Mental illness plays havoc with the mind as well as the heart
University of South Australia scientists have uncovered another reason why society should be paying more attention to mental health: it is closely aligned to blood pressure and heart rate variations.
A new study published in BioMedical Engineering draws a link between mental illness and widely fluctuating blood pressure, which can lead to cardiovascular disease and organ damage.
UniSA researcher Dr Renly Lim and colleagues from Malaysian universities say there is clear evidence that mental illness interferes with the body’s autonomic functions, including blood pressure, heart rate, temperature and breathing.
“We reviewed 12 studies on people with anxiety, depression and panic disorders and found that, regardless of age, mental illness is significantly associated with greater blood pressure variations during the day,” Dr Lim says.
“We also found that for people who are mentally ill, their heart rate does not adapt to external stressors as it should.
“Contrary to what many people think, a healthy heart is not one that beats like a metronome. Instead, it should adjust to withstand environmental and psychological challenges. A constantly changing heart rate is actually a sign of good health.”
Reduced heart rate variation (HRV) is common in people with mental illness and indicates that the body’s stress response is poor, exacerbating the negative effects of chronic stress.
Unlike a person’s heart rate – how many times a heart beats in a minute – which is usually consistent, HRV is more complex and is the time between two heartbeats, which should change according to external stressors.
“What we aim for is not a constantly changing heart rate but a high heart rate variation. This is achieved through a healthy diet, exercise, low stress and good mental health.”
Low HRV occurs when a person’s body is in fight-or-flight mode, easily stressed and common in people with chronic diseases, including cardiovascular and mental health problems.
While large blood pressure variations (BPV) during the day are not ideal, at night the systolic pressure should dip by between 10-20 per cent to allow the heart to rest. The researchers found that in people with mental health issues, their blood pressure does not drop sufficiently at night.
The reduced dipping – under 10 per cent – can be caused by many factors, including autonomic dysfunction, poor quality of sleep and disrupted circadian rhythms that regulate the sleep-wake cycle.
“The takeout from this study is that we need to pay more attention to the physical impacts of mental illness,” Dr Lim says.
“It is a major global burden, affecting between 11-18 per cent (one billion) of people worldwide. Since mental illness can contribute to the deterioration of heart and blood pressure regulation, early therapeutic intervention is essential.”
Notes for editors
“Association between mental illness and blood pressure variability: a systematic review” is published in BioMedical Engineering. For a copy of the paper, email candy.gibson@unisa.edu.au
The research was undertaken at the University of Malaya, University of South Australia, Universiti Kebangsaan Malaysia, and Universiti Tunku Abdul Rahman.
JOURNAL
BioMedical Engineering OnLine
METHOD OF RESEARCH
Meta-analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Association between mental illness and blood pressure variability: a systematic review
How can mental health professionals open their minds to psychosis?
Effective clinical care for patients with psychosis means understanding the ‘lived experience’ of their delusions, say researchers at the Universities of Birmingham, York and Melbourne.
By understanding the intricacies of feelings, attitudes, and experiences which are interlinked with delusions, clinicians will be better able to build trust and genuine engagement with patients.
In a new study, published today (4 May 2022) in The Lancet Psychiatry, researchers collated and reviewed first-hand accounts of the experience of delusions from patients with psychosis in mental health settings. In their review, the team used a new methodological approach informed by philosophy to combine and synthesis all the available qualitative evidence. The team then developed a new model to better understand how delusions emerge and are shaped by different contexts from multiple levels of explanation.
The authors examined the experiences of more than 370 patients, described in 24 different scientific studies and found a number of themes that were common across all the studies.
For most participants, for example, delusions were not just a symptom of illness or an irrational belief. Delusions often were the most compelling way that the person could make sense of their life, in the context of a radical alteration of reality and intense emotions. While the experience could be hostile, sparking fear or panic, individuals could also experience awe or wonder, or deep meaning in their delusions.
When reality is altered in this way, individuals can struggle to make sense of their own identity, experiencing self-doubt or a loss of control or, conversely, the feeling that they are someone special, or with a unique purpose. In the latter case, the delusional experience seemed to provide a sense of coherence, purpose and belonging at a time of intense life stress and can therefore be interpreted as temporarily adaptive or beneficial.
“These experiences are complex and nuanced,” said lead author Dr Rosa Ritunnano, consultant psychiatrist and researcher at the University of Birmingham’s Institute for Mental Health and the University of Melbourne. “When we train clinicians in treating psychosis, we need to ensure they are going beyond ‘correcting’ a dysfunction or ‘curing’ a symptom. Instead, by trying to understand how the delusion is shaped by the patient’s emotions, life experiences and socio-cultural contexts, we can devise treatment and support that is more relevant to the individual.”
The approach has particular resonance for situations in which a patient may be detained without their consent with the aim of protecting themselves from harm. The number of patients detained in this way has been steadily rising for several years, with particular ethnic groups and those with learning disabilities being particularly impacted in this process.
“One of the main issues is that all too often, the patient’s voice is lost within the process of trying to help them,” says Dr Clara Humpston, one of the senior authors on the paper. “Carers, clinicians and family members all have a challenging task in learning how to listen. That means accepting that there may not be a shared view of reality, but the patient’s experience is still true and valid, and ought not to be silenced.”
JOURNAL
The Lancet Psychiatry
METHOD OF RESEARCH
Data/statistical analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Subjective experience and meaning of delusions in psychosis: a systematic review and qualitative evidence synthesis
ARTICLE PUBLICATION DATE
3-May-2022
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