How nutritional psychiatry impacts comprehensive care

Integrative medicine is the idea of ​​providing services that cover a broad or wide range of clinical areas of interest. We see this with insurance companies, lab tests, and treatment options. For example, if an insurance company states that it offers comprehensive coverage, it means that it offers a wide range of services at different stages (inpatient, outpatient, rehabilitation, etc.). If your doctor says they will do a comprehensive test, they will not only order a standard blood test panel, but may also order specialized tests and imaging tests to cover all the bases for your symptoms. there is. Sadly, mental health treatment has lagged somewhat behind in adopting more comprehensive models. This may be partly because it is a specialty in its own right and because it prioritizes focusing on the current symptoms rather than the cause of the symptoms. Nevertheless, here are some important areas for mental health professionals to consider when discussing symptoms with clients.

exercise

There’s nothing new about the idea that exercise promotes mental health. In fact, most standard new client forms require you to ask about your exercise and activity habits. According to Mickelson et al. (2017), the physiological effects of exercise include increased endorphin levels, body temperature, mitochondrial function and formation, increased mammalian target of rapamycin (mTor) signaling, neurotransmitter production, and hypothalamic stimulation. This includes weakening of the adrenal glands (HPA). Axial response to stress. But how often does exercise come up during routine mental health visits, whether it’s medication management or psychotherapy?

I once had a client who had seen at least five therapists before me. In one of our sessions with him, I delved deeper into his physical health and exercise habits, rather than the typical “are you physically active” or “how often” questions. . I asked him to be more specific about his exercise routine, how often, and at what times of day. At first, he looked puzzled and said that no therapist had ever asked him a question like this before. He even said he thought he was there for a therapy session and not a “training session.” But what we uncovered was inconsistency in physical exercise and a lack of psychoeducation about how a sedentary lifestyle impacts mental health symptoms. Over time, he gained a gym membership, was able to increase his physical activity, and experienced a reduction in the intensity of his mental health symptoms. The topic of exercise and physical activity should be routinely incorporated into all medical appointments, including therapy sessions and follow-up appointments for medication management.

Meals/Nutrition

Only recently has the connection between diet/nutrition and mental health become a pressing topic. A seminal study by Hibbeln (1998) demonstrated a strong correlation between fish intake and reduced incidence of depression. Additionally, a study by Su et al. (2014) found that reducing inflammation by increasing omega-3 intake can even prevent some types of depression. Luckridge et al. (2017) found that certain micronutrients reduced impairment and improved inattention, emotion regulation, and aggression in children with her ADHD. Additional research has demonstrated a strong correlation between sugar consumption, glucose levels, and increased anxiety (Towler et al., 1993). Finally, many studies have shown that there is a strong correlation between food additives/preservatives and mental illness (Xiong et al., 2024).

But how does this lead to comprehensive care? In a large-scale Facebook survey, a group of therapists found out how often they talk to their clients about food and nutrition each week, excluding those who suffer from eating disorders. I was asked if I would like to discuss it. Only 26% of clinicians said they regularly address the topic of nutrition, with the number being “several times a month.” A whopping 46% said they only bring up the topic of diet and nutrition if the client brings it up first. The remaining 28% said they talked about it sometimes (once every few months) or rarely (once or twice during the entire counseling session).

There is a wealth of information about the importance of the gut-brain axis, the microbiome, and microdiversity, and the field of nutritional psychiatry is receiving a lot of attention. But perhaps a stronger connection is needed when discussing nutrition and its impact on mental health on a regular basis.

certain blood tests

People who are struggling with low mood, sadness, anxiety, or fatigue tend to think of mental health first. Maybe it’s depression, maybe anxiety? This person is seeking a therapist and possibly a psychiatrist for medication management. Perhaps counseling can help, and antidepressants may have a role, but perhaps the underlying cause is being overlooked.

There are several blood tests known to have very strong correlations with often overlooked mental health symptoms.

1. thyroid. Symptoms of psychogenic hypothyroidism include fatigue, insomnia or hypersomnia, cognitive problems, low or depressed mood, and anxiety. Psychogenic hyperthyroidism symptoms include irritability, insomnia, anxiety, restlessness, difficulty concentrating, and fatigue.
2. iron. Low iron levels can cause mental health symptoms such as anxiety, heart palpitations, sadness, and depression.
3. B12 and B vitamins. Reduced B12 levels or B12 deficiency can lead to mental health symptoms such as panic attacks, anxiety, depression, mania, lethargy, and even hallucinations and delusions.
4. vitamin D. Low vitamin D levels can lead to mental health symptoms such as fatigue, mood changes, low mood, hypersomnia, and depression.
5. omega 3. Low levels of omega-3s can lead to mental health symptoms such as mood swings, depression, fatigue, and memory loss.

Incorporating some of these laboratory tests as standard practice will help provide comprehensive care to patients. And from a therapeutic perspective, we make clients aware of the correlation between these tests and their mental health functioning, or encourage them to check their levels if it hasn’t been a while.

brain mapping

An invaluable tool for assessing brain function and mental health is brain mapping. Brain mapping technology allows clinicians to visually see which areas of the brain are dysregulated. Through this technology, clinicians can identify how areas of dysregulation correlate with specific mental health symptoms. For example, brain map images that show high levels of red in the left anterior region, known as F3, may indicate excessive slow brain wave activity. This is a typical symptom for people who suffer from depression. Clinicians can develop neurofeedback training protocols tailored to uptrain or downtrain specific brain waves. The goal of this type of training is to adjust your brain waves to a more optimal range and reduce symptoms. A limitation of brain mapping and neurofeedback is that the technology requires a specialized clinician to administer, and many insurance companies do not cover these advanced services. However, it can be a great tool to utilize for comprehensive care.

Comprehensive health care also includes mental health. To provide these services, clinicians not only need to be aware of these additional subsets but also need to know how to address them for their clients. Staying up-to-date on literature, practice, and testing can help close this gap. It is the clinician’s duty to practice only within the scope of his or her knowledge and expertise, but this also means making necessary referrals when necessary. In addition to psychotherapy and medication management, evaluation of physical activity levels, nutritional intake, relevant labs, and advanced testing all help create a more comprehensive mental health care system.

References