13 in the meta‐analysis). The prevalence estimate of food insecurity in adults with SMI was 41% (95% CI: 29% to 53%, I 2 = 99.9%, n = 13). Adults with SMI were 3.31 (95% CI: 2.03 to 5.41) times more likely to experience food insecurity than comparators without SMI ( z = 6.29, p < .001, I 2 = 98.9%, n = 6). Food insecurity appears to be a risk factor for developing SMI. Discussion This review suggests adults with SMI living in high‐ or upper‐middle income countries are more likely to experience food insecurity than the general population and that this relationship may be inverse. Implications for practice Mental health practitioners should be aware of food insecurity and support individuals with SMI to access sufficient food.

PURPOSE OF REVIEW: The aim of this study was to provide psychiatrists with the knowledge, tools and guidance to support physical activity promotion in clinical practice. The review also aims to provide an up-to-date summary of the evidence regarding physical activity in the prevention and treatment of mental disorders in adults. RECENT FINDINGS: There is emerging evidence demonstrating that physical activity can protect against incident anxiety and depression. There is robust evidence showing that physical activity is an effective adjunct treatment strategy for depressive disorders and anxiety and stress-related disorders, with emerging evidence for schizophrenia and bipolar disorders. Translation of this evidence into practice is in general ad hoc, and large physical health disparities for people with mental disorders persist. The reasons for this are multifactorial, and include the intersection of social, economic and personal barriers to physical activity. Evidence-based approaches include regular screening of physical activity levels, staff culture change within mental health services and established referral pathways. SUMMARY: Translation of evidence regarding physical activity for mental health into routine programmes is critical. Efforts to move beyond solely targeting individual-level barriers to physical activity and address systemic barriers include lack of access to appropriate exercise services. This requires consideration of training needs, service structure and culture change.

Objectives: To evaluate the effectiveness of integrated models of mental healthcare in enhancing clinical outcomes, quality of life, satisfaction with care and health service delivery outcomes in young people aged 12–25 years. A secondary objective was to identify common components of integrated mental health interventions. Methods: A systematic review and meta-analysis of studies published 2001–2023 that assessed clinical or health service use outcomes of integrated care, relative to treatment as usual, for any mental health condition in 12–25 years old accessing community-based care. Results: Of 11,444 titles identified, 15 studies met inclusion criteria and 6 studies were entered in the meta-analysis. Pooled effect size found integrated care was associated with a greater reduction in depressive symptoms relative to treatment as usual at 4–6 months (standardised mean difference = −0.260, 95% confidence interval = [−0.39, −0.13], p = 0.001). Of the seven studies reporting access or engagement, all reported higher rates of both in the intervention arm. The most frequent components of integration were use of a multidisciplinary team (13/15 studies), shared treatment planning (11/15) and workforce training in the model (14/15). Conclusions: Integrated models of mental healthcare are associated with a small, but significant, increase in effectiveness for depressive symptoms relative to treatment as usual. Given integrated care may increase access and engagement, future research should focus on assessing the impact of integrated care in a wider range of settings and outcomes, including clinical and functional recovery, satisfaction with care and system-level outcomes such as cost-effectiveness.

Anxiety is common in those with medical conditions and has significant impacts on mental well-being as well as physical health outcomes. While several systematic reviews have examined the prevalence of anxiety in specific dermatological conditions, no reviews have examined the prevalence across the entire dermatology outpatient setting. This systematic review aims to provide an overview to dermatologists of the prevalence of, and trends in, anxiety in their outpatient clinics. As such, prevalence of anxiety in dermatology outpatient clinics was examined, and variations across type of anxiety and dermatological conditions were assessed. A search of PubMed, Embase, Cochrane and PsycINFO was conducted for studies that assessed anxiety prevalence in dermatology outpatients, with the last search conducted on 7 September 2022. Results underwent title/abstract and full-text screening, followed by data extraction. Studies of patients 16 years and older and representative of dermatology clinics were included. Risk of bias was assessed using Joanna Briggs Institute Critical Appraisal Checklist. Meta-analysis was conducted using CMA software, and subgroup analysis was conducted on relevant variables. 5423 studies were identified, and 32 included, with a total n = 12,812 participants. Under the random effects model, prevalence was estimated at 26.7% (95%CI 22.4-31.4; 95%PI 9.7-55.4). Subgroup analysis revealed a higher prevalence among studies of psoriasis patients than general dermatology studies. Estimates of prevalence were higher when assessed via self-report screening than diagnostic interview. Anxiety occurred frequently among dermatology outpatients, especially psoriasis outpatients, at a higher rate than common estimates of prevalence in the general population. Given the effect of anxiety on patient outcomes and well-being, dermatologists are encouraged to consider how anxiety may impact patients in their clinic, and how they can best identify patients with anxiety and subsequently support them.

