A study protocol for a randomised controlled feasibility trial of an intervention to increase activity and reduce sedentary behaviour in people with severe mental illness: Walking fOR Health (WORtH) Study.

BACKGROUND: People with severe mental illness (SMI) are less physically active and more sedentary than healthy controls, contributing to poorer physical health outcomes in this population. There is a need to understand the feasibility and acceptability, and explore the effective components, of health behaviour change interventions targeting physical activity and sedentary behaviour in this population in rural and semi-rural settings. METHODS: This 13-week randomised controlled feasibility trial compares the Walking fOR Health (WORtH) multi-component behaviour change intervention, which includes education, goal-setting and self-monitoring, with a one-off education session. It aims to recruit 60 inactive adults with SMI via three community mental health teams in Ireland and Northern Ireland. Primary outcomes are related to feasibility and acceptability, including recruitment, retention and adherence rates, adverse events and qualitative feedback from participants and clinicians. Secondary outcome measures include self-reported and accelerometer-measured physical activity and sedentary behaviour, anthropometry measures, physical function and mental wellbeing. A mixed-methods process evaluation will be undertaken. This study protocol outlines changes to the study in response to the COVID-19 pandemic. DISCUSSION: This study will address the challenges and implications of remote delivery of the WORtH intervention due to the COVID-19 pandemic and inform the design of a future definitive randomised controlled trial if it is shown to be feasible. TRIAL REGISTRATION: The trial was registered on clinicaltrials.gov ( NCT04134871 ) on 22 October 2019.

Are We Really Impacting Duration of Untreated Psychosis and Does It Matter?: Longitudinal Perspectives on Early Intervention from the Irish Public Health Services.

Although early intervention in psychosis is clinically intuitive and theoretically feasible, the reality is that over recent decades the evidence base to support it has not advanced as much as might have been anticipated. Material benefits of early intervention in established psychosis have not been universally demonstrated and much uncertainty continues to surround the field of treatment in the prodromal phase. Undoubtedly methodological differences between studies are relevant and better understanding of different treatment models and the effectiveness of their constituent parts may yield the most benefit, particularly from a public health perspective.

Evaluation of knowledge and attitudes among primary care physicians in Cavan-Monaghan as 'gatekeepers-in-waiting' for the introduction of Carepath for Overcoming Psychosis Early (COPE).

AIM: To investigate general practitioners' current knowledge of and attitudes towards psychosis and its management by Cavan-Monaghan Mental Health Service, Ireland, prior to their involvement in the introduction of an early intervention service. METHODS: As part of a continuing medical education programme for psychosis, delivered to all 32 general practitioners practising in this region, participants were asked to complete a 29-item questionnaire designed to assess their baseline knowledge and attitudes. RESULTS: All 32 general practitioners participated in the study. Although 17% had received no previous psychiatric training, 93% described their knowledge of psychiatric disorders as average or above average. However, only 53% could correctly identify all of a set of psychiatric symptoms related to psychosis. Only 50% felt comfortable initiating treatment for psychotic symptoms. Whereas only 40% had heard of the early intervention model, 89% believed it to be advantageous. Easy accessibility to services and rapid assessment of patients referred were most commonly reported as helpful. However, concerns were expressed about the potential for associated increases in workload. CONCLUSIONS: As 'gatekeepers-in-waiting', these general practitioners will have a vital role in effective implementation of the early intervention service for psychosis. However, their knowledge needs improvement, through regular educational sessions, and this service must be responsive to their needs. In addition, general practitioners' concerns regarding the potential for increased workload must be adequately addressed in order to maintain enthusiasm and collaboration at the interface between primary care and mental health services, particularly in the context of early intervention.