Towards Interdisciplinary Efforts

In this systematic scoping review, Myers & Vigar (2019) examine the available evidence on multi-modality naturopathic medicine (alternative medicines based on the theory that diseases can be treated by techniques such as control of diet, exercise, and massage). Firstly, a systematic search was carried out to find human research analyzing the effectiveness of naturopathic medicine where two or more naturopathic modalities are delivered by naturopathic clinicians. Case studies of five or more cases were included, and no language restrictions were imposed. The search produced 33 studies that met the inclusion criteria and came from all around the world (11 American; 4 Canadian; 6 German; 7 Indian; 3 Australian; 1 United Kingdom; and 1 Japanese). These studies mainly backed up the evidence for naturopathic medicine’s efficacy in the various chronic clinical conditions in which they were investigated. The currently available research in whole-system, multi-modality naturopathic medicine indicated that it is effective in treating cardiovascular disease, musculoskeletal pain, type 2 diabetes, polycystic ovary syndrome, depression, anxiety.

While diet’s link with mood and behavior is evident, Watts (2011) highlights the lack of formalized educational writing on the role and application of nutritional science in mental health management. The author exposes the U.K. population’s limited consumption of fruits and vegetables, oily fish, and wholegrains. Instead, the people are said to eat large amounts of refined carbohydrates, altered fats, intensively reared meat and dairy products, as well as unknown combinations of synthetic chemicals and residues. Nutritional and environmental factors can trigger physiological responses in some individuals, affecting their mood, inducing overwhelming food/substance cravings, and increasing their risk of adopting anti-social behavior. The role of the nutritional therapist is to enhance diet and identify potential food intolerances, hormone imbalances, blood sugar problems, enzyme deficiencies, compromised gut immunity, increased nutrient requirements, a toxic metal burden or chemical sensitivities. Due to the variation in genetic and environmental factors among individuals, the nutritional therapist needs to intervene safely and effectively in mental health conditions while examining each case individually based on the multiple, highly complex factors involved. Yet, nutritional therapists are not currently part of the multidisciplinary team attending to patients with mental health problems, and at the moment work in private clinics treating clients on an individual basis.

According to Briguglio et al. (2020), the development of neuropsychiatric disorders stems from the interaction between human genes and the environment (epigenetics) and can be prevented by making healthy lifestyle choices in some cases. While unhealthy lifestyles seem to contribute significantly to the incidence of neuropsychiatric disorders, the adoption of Healthy Eating education, Physical Activity programs, and Sleep hygiene promotion (HEPAS) may be one of the most suitable interventions for reducing the risk of developing this impairing disorder. If implemented alongside pharmacological and psychological therapies, the degree of disability could be reduced and the quality of life of these patients could be increased. As well as providing suggestions for clinical practice, this present review summarizes the current evidence connecting HEPAS components with the prevention and management of neuropsychiatric disorders.

4. Kazdin, A. E. (2016). Editor’s introduction: special series on nutrition and mental health. Clinical Psychological Science, 4(6), 1080–1081. https://doi.org/10.1177/2167702616651051 Kazdin (2016) states that in this current environment where there is pressure to be “fashionably thin” even if one is not overweight or obese, there are countless new diets that supposedly help weight loss, and the media often feed us some non-scientifically based diets. Moreover, there are gross main-effect types of recommendations that do not consider dose or moderating factors. This type of information on “nutrition and health” is at a different level from the extensive scientific basis of this present journal. There are controlled clinical trials, for example, that demonstrate that psychiatric symptoms and disorders respond to micronutrient intervention. On the other hand, there is basic scientific literature that looks at the interaction between micronutrients and structures, functions, and cellular and neurobiological processes such as DNA, oxidative stress, mitochondria, enzymes, and metabolism. Nutrition may not be mainstream within the realm of mental health and illness research, but this journal can hopefully answer a few important questions.

The aim of this 2019 study was to evaluate clinical psychologists in Indonesia on their knowledge of complementary and alternative medicine (CAM). Liem held semi-structured face-to-face interviews with 43 clinical psychologists in public health centers in Indonesia. There was a wide range of responses to questions around complementary and alternative medicine use. Some had little or no prior knowledge while others were much more familiar. The source of the knowledge also ranged widely from popular to scientific literature. Some respondents also regarded complementary and alternative medicine as an important part of Indonesian culture and therefore consider it crucial to be educated on this area of medicine. The interview revealed that the challenges for learning even more about complementary and alternative medicines came from institutions and were also due to personal reasons. But the professionals admit that some of these treatments should be introduced in training sessions. Overall, complementary and alternative medicine was determined to be neither well-known nor understood widely by the clinical psychologists in Indonesia.