People from refugee and asylum seeker backgrounds resettling in Australia often experience intersecting risks for poor mental and physical health. Physical activity can promote better health outcomes, however there are limited programs tailored for this population. Therefore, understanding how to support refugees and asylum seekers to engage in physical activity is crucial. This paper aims to describe how the experience-based co-design (EBCD) process was used to identify priorities for a new physical activity service for refugees and asylum seekers. Using an EBCD framework we conducted qualitative interviews and co-design workshops with service users (refugees and asylum seekers living in the community) and service providers at a community Centre in Sydney, Australia. Sixteen participants, including eight service users and eight service providers engaged in the EBCD process over 12-months. The interviews revealed common themes or 'touchpoints' including barriers and enablers to physical activity participation such as access, safety and competing stressors. Subsequent co-design focus groups resulted in the establishment of five fundamental priorities and actionable strategies; ensuring cultural and psychological safety, promoting accessibility, facilitating support to access basic needs, enhancing physical activity literacy and fostering social connection. Using EBCD methodology, this study used the insights and lived experiences of both service users and providers to co-design a physical activity service for refugees and asylum seekers which is safe, supportive, social and accessible. The results of the implementation and evaluation of the program are ongoing.

, penalized cubic splines, linear regression, correlation analyses were conducted. Analyzing 121,066/142,364 initiated surveys, WHO-5/P-score worsened intra-pandemic by 11.1±21.1/13.2±17.9 points (effect size d=0.50/0.60) (comparable results in representative/weighted non-probability samples). Persons with WHO-5 scores indicative of depression screening (<50, 13% to 32%) and major depression (<29, 3% to 12%) significantly increased. WHO-5 worsened from those with mental disorders, female sex, COVID-19-related loss, low-income country location, physical disorders, healthcare worker occupations, large city location, COVID-19 infection, unemployment, first-generation immigration, to age=18-29 with a cumulative effect. Similar findings emerged for P-score. Changes were significantly but minimally related to COVID-19 deaths, returning to near-pre-pandemic values after >2 years. The most subjectively effective coping strategies were exercise and walking, internet use, social contacts. Identified risk groups, coping strategies and outcome trajectories can inform global public health strategies.

People living with serious mental illness (SMI) experience physical health complications at disproportionate rates to people without an SMI. Unhealthy dietary intake and disordered eating behaviors are key driving factors. There is a lack of valid nutrition-risk screening tools targeted to mental health services, and typically used nutrition-risk screening tools are not suitable for mental health services. This paper details the rationale and study protocol for development and validation of the NutriMental screener, a tool for use in clinical practice to identify service users who are at risk for common nutrition issues experienced by this population group and trigger referral to a specialist clinician. The development process includes five phases. Phase I is the development of nutrition-related domains of interest from screening tools used in mental health services. Phase II involves a literature review and service-user interviews to identify additional domains. Phase III consists of international workshops with relevant clinicians and persons with SMI to gain a consensus on questions to be included in the draft tool. Phase IV involves conducting multinational feasibility and preliminary validation studies. Phase V consists of performing formal validation studies. The development of a nutrition-risk screening tool for mental health services is a necessary step to help rectify the physical-health disparities and life-expectancy gap for people with SMI.

