REVIEW A review of the nutritional challenges experienced by people living with severe mental illness: a role for dietitians in addressing physical health gaps S. B. Teasdale, 1,2 K. Samaras, 3,4 T. Wade, 1 R. Jarman 1 & P. B. Ward 2,5 1 Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, Australia 2 School of Psychiatry, University of New South Wales, Kensington, Australia 3 Department of Endocrinology, St Vincent’s Hospital, Darlinghurst, Australia 4 Diabetes and Metabolism Division, Garvan Institute of Medical Research, Darlinghurst, Australia 5 Schizophrenia Research Unit, South Eastern Sydney Local Health District & Ingham Institute for Applied Medical Research, Liverpool, Australia Keywords diet, mental illness, nutrition, psychosis, schizophrenia. Correspondence Scott Teasdale, Keeping the Body in Mind Program, South Eastern Sydney Local Health District, 26 Llandaff St, Bondi Junction, NSW 2022, Australia. Tel.: +61 2 9366 8610 Fax: +61 2 9387 1070 E-mail: scott.teasdale@health.nsw.gov.au How to cite this article Teasdale S.B., Samaras K., Wade T., Jarman R., Ward P.B. (2017) A review of the nutritional challenges experienced by people living with severe mental illness: a role for dietitians in addressing physical health gaps. J Hum Nutr Diet. doi: 10.1111/jhn.12473 Abstract People experiencing a severe mental illness (SMI), such as schizophrenia, schizoaffective disorder, bipolar affective disorder or depression with psy- chotic features, have a 20-year mortality gap compared to the general popu- lation. This ‘scandal of premature mortality’ is primarily driven by preventable cardiometabolic disease, and recent research suggests that the mortality gap is widening. Multidisciplinary mental health teams often include psychiatrists, clinical psychologists, specialist mental health nurses, social workers and occupational therapists, offering a range of pharmacolog- ical and nonpharmacological treatments to enhance the recovery of clients who have experienced, or are experiencing a SMI. Until recently, lifestyle and life skills interventions targeting the poor physical health experienced by people living with SMI have not been offered in most routine clinical settings. Furthermore, there are calls to include dietary intervention as mainstream in psychiatry to enhance mental health recovery. With the inte- gration of dietitians being a relatively new approach, it is important to review and assess the literature to inform practice. This review assesses the dietary challenges experienced by people with a SMI and discusses potential strategies for improving mental and physical health. Understanding severe mental illness Severe mental illness (SMI) is a term most frequently used to describe people experiencing a psychotic illness, where the psychosis refers to a loss of contact with reality. Psy- chosis is a key component of several psychiatric disorders, including schizophrenia, schizoaffective disorder, bipolar affective disorder, psychotic depression, drug-induced psychosis and organic psychosis (1) . People with psy- chotic symptoms experience changes in thoughts, beliefs, feelings and/or behaviour. Psychotic symptoms include: (i) hallucinations- seeing, hearing, feeling, tasting something not experienced by others; (ii) delusions- firmly held, false beliefs not consistent with ones culture; and (iii) disorgan- ised speech and behaviour, such as incorporating unrelated topics during conversation, and producing an inappropri- ate emotional response to a situation. In addition, people living with SMI also experience ‘negative symptoms’, which include being withdrawn, an inability to feel pleasure, lack of interest, low levels of motivation and emotional blunt- ing. They may also experience cognitive impairments, including memory and planning deficits, as well as sleep disturbances .(1) . Treatments for psychotic illness include antipsychotic medications (APMs), which are frequently 1 ª 2017 The British Dietetic Association Ltd. Journal of Human Nutrition and Dietetics