Since patients are becoming more aware of complementary and alternative medicines, Liem (2019) finds it important to investigate psychologists’ attitudes towards this type of non-standard medical care. This present study specifically assessed and compared Australian and Indonesian psychologists’ attitudes towards complementary and alternative medicines. An online survey was sent to Indonesian psychologists (247 completed the survey), while the Australians’ attitudes were measured using a previously published study on Psychologists' Attitudes Towards Complementary and Alternative Therapies (PATCAT) scale validation. Psychologists from both countries showed similarly mixed feelings or contradictory ideas about complementary and alternative medicine. The medical models in both nations also adopt the same Western psychology education, which may be the root of the uncertainty displayed by both groups of healthcare professionals. Furthermore, both Indonesian and Australian clinical psychologists thought positively of integrating complementary and alternative medicine into psychological services. But they do believe that these “medicines” hold some risks. In conclusion, both psychologists from Australia and Indonesia had mixed perspectives on complementary and alternative medicines. These viewpoints might be reduced with clear regulation of its use in psychological services.

Mogre et al. (2018) comment on the report that medical students and doctors have been insufficiently educated on nutrition during their training despite the many benefits of nutritional care in the medical sector (can reduce morbidities, mortalities, and overall medical costs). In this study, medical students were asked about their opinions on the doctors’ role in nutrition care, and on the education, they receive regarding nutrition. The sample included 23 fifth to final year medical students in the School of Medicine and Health Sciences of the University for Development Studies in Ghana. Semi-structured interviews on nutrition education were conducted with the students. Although the academics believed doctors have a crucial role to play in providing nutritional care to their patients, the nutritional education they received was not enough from their perspectives. Poor application of nutritional science was reported, as well as poor collaboration with dietary professionals. The students provided several suggestions for strategies to improve nutritional educational experiences. These included increasing the awareness of nutrition education’s importance, revision of the curriculum to include nutrition, and involving nutrition/dietician specialists in medical education. These are only some of the suggestions for addressing the barriers to nutrition education.

In this 2017 study, medical students, residents, and physicians at a Midwestern medical school were asked about their nutritional education experiences. It has been reported that most medical schools provide little to no training in nutrition to their students, although the National Academy of Sciences recommends a minimum of 25 hours of nutrition education. This study set up a series of focus groups and one-on-one interviews with the students, residents, and physicians, revealing the poor integration of nutrition into the medical curriculum (according to the students) and the residents’ desire for further education in this area. The students talked about their shadowing experiences where nutritional counseling was rare, and nutritional information passed on to patients was often outdated or incorrect. This was congruent with the residents’ comments that they felt ill-prepared to advise patients on nutrition. In conclusion, both students and residents agreed that nutritional education currently provided in medical school is inadequate. The provision of more training on nutrition could lead to better patient health outcomes.

According to Kaplan et al. (2015), research is currently transforming our understanding on the etiology of mental disorders. While we had a great breakthrough in understanding 60 years ago (leading to the introduction of psychopharmacology), the current revolution is broader. There has been a rapid intake of knowledge on how various factors affect brain function (for example inflammation, microbiome imbalance (gut dysbiosis), oxidative stress, and impaired mitochondrial output). Several effective interventions have been identified for combating inflammation, restoring normal gut function, reducing oxidative stress, and improving mitochondrial metabolism. These include modifying lifestyle choices (e.g. using probiotics and increasing nutrient consumption). This article hopes to provide an update on this emerging model of the biological basis of mental illness, discussing this new field in mental health referred to as nutritional psychology/psychiatry.

12. Rucklidge, J. J., & Kaplan, B. J. (2016). Nutrition and mental health. Clinical Psychological Science, 4(6), 1082–1084. https://doi.org/10.1177/2167702616641050 Rucklidge & Kaplan (2016) present a series of studies conducted in the rapidly emerging field of nutrition and mental health. The authors hope to inform other scientists and bring attention to this field of research in general. This review firstly demonstrates that dietary patterns influence mental health by referring to several key studies. The work of Sanchez-Villegas and colleagues is highlighted since they found that dietary pattern, physical activity, and social activities were negatively related to the risk of depression. Moving on to research on nutritional interventions, there was a particular study that suggested that children with attention-deficit hyperactivity disorder (ADHD) might require more essential fatty acids than normal to prevent deficiencies. This led to the topic of micronutrients and how these correlate with mental disorders. Testing the effectiveness of n-acetyl-cysteine (NAC) in treating obsessive compulsive disorder, the researchers deduced that participants responded better if they were younger and had been diagnosed more recently. Lastly, research on epigenetics (study of non-genetic influences on gene expression) and inflammation biomarkers are discussed to explore who might benefit from nutrients.