BACKGROUND: Mental health is a rapidly evolving area of practice for dietitians. The role of dietitians in supporting the physical health of consumers experiencing mental illness is becoming more widely recognised given the importance of lifestyle interventions for physical health. The present study aimed to explore the dietitian role in mental health services as well as identify barriers and enablers to service delivery. METHODS: This was a cross-sectional survey of dietitians currently employed in any capacity in public and private mental health services. An online survey comprised of questions pertaining to four domains, including demographics, role and service provision, experience and supervision, barriers/challenges and drivers/enablers was completed and included closed and open-ended responses. RESULTS: In total, 48 responses were included. The mean ± SD age of respondents was 36.1 ± 10.9 years (range 23-67 years) with the majority working in inpatient settings. The top three tasks respondents reported conducting were individual consultations (n = 47; 98%), group programs (n = 23; 48%) and multidisciplinary team meetings. Barriers included a lack of awareness from others regarding a dietitian's role in mental health, and a lack of specific tools for nutrition screening. More training, resources and increased evidence base to guide practice would enable better service provision. CONCLUSIONS: The present study provides insights regarding the possible drivers and barriers to effective service provision for dietitians working in mental health services focusing on the local contexts of respondents. The findings highlight the importance and value of working collaboratively within a multidisciplinary team.

