Relationships between gastrointestinal viscera and human emotions have been documented by virtually all medical traditions known to date. The focus on this relationship has waxed and waned through the centuries, with noted surges in interest driven by cultural forces. Here we explore some of this history and the emerging trends in experimental and clinical research. In particular, we pay specific attention to how the hygiene hypothesis and emerging research on traditional dietary patterns has helped re-ignite interest in the use of microbes to support mental health. At present, the application of microbes and their structural parts as a means to positively influence mental health is an area filled with promise. However, there are many limitations within this new paradigm shift in neuropsychiatry. Impediments that could block translation of encouraging experimental studies include environmental forces that work toward dysbiosis, perhaps none more important than westernized dietary patterns. On the other hand, it is likely that specific dietary choices may amplify the value of future microbial-based therapeutics. Pre-clinical and clinical research involving microbiota and allergic disorders has predated recent work in psychiatry, an early start that provides valuable lessons. The microbiome is intimately connected to diet, nutrition, and other lifestyle variables; microbial-based psychopharmacology will need to consider this contextual application, otherwise the ceiling of clinical expectations will likely need to be lowered.
Allergy and Immunology ; Anxiety ; Depression ; Diet ; Dysbiosis ; Hand ; Humans ; Hygiene Hypothesis ; Life Style ; Mental Health* ; Microbiota* ; Neuropsychiatry ; Psychopharmacology ; Viscera ; Child Health

Introduction: Non-communicable diseases (NCDs) are the major causes of premature death and disability in Fiji, accounting for 80% of mortality in the Fijian population [1]. This is the first community-based research in Fiji on knowledge, attitude, practice and barriers (KAPB) regarding lifestyle risk factors that contribute to NCDs and the impact of health promotion activities on their KAPB. This paper reports on baseline demographics and KAPB findings. Paper 2 will report on the impact of health promotion activities on KAPB. Methods: This is a prospective questionnaire based survey in 30 randomly selected communities located in Ba Province, Fiji, conducted between May 2016 and April 2018. Results: There were 952 participants with mean age was 43.2years (SD=15.4) range 18 to 83; 63.4% were iTaukei, 35.8% were Fijians of Indian Descent (FID) and 0.7% ‘Others’ and 70% were females. There was high awareness that smoking (94.3%), alcohol abuse (82.8%), kava abuse (72.6%), high salt intake (94.3%) and physical inactivity (97.9%) were not good for health. However, in-depth knowledge of effects of these risk factors was low, with only around 20% having a good knowledge. For attitude, 52.6% disagreed and 41.4% were neutral to smoking, 89.9% disagreed with alcohol abuse, 79% disagreed with Kava abuse, 84% agreed with low salt intake, and 84.6% agreed with being physically active. As for practice, 20.7%of participants were current smokers, 20.6% drank alcohol, 37.9% drank kava, 30.5% added extra salt to food, and 30.1% were physically inactive. Having good knowledge did not significantly decrease practice of smoking, alcohol or kava use. Addiction was the major reported barrier to cessation of smoking (60.2%), alcohol abuse (46%) and kava abuse (34.2%) whereas, ‘unwilling to change’ for good nutrition (51.6%) and ‘laziness’ for physical activity (43%). Conclusion The awareness of the various NCD lifestyle risk factors is high with poor in-depth knowledge of their impact on NCDs. Unfortunately having good knowledge and appropriate attitude did not translate to decreases in risky lifestyle practices.

Objective: Bipolar disorder often co-occurs with post-traumatic stress disorder, yet few studies have investigated the impact of post-traumatic stress disorder in bipolar disorder on treatment outcomes. The aim of this sub-analysis was to explore symptoms and functioning outcomes between those with bipolar disorder alone and those with comorbid bipolar disorder and post-traumatic stress disorder. Methods: Participants (n = 148) with bipolar depression were randomised to: (i) N-acetylcysteine alone; (ii) a combination of nutraceuticals; (iii) or placebo (in addition to treatment as usual) for 16 weeks (＋4 weeks discontinuation).Differences between bipolar disorder and comorbid bipolar disorder and post-traumatic stress disorder on symptoms and functioning at five timepoints, as well as on the rate of change from baseline to week 16 and baseline to week 20, were examined. Results: There were no baseline differences between bipolar disorder alone and comorbid bipolar disorder and post-traumatic stress disorder apart from the bipolar disorder alone group being significantly more likely to be married (p = 0.01). There were also no significant differences between bipolar disorder alone and comorbid bipolar disorder and post-traumatic stress disorder on symptoms and functioning. Conclusion There were no differences in clinical outcomes over time within the context of an adjunctive randomised controlled trial between those with bipolar disorder alone compared to those with comorbid bipolar disorder and post-traumatic stress disorder. However, differences in psychosocial factors may provide targets for areas of specific support for people with comorbid bipolar disorder and post-traumatic stress disorder.

Objective: There is often a shortfall in recovery following treatment for an episode of bipolar disorder (BD). Exploration of participant’s experience provides vital information to enhance statistical outcomes for novel therapy trials. This study used mixed-methods to explore participants’ experience of a trial testing N -acetyl cysteine (NAC) and mitochondrially active nutraceuticals for BD depression. Methods: Case report forms from a randomised controlled trial (RCT) of BD depression (n = 148) were analysed using a pragmatic adaption of grounded theory and thematic analysis. Results: Thematic analysis of 148 study participants indicated numerous changes in participant experience over time. For example, perceived environmental stressors reported by participants decreased over the trial in both treatment groups. Quantitative analysis of the themes revealed more positive theme reports in the combination treatment arm compared to the placebo arm and there were more negative themes identified in the placebo arm, compared to the NAC arm. Conclusion This approach revealed additional results not elucidated in the primary quantitative analysis. This emphasises the value of mixed-methods research in capturing participants’ experiences in RCTs and detecting possible latent benefits and risks. Such methods can detect latent target signals in novel therapy trials conducted in BD and generate novel hypotheses.