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Systematic review

Effect of physical activity without use of antipsychotics compared to physical activity and antipsychotics for patients with active psychosis: a systematic review

  • Year: 08-2017
  • By: Norwegian Institute of public Health
  • Authors Dahm KT, Holte, HH, Dalsbø TK, Straumann GH, Reinar LM.
  • ISBN (digital): 978-82-8082-868-2
Fysisk aktivitet psykose forside.jpg

We were to summarize research on the effect of physical activity without the use of antipsychotics for persons with active psychosis compared to physical activity and the use of antipsychotics.

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Key message

Psychosis is a set of symptoms, rather than a specific disease. A person with psychosis experience hallucinations and cognitive disturbances. The condition can be transient and benign, but is for some people serious and prolonged, sometimes chronic. Severe psychosis disorders develop in phases and often have precursors with "common" symptoms such as depression, anxiety and social isolation. The most common psychosis disorder is schizophrenia. It is estimated that one percent of the world's population is affected by schizophrenia. In Norway it is estimated that between 600 and 800 people are affected every year.

The Directorate of Health asked the Norwegian Institute of Public Health, Division for Health Services to search for, identify and summarize research on the effect of physical activity without the use of antipsychotics compared to physical activity where the patient with active psychosis is receiving antipsychotics related to the outcomes; symptoms, death and serious events, physical function, social functioning, quality of life, the use of medication or healthcare.

We conducted a systematic search for controlled studies in six databases.

We found no relevant studies, therefore we do not know whether physical activity with or physical activity without antipsychotics is most effective.

Summary

Background

In 2015 The Directorate of Health instructed the regional authorities to establish drug-free treatment for patients in mental health care, including those with mental disorders. The order came at the request from the user organizations. The introduction of the drug-free treatment has been discussed among professionals. Among other things, it has been discussed whether it is ethical to provide drug-free treatment to people with psychosis and what research is the basis for such an alternative.

It is unclear how many patients with psychosis want drug-free treatment.

We conducted a systematic review to answer the following question:

What is the effect of physical activity without the use of antipsychotics compared to physical activity where the patient with active psychosis is receiving antipsychotics?

Method

Librarian Gyri Hval Straumann conducted a systematic literature search and searched in the following databases CENTRAL, Medline, EMBASE, CINAHl. and PsycINFO, in April 2017. The search was conducted for two projects together. In the second project, we looked for studies on the effect of psychosocial treatment on psychotic symptoms, with or without antipsychotics. Both projects assess antipsychotics-free treatment for people with psychosis.

Inclusion criteria: Design: Studies with control group. Population: Adults with active psychosis with a history of mental illness not treated with antipsychotics at the start of psychosis episodes.

Active psychosis means presence of positive symptoms such as delusions (e.g. paranoid) and sight or hearing hallucinations etc.

Intervention: Physical activity without the use of antipsychotics. Comparison: Physical activity with the use of antipsychotic. Outcome: Symptoms, death and serious events, physical function, social functioning, quality of life, the use of medication or healthcare.

Three researchers Hilde H. Holte, Astrid Austvoll-Dahlgren and Kristin Thuve Dahm, independently screened title and abstracts. We read 12 articles in full texts according to inclusion or exclusion for both projects. One reference concerning physical activity did not meet our inclusion criteria.  

Result

After reviewing 19 516 references, we found no studies that evaluated the effect of physical activity without using antipsychotics compared to physical activity where the patient with active psychosis received antipsychotics.

Discussion

We found no relevant studies. We used systematic and explicit methods in the preparation of this systematic review. We conducted a broad literature search and identified nearly 20,000 references. There is always a possibility that we may have missed relevant studies, but we consider the risk to be small. We received many references in the literature search, and we perceive that the references have covered related issues, but it was nevertheless no study that answered our specific issue.

Conclusion

We found no controlled studies that compared physical activity without antipsychotics with physical activity and use of antipsychotics in patients with active psychosis.