High prevalence and associated health care and social costs demand a change in health care paradigms for functional neurological disorders All practising doctors see somatic symptom (previously known as “somatoform”) disorders in their patients, and most experience some discomfort in making a clear diagnosis and undertaking management. FND can be understood as somatisation presenting with neurological symptoms, and as with all somatic symptom disorders, the high prevalence and associated health care costs demand a change in the way we deal with patients with FND. In this perspective, we outline clinical, health resource and service delivery issues surrounding FND in Australia, and propose a way forward to improve the landscape for people experiencing FND and the clinicians who provide their care. FND — Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5):3 conversion disorder (functional neurological symptom disorder); International Classification of Diseases, 11th revision (ICD-11): F44 (dissociative neurological symptom disorder)4 — is the occurrence of neurological symptoms due to malfunction, rather than neuropathology or neurological disease, of the nervous system. FND presents with various core neurological symptoms, often concurrently, and of duration varying from acute onset to decades. Core symptoms include seizure-like attacks, gait difficulties, tremor and other movement disorders, cognitive and speech issues, disordered vision, and abnormal function of other special senses. Patients with FND often report additional associated symptoms, including chronic pain, fatigue, and gut and respiratory symptoms, and although psychiatric comorbid conditions and psychological stressors are common, they are not universal.5, 6 FND can occur across the age spectrum and often coexists with other neurological conditions. Diagnosis, therefore, requires careful clinical assessment, but where possible should be made early by identification of typical FND clinical features and without exhaustive, prolonged and potentially harmful investigation in a futile quest to exclude rare organic disorders. For example, lower limb weakness due to FND may vary with distraction, posture or activity, and the often-cited Hoover sign may be demonstrable.7 Australian neurologists are now encouraged to take a rule-in approach to FND diagnosis, aimed at minimising iatrogenic harm.7, 8 FND is a common neurological condition anecdotally. Even though the prevalence of FND in the Australian community is unknown, 74% of 152 general practitioners based in the New South Wales Hunter Region reported seeing patients with “neurological symptoms due to somatisation” at least monthly in a 2021 survey (unpublished data). The reported prevalence of FND in international neurology outpatient series varies by clinic characteristics and definition, with neurological symptoms either “not at all” or only “somewhat explained by organic disease” in up to one-third of patients.8 One published Australian neurology clinic series reported FND in 15% of patients.9 About 8% of acute stroke admissions may be due to FND,10, 11 and a recent report that FND represents 9% of neurology hospital admissions in New Zealand is consistent with anecdotal Australian public hospital neurology experience.12 The NSW Health Admitted Patient Collection 2001–2016 includes an average of 566 patients with ICD code F44 per year for the entire state.13 The direct health care utilisation costs related to FND are high (eg, in 2019, the estimated cost in the United States was US$900 million),14 with delayed diagnosis, recurrent health care visits and repeated investigations all contributing. Australian specific data on health care utilisation are sparse, but a Victorian cohort of patients with non-epileptic seizure (undergoing video electroencephalogram between 2009 and 2014) reported median pre-diagnosis health care utilisation costs per patient of AU$26 468.15 To the authors’ knowledge, only pilot data are available for Australian health care costs of FND more broadly (unpublished data). At least as important are the hidden costs of FND, particularly, when not diagnosed and treated early, as FND can cause chronic and significant disability at any age. In the 2018 National Mental Health Commission-sponsored survey of 179 Australians and carers living with FND, around 50% reported quality of life as poor or worse, 70% were unable to work and the majority were struggling financially.16 Many seek support from the National Disability Insurance Scheme and Centrelink. Following assessment, we contend that the manner in which the FND diagnosis is presented to the patient strongly sets the scene for their future management and health outcomes.7 This initial clinician–patient interaction is critical to empower patients to participate in a recovery model of care. A structured diagnostic explanation, providing opportunity and time to explore patient understanding and beliefs, can lay the foundation for a productive therapeutic relationship and facilitate effective health care utilisation and outcomes. The use of one such structured approach in a study of newly diagnosed patients with non-epileptic (functional) seizure showed an improvement in patient understanding and acceptance of the diagnosis while reducing negative emotions and symptom frequency in the short term.17 Equally, a dismissive approach to communicating the diagnosis can jeopardise patient confidence in the validity of their illness experience, leaving them feeling angry, ashamed and strongly rejecting discussion of the diagnosis and treatment plan.18 In our own clinical practice, there is a strong emphasis on fostering optimism and developing a collaborative and individualised management plan with the patient’s illness narrative at the centre. For the past half century, the clinical management of FND has been subject to a great deal of buck-passing between neurologists and psychiatrists, thanks in no small part to traditional models of service delivery shaped by notions of the presence or absence of organicity.19 Fortunately, advances in evidence-based treatments and new pathophysiological models for FND have catalysed a shift in these outdated models, and consequent recognition of the need for truly multidisciplinary care is slowly changing the culture of FND care in Australia. Clinical formulations of FND genesis and maintenance have evolved from older notions of “psychic conflict” and “conversion” of psychological difficulties and prior traumatic events to consider a broader range of cognitive, emotional, physical and social factors.20 The science behind these changes includes neurobiological experiments that suggest malfunction of unconscious predictive systems important to normal movement, sensation and cognition, and neuropsychological models emphasising abnormalities in higher order cognitive functions, particularly attention and agency (sense of control).21 A detailed review of the evidence base for treatment is beyond the scope of this article. Instead, we refer readers to recent reviews and consensus statements22-24 and confine ourselves to emphasising the underpinning principles of treatment. First, empathic and positive diagnostic explanation is fundamental to the success of all treatment that follows. Second, individualised, multidisciplinary treatment plans must address the most prominent presenting core and non-core symptoms for the individual patient. Third, the allied health team, including physiotherapists, occupational therapists and speech therapists, should base therapy on a biopsychosocial formulation addressing illness beliefs, symptom-focused attentional biases, aberrant movement patterns, and functional limitations. Finally, there is evidence for both psychodynamic and cognitive behavioural approaches in the management of FND, although the evidence for cognitive behaviour therapy is of higher quality.24 The reported dissatisfaction with the experience of health care interactions by Australians with FND16 is reflective of systemic problems in the clinical care pathways. We need to adopt a model of care for FND shaped by patient experiences. Best practice management includes neurology, psychiatry, general practitioners, emergency department and rehabilitation physicians as well as clinical psychologists and allied health practitioners, although not all may be required for every patient.16 Effective communication between these stakeholders and the patient is essential to prevent the fragmented care and negative health care experiences that remain commonplace in FND. Given the current constraints around health care resources, we suggest the most pragmatic way forward will be to develop a stepped care approach, building capacity in primary and secondary care settings, with specialist FND clinics at the apex.25 It is time, therefore, for FND to become everyone’s business; all of us need to take responsibility for our own part in the health care journey of people with FND. Investigator-led clinical consortia have the potential to promote health equity, set standards for care, promote sharing of knowledge and expertise, and foster the development of a cohesive translational research agenda.26 An Australian consortium of FND clinics is needed to allow prospective collection of accurate epidemiological and resource utilisation data to inform health administrators and government bodies regarding the need for further investment to address ongoing gaps and inequities in FND care. Open access publishing facilitated by University of New South Wales, as part of the Wiley - University of New South Wales agreement via the Council of Australian University Librarians. No relevant disclosures. Commissioned; externally peer reviewed.

