The Lifestyle Psychiatry project of the <scp>WPA</scp> Section on Medicine, Psychiatry and Primary Care
Authors: David Baron, Douglas Noordsy
Journal: World Psychiatry (2021)

The importance of psychiatry and behavioral health in the delivery of overall health care and optimization of health is widely acknowledged. However, the stigma related to mental illness in society and the separation of psychiatric care from tra­ditional medical settings has resulted in significant challenges in integrating all aspects of care necessary in maintaining op­timal health and well-being. The sub-specialty of consultation/liaison psychiatry has attempted to address this issue in the inpatient medical setting by providing psychiatric consultation to medical patients experiencing psychiatric symptoms and syndromes. Unfortunately, we have been less effective in creating integrated models of care, especially in the outpatient setting. Compounding this problem is the lack of psychiatrists internation­ally, with very few formally trained in integrated care models. The COVID-19 pandemic has produced unprecedented challenges, while generating unique opportunities for education and novel clinical care models. The need for interdisciplinary collaborative models of care, integrating public health, public policy and public education, in concert with mental health and primary care provision, has never been so significant. The WPA Section on Medicine, Psychia­try and Primary Care has restructured to ad­dress these issues, with a focus on expand­ing collaboration with other WPA Scientific Sections and by reaching out to interprofessional colleagues and health care professional organizations. The Section leadership has created projects to focus on var­ious aspects of this new strategy. One of these is the Lifestyle Psychiatry project. We see this as a true opportunity for collaboration between many WPA Scientific Sections with related interests, along with non-psychiatric stakeholders. The WPA leadership has endorsed the concept and is supporting the growth of this model. Any WPA member or Section Chair is warmly invited to contact our Section to discuss additional collaborations. Lifestyle psychiatry refers to the application of lifestyle medicine principles to support individuals in managing psychiatric disorders and cultivating brain health1. It includes studies on the impact of lifestyle behaviors on the prevalence of psychiatric symptoms or disorders in general populations, the impact of lifestyle behaviors on symptoms among people at risk for psychiatric disorders, the impact of lifestyle interventions on severity of symptoms among people with a psychiatric disorder, the neu­roscience of brain response to lifestyle behaviors, and the science of lifestyle behavior change2. The domains of lifestyle behaviors include physical exercise, diet and nutrition, meditation, mind-body practices, sleep, and social relationships1, 2. There is now an impressive body of lit­erature on the neuroscience of physical ex­ercise suggesting an upregulation of neurotransmitters associated with positive mood and neurotrophic factors that support neu­ronal vitality. Neurotrophins promote neo-neurogenesis and synaptic proliferation associated with increases in regional brain volume and connectivity and enhanced co­gnitive function3. Sustained exercise leads to epigenetic upregulation of brain-derived neurotrophic factor (BDNF) synthesis, promoting brain health over a lifetime4. These regulatory interactions have been correlated with the evolutionary steps allowing early hominids to thrive in a hunter-gather lifestyle5. There is a similarly impressive literature demonstrating robust brain functional and volumetric responses to meditation and sleep6. We also know that lifestyle factors are powerfully correlated with the prevalence, onset and perpetuation of psychiatric symp­toms and syndromes. Sedentary behavior has been correlated with risk for suicidal behavior, depression, cognitive decline of aging, and psychosis, while physical exercise has been correlated with improvements in mood, motivation and cognition7. Sleeping less than 6 hours nightly is correlated with risk for major neurocognitive disorders. Mindfulness practices have been associated with improvements in anxiety and treatment-resistant depression. A Mediterranean style diet has been correlated with improvements in depression, and omega-3 fatty acids and N-acetylcysteine appear to have neuroprotective effects8. However, our societies continue to shape human behavior in unhealthy directions. Sedentary time continues to rise in parallel to increases in substance abuse, suicide and emergency room visits for mental health care. Traditional diets are being progressively displaced by processed foods. Twenty-four hour virtual experiences constrain sleep opportunity, and social interaction is increasingly impersonal9. Global health care systems are stressed by esca­lating rates of lifestyle-related disorders such as diabetes mellitus type 2, cardiovas­cular disease, cancer and psychiatric dis­orders. Lifestyle Psychiatry offers a unique op­portunity for psychiatrists to join and lead other medical disciplines in promoting attention to the impact of lifestyle on health and disease. When clearly identified, the potential dual benefit for mental and phys­ical health may enhance motivation to ad­here to positive lifestyle changes. Psychiatrists also bring expertise in effective behavior change strategies. Lifestyle interventions may be useful for primary prevention, first-line therapy, multimodal therapy, augmentation, precision therapy and relapse prevention. There is an urgent need for psychiatry to step forward to assist governments, employers, corporations and health care systems to effectively position health-promoting lifestyle practices to address the rising tide of distress, disability and loss of life flowing from modern cultural trends in a global society. We must articulate the strength of the cur­rent evidence on the impact of lifestyle behaviors on mental and physical health outcomes, while identifying areas where further evidence is needed to offset the influences of globalization and corporate interest on human and societal health. The WPA Section on Medicine, Psychi­atry and Primary Care aims to develop aware­ness and expand consideration of Lifestyle Psychiatry as a vital component in improving the health and well-being of people around the world.