PURPOSE OF REVIEW: There is a large evidence base of clinical trials that have investigated the efficacy of a range of nutraceuticals on mood disorders. The aim of the current review is to provide an update regarding the efficacy and safety of nutraceutical agents in mood disorders and to highlight considerations for future research. RECENT FINDINGS: Nutraceuticals such as omega-3, probiotics, zinc, saffron and curcumin have been recommended as adjunctive interventions to standard treatments for people with depression, while St John's wort has been recommended as a monotherapy. In contrast, less research has been devoted to investigating the effect of nutraceuticals in bipolar disorder, with omega-3 being weakly recommended as an adjunctive to standard treatments. Although the safety profile of most nutraceuticals appears acceptable, more insight into the long-term effects within a range of cohorts is recommended. SUMMARY: There are a number of nutraceuticals that have clinical trial support for their use as either adjunctive interventions for depression; however, there is mostly limited support for their use in bipolar disorder. Further randomized controlled trials that take into consideration a number of emerging mechanisms, potential nutraceutical combinations and factors that may predict treatment response are required to inform clinical use.

Objective Emergency service workers are at risk of experiencing poor mental health due to repeated exposure to potentially traumatic events. Promoting healthy lifestyle factors may help improve health outcomes and quality of life among this population. This study aimed to evaluate the efficacy of a 10-week physical activity (PA) and diet programme delivered via Facebook for sedentary emergency service workers and their support partners on levels of psychological distress. Methods We delivered a 10-week intervention via a private Facebook group facilitated by exercise physiologists, a dietitian and peer-facilitators. Weekly education modules and telehealth calls were delivered, and participants were provided with a PA tracking device (Fitbit accelerometer). A stepped-wedge design was applied to compare levels of psychological distress (K6) during baseline, to intervention by comparing slopes of change. Secondary pre–post outcomes included mental health symptoms, PA, quality of life, social support to exercise, sleep quality and suicidal ideation. Results In total, N=90 participants ( n=47 emergency service workers and n=43 support partners) were recruited in 4 cohorts (aged 42.3±11.5 years, 51% male). Levels of psychological distress did not change significantly during the baseline (control) slope and reduced significantly during the first 6 weeks of intervention (intervention slope 1). The slopes were significantly different, b=−0.351, p = 0.003 (i.e. the trajectories of change) and improvements plateaued until follow up. Retention was high (92%) and improvements in mental health symptoms, minutes of PA, sedentary time and quality of life were significant. Conclusions Our intervention delivered via social media is feasible and associated with reduced levels of psychological distress among emergency service workers and support partners. Trial registration Australian New Zealand Clinical Trials Registry (ACTRN): 12619000877189.

Disordered eating behaviors are common in people with a serious mental illness (SMI) such as schizophrenia, bipolar disorder and major depressive disorder. This study employed qualitative exploration to understand the perceived determinants of eating behaviors, in particular those connected to disordered eating patterns, in people with SMI. In total, 28 semi-structured interviews were conducted in a consecutive sample of people with SMI under treatment in local mental health services in Australia (n = 12), Germany (n = 8) and Austria (n = 8) (mean age: 43.3 years, proportion of female participants: 61%, proportion of participants with ICD-10 F2 diagnosis: 57%, proportion of participants with ICD-10 F3 diagnosis: 64%). A thematic analysis approach, the framework method, was applied using MAXQDA 2020. Three main themes of determinants were derived: (i) impacts to daily functioning, (ii) disrupted physical hunger cues and (iii) emotional hunger. For impacts to daily functioning, the following themes emerged: lack of daily structure, time and drive, and difficulty planning ahead. For physical hunger, themes emerged for disrupted hunger and satiety cues, and mindless eating. All motives listed in the Palatable Eating Motives Scale (PEMS), i.e., coping, reward, social and conformity, have been reported by participants to be drivers for their emotional eating behavior. Subsequent reported behaviors were eating too much or too little, binge eating, night eating and food cravings. We conclude that interprofessional approaches should target daily functioning, disrupted physical hunger cues and emotional eating to reduce disordered eating behaviors in people with SMI.